Digital Versus Hybrid Interventions in Promoting Nutrition Knowledge Among Saudi Adolescent Girls

Generalized Anxiety Disorder Scores (GAD)

Anxiety levels were measured using the GAD-7. This is a 7-item validated questionnaire (28), which is widely used to screen for and quantify the severity of GAD. The Arabic version of this tool has been adopted by the Saudi Arabian Ministry of Health for initial anxiety screening. Each item is rated on a 4-point Likert scale, ranging from 0 (not at all) to 3 (nearly every day), with total scores ranging from 0 to 21. Higher scores reflect greater anxiety levels. Anxiety was defined using a cutoff score of 10 or above, which differentiated between minimal to mild anxiety and moderate to severe anxiety (28).

Time frame: From enrollment to the end of treatment at 4 weeks

Dietary habits

Dietary habits were evaluated using a questionnaire adapted from research on food consumption frequencies in Qatar, which share similar characteristics with Saudi Arabia. The questionnaire assessed the frequency of consumption of various food groups, including vegetables, fruits, carbohydrates (e.g., bread, rice, pasta), proteins (e.g., chicken, beef, fish), and dairy products (e.g. yoghurt and cheese). Participants responded to questions such as, "How often do you consume fresh fruits/green leafy vegetables/fish? To evaluate dietary variety, the study employed the Healthy Plate Variety Score, calculated using a modified methodology based on Jones et al. (2015). This approach involved dichotomizing food intake from the five main groups into two categories (daily intake vs. non-daily). Foods consumed daily received a score of 1, while those not consumed daily received a score of 0 with a potential maximum score of 5.0.

Time frame: From enrollment to the end of treatment at 4 weeks

Anthropometric measurements (Body mass index)

Body measurements were obtained using standardized equipment following established operating procedures. Trained senior dietitians objectively assessed the height and weight of adolescents using a mechanical combined scale and a stadiometer (Detecto). Prior to measurement, a technician ensured that the equipment was properly calibrated. Height was recorded to the nearest 0.1 cm while participants were barefoot and dressed in minimal clothing. Weight was measured and documented to the nearest 0.1 kg. The Body Mass Index (BMI) was calculated by dividing the weight in kilograms by the square of the height in meters. Weight status was classified according to the criteria set by the World Health Organization (WHO): underweight was defined as a BMI of less than 18.5 kg/m², normal weight ranged from 18.5 to 24.9 kg/m², overweight was categorized as a BMI between 25.0 and 29.9 kg/m², and obesity was indicated by a BMI of 30.0 kg/m² or higher.

Time frame: From enrollment to the end of treatment at 4 weeks