Web-based nutrition education intervention improves self-efficacy and self-regulation related to increased dairy intake in college students

mHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention Study

BACKGROUND

Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population.

OBJECTIVE

The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults.

METHODS

Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ≥80 mm Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant's BP was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealth intervention.

RESULTS

The participants' (N=9) mean age was 22.64 (SD 4.54) years; 56% (5/9) were overweight, and 11% (1/9) were obese. The average daily participation rate was 86%. Of the 9 participants, 8 completed the survey, and all indicated the intervention was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of the intervention and program. Overall, no significant changes were noted in BP over the 28 days.

CONCLUSIONS

The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible to implement, as our study indicated high rates of participation and acceptability. These encouraging findings support further development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention among college-aged adults, filling a gap in current research.

The effect of web-based education on self-care behaviors in cardiovascular patients: application of the pender's health promotion model

BACKGROUND

Coronary artery disease is the most common cardiovascular disease, the mortality rate of which is increasing significantly. The most important way to prevent a second attack in patients undergoing angioplasty is self-care, which can be influenced by several factors such as the patient's beliefs. Thus, the present study aimed to determine the effect of a web-based intervention based on the Pender's health promotion model in patients with cardiovascular disease.

METHODS

The present clinical trial study was conducted with 99 patients undergoing angioplasty treatment referring to Bushehr Heart Specialist Center. Random sampling was done and the participants were divided into two groups (50 subjects in intervention group and 49 subjects in control group). The data collection tool was a three-part questionnaire (including demographic information, a researcher-made questionnaire based on the health promotion model constructs, and self-care behaviors), which was completed in three stages (before, two weeks, and three months after the intervention). In addition to routine hospital services, the intervention group received multimedia training based on the constructs of the Pender's health promotion model from the website. The control group received usual hospital services. Data were analyzed with chi-square, independent T-test and repeated measure ANOVA using SPSS-22 software.

RESULTS

The results showed that 2 weeks and 3 months after the intervention, the mean scores of perceived benefits, perceived self-efficacy and perceived social support had a significant increase in the intervention group compared to the control group, but the mean score of perceived barriers had a significant decrease in the intervention group (p < 0.001). Regarding self-care behaviors, after the intervention, the mean scores of self-care behaviors, physical activity, healthy diet, medication adherence and stress management had a significant increase in the intervention group compared to the control group (p < 0.001), but no significant was observed between the two groups in terms of changes in the non-smoking (p = 0.38).

CONCLUSION

The results of the study showed that the web-based educational intervention based on the health promotion model is useful in improving the self-care behaviors of cardiac patients undergoing angioplasty. Nursing education and care have a great role in improving the self-care behaviors of cardiovascular patients.

TRIAL REGISTRATION

Registration number: IRCT2017080635429N2. Registration date: 09/03/2017 ( https://en.irct.ir/trial/26775 ).

New in Town-An internet-based self-efficacy intervention for internal migrants: A randomized controlled trial

OBJECTIVE

Migration is a profound life transition that may threaten migrants' well-being and mental health. Results of several studies suggest that social self-efficacy beliefs may be beneficial for the psychological adjustment of migrants, buffering the effect of specific stressors related to migration, helping them reduce anxiety levels, and providing support in forming of new social bonds and better integration with a new community or culture. The primary purpose of this randomized controlled trial was to examine the effectiveness of the New in Town internet-based self-efficacy intervention for internal migrants in Poland.

METHODS

Participants were 158 internal adult migrants who had changed residence in the last 6 months. They were randomized into two groups: an experimental group (receiving an internet-based self-efficacy intervention), and a waiting list control group. We examined if the intervention was effective in enhancing participants' social self-efficacy (primary outcome), general self-efficacy, social support, satisfaction with life, and reduced reported loneliness (secondary outcomes). Outcome measures were assessed at baseline (Time 1) and 3-weeks later (Time 2). The dropout rate was 50.6%. Initially, we planned to gather follow-up data also 8-weeks after baseline (Time 3). However, due to health and safety reasons related to the COVID-19 pandemic, we decided to stop the trial. Finally, we included in our analysis only data gathered before the COVID-19 pandemic at Time 1 and Time 2.

RESULTS

A total of 159 individuals who met the study's inclusion criteria and completed the baseline assessment were randomly assigned to either the experimental group (n = 80) or the waiting list control group (n = 79). Nevertheless, one participant assigned to the control group was excluded from the analyses because they withdrew their consent to participate after being randomized. The study results suggest that compared to the waitlist control group (n = 78), participants in the experimental group (n = 80) reported a higher level of general self-efficacy beliefs at Time 2 (Cohen's d = 0.47; 95% CI: 0.15-0.79). However, there were no statistically significant effects on social self-efficacy, social support, satisfaction with life, and loneliness.

CONCLUSION

The study offers preliminary support for the effectiveness of an internet-based self-efficacy intervention designed for internal migrants on general self-efficacy beliefs.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov (identifier: NCT04088487) on 11th September 2019.

Are College Students Interested in Family Health History Education? A Large Needs Assessment Survey Study

Family health history (FHH) is an essential foundation for personalized disease prevention. As the incidence of early-onset chronic diseases is increasing among college students, it is important to provide them with the education required to learn about their FHH. This study aimed to assess college students' interest in receiving FHH education, preferred topics, and desired learning methods. We invited college students to complete an online survey from a large research-intensive university. A total of 2276 college students completed the survey. Nearly half of the participants self-identified as non-Hispanic white (45.5%). Slightly more than half of the sample (53.9%) were not interested in receiving FHH education mainly due to low prioritization. Among those who expressed interest in obtaining FHH education, the three most desired learning topics were the ability to interpret FHH information (76.1%), the application of FHH in disease prevention (72.0%), and FHH information collection strategies (63.6%). Computer-based learning (51.1%) was the most preferred educational method. Moreover, females, older individuals, those who have FHH in first-degree relatives, and participants who were members of racial and ethnic groups showed greater interests in receiving FHH education (ps < 0.05). Strategies to promote college students' awareness, collection, and use of FHH are needed.

Virtual Reality and Powerpoint Grocery Store Tours: Equally Effective in Improving Self-efficacy in Randomised Control Trial

PURPOSE

Compare computer-based virtual reality (CBVR) and voice-over PowerPoint (PP) grocery store tours (GST) on adult nutrition literacy (NL) and healthful food purchasing self-efficacy (HFPSE).

DESIGN

Participants (n = 68) recruited from University worksite wellness program and randomly assigned to CBVR or PP (CBVR = 35; PP = 33).

INTERVENTION

Four-week culinary/nutrition education program. Initial three weeks provided identical education for both groups. Week four implemented GST intervention using CBVR or PP.

MEASURES

NL and HFPSE surveys before, after, and three-months post from the start of program.

ANALYSIS

Intent-to-treat (ITT) analysis with RMANOVA (95% confidence intervals [CI] and effect sizes) to examine change in NL and HFPSE between CBVR and PP groups over 4-week intervention and 3-month retention period.

RESULTS

43 of 68 participants [CBVR (n = 19) and PP (n = 24)] were included in analyses. Both groups significantly improved HFPSE over time (P<.001, CBVR = 46.23% PP = 33.34%), but there were no differences between groups (P = .21) or group by time interaction (P = .31). NL did not change for either group (P = .83, CBVR = 1.11%; PP = .12%) nor were there differences between groups (P = .07).

CONCLUSIONS

CBVR and PP GST significantly improved and maintained higher HFPSE scores.

Pilot Intervention Using Food Challenges and Video Technology for Promoting Fruit and Vegetable Consumption

OBJECTIVE

To evaluate the feasibility of a Social Cognitive Theory-based intervention on cognitive, affective, and behavioral outcomes in a college nutrition course.

DESIGN

A pre-post quasi-experimental design.

SETTING

Large metropolitan university.

PARTICIPANTS

College students (n = 138) aged 18-40 years.

INTERVENTIONS

Students participated in weekly food challenges during a 15-week nutrition course to apply nutrition knowledge, develop self-efficacy and promote positive behavior change. Food challenges were implemented by a guided goal-setting strategy. Cooking videos, which modeled important nutrition-related skills, accompanied each challenge. Students independently selected 2-goal options to implement weekly and wrote a reflection about their experiences.

