This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
The Internet contains a plethora of nutrition information. Health organizations are increasingly using the Internet to deliver population-wide health information and interventions. Effective interventions identify their target population and their needs; however, little is known about use of the Internet as a source of nutrition information.
The aim was to assess the change in prevalence and demographic characteristics of Western Australian adults accessing the Internet as a source of nutrition information and identify specific information needs.
Data were pooled from the Western Australian Department of Health’s 3-yearly Nutrition Monitoring Survey Series telephone survey between 1995 and 2012 of 7044 participants aged 18 to 64 years. Outcome variables were the main sources of nutrition information used in the last year and yes/no responses to 4 suggestions to what would make it easier to eat a healthy diet. Sociodemographic variables were collected.
The proportion of respondents using the Internet for nutrition information increased from <1% in 1995-2001 to 9.1% in 2004 and 33.7% in 2012. Compared to 2004, logistic regression showed that the odds of using the Internet for this information increased significantly in 2009 (OR 2.84, 95% CI 2.07-3.88) and 2012 (OR 5.20, 95% CI 3.86-7.02,
Use of the Internet as a main source of nutrition information has grown rapidly since 2004; one-third of Western Australian adults reported using the Internet for this purpose in 2012. Information on preparing healthy foods (ideas, quicker ways), choosing ingredients, and knowing more about cooking would make it easier to eat a healthy diet. For Internet users, emphasis should be on quicker ways and choosing ingredients. These finding have implications for policy makers and practitioners and suggest that traditional health promotion tactics should continue to be used to reach the broader population.
Use of technology for communication has increased and traditional sources of information have changed in importance over time. Use of the Internet in Australian homes has risen dramatically from 3.4% of households in 1996 to 80% in 2012 [
In Australia, diet is a significant factor contributing to the burden of disease [
Online health interventions have the capacity to influence voluntary behavior change and have the advantage of lower costs and increased reach when compared with more traditional channels, such as print media, with similar impact [
As use of the Internet has grown, the potential to reach a large number of people has made it appealing for dissemination of nutrition interventions. Government and not-for-profit health organizations increasingly use the Internet for population-wide health interventions [
The primary aim of this paper was to assess the change in prevalence and demographic characteristics of those using the Internet as a source to obtain nutrition and dietary information among Western Australian adults over 2 decades. To assist with the development of population-wide nutrition interventions, the association between use of the Internet as a source of nutrition and dietary information and the respondents’ perception of what would make it easier for them to eat a healthy diet was explored.
The data were part of the Department of Health in Western Australia’s Nutrition Monitoring Survey Series (NMSS), which aims to investigate the nutrition knowledge, attitudes, and behaviors of Western Australian adults related to the Dietary Guidelines to prioritize and monitor the impact of nutrition interventions. Computer-assisted telephone interviews with 7044 Western Australian adults aged 18 to 64 years were conducted from July to August in 1995, 1998, 2001, 2004, 2009, and 2012. The 1995 sample was stratified by geographic area and the 1998, 2001, and 2004 samples were quota sampled by gender and geographic area. The telephone numbers were selected randomly by a computer-generated random digit dialing program. In 2009 and 2012, the samples were randomly drawn from the 2008 and 2011 Electronic White Pages for Western Australia, respectively, and stratified according to area of residence. The details of survey and sampling strategies can be found elsewhere [
The main purpose of this study was to assess change in prevalence and demographic characteristics of Western Australian adults using the Internet as a source of nutrition and dietary information. To answer the main purpose, respondents were asked an open-ended question: “In the last 12 months, what have been your main sources of nutrition and dietary information?” After first responses were given, the interviewer probed “anything else?” The main sources of nutrition information used were television advertising and programs, magazine articles, books, and the Internet; this study reports on respondents’ use of the Internet. We compared respondents who used the Internet as the main source of nutrition and dietary information with those who did not mention using the Internet. The secondary aim of the study was to explore the association between use of the Internet as a source of nutrition and dietary information and the respondents’ perception of what would make it easier for them to eat a healthy diet to assist with the development of population-wide nutrition interventions. To answer the secondary aim, respondents were asked “Which of the following would make it easier for you or your family to eat a healthy diet?” with the following options: (1) knowing more ways of preparing healthy foods, (2) knowing quicker ways of preparing healthy foods, (3) having more information to help me decide if foods are healthy, and (4) knowing more about cooking (all answered “yes” or “no”). The response options for making it easier to eat a healthy diet were identified during the development stages for the NMSS tool in which open-ended questions were used and typical responses identified. Participants’ sociodemographic information (gender, age, education, area of residence, household income, employment status, country of birth, area of residence, height, and weight) was also collected.
