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Caso D, Canova L, Capasso M, Bianchi M. Integrating the theory of planned behavior and the self-determination theory to promote Mediterranean diet adherence: A randomized controlled trial. Appl Psychol Health Well Being 2024; 16:80-101. [PMID: 37435877 DOI: 10.1111/aphw.12470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
The Mediterranean diet (MD) is one of the healthiest and most sustainable food regimes. Nevertheless, MD diffusion is still limited, emphasizing the need to understand the psychosocial factors that could predict and promote its adoption. Starting from an integrated model of Theory of Planned Behavior (TPB) and Self-Determination Theory (SDT), the present randomized controlled trial investigated the effect of manipulating motivation (autonomous vs. controlled) on intention and MD adherence behavior. Participants included 726 Italian adults randomly allocated to one of three conditions: autonomous motivation manipulation, controlled motivation manipulation, and control group. TPB variables were measured immediately after manipulation (T1), while MD adherence was evaluated 2 weeks later (T2). Results from multivariate analyses of variance highlighted that participants in the autonomous motivation condition reported higher intention and a more favorable cognitive attitude than control group participants. However, no change in behavior was found. Moreover, a path analysis with mediation effect showed that the impact of autonomous motivation condition versus control group on intention was mediated by cognitive attitude. Findings support the integration of TPB and SDT to encourage intention to adhere to the MD, also suggesting that prompting autonomous motivation may help to promote a greater diffusion of this healthy and sustainable dietary pattern.
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Affiliation(s)
- Daniela Caso
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Luigina Canova
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Miriam Capasso
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Marcella Bianchi
- Department of Humanities, University of Naples Federico II, Naples, Italy
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Capasso M, Califano G, Caracciolo F, Caso D. Only the best for my kids: An extended TPB model to understand mothers' use of food labels. Appetite 2023; 191:107040. [PMID: 37730151 DOI: 10.1016/j.appet.2023.107040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/21/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
Despite the evidence that mothers' food purchasing behavior impacts the quality of children's diet, few studies have explored psycho-social factors influencing how mothers choose the food to buy for their children. To fill this gap, this study tested an extended Theory of Planned Behavior (TPB) model to predict mothers' tendency to seek information on food labels before purchasing food for children. Participants included 311 Italian mothers who completed a self-report questionnaire measuring their information-seeking behavior, TPB variables, anticipated regret and healthy-eater identity. Results from a Multiple Correspondence Analysis showed that mothers' information-seeking behavior involved a continuum of choices ranging from selecting conventional or prepackaged foods to choosing to read the food label before making a purchase. Besides, a Partial Least Squares-Structural Equation Modeling analysis showed that information-seeking behavior was positively predicted by intention (β = 0.309, p < 0.001) and healthy-eater identity (β = 0.195, p < 0.001). In turn, intention was positively affected by attitude (β = 0.208, p < 0.001), subjective norms (β = 0.155, p < 0.01), perceived behavioral control (β = 0.124, p < 0.05), anticipated regret (β = 0.193, p < 0.001), and healthy-eater identity (β = 0.191, p < 0.001). These findings emphasize that future initiatives could usefully target attitude, anticipated regret and self-identity to encourage mothers' informed food choices for their children.
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Affiliation(s)
- Miriam Capasso
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | | | - Francesco Caracciolo
- Department of Agricultural Sciences, University of Naples Federico II, Naples, Italy
| | - Daniela Caso
- Department of Humanities, University of Naples Federico II, Naples, Italy.