MAIN OUTCOME MEASURES

Cognitive outcomes (nutrition and cooking self-efficacy), affective outcome (cooking attitudes), and behavioral outcomes (fruit and vegetable consumption).

ANALYSIS

Descriptive statistics and paired sample t tests.

RESULTS

Analyses showed significant increases in cognitive outcomes (produce consumption self-efficacy [P = 0.004], cooking self-efficacy [P = 0.002], using fruit/vegetables and seasoning self-efficacy [P = 0.001]) and behavioral outcomes (fruit consumption [P < 0.001], and vegetable consumption [P < 0.001]).

CONCLUSION AND IMPLICATIONS

This pilot study suggested a framework for behavioral change, grounded in constructs central to Social Cognitive Theory, that simplified the goal-setting process (by using guided goal setting) and used video technology to decrease the cost of implementation.

An examination of electronic nicotine delivery system use among college students using social cognitive theory

Objective: Using social cognitive theory as a framework, this study examined electronic nicotine delivery systems (ENDS) use, related cognitions, and context among college students. Participants: Respondents were 1229 students attending a mid-sized, northeastern university. Methods: A cross-sectional survey was administered and SPSS was used for analysis. Results: Almost 41% of respondents reported ENDS use in the prior month (past-month user), 26.8% reported trying ENDS but no use in the prior month (occasional user), and 32.3% reported never trying ENDS. The results highlight significant associations in past-month versus occasional use and reasons for initation, location for ENDS use, perceived norms for ENDS use, and outcome expectations for ENDS use. Conclusions: This study highlights a need for theory-based, multi-level strategies to reduce ENDS use. Interventions should increase awareness about the risks of ENDS, include peer-based interventions to foster health-promoting campus social environments, and explore the use of policies restricting campus ENDS use.

Calorie Compensation and Self-Regulation of Food Intake in College Students

OBJECTIVE

To examine self-regulation of food intake among college students.

DESIGN

Randomized cross-over study completed between September and November, 2019.

SETTING

A large public university, Florida International University in South Florida.

PARTICIPANTS

A total of 60 undergraduate college students, mean age of 19.8 ± 1.43 years old, 62% female, 74% Hispanic, 76% White.

INTERVENTION(S)

Participants attended 2 trials 1 week apart. During each visit, students were offered a preload drink (either 0 or 210 kcal) followed by a buffet-style lunch. Food intake was estimated using weights and pictures of the plates before and after eating and was compared between the 2 sessions.

MAIN OUTCOME MEASURE(S)

Self-regulation by calculating compensation indices (COMPX) and their correlation with students' body mass index (BMI).

ANALYSIS

Intake differences were examined using Welch and t tests. Regression analysis was used to assess correlations.

RESULTS

Students exhibited the ability to calorie compensate when intake is manipulated with a mean COMPX of 95.57 ± 71.19. No score was perfect. There was a significant correlation between BMI and COMPX scores (F = 10.71, P < 0.001, r² = 0.292). Food choices differed between different BMI categories.

CONCLUSIONS AND IMPLICATIONS

Participants showed some degree of self-regulation, which suggests opportunities for creating effective interventions to improve health status and promote a more sustainable method to control consumption among college students.

Trends in the Number of Behavioural Theory-Based Healthy Eating Interventions Inclusive of Dietitians/Nutritionists in 2000-2020

Nutrition interventions developed using behaviour theory may be more effective than those without theoretical underpinnings. This study aimed to document the number of theory-based healthy eating interventions, the involvement of dietitians/nutritionists and the behaviour theories employed from 2000 to 2020. We conducted a review of publications related to healthy eating interventions that used behaviour change theories. Interventional studies published in English between 2000 and 2020 were retrieved from searching Medline, Cinahl, Embase, Psycinfo and Cochrane Central. Citation, country of origin, presence or absence of dietitian/nutritionist authors, participants, dietary behaviours, outcomes, theories and any behaviour change techniques (BCTs) stated were extracted. The publication trends on a yearly basis were recorded. A total of 266 articles were included. The number of theory-based interventions increased over the two decades. The number of studies conducted by dietitians/nutritionists increased, but since 2012, increases have been driven by other researchers. Social cognitive theory was the most used behaviour theory. Dietitians/nutritionists contributed to growth in publication of theory-based healthy eating interventions, but the proportion of researchers from other professions engaged in this field increased markedly. The reasons for this growth in publications from other professions is unknown but conjectured to result from greater prominence of dietary behaviours within the context of an obesity epidemic.

Predicting Treatment Outcomes in Guided Internet-Delivered Therapy for Anxiety Disorders-The Role of Treatment Self-Efficacy

Aim: Guided Internet-delivered therapy has shown to be an effective treatment format for anxiety disorders. However, not all patients experience improvement, and although predictors of treatment outcome have been identified, few are consistent over time and across studies. The current study aimed to examine whether treatment self-efficacy (self-efficacy regarding the mastery of obstacles during treatment) in guided Internet-delivered therapy for anxiety disorders in adults could be a predictor of lower dropout rates and greater symptom reduction. Method: The analyzed data comes from an open effectiveness study including 575 patients receiving guided Internet-delivered therapy for panic disorder or social anxiety disorder. Treatment self-efficacy was measured at pre-treatment. Symptom reduction was measured at 10 measurement points, including a 6-month follow-up. A mixed linear model was applied in the analysis. Results: The results showed that high treatment self-efficacy was a predictor of both lower dropout rates and greater symptom reduction. Significant interaction effects between time and treatment self-efficacy were found for several of the nine modules that constitutes the treatment program, suggesting that treatment self-efficacy could be a moderator of symptom reduction. Three of nine modules in the panic disorder treatment and six of nine in the social anxiety disorder treatment showed significant interaction effects. Conclusion: The results suggest that measuring treatment self-efficacy may be a valuable tool to identify patients at risk of dropping out, and that treatment self-efficacy could be a predictor and moderator of symptom reduction in guided Internet-delivered therapy. The implications of the results are discussed.

Effectiveness of a nutrition education and intervention programme on nutrition knowledge and dietary practice among Princess Nourah Bint Abdulrahman University's population

OBJECTIVE

The study sought to assess the influence of nutrition education and intervention programmes on nutrition knowledge and dietary practice among both students and staff (including faculty) of Princess Nourah Bint Abdulrahman University in Saudi Arabia.

DESIGN

A pretest-posttest, non-randomised experimental study design was implemented at Princess Nourah Bint Abdulrahman University in Riyadh City between September 2019 and February 2020.

SETTING

Princess Nourah Bint Abdulrahman University is the largest women's university in the world and has eighteen colleges and institutions and around ninety academic programmes.

PARTICIPANTS

The survey was completed by 1824 participants (1350 students and 474 staff/faculty) before the intervention and by a different cohort of 1731 participants (1317 students and 414 staff/faculty) after the intervention. In total, an independent sample of 3555 staff and students participated. Participants were asked about dietary knowledge and practices. Dietary knowledge entailed food variety and nutrients, fast food and its poor nutritional value, and the influence of cooking style on the nutritional quality of food. Dietary practices involved eating breakfast; consuming salt/sugar, eating high-salt food; eating pre-packaged food and consumption of vegetables, fruits, supplements, water and caffeine.

RESULTS

The majority of the sample consisted of students (75·1 %) and had not been diagnosed with any disease (73·7 %). The result of the current study showed that nutrition knowledge improved after completion of the nutrition programme.

CONCLUSIONS

The nutrition awareness programme improved students' nutritional knowledge; however, there was no significant effect on their dietary practices. Future nutrition awareness programmes should separate activities for students and staff, focusing on one target population at a time.