The data were collected to be representative of the Western Australian population. Data for all the years were pooled and weighted to account for sampling design and adjusted for age, sex, and geographic area to a single standard population to allow for comparisons over time. The standard population used was the 2011 estimated resident population of Western Australia [
The descriptive statistics report the prevalence and 95% confidence interval (95% CI) of using the Internet to obtain nutrition and dietary information by survey year, gender, and age. Binary logistic regression was used to assess the association between respondents using the Internet as a source of nutrition and dietary information and sociodemographic characteristics. The covariates in the full model included survey year as a measure of time, gender, age, education, household income, employment status, country of birth, area of residence (metropolitan vs nonmetropolitan), body mass index (BMI) categories, and Socioeconomic Indexes for Areas (SEIFA) quintile [
All analyses were performed using Stata 12.0 (StataCorp LP, College Station, TX, USA) under the survey module and a
Between 1995 and 2012, a total of 7044 adults participated in the NMSS. Details of the sample and demographic information are shown in
The main purpose of this study was to assess change in prevalence and demographic characteristics of Western Australian adults using the Internet as a source of nutrition and dietary information.
Sample demographics of the Nutrition Monitoring Survey Series, Western Australia, 1995-2012.
Demographic characteristics | Survey year, n | Total, %a N=7044 | ||||||
|
1995 |
1998 |
2001 |
2004 |
2009 |
2012 |
|
|
|
|
|
|
|
|
|
|
|
|
Female | 631 | 502 | 502 | 601 | 830 | 1005 | 49.18 |
|
Male | 371 | 502 | 502 | 601 | 454 | 543 | 50.82 |
|
|
|
|
|
|
|
|
|
|
18-24 | 119 | 110 | 118 | 103 | 71 | 66 | 15.80 |
|
25-34 | 257 | 210 | 245 | 232 | 180 | 144 | 23.01 |
|
35-44 | 291 | 305 | 296 | 333 | 340 | 377 | 22.41 |
|
45-54 | 207 | 234 | 212 | 297 | 356 | 466 | 21.33 |
|
55-64 | 128 | 145 | 133 | 237 | 337 | 495 | 17.45 |
|
|
|
|
|
|
|
|
|
|
Metropolitan | 748 | 751 | 75 | 601 | 965 | 1011 | 78.33 |
|
Remote areas | 51 | 63 | 62 | 150 | 29 | 82 | 4.80 |
|
Rural areas | 203 | 190 | 18 | 451 | 290 | 455 | 16.87 |
|
|
|
|
|
|
|
|
|
|
Less than high school | 376 | 336 | 303 | 330 | 221 | 211 | 19.67 |
|
High school | 251 | 237 | 265 | 257 | 178 | 198 | 21.98 |
|
Trade/certificate/diploma | 90 | 95 | 77 | 177 | 481 | 632 | 25.47 |
|
University degree | 284 | 336 | 344 | 435 | 399 | 504 | 33.58 |
|
Missing | 1 | 0 | 1 | 3 | 5 | 3 | 0.30 |
|
|
|
|
|
|
|
|
|
|
≤$60,000 | 748 | 603 | 558 | 603 | 349 | 346 | 37.47 |
|
>$60,000 | 174 | 305 | 340 | 560 | 814 | 1024 | 51.40 |
|
Missing | 80 | 96 | 106 | 39 | 121 | 178 | 11.13 |
|
|
|
|
|
|
|
|
|
|
Currently not in paid employment | 330 | 263 | 278 | 285 | 364 | 408 | 26.82 |
|
Currently in paid employment | 669 | 741 | 726 | 917 | 920 | 1139 | 73.14 |
|
Missing | 3 | 0 | 0 | 0 | 0 | 1 | 0.04 |
|
|
|
|
|
|
|
|
|
|
Australia | 656 | 665 | 668 | 868 | 867 | 1122 | 68.64 |
|
UK/Ireland | 189 | 209 | 193 | 155 | 202 | 221 | 15.96 |
|
Other countries | 157 | 130 | 143 | 179 | 214 | 205 | 16.38 |
|
Missing | 0 | 0 | 0 | 0 | 1 | 0 | 0.02 |
a Percentages were weighted for probability of sample selection and adjusted by age, sex, and geographic area to the 2011 Estimated Resident Population of Western Australia.
