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Online and In-Person Nutrition Education Improves Breakfast Knowledge, Attitudes, and Behaviors: A Randomized Trial of Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children

Published:December 03, 2015DOI:



      Although in-person education is expected to remain central to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) service delivery, effective online nutrition education has the potential for increased exposure to quality education and a positive influence on nutrition behaviors in WIC participants. Education focused on promoting healthy breakfast behaviors is an important topic for WIC participants because breakfast eating compared with breakfast skipping has been associated with a higher-quality diet and decreased risk for obesity.


      To examine the influences of online and in-person group nutrition education on changes in knowledge, attitudes, and behaviors related to breakfast eating.


      Randomized-controlled trial comparing the effectiveness of online and in-person nutrition education between March and September 2014.


      Five hundred ninety WIC participants from two Los Angeles, CA, WIC clinics were randomly assigned to receive in-person group education (n=359) or online education (n=231). Education focused on ways to reduce breakfast skipping and promoted healthy options at breakfast for parents and their 1- to 5-year-old children participating in WIC. Questionnaires assessing breakfast-related knowledge, attitudes, and behaviors were administered before and after education, and at a 2- to 4-month follow-up.

      Statistical analysis

      Changes within and between in-person and online groups were compared using t tests and χ2 tests. Analysis of covariance and generalized estimating equations were used to assess differences in change between groups.


      Changes in knowledge between pretest and follow-up at 2 to 4 months were similar between groups. Both groups reported reductions in barriers to eating breakfast due to time constraints, not having enough foods at home, and difficulty with preparation. Increases in the frequency of eating breakfast were greater for both the parent (P=0.0007) and child (P=0.01) in the online group compared with the in-person group during the same time points.


      Overall, this study demonstrates that both in-person and online nutrition education were effective in increasing breakfast-related knowledge in WIC participants, reducing breakfast skipping, and improving other breakfast-related behaviors, showing the potential usefulness for online education modalities for future WIC services.


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      L. E. Au is an assistant researcher, Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Berkeley.


      S. Whaley is the director, Research and Evaluation, Public Health Foundation Enterprises WIC, Irwindale, CA.


      M. Meza is an executive assistant, Special Projects, Public Health Foundation Enterprises WIC, Irwindale, CA.


      N. J. Rosen is a senior associate, Informing Change, Berkeley, CA.


      L. D. Ritchie is the director and a cooperative extension specialist, Division of Agriculture and Natural Resources, University of California, Oakland.