Internet-based self-help intervention aimed at increasing social self-efficacy among internal migrants in Poland: Study protocol for a randomized controlled trial

BACKGROUND

Migration is a challenging life transition that may be a source of various problems related to well-being and mental health. However, the psychological adaptation of migrants may be potentially facilitated by social self-efficacy-the beliefs in one's ability to initiate and maintain interpersonal relationships. Previous research suggests that social self-efficacy is positively related to adjustment and negatively related to loneliness, depression, and psychological distress. Research also confirms that self-efficacy beliefs can be effectively enhanced using Internet-based interventions. These results served as a background for creating the New in Town, a self-help Internet-based intervention for internal migrants in Poland that aims at increasing social self-efficacy. Exercises in the intervention are based on the principles of Cognitive Behavioral Therapy and relate to sources of self-efficacy beliefs: mastery experiences, vicarious experiences, verbal persuasions, and emotional and physiological states. Users complete increasingly challenging tasks that encourage them to interact with their environment. The aim of this trial was to investigate the efficacy of the New in Town intervention.

METHODS

The efficacy of the New in Town intervention will be tested in a two-arm randomized controlled trial with a waitlist control group. Social self-efficacy will be the primary outcome. Secondary outcomes will include loneliness, perceived social support, and satisfaction with life. Additionally, we will measure user experience among participants allocated to the experimental group. We aim to recruit a total of N = 280 participants aged at least 18 years who have changed their place of residence in the last 6 months and have an Internet connection. Participants will be assessed at baseline, 3-week post-test, and 8-week follow-up.

DISCUSSION

The trial will provide insights into the efficacy of Internet-based self-help interventions in increasing social self-efficacy. Given that the intervention works, New in Town could provide an easily accessible support option for internal migrants in Poland.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov (identifier: NCT04088487) on 11th September 2019.

Effect of nutrition education received by teachers on primary school students' nutrition knowledge

BACKGROUND/OBJECTIVES

The aim of this study was to assess the effect of nutrition education received by fourth- and fifth-grade teachers in state schools in Famagusta, Northern Cyprus, on their students.

SUBJECTS/METHODS

The aim of this study is to assess the effect of nutrition education received by fourth- and fifth-grade teachers (n = 27) in state schools in Famagusta on their students. Participants (n = 718) were selected through a regional pilot scheme. The teachers were instructed on nutrition by the researcher and provided with a researcher-prepared nutrition education book “I Am Learning about Healthy Nutrition”. Before receiving their nutrition education, the teachers were pretested to assess their baseline nutrition knowledge. Following receipt of their nutrition education, a posttest, which included the same questions as those in the pretest, was administered to the teachers to assess the effectiveness of the training session. Similarly, students were asked pretest researcher-prepared questions to evaluate their baseline nutrition knowledge level. The teachers were then given a period of three to four weeks to instruct the students in nutrition education. Following this instructional period, a posttest that included the same questions as those in the pretest was administered to the students.

RESULTS

The results showed that there were significant differences between the pre- and posttest scores of both teachers and students; in both groups, the nutrition knowledge level increased (P < 0.05).

CONCLUSIONS

These results show that the provision of nutrition education training to teachers positively affected the nutrition knowledge level of both teachers and students.

Promoting Healthy Eating Habits for College Students Through Creating Dietary Diaries via a Smartphone App and Social Media Interaction: Online Survey Study

Background

Youth in developed countries face the contradictory health problems of obesity and an excessive desire for weight loss. Developing a better health attitude for college students is essential as this period of life establishes future lifestyle and habits. Online interaction on social media can help to improve eating habits by creating dietary diaries through a smartphone app; however, the effects of such interactions for college students have not been examined to date.

Objective

The aim of this study was to evaluate the potential effectiveness of social media interactions with the use of dietary diaries on a smartphone app to motivate college students in raising self-awareness of their eating habits.

Methods

Forty-two college students in the greater Tokyo area of Japan participated in the study by creating dietary diaries online through a smartphone app and then followed/interacted with each other using social media for 7 consecutive days in September to November 2017. Online surveys were administered at baseline, immediately after creating the dietary diaries, and at 1-month follow up. Participants rated their degree of interest and self-evaluation of eating habits using 7-point scales, and answered multiple choice questions related to their thoughts in choosing meals/drinks among 10 topics. Free descriptions about their overall experience throughout the project were also collected in the follow-up survey.

Results

Data from 38 participants who completed all processes were analyzed. Over time, the mean score for degree of interest in eating habits increased from 4.6 to 6.2 (P<.001), while the self-evaluation score decreased from 4.5 to 3.6 (P<.001); these significant differences remained after 1 month (5.3, P=.002; 4.1, P=0.04, respectively). A weak negative correlation (P=.009) was observed between scores for degree of interest and self-evaluation. Participants with lower scores for degree of interest at baseline tended to increase their interest level by more than 2 points above the average (P<.001). Participants gradually thought more about their eating habits from various perspectives when choosing a meal/drink, particularly with respect to maintaining well-balanced diets and introducing diverse ingredients. Participants evaluated their experiences as interesting/fun and reported familiarity with using the smartphone app and social media as the preferred method to keep track of their eating. All participants welcomed communication with fellow participants on social media and motivated each other, in addition to monitoring their eating habits through online dietary diaries. Some participants experienced difficulty, especially when they were busy or faced a lack of internet access.

Conclusions

Through interactions on social media, college students experienced encouragement and developed an interest and critical thinking with respect to their eating habits. This approach, which embraces peer education and peer support with social media, holds promise for the future of youth health promotion. Further examination will be needed to explore how to sustain this level of heightened awareness.

Learn first, practice second approach to increase health professionals' nutrition-related knowledge, attitudes and self-efficacy

Health professionals generally have positive attitudes towards the role of nutrition in medicine, but limited knowledge and low self-efficacy for incorporating it into routine care. To assess the effectiveness of a "learn first, practice second" intervention on the nutrition-related knowledge, attitudes, and self-efficacy of multidisciplinary health professionals, the present approach consisted of 16 weeks of online education and 2 weeks of cultural immersion in Tuscany, Italy. Data was captured via online surveys at Baseline, Post-education, Post-immersion, and Follow Up. Repeated measures ANOVA with irregular spacing was used, followed by Dunnett's or Cochran-Mantel-Haenszel testing. Results indicate significantly improved participant nutrition knowledge (nonzero correlation p = .0136, means score p = .0075) and self-efficacy (T0-T1 p < .0001, T0-T2 p < .0001, T0-T3 p = .0002), with differences in attitude trending towards significance (p = .0764). Findings from this study suggest that a combination of online education and hands on learning experiences can be beneficial for increasing health professionals' nutrition knowledge, confidence, and potentially attitude.

Use of Wearable Technology and Social Media to Improve Physical Activity and Dietary Behaviors among College Students: A 12-Week Randomized Pilot Study

College students demonstrate poor physical activity (PA) and dietary behaviors. We evaluated the feasibility of a combined smartwatch and theoretically based, social media-delivered health education intervention versus a comparison on improving college students' health behaviors/outcomes. Thirty-eight students (28 female; Xage = 21.5 ± 3.4 years) participated in this two-arm, randomized 12-week pilot trial (2017-2018). Participants were randomized into: (a) experimental: Polar M400 use and twice-weekly social cognitive theory- and self-determination theory-based Facebook-delivered health education intervention; or (b) comparison: enrollment only in separate, but content-identical, Facebook intervention. Primary outcomes pertained to intervention feasibility. Secondary outcomes included accelerometer-estimated PA, physiological/psychosocial outcomes, and dietary behaviors. Intervention adherence was high (~86%), with a retention of 92.1%. Participants implemented health education tips 1-3 times per week. We observed experimental and comparison groups to have 4.2- and 1.6-min/day increases in moderate-to-vigorous PA (MVPA), respectively, at six weeks-partially maintained at 12 weeks. In both groups, similarly decreased body weight (experimental = -0.6 kg; comparison = -0.5 kg) and increased self-efficacy, social support, and intrinsic motivation were observed pre- and post-intervention. Finally, we observed small decreases in daily caloric consumption over time (experimental = -41.0 calories; comparison = -143.3). Both interventions were feasible/of interest to college students and demonstrated initial effectiveness at improving health behaviors/outcomes. However, smartwatch provision may not result in an additional benefit.