Prevalence of using the Internet as a source to obtain nutrition and dietary information, the Nutrition Monitoring Survey Series, Western Australia, 1995-2012.
Variable | No, % (95% CI)a | Yes, % (95% CI)a |
|
|
|
|
|
<.001 | |
|
1995 | 99.83 (98.84, 99.98) | 0.17 (0.02, 1.16) |
|
|
1998 | 99.43 (98.78, 99.73) | 0.57 (0.27, 1.22) |
|
|
2001 | 99.84 (98.89, 99.98) | 0.16 (0.02, 1.11) |
|
|
2004 | 90.86 (88.62, 92.70) | 9.14 (7.30, 11.38) |
|
|
2009 | 77.09 (73.95, 79.96) | 22.91 (20.04, 26.05) |
|
|
2012 | 66.27 (63.23, 69.18) | 33.73 (30.82, 36.77) |
|
|
|
|
<.001 | |
|
Female | 80.36 (78.51, 82.09) | 19.64 (17.91, 21.49) |
|
|
Male | 85.80 (83.95, 87.47) | 14.20 (12.53, 16.05) |
|
|
|
|
.21 | |
|
18-24 | 79.92 (74.69, 84.30) | 20.08 (15.70, 25.31) |
|
|
25-34 | 83.93 (81.01, 86.47) | 16.07 (13.53, 18.99) |
|
|
35-44 | 83.22 (81.04, 85.19) | 16.78 (14.81, 18.96) |
|
|
45-54 | 82.89 (80.51, 85.04) | 17.11 (14.96, 19.49) |
|
|
55-64 | 85.14 (82.70, 87.29) | 14.86 (12.71, 17.30) |
|
Total | 83.13 (81.83, 84.35) | 16.87 (15.65, 18.17) |
|
a Percentages were weighted for probability of sample selection and adjusted by age, sex, and geographic area to the 2011 Estimated Resident Population of Western Australia.
b
The logistic regression results showed a sharp increase in using the Internet for obtaining nutrition and dietary information from 2004 (
Factors associated with using the Internet as a source of obtaining nutrition and dietary information, the Nutrition Monitoring Survey Series, Western Australia, 1995-2012.
