An interventional study of Screen-Based Simulation Healthy Eating Education and Slide Presentation Healthy Eating Education in Healthy Eating, Nutrition Literacy and Adolescent Nutrition, sponsored by Balikesir University. Completed at 1 site in Turkey (Türkiye). Open to participants aged 15 Years to 17 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-10-30.
Sponsored by Balikesir University · Not applicable, Interventional, and Prevention
This randomized controlled trial aimed to evaluate the effect of healthy eating education delivered through screen-based simulation on healthy eating attitudes and nutrition literacy in adolescents attending a high school. The study tested the following hypotheses: H1: Healthy eating education delivered to adolescents through screen-based simulation has an effect on their healthy eating attitudes. H2: Healthy eating education delivered to adolescents through screen-based simulation has an effect on their nutrition literacy. Adolescents were randomly assigned to a simulation-based education group or a slide presentation group (active comparator). Participants completed a pre-test, received a single 40-minute healthy eating education session (either an individual screen-based simulation on their own mobile phones or a slide-supported lecture with a question-and-answer session), and completed a post-test 20 days after the education.
Adolescence is a critical period in which lifelong eating habits are established, and nutrition literacy is an important determinant of adolescents' healthy eating attitudes and behaviors. Adolescents interact closely with technology, and simulation-based education places the learner at the center of the learning process. However, no study examining the effect of screen-based simulation on adolescents' healthy eating attitudes and nutrition literacy was found in the literature.
This two-group, pre-test/post-test randomized controlled trial was conducted between March and June 2024 at a public vocational and technical high school in Balikesir, Turkey, and was designed and reported in accordance with the CONSORT guidelines. Based on a power analysis (G*Power 3.1.9.2; 95% power, alpha = 0.05, effect size d = 0.40), at least 167 students per group (334 in total) were planned. Because 11 students stopped attending school, the study was completed with 323 students (simulation-based education group n = 160; slide presentation group n = 163).
Randomization: The randomization list was generated by an independent statistician using www.randomizer.org. Students were allocated in equal numbers to the two groups using stratification by class lists and grade level. The allocation list was kept only by the person who generated it until the education sessions began; the researcher who enrolled the students and collected pre-test data had no access to it. Due to the nature of the interventions, participants and educators could not be blinded. Data were coded as Group A and Group B and analyzed by a statistician blinded to group allocation.
Interventions: The screen-based simulation was developed in accordance with the INACSL Healthcare Simulation Standards of Best Practice. It featured an avatar designed as a virtual school nurse and included scenarios on preparing a healthy breakfast plate, lunch choices at school and their consequences, nutrition literacy concepts with a reading activity based on a World Health Organization text, building a healthy plate using a drag-and-drop method, and purchasing healthy foods at a supermarket followed by guidance on cooking techniques. The slide presentation covered adequate and balanced nutrition in adolescence, energy balance, nutrition-related health problems, the four basic food groups, the healthy plate model, the Turkey Nutrition and Physical Activity Pyramid, and food safety. Both educational materials were prepared based on the same national guidelines and literature. Education sessions were delivered face-to-face to groups of 30 students during one class period (40 minutes).
Data collection: The Sociodemographic Data Form, the Adolescent Nutrition Literacy Scale (ANLS), and the Attitude Scale for Healthy Nutrition (ASHN) were administered immediately before the education (pre-test) and 20 days after the education (post-test). Data were analyzed using SPSS 21 with descriptive statistics, the chi-square test, the independent samples t-test, and the paired samples t-test; p \< 0.05 was considered statistically significant. No interim analysis was performed and no adverse events were observed.
201 studies on the registry are indexed under Literacy; 69 are open to participants now.
This study's enrollment of 334 is above the median of 124 across 170 interventional studies indexed under Literacy.
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Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Adolescents in this arm received healthy eating education through an individually completed screen-based simulation on their own mobile phones in a single 40-minute supervised session. Pre-test was administered immediately before the education and post-test 20 days after the education.
Behavioral: Screen-Based Simulation Healthy Eating Education
Adolescents in this arm received healthy eating education through a face-to-face, slide presentation-supported lecture followed by a question-and-answer session in a single 40-minute session. Pre-test was administered immediately before the education and post-test 20 days after the education.
Behavioral: Slide Presentation Healthy Eating Education
A single 40-minute, face-to-face session delivered to groups of 30 students, in which each student individually completed a screen-based simulation on their own mobile phone under researcher supervision. The simulation, developed according to INACSL Healthcare Simulation Standards of Best Practice (Canva Pro, Lumi Education, Voiser), features an avatar virtual school nurse and includes scenarios on preparing a healthy breakfast plate, school lunch choices and their consequences, nutrition literacy concepts with a WHO text reading activity, building a healthy plate by drag-and-drop, and purchasing healthy foods at a supermarket with guidance on cooking techniques.
A single 40-minute, face-to-face, presentation-supported lecture delivered to groups of 30 students by a school nurse specializing in public health nursing, followed by a question-and-answer session. The slide presentation (prepared on Canva based on Ministry of Health, TUBER and Ministry of National Education guidelines) covers adequate and balanced nutrition in adolescence, energy balance, nutrition-related health problems (obesity, anemia, iodine deficiency, eating disorders, dental caries), the four basic food groups, the healthy plate model, the Turkey Nutrition and Physical Activity Pyramid, foods to increase or reduce, and food safety.
Nutrition Literacy (Adolescent Nutrition Literacy Scale, ANLS)
Nutrition literacy was measured with the Adolescent Nutrition Literacy Scale (ANLS), using its validated Turkish version. The 22-item, 5-point Likert scale has three subdimensions: functional (7 items, reverse-scored), interactive (6 items), and critical (9 items) nutrition literacy. Total scores range from 22 to 110; higher scores indicate a higher level of nutrition literacy (better outcome). Total and subdimension scores were compared within and between groups.
Time frame: Baseline (immediately before the education) and 20 days after the education
Healthy Eating Attitude (Attitude Scale for Healthy Nutrition, ASHN)
Attitude toward healthy eating was measured with the Attitude Scale for Healthy Nutrition (ASHN). The 21-item, 5-point Likert scale has four factors (Information on Nutrition, Emotion for Nutrition, Positive Nutrition, Malnutrition) and was analyzed based on the total score. Total scores range from 21 to 105; higher scores indicate a more positive attitude toward healthy eating (better outcome).
Time frame: Baseline (immediately before the education) and 20 days after the education
Plan to share: No — Individual participant data will not be shared publicly because participants are minors and confidentiality was guaranteed in the informed consent. Data may be made available by the corresponding author upon reasonable request.
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