Types of Interventions Targeting Dietary, Physical Activity, and Weight-Related Outcomes among University Students: A Systematic Review of Systematic Reviews

A plethora of studies aiming to improve dietary, physical activity (PA), and weight-related (WR) outcomes among university students have been implemented and summarized in a series of systematic reviews, with unclear conclusions regarding their effectiveness. This overview aims to identify systematic reviews and meta-analyses of studies aiming to improve health outcomes in university students, to assess their methodological quality, to identify the different types of interventions used and outcomes assessed, and to estimate their overall effect. Four electronic databases were searched until 19 March, 2018 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The identified reviews were described and their methodological quality was rated. The studies of reviews were investigated to identify the different types of interventions used and outcomes assessed. Effectiveness was assessed by measuring the overall number of improved outcomes out of the total number of outcomes reported. As a result, 8 reviews were identified targeting food sales (n = 2), dietary (n = 3), PA (n = 1), WR (n = 1), or all outcomes (n = 1). The methodological quality of the reviews was moderate (n = 5) to low (n = 3). In all, the reviews included 122 studies, of which 36 used an environmental, 51 a face-to-face, 30 an e-intervention, and 5 a combined approach. Environmental interventions improved a moderate number of food sales (32 of 61) and dietary intake (22 of 47) outcomes. Face-to-face interventions improved a high number of dietary cognitive outcomes (15 of 18), a moderate number of dietary intake (28 of 65) and WR (11 of 18) outcomes, and a low number of PA behavioral (22 of 69) and cognitive (2 of 14) outcomes. E-interventions improved a high number of dietary cognitive variables (11 of 16) but had a low effect (≤33%) on the other types of outcomes. In conclusion, face-to-face and e-interventions improved cognitive variables toward diet or PA but were less effective in changing actual behaviors. Environmental interventions favorably changed food sales. Face-to-face and e-interventions moderately affected WR outcomes. Future research should focus on long-term studies.

The Effect of a Self-Efficacy-Enhancing Intervention on Perceived Self-Efficacy and Actual Adherence to Healthy Behaviours Among Women with Gestational Diabetes Mellitus

Objectives

This study aimed to evaluate the effectiveness of a self-efficacy-enhancing intervention (SEEI) on perceived self-efficacy and actual adherence to healthy behaviours among women with gestational diabetes mellitus (GDM).

Methods

This comparative pre-post study was conducted at the Antenatal Clinic of the Sultan Qaboos University Hospital, Muscat, Oman, between October 2016 and January 2017. A total of 90 adult Omani women with GDM were randomised to either a control group receiving standard prenatal care or a SEEI group. The SEEI group received an additional health education session and biweekly text messages to encourage adherence to healthy behaviours. All participants completed self-reported standardised questionnaires to determine perceived self-efficacy and actual adherence at baseline and after four weeks.

Results

At baseline, there were no significant differences between the control and SEEI groups in mean scores for perceived self-efficacy (122.9 ± 19.9 versus 118.2 ± 19.5; P = 0.26) or actual adherence to healthy behaviours (3.1 ± 1.2 versus 3.2 ± 1.0; P = 0.23). However, after four weeks, there was a significant positive difference between the SEEI and control groups in terms of pre-post change in scores for both perceived self-efficacy (9.9 ± 19.6 versus -1.8 ± 17.6; P <0.05) and actual adherence to healthy behaviours (1.5 ± 1.1 versus 0.4 ± 0.8; P <0.01).

Conclusion

The SEEI was found to significantly improve perceived self-efficacy and actual adherence to healthy behaviours among a group of Omani women with GDM.

Assessing the effectiveness of nutrition interventions implemented among US college students to promote healthy behaviors: A systematic review

BACKGROUND:

Nutrition interventions are used to increase knowledge, change attitudes and beliefs about healthy eating, to increase skills, and promote healthy eating.

AIMS:

To review the effectiveness of published nutrition interventions implemented among college students to promote healthy behaviors.

METHODS:

The authors explored multiple electronic databases, such as ERIC, Science Direct, and EBSCOhost. Search criteria included nutritional interventions implemented among students attending US colleges, written in English, and published in peer-reviewed journals between 2000 and 2015. The authors conducted a systematic search of 1413 articles, and an in-depth review of 30 articles. The authors evaluated the following: (a) participants; (b) research design; (c) assessment instruments; (d) outcome measures; (e) results; and (f) methodological issues.

RESULTS:

Short-term interventions showed promise in promoting positive dietary changes, which can serve as a protective factor for developing overweight and obesity. Methodological issues related to lack of comparison groups and minimal long-term follow-up do not allow researchers to determine if the interventions were the cause of the change, or if these changes are sustained over time. Studies that have a comparison group, use visual displays, or have longer durations, may maximize outcomes, improving long-term effects.

CONCLUSIONS:

Nutrition interventions can effectively change dietary habits among college students. This can lead to healthy weight management and reduce the risk for overweight and obesity. Future research should consider the highlighted methodological issues to improve the quality of nutrition interventions.

Determining attitudinal and behavioral factors concerning milk and dairy intake and their association with calcium intake in college students

BACKGROUND/OBJECTIVES

Average intake of calcium among college students is below the recommended intake, and knowledge surrounding the attitudinal and behavioral factors that influence milk and dairy intake, a primary food source of calcium, is limited. The purpose of this study was to evaluate college students' attitudes and behaviors concerning milk and dairy consumption and their association with calcium intake.

SUBJECTS/METHODS

Participants were 1,730 undergraduate students who completed an online survey (SurveyMonkey) as part of baseline data collection for a social marketing dairy campaign. The online survey assessed attitudes and behaviors concerning milk and dairy intake, and calcium intake. Questions about milk- and dairy-related attitudes and behaviors were grouped into 14 factors using factor analysis. Predictors of calcium intake were then evaluated.

RESULTS

Median calcium intake across all participants was 928.6 mg/day, with males consuming higher calcium intakes than females (P < 0.001). Adjusted for gender, calcium intakes were most strongly (and positively) correlated with associating milk with specific eating occasions and availability (i.e., storing calcium-rich foods in one's dorm or apartment) (both P < 0.001). Other correlates of calcium intake included: positive-viewing milk as healthy (P = 0.039), having family members who drink milk) (P = 0.039), and taking calcium supplements (P = 0.056); and negative-parent rules concerning milk (P = 0.031) and viewing milk in dining halls negatively (P = 0.05).

CONCLUSIONS

Calcium intakes among college students enrolled in the current study was below the recommended dietary allowance of 1,000 mg/day, reinforcing the need for dietary interventions in this target population, especially females. Practitioners and researchers should consider the factors found here to impact calcium intake, particularly associating milk with specific eating occasions (e.g., milk with breakfast) and having calcium-rich foods available in the dorm room or apartment, as intervention strategies in future efforts aimed at promoting milk and dairy foods and beverages for improved calcium intake in college students.

Exploring Digital Health Use and Opinions of University Students: Field Survey Study

Background

During university, students face some potentially serious health risks, and their lifestyle can have a direct effect on health and health behaviors later in life. Concurrently, university students are digital natives having easy access to the internet and new technologies. Digital health interventions offer promising new opportunities for health promotion, disease prevention, and care in this specific population. The description of the current use of and opinions on digital health among university students can inform future digital health strategies and interventions within university settings.

Objective

The aim of this exploratory study was to report on university students’ use and opinions regarding information and communication technologies for health and well-being, taking into account sociodemographic and self-rated general and mental health correlates.

Methods

This field survey was conducted from March to April 2017. An informed consent form and a paper questionnaire were given to students aged 18 to 24 years in 4 university campuses in Bordeaux, France. The survey was formulated in 3 sections: (1) sociodemographic characteristics and self-rated general and mental health, (2) information about the use of digital health, and (3) opinions about digital health. Data were analyzed using descriptive statistics and tests of independence.

Results

A total of 59.8% (303/507 females) students completed the questionnaire. Concerning digital health use, 34.9% (174/498) had at least 1 health app mostly for physical activity (49.4%, 86/174) and general health monitoring (41.4%, 72/174,), but only 3.9% (20/507) of students had a wearable device. Almost all (94.8%, 450/476) had searched for Web-based health-related information at least once in the last 12 months. The most sought health-related topics were nutrition (68.1%, 324/476); pain and illnesses (64.5%, 307/476); and stress, anxiety, or depression (51.1%, 243/476). Although Wikipedia (79.7%, 357/448) and general health websites (349/448, 77.9%) were the most consulted sources, students considered institutional or official websites as the most credible sources (309/335, 92.2%). There were significant differences in digital health use by gender, field, and year of study. No statistically significant association was found between digital health use and self-rated general and mental health status. Concerning opinions on digital health, although 94.1% (475/505) of students estimated that today’s digital health cannot replace traditional health services and medical consultations, 44.6% (207/464) of students declared that this could be possible in the future, provided that digital health interventions are promoted by institutional or official entities.