Factor | OR (95% CI) |
|
|
|
|
<.001 | |
|
1995 | 0.02 (0, 0.12) |
|
|
1998 | 0.06 (0.03, 0.13) |
|
|
2001 | 0.02 (0.00, 0.11) |
|
|
2004 | 1.00 |
|
|
2009 | 2.84 (2.07, 3.88) |
|
|
2012 | 5.20 (3.86, 7.02) |
|
|
|
.02 | |
|
Male | 1.00 |
|
|
Female | 1.30 (1.05, 1.60) |
|
|
|
<.001 | |
|
18-24 | 1.00 |
|
|
25-34 | 0.78 (0.51, 1.20) |
|
|
35-44 | 0.64 (0.43, 0.95) |
|
|
45-54 | 0.51 (0.34, 0.76) |
|
|
55-64 | 0.38 (0.25, 0.57) |
|
|
|
<.001 | |
|
Less than high school | 1.00 |
|
|
High school | 1.16 (0.76, 1.76) |
|
|
TAFE/trade/diploma | 1.80 (1.29, 2.52) |
|
|
Tertiary | 2.46 (1.77, 3.42) |
|
|
|
.02 | |
|
Australia/UK/Ireland | 1.00 |
|
|
Other countries | 1.41 (1.07, 1.85) |
|
|
|
.03 | |
|
Nonmetropolitan | 1.00 |
|
|
Metropolitan | 1.26 (1.03, 1.54) |
|
a Results were derived from a binary logistic regression under survey module.
The secondary aim of this study was to explore the association between use of the Internet as a source of nutrition and dietary information and the respondents’ perception of what would make it easier for them to eat a healthy diet to assist with the development of population-wide nutrition interventions. A high proportion of all respondents agreed that the following information would make it easier for them to eat a healthier diet: knowing more ways of preparing healthy foods (71.99%, 95% CI 70.67-73.27), knowing quicker ways of preparing healthy foods (78.96%, 95% CI 77.80-80.08), more information to help decide if foods are healthy (68.80%, 95% CI 67.49-70.07), and knowing more about cooking (54.68%, 95% CI 53.25-56.11).
When comparing survey results for 2009 and 2012,
Association between using the Internet as a source to obtain nutrition and dietary information and perception of whether it would be easier for respondents to eat healthy diet.
Would make easier to eat healthy diet | Participants, % (95% CI)a |
|
Total, % (95% CI)a | ||
|
Not using Internet | Using Internet |
|
|
|
|
|
|
.06 |
|
|
|
No | 28.65 (27.29, 30.05) | 24.88 (21.45, 28.65) |
|
28.01 (26.73, 29.33) |
|
Yes | 71.35 (69.95, 72.71) | 75.12 (71.35, 78.55) |
|
71.99 (70.67, 73.27) |
|
|
|
.005 |
|
|
|
No | 21.86 (20.65, 23.12) | 16.97 (14.27, 20.07) |
|
21.04 (19.92, 22.20) |
|
Yes | 78.14 (76.88, 79.35) | 83.03 (79.93, 85.73) |
|
78.96 (77.80, 80.08) |
|
|
|
<.001 |
|
|
|
No | 32.73 (31.35, 34.15) | 23.72 (20.58, 27.18) |
|
31.20 (29.93, 32.51) |
|
Yes | 67.27 (65.85, 68.65) | 76.28 (72.82, 79.42) |
|
68.80 (67.49, 70.07) |
|
|
|
.33 |
|
|
|
No | 45.69 (44.19, 47.20) | 43.49 (39.42, 47.64) |
|
45.32 (43.89, 46.75) |
|
Yes | 54.31 (52.80, 55.81) | 56.51 (52.36, 60.58) |
|
54.68 (53.25, 56.11) |
a Percentages were weighted for probability of sample selection and adjusted by age, sex, and geographic area to the 2011 Estimated Resident Population of Western Australia.
b
Prevalence of using Internet as a source obtaining nutrition and dietary information, the Nutrition Monitoring Survey Series, Western Australia, 2009 and 2012.
