Intervention Using Video and Comic Books Targeting Nutritional Outcomes in Children and Adolescents: A Systematic Review

Abstract

Introduction

Unhealthy eating behaviours and rising rates of undernutrition and obesity remain widespread among children and adolescents. Traditional education often fails to engage this population. In contrast, video and comic book formats offer accessible, engaging tools for nutrition education, but evidence on their effectiveness is inconsistent. This systematic review synthesises and critically appraises the evidence on video- and comic-based interventions for improving nutritional outcomes in children and adolescents.

Methods

In accordance with PRISMA guidelines a protocol was registered in PROSPERO (CRD420251138451). We systematically searched PubMed, Embase, and CENTRAL from January 2000 to October 2025 for randomised, cluster-randomised, and non-randomised intervention studies in participants aged ≤ 18 years using video- or comic-based formats. Outcomes included nutritional status, dietary intake, food consumption, dietary patterns, and nutrition literacy. The risk of bias quality of the included studies were independently assessed by two reviewers.

Results

Of 498 records, 18 studies met inclusion criteria—14 video-based and 4 comic-based interventions across school, digital, and clinical settings in Asia, Africa, Europe, North America, and Australia (sample sizes ranged from 57 to 6,640). Interventions consistently improved nutrition-related knowledge, attitudes, and self-efficacy. Effects on dietary behaviours, including fruit and vegetable consumption, were favourable, but rarely sustained at follow-up. The effects of anthropometric factors on BMI and body composition were limited and inconsistent. Risk of bias ranged from some concerns to high or serious.

Conclusion

Video- and comic-based interventions effectively improve nutrition literacy among children and adolescents but show limited and inconsistent effects on dietary behaviours and anthropometric outcomes. Future interventions should move beyond information delivery and embed multimedia within multilevel strategies addressing behavioural, environmental, and parental determinants of diet.