Conclusions

University students are largely using the internet for health information seeking, but using less mobile health apps and very few wearable devices. Our data suggest that digital health has the potential for improving health and well-being at the university, especially if digital health interventions take into account students’ profiles, interests, and needs.

Systematic review and meta-analysis of remotely delivered interventions using self-monitoring or tailored feedback to change dietary behavior

Background

Self-monitoring (SM) of diet and tailored feedback (TF) have been suggested as tools for changing dietary behavior. New technologies allow users to monitor behavior remotely, potentially improving reach, adherence, and outcomes.

Objective

We conducted a systematic literature review and meta-analysis to address the following question: are remotely delivered standalone (i.e., no human contact) interventions that use SM or TF effective in changing eating behaviors?

Design

Five databases were searched in October 2016 (updated in September 2017). Only randomized controlled trials published after 1990 were included. Trials could include any adult population with no history of disordered eating which delivered an SM or TF intervention without direct contact and recorded actual dietary consumption as an outcome. Three assessors independently screened the search results. Two reviewers extracted the study characteristics, intervention details, and outcomes, and assessed risk of bias using the Cochrane tool. Results were converted to standardized mean differences and incorporated into a 3-level (individuals and outcomes nested in studies) random effects meta-analysis.

Results

Twenty-six studies containing 21,262 participants were identified. The majority of the studies were judged to be unclear or at high risk of bias. The meta-analysis showed dietary improvement in the intervention group compared to the control group with a standardized mean difference of 0.17 (95% CI: 0.10, 0.24; P < 0.0001). The I2 statistic for the meta-analysis was 0.77, indicating substantial heterogeneity in results. A "one study removed" sensitivity analysis showed that no single study excessively influenced the results.

Conclusions

Standalone interventions containing self-regulatory methods have a small but significant effect on dietary behavior, and integrating these elements could be important in future interventions. However, there was substantial variation in study results that could not be explained by the characteristics we explored, and there were risk-of-bias concerns with the majority of studies.

Does Self-Efficacy Mediate the Relationships Between Social-Cognitive Factors and Intentions to Receive HPV Vaccination Among Young Women?

Drawing upon health behavior change theories, the current study examined whether self-efficacy mediated relationships between social-cognitive factors (i.e., perceived risk, perceived benefits, perceived barriers, perceived severity, and cue to action) and human papillomavirus (HPV) vaccination intentions among college women. Unvaccinated women (N = 115) aged 18 to 25 years attending a Midwestern university completed an anonymous web-based survey assessing study variables. Correlational analyses and mediation analyses were conducted. Self-efficacy mediated relationships between two social-cognitive factors (i.e., perceived barriers to HPV vaccination-indirect effect = -.16, SE = .06, 95% confidence interval [CI] = [-.31, -.06]-and perceived risk of HPV-related conditions-indirect effect = .16, SE = .09, 95% CI = [.01, .37]) and HPV vaccination intentions but was unrelated to the other three social-cognitive factors. Based on these findings, future research should test whether increasing self-efficacy through education on risk of HPV-related conditions and reducing barriers to HPV vaccination improves vaccine uptake in college women.

A Web-Based Lifestyle Medicine Curriculum: Facilitating Education About Lifestyle Medicine, Behavioral Change, and Health Care Outcomes

BACKGROUND

Lifestyle medicine is the science and application of healthy lifestyles as interventions for the prevention and treatment of disease, and has gained significant momentum as a specialty in recent years. College is a critical time for maintenance and acquisition of healthy habits. Longer-term, more intensive web-based and in-person lifestyle medicine interventions can have a positive effect. Students who are exposed to components of lifestyle medicine in their education have improvements in their health behaviors. A semester-long undergraduate course focused on lifestyle medicine can be a useful intervention to help adopt and sustain healthy habits.

OBJECTIVE

To describe a novel, evidence based curriculum for a course teaching the concepts of Lifestyle Medicine based on a web-based course offered at the Harvard Extension School.

METHODS

The course was delivered in a web-based format. The Lifestyle Medicine course used evidence based principles to guide students toward a "coach approach" to behavior change, increasing their self-efficacy regarding various lifestyle-related preventive behaviors. Students are made to understand the cultural trends and national guidelines that have shaped lifestyle medicine recommendations relating to behaviors. They are encouraged to engage in behavior change. Course topics include physical activity, nutrition, addiction, sleep, stress, and lifestyle coaching and counseling. The course addressed all of the American College of Preventive Medicine/American College of Lifestyle Medicine competencies save for the competency of office systems and technologies to support lifestyle medicine counseling.

RESULTS

The course was well-received, earning a ranking of 4.9/5 at the school.

CONCLUSIONS

A novel, semester-long course on Lifestyle Medicine at the Harvard Extension School is described. Student evaluations suggest the course was well-received. Further research is needed to evaluate whether such a course empowers students to adopt behavior changes.

Assessing the efficacy and external validity of interventions promoting calcium or dairy intake in young adults: A systematic review with meta-analysis

Calcium and dairy products have a role in the prevention of chronic diseases and attainment of peak bone mass, during adolescence to young adulthood. However, intakes are often suboptimal and interventions to improve consumption of food sources are needed. This systematic review aimed to investigate the efficacy and external validity of interventions promoting calcium or dairy foods among young adults. Eight databases were searched from inception to identify relevant studies. Inclusion criteria included those aged 18 to 35 years in an intervention promoting calcium or dairy food intake. The mean age of the participants was 19.9 ± 1.4 years. Of the 16 studies that met the selection criteria, five studies were included in the meta-analyses for calcium (pooled effect size 0.35, 95% CI 0.04 to 0.67) and three studies for dairy (pooled effect size 0.31, 95% CI 0.11 to 0.50). The quality of the body of evidence was determined using the GRADE system, and was of overall low quality with high risk of bias. Our review suggests young adults respond favorably to interventions but the effect size is small.

Effect of Digital Nutrition Education Intervention on the Nutritional Knowledge Levels of Information Technology Professionals

The purpose of the study was to determine the changes in knowledge of information technology (IT) professionals after receiving a nutrition education intervention for a month. The sample comprised of 40 IT professionals (29 males and 11 females). The sample was drawn from four IT companies of Hyderabad city using random sampling techniques. The data on the general information of the subjects was collected. The data regarding the commonly accessed sources of nutrition and health information by the subjects was also obtained from the study. The intervention study group received nutrition education by distribution of the developed CD-ROMs to them followed by interactive sessions. To assess the impact of nutrition education intervention, the knowledge assessment questionnaire (KAQ) was developed and administered before and after the education programme. A significant improvement in the mean nutritional knowledge scores was observed among the total study subjects from 22.30 to 40.55 after the intervention (p < 0.05). The findings support the importance of providing professionals with nutrition knowledge to promote healthy dietary behaviors.Thus, the method of e-learning and development of CD-Rom is essential for teaching the educated groups on nutrition, physical activity and overall health education to improve their health, lifestyle and eating habits.

Efficacy of HBM-Based Dietary Education Intervention on Knowledge, Attitude, and Behavior in Medical Students

Background

Using various models of behavior change, a number of studies in the area of nutrition education have confirmed that nutrition habits and behaviors can be improved.

Objectives

This study sought to determine the effects of education on patterns of dietary consumption among medical students at the military university of Tehran, with a view to correcting those patterns.

Methods

In this quasi-experimental study, 242 medical students from the Military University of Tehran were chosen by convenience sampling and then divided into control (n = 107) and intervention groups (n = 135) by block randomization. The self-administered questionnaire involving six categories of item (knowledge, perceived benefits, perceived barriers, perceived threats, self-efficacy and behavior) has been validated (Cronbach alpha > 0.7 for each).