Age range | 2009 Yes, % (95% CI)a |
|
2012 Yes, % (95% CI)a |
|
||
|
Female | Male |
|
Female | Male |
|
18-24 years | 31.58 (18.15, 49.01) | 34.56 (19.05, 54.23) | .81 | 56.81 (38.09, 73.77) | 25.80 (13.59, 43.45) | .01 |
25-34 years | 28.40 (20.12, 38.44) | 32.83 (21.07, 47.22) | .59 | 58.77 (46.40, 70.13) | 32.67 (20.73, 47.38) | .005 |
35-44 years | 24.19 (18.99, 30.27) | 16.98 (10.76, 25.76) | .13 | 39.66 (33.37, 46.31) | 36.57 (27.08, 47.24) | .62 |
45-54 years | 16.91 (12.42, 22.62) | 18.21 (11.58, 27.45) | .79 | 33.19 (27.41, 39.52) | 27.11 (20.14, 35.43) | .22 |
55-64 years | 13.48 (9.14, 19.45) | 18.21 (11.64, 27.34) | 0.32 | 23.39 (18.58, 29.01) | 22.39 (16.44, 29.72) | .82 |
a Percentages were weighted for probability of sample selection and adjusted by age, sex, and geographic area to the 2011 Estimated Resident Population of Western Australia.
Proportion of participants using the Internet as a source of obtaining nutrition and dietary information over the survey period, the Nutrition Monitoring Survey Series, Western Australia, 1995-2012 (derived after the logistic regression).
Proportion of respondents using the Internet as a source of nutrition and dietary information over the survey period by gender and age, the Nutrition Monitoring Survey Series, Western Australia, 1995-2012 (derived after logistic regression).
This study is unique because it examines characteristics of Australian adults’ use of the Internet for nutrition and dietary information and changes in usage over 2 decades. The study found dramatic growth in use of the Internet as a main source of nutrition and dietary information from 9.1% in 2004 to 33.7% in 2012 when it became the most popular main source of nutrition information. This is consistent with overall growth in Internet use in Australian homes, which increased from 3.4% in 1996 to 56% in 2004 and to 83% in 2012 [
Comparison of the most recent data available from Australia, the United States, and Canada shows that a similar proportion of the adult population use the Internet overall. In Australia, 83% of adults used the Internet at home in 2012 [
Western Australian adults using the Internet as a source of nutrition and dietary information were significantly more likely to be female; living in a metropolitan area; born in countries other than Australia, the United Kingdom, and Ireland; more educated; and younger. This is consistent with other studies from the United States, Switzerland, and Canada, which found that adults using the Internet as a source of dietary information are more likely to be female [
Weight status was not associated with using the Internet for nutrition and dietary information in this study. This is surprising because the Internet has been identified as an important source of information and support for individuals with stigmatized health conditions [
Western Australians who used the Internet as a source of nutrition and dietary information were more likely than nonusers to agree that quicker ways of preparing healthy foods and help deciding if foods are healthy would help them to eat more healthily. The majority of all respondents also agreed that information about preparing healthy foods and cooking would assist. These findings are consistent with identified barriers to healthy eating. Barriers typically include time pressures, the desire for convenience, and lack of motivation to cook, rather than a lack of skills or knowledge [
Data from the 2009 and 2012 surveys were examined to explore recent changes in prevalence and the demographic profile of Internet users to guide current nutrition program development. Results showed that more than half of females aged between 18 and 34 years used the Internet as a source of nutrition and dietary information in 2012. The percentage of female users aged between 25 and 34 years doubled between 2009 and 2012 as did the percentage of male users aged between 35 and 44 years (to 37%). These results suggest that the Internet is increasing in importance for males and females. The opposite trend was seen for males aged between 18 and 24 years. One possibility is that younger males, typically the early adopters of newer technologies, are using other sources of information (eg, smartphone apps) and this should be investigated in further research. The demographic characteristics of US Internet users were also found to change significantly between 2007 and 2011 [
The recent increase in use of the Internet for nutrition and dietary information by younger females aged between 18 and 34 years and males aged between 35 and 44 years shows the dynamic nature of the resource. Although the overall proportion of Western Australians using the Internet as a source was relatively lower than results of similar studies, there are subgroups emerging that rely on the Internet more heavily. Changes in the demographic characteristics of users over time is an important area to continue to monitor.
