Reviewer's report
Title:Evaluation of About Being Active, an online lesson about physical activity
shows that perception of being physically active is higher in eating competent
low-income women
Version: 2Date:13 November 2012
Reviewer: Debbie Penava
Reviewer's report:
The purpose of the study is documented on page 5: “To compare eating
competence (EC) and sociodemographic characteristics of low income women
who perceive being physically active with women who don’t perceive being
physically active”, then to compare responses to online nutrition education
designed to foster awareness of and attention to a physically active lifestyle for
low-income audiences. The authors should make it more clear that it is the
impact of physical education information that is ultimately being assessed here,
not nutrition.
The methods are well-described with appropriate sample selection. Selection is
through 2 sources--venues which low SES women should frequent and then
through SNAP participants through State public welfare Office. This should make
most eligible women available for participation. Women who were excluded are
reasonable (Non-literate, cancer, severe heart disease, those who studied
nutrition).
The design description includes a online education program, with link provided. It
is reviewed from a program for undergraduate students, by participants similar to
patient group and then reviewed again after revisions made for further
comments. The nutrition lessons in the program are far less interactive than
physical activity module, as I reviewed the program online myself. Baseline
measures appropriate with height and weight, as well as activity self-reported,
but as reviewed, this is standard for much of this literature. Other demographics,
worry about money for food, Satter Eating Competence Inventory for Low Income
(16 point Likert scale with established construct validity and internal reliability)
and Adult Food Security Screener of USDA.
For the data analysis, the eating competence was divided into tertiles based on
ecSI/LI, which is likely what has been assessed in past literature. BMI and
education were used as fixed factors and tested for interaction; this is important
in assessing knowledge and impact of the internet lesson. Order effect also
assessed (19 women were assigned to complete it last). Time spent on lesson
was assessed for impact. Qualitative analysis performed, which broadens the
assessment of the modules.
Demographics seem representative of the population to be sampled, with 60% of
women overweight/obese and the majority used SNAP over past year (low SES).
The majority access internet daily from home, therefore demonstrating that the
intervention is accessible. They have assessed EC across the sample, using
scales described in methods. Physically active women had higher EC than not,
regardless of assessment of physical activity. This persisted with control for other
factors, including BMI, age, weight satisfaction and education.
The online education tool was relatively well reviewed. No impact of order of
learning or time effect, regardless of desire for weight loss or amount of time
spent on physical activity. Quiz scores on About Being Active did not differ by
amount of time spent on physical activity. Therefore amount of time spent on
physical activity did not translate to more knowledge. Participants could choose
one of four “case studies” to identify and learn from in this online tool kit.
The authors were appropriate in their reporting of results. Table 2 is clear and
well-reported. Figures are helpful. Visiting the website is more helpful than than
the reports from the participants. Discussion of results is to the point and
relevant. Review of measure of EC as capability, autonomy, self-control,
self-awareness. Otherwise a measure of interpersonal support. Perhaps their
future online tools could work on this nutritionally as I found their nutritional online
tools less exciting than the physical activity tool. Why couldn’t there by case
studies for the nutrition modules?
The tool kits were well-received…keep the design going….a good start. Agree
that About Being Active is a stand alone lesson and may want to let women
choose where they would like to focus.
The authors review the limitations of the study, with statements of self-reporting
of weight, height and activity. However, insufficient time is given to the
development of the nutritional component of modules and learning therein.
The lead author is well-cited in the references here, particularly in the population
studied and in the eating competence literature, which is well studied in this
paper. The translation of Eating Competence to physical activity needs to be
stronger, however, because I am uncertain why the physical activity is linked to
the nutrition….as a physician I know why, but it needs to be more clearly linked
why it was linked in the background to a nutritional platform.
The title and abstract link nicely to the results. However, the purpose of the
paper, which was to impact Nutrition should be broadened likely to incorporate
“physical education”.
Minor Essential Revisions: the purpose of the Paper should be revised to reflect
the importance of the educational component of physical education into nutrition.
It is not nutrition. This is the most important part of the paper as the hypothesis or
purpose does not match the remainder of the paper, which otherwise is quite
good and relevant to ongoing research.