Results

Following the educational intervention, the mean score of knowledge, health belief model (HBM) structure, and behavior of students in relation to healthy patterns of food intake increased significantly (P < 0.05). The mean pre-intervention knowledge score was 6.76 (1.452), referring to threats to HBM constructs including perceived threat 2.93 (1.147), perceived benefits 7.28 (1.07), perceived barriers 5.44 (1.831), self- efficacy 4.28 (1.479), and behavior 8.84 (2.527). The post-intervention scores all improved as follows: knowledge 8.3 (1.503), perceived threats 3.29 (1.196), perceived benefits 7.71 (0.762), perceived barriers 5.9 (1.719), self- efficacy 4.6 (1.472), and behavior 9.45 (2.324). This difference in mean scores for knowledge, health belief structures and employee behavior before and after educational intervention was significant (P ≤ 0.05).

Conclusions

The significant improvement in the experimental group’s mean knowledge, HBM structures , and behavior scores indicates the positive effect of the intervention.

If You Build It They Will Come: Satisfaction of WIC Participants With Online and Traditional In-Person Nutrition Education

OBJECTIVE

To examine satisfaction with in-person group and online nutrition education and compare findings based on language preference by Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants.

METHODS

A total of 1,170 WIC participants were randomly assigned to 2 nutrition education modalities between March, 2014 and October, 2015 in Los Angeles, CA. Logistic regressions compared differences between groups in satisfaction outcomes.

RESULTS

Participants in both education groups were highly satisfied regardless of modality of nutrition education (89% and 95%; P = .01). The online group reported a stronger preference for online education than did the in-person group (P < .001). In the in-person group, Spanish-speaking participants were less likely than were English-speaking participants to prefer online education (P < .001). A training video improved access to online education.

CONCLUSIONS AND IMPLICATIONS

Online delivery of education can be an acceptable addition for WIC participants with online access. High-quality online education platforms represent an important avenue to promote continued satisfaction with nutrition education.

University Students Intend to Eat Better but Lack Coping Self-Efficacy and Knowledge of Dietary Recommendations

OBJECTIVE

To assess university students' knowledge, intentions, and coping self-efficacy related to dietary recommendations.

DESIGN

The study used a cross-sectional online survey.

SETTING

Large university campus.

PARTICIPANTS

Students (n = 6,638; 22% response).

VARIABLES MEASURED

Self-efficacy and intentions were measured using 11-point scales. Students' perceived dietary recommendations were evaluated as correct or incorrect.

ANALYSIS

Categorical variables were analyzed using chi-square and continuous variables by t tests or ANOVAs. Significance was set at P ≤ .05 and multiple comparisons at P ≤ .01.

RESULTS

Respondents believed that they need fewer vegetables and fruit and more milk or alternatives servings/d than recommended; eg, males aged ≥ 19 years perceived milk or alternatives recommendations to be 4.3 ± 2.1 servings/d, significantly more than the 2 servings/d recommended (P < .001). Students in health sciences or with a food or nutrition course were significantly more likely to claim that they met recommendations (eg, 56% with vs 47% without a food or nutrition course for vegetables and fruit; P < .001); however, they were no more likely to identify them correctly. Males aged < 19 years had higher coping self-efficacy than females aged < 19 years to consume vegetables (68.3 ± 24.2 vs 64.0 ± 24.7; P < .01) and avoid high-calorie foods and beverages (HCFB) (56.2 ± 27.2 vs 49.0 ± 25.2; P < .01) when under stress; however, they had significantly lower intentions to consume vegetables (72.1 ± 24.5 vs 80.9 ± 20.3; P < .01) and avoid HCFB (60.5 ± 30.3 vs 77.7 ± 22.8; P < .01).

CONCLUSIONS AND IMPLICATIONS

Students do not have adequate knowledge of age- and sex-specific food guide recommendations. Simpler food guide recommendations or age- and sex-targeted campaigns may enhance knowledge. Students intend to consume more vegetables and less HCFB; however, they have low coping self-efficacy, all of which could be targeted in nutrition interventions.

Online and In-Person Nutrition Education Improves Breakfast Knowledge, Attitudes, and Behaviors: A Randomized Trial of Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND

Although in-person education is expected to remain central to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) service delivery, effective online nutrition education has the potential for increased exposure to quality education and a positive influence on nutrition behaviors in WIC participants. Education focused on promoting healthy breakfast behaviors is an important topic for WIC participants because breakfast eating compared with breakfast skipping has been associated with a higher-quality diet and decreased risk for obesity.

OBJECTIVE

To examine the influences of online and in-person group nutrition education on changes in knowledge, attitudes, and behaviors related to breakfast eating.

DESIGN

Randomized-controlled trial comparing the effectiveness of online and in-person nutrition education between March and September 2014.

PARTICIPANTS/SETTING

Five hundred ninety WIC participants from two Los Angeles, CA, WIC clinics were randomly assigned to receive in-person group education (n=359) or online education (n=231). Education focused on ways to reduce breakfast skipping and promoted healthy options at breakfast for parents and their 1- to 5-year-old children participating in WIC. Questionnaires assessing breakfast-related knowledge, attitudes, and behaviors were administered before and after education, and at a 2- to 4-month follow-up.

STATISTICAL ANALYSIS

Changes within and between in-person and online groups were compared using t tests and χ(2) tests. Analysis of covariance and generalized estimating equations were used to assess differences in change between groups.

RESULTS

Changes in knowledge between pretest and follow-up at 2 to 4 months were similar between groups. Both groups reported reductions in barriers to eating breakfast due to time constraints, not having enough foods at home, and difficulty with preparation. Increases in the frequency of eating breakfast were greater for both the parent (P=0.0007) and child (P=0.01) in the online group compared with the in-person group during the same time points.

CONCLUSIONS

Overall, this study demonstrates that both in-person and online nutrition education were effective in increasing breakfast-related knowledge in WIC participants, reducing breakfast skipping, and improving other breakfast-related behaviors, showing the potential usefulness for online education modalities for future WIC services.

The Green Eating Project: web-based intervention to promote environmentally conscious eating behaviours in US university students

OBJECTIVE

To investigate the effectiveness of an online, interactive intervention, referred to as the Green Eating (GE) Project, to motivate university students to adopt GE behaviours.

DESIGN

The study was quasi-experimental and integrated into courses for credit/extra credit. Courses were randomly stratified into experimental or non-treatment control. The 5-week intervention consisted of four modules based on different GE topics. Participants completed the GE survey at baseline (experimental, n 241; control, n 367) and post (experimental, n 187; control, n 304). The GE survey has been previously validated and consists of Transtheoretical Model constructs including stage of change (SOC), decisional balance (DB: Pros and Cons) and self-efficacy (SE: School and Home) as well as behaviours for GE. Modules contained basic information regarding each topic and knowledge items to assess content learning.

SETTING

The GE Project took place at a public university in the north-eastern USA.

SUBJECTS

Participants were full-time students between the ages of 18 and 24 years.

RESULTS

The GE Project was effective in significantly increasing GE behaviours, DB Pros, SE School and knowledge in experimental compared with control, but did not reduce DB Cons or increase SE Home. Experimental participants were also more likely to be in later SOC for GE at post testing.

CONCLUSIONS

The GE Project was effective in increasing GE behaviours in university students. Motivating consumers towards adopting GE could assist in potentially mitigating negative consequences of the food system on the environment. Future research could tailor the intervention to participant SOC to further increase the effects or design the modules for other participants.

Exploring the potential for internet-based interventions for treatment of overweight and obesity in college students

Objective:

To assess the use of internet-enabled technology for seeking health information and resources in overweight/obese college students.

Participants:

College students ( N = 706) in Vancouver, Canada surveyed in April 2012.

Methods:

An online survey assessed socio-demographics, health behaviors, and use of internet-enabled technology.

Results:

Eating habits, dieting and/or exercising to lose weight, and weight satisfaction differed by weight status (all p < 0.05). Of overweight/obese participants, 48% reported they would use online student health resources. When seeking general health information, 91% would use websites; 45% would use online videos; and 75% trusted information from government or health organizations.