The NMSS is a government survey that contributes evidence of prevalence of use and demographic information to Western Australian policy and programs. It is critical that high-quality information is used to guide population dietary decision making. The size and scale of the Internet raises concerns about the credibility and reliability of the nutrition and dietary information available [
Use of the Internet as a source of nutrition and dietary information has shown recent rapid uptake by Western Australian adults making it appealing for dissemination of public health interventions. Internet-based nutrition and dietary interventions should incorporate good practice characteristics [
In this study, the majority of the population did not report that they used the Internet as a main source of nutrition and dietary information. It is important for population-wide education, such as nutrition interventions, to be inclusive and reach the majority of the population, in this case, reaching adults that report using sources other than the Internet. Australian adults living in regional areas, older than 65 years, living alone, or with low household income are less likely to use the Internet in general [
Another important consideration for Internet-based nutrition and dietary interventions is the level of literacy required. Almost half of Australians aged between 15 and 74 years have literacy skills below the level deemed suitable to meet societal demands, including using the Internet [
There are strengths and limitations to the current study. The results can be generalized to Western Australia due to the high response rate and representative sample selection. Development of survey question terminology including “the Internet” was completed in 1995. Due to the recent rapid uptake of the Internet and other developments, including Web 2.0 social media platforms and smartphone technology, terminology may need to be updated in future surveys to reflect commonly used language to ensure usage is captured fully. Use of the Internet to source nutrition and dietary information has been reported for the Western Australian adult population, not of Western Australian Internet users. In future, collecting data on use of the Internet, device used, and other relevant technology may help to provide context to use of the Internet to source health and nutrition information. Frequency of use of the Internet to source nutrition and dietary information, the websites that were used, and quality of information sourced were not measured and more information is urgently needed in this area. The study does not specifically investigate the information sources used depending on the information required; for example, information sources for how to feed a toddler a healthy diet may differ to seeking advice on losing weight or healthy recipe ideas for family eating. The cross-sectional survey results are self-reported and are not validated against objective measures; however, it provides useful evidence to measure public attitudes. Height and weight measures are self-reported; however, the use of a correction formula attempted to account for possible underestimation of weight status. This is a population study but there may be differences between Western Australia and other Australian states and territories; for example, more Western Australian households are connected to broadband Internet using mobile broadband (41% vs national average of 33%) [
This study found that there had been dramatic growth in using the Internet as a source of nutrition and dietary information since 2004; however, the majority of the adult population still obtain their information from other sources. Relatively fewer Western Australians used the Internet for this purpose when compared with other Western countries, but their demographic characteristics were broadly consistent. This study found that increased weight was not associated with use of the Internet as a source, which was surprising because the Internet has been identified as an important resource for individuals with stigmatized health conditions, including obesity. Given the rapid increase in use of the Internet in recent years, it is likely that prevalence of using the Internet to source nutrition and dietary information will continue to change. Changes in the prevalence and characteristics of users over time are important areas to continue to monitor to inform future development of nutrition interventions.
The Internet provides a cost-effective platform to reach the identified users with nutrition and dietary interventions, but should be integrated with traditional health promotion tactics to reach the broader population. Policy makers and practitioners delivering Internet-based nutrition interventions should ensure they identify and understand the target population, and customize and tailor communications to meet their needs. Use of non–text-based social media, including images, illustrations, video, and sound, should be included to meet the needs of those with limited literacy. Provision of credible, reliable, and practical information is recommended, including quicker ways to prepare healthy foods and how to choose healthy foods. It is also important for policy makers to improve provision of quality nutrition and dietary information on the Internet generally, which could include certification of websites that provide trustworthy information.
body mass index
Nutrition Monitoring Survey Series
Socio Economic Indexes For Areas
Supplemental Nutrition Assistance Program
The Nutrition Monitoring Survey Series were funded and conducted by the Department of Health in Western Australia. Healthway, the Western Australian Health Promotion Foundation, funded Curtin University to assist the translation of research into practice through the 5-year Food Law, Policy and Communications to Improve Public Health Project.
None declared.