Conclusions:

Overweight/obesity is prevalent among college students. The majority of overweight/obese students reported trying to lose weight and would use the internet for health information, especially if a website is associated with a health organization. The internet is a cost-effective channel for screening coupled with the delivery of tailored, evidence-based interventions for college students.

Psychometric Evaluation of Dietary Self-Efficacy and Outcome Expectation Scales in Female College Freshmen

Lifestyle interventions commonly measure psychosocial beliefs as precursors to positive behavior change, but often overlook questionnaire validation. This can affect measurement accuracy if the survey has been developed for a different population, as differing behavioral influences may affect instrument validity. The present study aimed to explore psychometric properties of self-efficacy and outcome expectation scales—originally developed for younger children—in a population of female college freshmen ( N = 268). Exploratory principal component analysis was used to investigate underlying data patterns and assess validity of previously published subscales. Composite scores for reliable subscales (Cronbach’s α ≥ .70) were calculated to help characterize self-efficacy and outcome expectation beliefs in this population. The outcome expectation factor structure clearly comprised of positive (α = .81-.90) and negative outcomes (α = .63-.67). The self-efficacy factor structure included themes of motivation and effort (α = .75-.94), but items pertaining to hunger and availability cross-loaded often. Based on cross-loading patterns and low Cronbach’s alpha values, respectively, self-efficacy items regarding barriers to healthy eating and negative outcome expectation items should be refined to improve reliability. Composite scores suggested that eating healthfully was associated with positive outcomes, but self-efficacy to do so was lower. Thus, dietary interventions for college students may be more successful by including skill-building activities to enhance self-efficacy and increase the likelihood of behavior change.

Theory of reasoned action and theory of planned behavior-based dietary interventions in adolescents and young adults: a systematic review

BACKGROUND

Childhood obesity has reached epidemic proportions in many nations around the world. The theory of planned behavior (TPB) and the theory of reasoned action (TRA) have been used to successfully plan and evaluate numerous interventions for many different behaviors. The aim of this study was to systematically review and synthesize TPB and TRA-based dietary behavior interventions targeting adolescents and young adults.

METHODS

THE FOLLOWING DATABASES WERE SYSTEMATICALLY SEARCHED TO FIND ARTICLES FOR THIS REVIEW: Academic Search Premier; Cumulative Index to Nursing and Allied Health (CINAHL); Education Resources Information Center (ERIC); Health Source: Nursing/Academic Edition; Cochrane Central Register of Controlled Trials (CENTRAL); and MEDLINE. Inclusion criteria for articles were: 1) primary or secondary interventions, 2) with any quantitative design, 3) published in the English language, 4) between January 2003 and March 2014, 5) that targeted adolescents or young adults, 6) which included dietary change behavior as the outcome, and 7) utilized TPB or TRA.

RESULTS

Of the eleven intervention studies evaluated, nine resulted in dietary behavior change that was attributed to the treatment. Additionally, all but one study found there to be a change in at least one construct of TRA or TPB, while one study did not measure constructs. All of the studies utilized some type of quantitative design, with two employing quasi-experimental, and eight employing randomized control trial design. Among the studies, four utilized technology including emails, social media posts, information on school websites, web-based activities, audio messages in classrooms, interactive DVDs, and health-related websites. Two studies incorporated goal setting and four employed persuasive communication.

CONCLUSION

Interventions directed toward changing dietary behaviors in adolescents should aim to incorporate multi-faceted, theory-based approaches. Future studies should consider utilizing randomized control trial design and operationalize variables. More research is needed to identify the optimal TPB and TRA modalities to modify dietary behaviors.

Psychosocial Predictors of Diet and Physical Activity in African-Americans: Results from the Delta Body and Soul Effectiveness Trial, 2010–2011

Purpose.

To examine associations among psychosocial constructs of behavior change and postintervention changes in diet and physical activity (PA).

Design.

Quasi-experimental with cluster (church) treatment assignment.

Setting.

Churches (n = 8) in a rural, southern region of the United States.

Subjects.

A total of 403 African-American adults participating in the Delta Body and Soul study.

Intervention.

Six-month diet and PA intervention consisting of monthly didactic educational sessions with specific emphasis on increasing consumption of fruits, vegetables, and whole grains, and decreasing consumption of added sugars. Self-directed PA was promoted throughout the intervention.

Measures.

Validated surveys for all dietary, PA, and psychosocial measures.

Analysis.

Secondary analysis using generalized linear mixed models to test for significant intervention effects on psychosocial constructs and for significant associations between changes in psychosocial constructs and changes in diet and PA outcomes after controlling for covariates.

Results.

Intervention effects were apparent for several dietary psychosocial constructs (improvements ranging from .5 to 2.0 points), but only one PA construct (decisional balance for exercise). Changes in psychosocial constructs, including self-efficacy, social support, and decisional balance, were significant predictors of dietary outcome changes (model coefficients ranging from .03 to .42), but not PA changes.

Conclusion.

Understanding which psychosocial constructs predict improvements in dietary and PA behaviors helps inform theoretical mechanisms of action and identify social and behavioral processes to target in faith-based interventions.

A 10-Week Multimodal Nutrition Education Intervention Improves Dietary Intake among University Students: Cluster Randomised Controlled Trial

The aim of the study was to evaluate the effectiveness of implementing multimodal nutrition education intervention (NEI) to improve dietary intake among university students. The design of study used was cluster randomised controlled design at four public universities in East Coast of Malaysia. A total of 417 university students participated in the study. They were randomly selected and assigned into two arms, that is, intervention group (IG) or control group (CG) according to their cluster. The IG received 10-week multimodal intervention using three modes (conventional lecture, brochures, and text messages) while CG did not receive any intervention. Dietary intake was assessed before and after intervention and outcomes reported as nutrient intakes as well as average daily servings of food intake. Analysis of covariance (ANCOVA) and adjusted effect size were used to determine difference in dietary changes between groups and time. Results showed that, compared to CG, participants in IG significantly improved their dietary intake by increasing their energy intake, carbohydrate, calcium, vitamin C and thiamine, fruits and 100% fruit juice, fish, egg, milk, and dairy products while at the same time significantly decreased their processed food intake. In conclusion, multimodal NEI focusing on healthy eating promotion is an effective approach to improve dietary intakes among university students.

Process evaluation of Project WebHealth: a nondieting Web-based intervention for obesity prevention in college students

OBJECTIVE

To evaluate the motivational effect of the Project WebHealth study procedures and intervention components on weight-related health behavior changes in male and female college students.

DESIGN

Process evaluation.

SETTING

Eight universities in the United States.

PARTICIPANTS

Project WebHealth participants (n = 653; 29% men).

MAIN OUTCOME MEASURES

Participants rated motivational effects of study procedures and intervention components. Participants were grouped into outcome-based health behavior categories based on achievement of desired targets for fruit and vegetable intake, physical activity, and/or body weight.

ANALYSIS

Differences in motivation from each procedure and component were analyzed by gender- and outcome-based health behavior category.

RESULTS

Women were generally more motivated than men. Compared to those who did not meet any target health behaviors, men with improved health outcomes (68%) were significantly more motivated by the skills to fuel the body lesson, goal setting, and research snippets. Their female counterparts (63%) were significantly more motivated by the lessons on body size and eating enjoyment, and by the suggested weekly activities.

CONCLUSIONS AND IMPLICATIONS

Specific study procedures and components of Project WebHealth motivated study participants to improve their weight-related health behaviors, and they differed by gender. Findings support the need for gender-tailored interventions in this population.

Systematic review of dietary interventions with college students: directions for future research and practice

OBJECTIVE

To clarify directions for research and practice, research literature evaluating nutrition and dietary interventions in college and university settings was reviewed.

DESIGN

Systematic search of database literature.

SETTING

Postsecondary education.

PARTICIPANTS

Fourteen research articles evaluating randomized controlled trials or quasi-experimental interventions targeting dietary outcomes.

MAIN OUTCOME MEASURES

Diet/nutrition intake, knowledge, motivation, self-efficacy, barriers, intentions, social support, self-regulation, outcome expectations, and sales.

ANALYSIS

Systematic search of 936 articles and review of 14 articles meeting search criteria.

RESULTS

Some in-person interventions (n = 6) show promise in improving students' dietary behaviors, although changes were minimal. The inclusion of self-regulation components, including self-monitoring and goal setting, may maximize outcomes. Dietary outcomes from online interventions (n = 5) were less promising overall, although they may be more effective with a subset of college students early in their readiness to change their eating habits. Environmental approaches (n = 3) may increase the sale of healthy food by serving as visual cues-to-action.

CONCLUSIONS AND IMPLICATIONS

A number of intervention approaches show promise for improving college students' dietary habits. However, much of this research has methodological limitations, rendering it difficult to draw conclusions across studies and hindering dissemination efforts.

Knowledge, Self-Efficacy, and Perceived Barriers on the Low-Iodine Diet among Thyroid Cancer Patients Preparing for Radioactive Iodine Therapy

The purposes of the study were to assess knowledge, self-efficacy, and perceived barriers on a low-iodine diet among thyroid cancer patients and to identify strategies for nutrition education. A self-administered questionnaire was developed based on a review of literature and pilot-tested. A total of 121 female thyroid cancer patients participated in a survey and 117 responses were used for data analysis. An average knowledge score of the thyroid cancer patients was 4.5 point (available score: 0-10 point). Majority of the respondents knew that seaweeds such as lavers, brown seaweeds, and sea tangles contain large amount of iodine. However they mistook the low iodine diet as a low salt diet and were not aware of foods and seasonings that are allowed on the low iodine diet. While self-efficacy related to consuming various fruits and vegetables, to choosing potatoes and sweet potatoes for snacks, and restricting consumption of eggs, milk and milk products, and processed foods was rated highly, self-efficacy for preparing foods without using sea salts was rated low. The self-efficacy score increased as their interest on the dietary life and perceived cooking skills were greater. Most perceived barriers toward practicing the low iodine diet were related to preparation of the low iodine menus. As their interest in the dietary life and cooking and perceived cooking skills were greater, the patients perceived barriers on practicing the low iodine diet less. While the patients showed higher self-efficacy and lower barrier perception on selecting foods low in iodine and restricting food high in iodine, they showed lower self-efficacy and higher barrier perceptions on preparing low iodine meals. Clinical dietitians should recognize the gap between what the patients should know and what they really know and identify strategies on how to improve self-efficacy and reduce perceived barriers on the low iodine diet. Recent literature and the findings of the study reveal that incorporating cooking classes into nutrition education for thyroid patients is effective to enhance self-efficacy and to reduce perceived barriers on the low iodine diet.

A systematic review of randomized controlled trials on the effectiveness of computer-tailored physical activity and dietary behavior promotion programs: an update

Background

A review update is necessary to document evidence regarding the effectiveness of computer-tailored physical activity and nutrition education.

Purpose

The purpose of this study was to summarize the latest evidence on the effectiveness of computer-tailored physical activity and nutrition education, and to compare the results to the 2006 review.

Methods

Databases were searched for randomized controlled trials evaluating computer-tailored physical activity and nutrition education aimed at primary prevention in adults, published from September 2004 through June 2011.

Results

Compared to the findings in 2006, a larger proportion of studies found positive effects for computer-tailored programs compared to generic or no information, including those for physical activity promotion. Effect sizes were small and generally at short- or medium-term follow-up.

Conclusions

The results of the 2006 review were confirmed and reinforced. Future interventions should focus on establishing larger effect sizes and sustained effects and include more generic health education control groups and objective measurements of dietary behavior.

Electronic supplementary material

The online version of this article (doi:10.1007/s12160-012-9384-3) contains supplementary material, which is available to authorized users.

Development of the SALdável programme to reduce salt intake among hypertensive Brazilian women: an intervention mapping approach

BACKGROUND

Despite strong evidence for a relationship between high salt intake and hypertension, plus the widespread recommendations for dietary salt restriction among hypertensive subjects, there are no nursing studies describing effective theory-based interventions.

AIM

To describe a systematic process for development of a theory-based nursing intervention that is aimed at reducing salt intake among hypertensive women, by applying the 'intervention mapping' protocol.

METHODS

We developed our intervention following the six steps of the 'intervention mapping' protocol: assessing needs, creating a matrix of change objectives, selecting theoretical methods and practical applications, defining the intervention programme, organizing the adoption and implementation plan, and defining the evaluation plan.

RESULTS

Addition of salt during cooking is identified as the main source for salt consumption, plus women are identified as the people responsible for cooking meals at home. In our study, the motivational predictors of this behaviour were self-efficacy and habit. Guided practice, verbal persuasion, coping barriers, consciousness-raising and counter-conditioning were the theoretical methods we selected for enhancing self-efficacy and promoting habit change, respectively. Brainstorming, role-playing, cookbook use, measuring spoon use, label reading, hands-on skill-building activities and reinforcement phone calls were the chosen practical applications. We designed our intervention programme, and then organized the adoption and implementation plans. Finally, we generated a plan to evaluate our intervention.

CONCLUSIONS

'Intervention mapping' was a feasible methodological framework to guide the development of a theory-based nursing intervention for dietary salt reduction among hypertensive women.

Dairy intake and related self-regulation improved in college students using online nutrition education

BACKGROUND

Dairy intake by college students is markedly lower than recommendations. Interventions to improve dairy intake based on Social Cognitive Theory (SCT) have potential to successfully change behavior by improving mediators that influence dietary choices.

OBJECTIVE

We aimed to use SCT to improve social support, self-efficacy, outcome expectations, self-regulation, and behavior related to dairy intake in college students.

DESIGN

We conducted a randomized nutrition education intervention.

PARTICIPANTS/SETTING

Participants included 211 college students (mean age 20.2 ± 0.1 years; 63% women and 37% men) recruited from a university campus. Participants in the intervention group (n=107) and comparison group (n=104) received an 8-week dairy intake or stress management intervention, respectively, via electronic mail. Data collection included dairy intake from 7-day food records and SCT variables from questionnaires administered during January 2008 and April 2008.

MAIN OUTCOME MEASURES

Changes in dairy intake and SCT variables (ie, social support, self-efficacy, outcome expectations, and self-regulation).

STATISTICAL ANALYSES PERFORMED

Multivariate analysis of covariance, with age and sex as covariates (P<0.05).

RESULTS

Ninety-one percent of participants (n=97 intervention, n=94 comparison) provided data; complete data were analyzed for 85% of participants (n=90 intervention, n=89 comparison). Participants in the intervention group reported higher intake of total dairy foods (P=0.012) and improved use of self-regulation strategies for consuming three servings per day of total dairy (P=0.000) and low-fat dairy foods (P=0.002) following the intervention.

CONCLUSIONS

Nutrition education via electronic mail based on an SCT model improved total dairy intake and self-regulation. Participants reported increased dairy intake and better use of self-regulation strategies. Future interventions should focus on benefits of consuming low-fat vs higher-fat dairy foods.

Interventions for weight gain prevention during the transition to young adulthood: a review of the literature

PURPOSE

To review studies examining weight gain prevention interventions among young adults.

METHODS

A snowball strategy was used to identify relevant studies, beginning with systematic PubMed, MEDLINE, PsychINFO, Education Resources Information Center (ERIC), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) searches.

INCLUDED STUDIES

(a) were published from 1985 to 2011; (b) were completed in the United States or Canada; (c) focused on weight gain prevention among young adults aged 18-35 years, assessing weight, body mass index, body composition, diet, or physical activity as an outcome; and (d) comprised pre- and postintervention assessments.

RESULTS

Thirty-seven interventions were identified. Ten interventions assessed weight, body mass index, or body composition; 27 addressed other relevant outcomes (e.g., diet, physical activity). Of the studies examining weight or body composition, six evaluated university courses or seminar-based interventions. Overall, many studies focused on individual-level intervention delivery and changes in weight-related knowledge and/or skills, although some incorporated relatively unique aspects (e.g., focusing on eating disorders and obesity simultaneously, using online technology, providing personalized feedback on weight change). Most showed promising results as small-scale pilot studies but lacked data from fully powered randomized trials.

CONCLUSIONS

There is an urgent need to develop effective young adult-focused weight gain prevention strategies. This review identified promising areas for future work, although much additional research is needed.