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Walker AE, Olfert MD, Scarneo-Miller SE, Totzkay D, Claydon EA. Nutrition-Specific Dissemination and Implementation Science Training Development and Feedback. AMERICAN JOURNAL OF HEALTH EDUCATION 2023. [DOI: 10.1080/19325037.2023.2164942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Yang HM, Choo J. Effects of a parent-led childhood obesity management program for socioeconomically vulnerable families: A randomised controlled trial. Collegian 2023. [DOI: 10.1016/j.colegn.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Gerber S, Folta SC. You Are What You Eat… But Do You Eat What You Are? The Role of Identity in Eating Behaviors—A Scoping Review. Nutrients 2022; 14:nu14173456. [PMID: 36079713 PMCID: PMC9458161 DOI: 10.3390/nu14173456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Identity is a major construct in the fields of psychology and anthropology that can relate to both the maintenance of eating behaviors and cultural sensitivity. However, there has not been any systematic effort to understand the role of identity in eating behaviors and the maintenance of eating behaviors, or to address multiple aspects of identity within an individual across scientific disciplines. This scoping review aims to understand and describe existing research relating identity to eating behaviors and to detail the measurement of identity. Methods: We conducted a systematic search of Ovid, PsychINFO, Embase, and Web of Science for articles on identity and eating behaviors published between January 1946 and March 2022. We utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, and search methods were developed with the assistance of a research librarian. We rated articles from 1 to 5 based on the depth, complexity, and multi-dimensionality of the identity measurement conducted. Scoring criteria included a review of the number of items directly querying or evaluating identity and the extent of measurement of identity domains. Results: In total, 100 articles were included, examining 10 different identities, 8 identity constructs, 11 eating behaviors, and construct contributions from 26 theories. The mean score of all articles was 2.9 on the scale from 1 to 5. A total of 10 studies scored a “1”; 30 scored a “2”, indicating the use of 1–2 basic questions about identity; 31 received a “3” for use of a common but non-complex identity instrument; 19 received a “4”, meaning they contained strong evaluation and included multiple types of identity but were lacking in terms of depth of measure and/or the comparison of identity effects to constructs; and 10 scored a “5” for their strong, in-depth measure of identity and inclusion of multiple types. Identity was found to be significantly related to eating behaviors in all but one study. Conclusion: Identity measurements seldom accounted for complexities such as multiple identities and identity shifting over time. Nonetheless, our findings indicate that multiple aspects of identity reciprocally reinforce behavior and that change maintenance is associated with identity salience and centrality. Identity is underutilized and heterogeneously applied in eating behavior research. The inclusion of identity assessments may lead to better outcomes being obtained within differing cultural, normative, and environmental scenarios.
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Affiliation(s)
- Suzannah Gerber
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
- Betty and Guy Beatty Liver and Obesity Research Program, Inova Medical System, Falls Church, VA 22043, USA
- Correspondence:
| | - Sara C. Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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Khani Jeihooni A, Layeghiasl M, Yari A, Rakhshani T. The effect of educational intervention based on the theory of planned behavior on improving physical and nutrition status of obese and overweight women. BMC Womens Health 2022; 22:13. [PMID: 35033045 PMCID: PMC8761043 DOI: 10.1186/s12905-022-01593-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Regarding the high rate of obesity and overweight among women, develop a comprehensive and effective program it seems necessary to improve their nutritional behaviors and physical activity. This study aims to survey the effect of educational intervention based on the theory of planned behavior (TPB) on improving physical and nutritional activities of obese and overweight women. Methods This experimental study was performed on 400 obese and overweight women over the age of 20. The sampling method was A simple random sampling. The data collection was valid and reliable self-reports measure, questionnaires. This tools was including demographic information, questionnaire based on the constructs of the theory of planned behavior, physical activity performance questionnaire and nutritional performance questionnaire that individuals completed before and 6 months after the educational intervention. The training intervention for the experimental group consisted of 12 sessions of 50–55 min. Data analyzed by SPSS22 and by using chi-square test, independent t-test and paired t-test. Results Findings showed that before the educational intervention, was no significant difference between the experimental and control groups in terms of education, household monthly income, occupation, mean age, marital status, awareness, attitude, perceived behavioral control, subjective norms, physical activity and nutritional behavioral intentions, and physical activity and nutritional performance, weight and BMI. However, six months after the training intervention, there was a significant increase in each of the TPB contracts, weight and BMI in the experimental group, while no significant difference was observed in the control group. The meaningful level was considered 0.05. Conclusion Our findings partially support of applying theory of planned behavior in reducing the weight, BMI and improved nutritional performance and physical activity of the study subjects. TPB could be an important strategy for effective future educational interventions.
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Affiliation(s)
- Ali Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Layeghiasl
- Departement of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Asiyeh Yari
- Department of Health Education and Health Promotion, School of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Tayebeh Rakhshani
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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Luo M, Allman-Farinelli M. Trends in the Number of Behavioural Theory-Based Healthy Eating Interventions Inclusive of Dietitians/Nutritionists in 2000-2020. Nutrients 2021; 13:nu13114161. [PMID: 34836417 PMCID: PMC8623843 DOI: 10.3390/nu13114161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Man Luo
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia;
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310020, China
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia;
- Correspondence: ; Tel.: +61-2-90367045
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Snippe MHM, Peters GJY, Kok G. The operationalization of self-identity in reasoned action models: a systematic review of self-identity operationalizations in three decades of research. Health Psychol Behav Med 2021; 9:48-69. [PMID: 34104549 PMCID: PMC8158252 DOI: 10.1080/21642850.2020.1852086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background Self-identity has frequently been proposed as a useful addition to the Theory of Planned Behavior; yet Fishbein and Ajzen decided to not include self-identity when they published that theory's successor, the Reasoned Action Approach. One of their reasons for exclusion is the lack of clear conceptual independence, as manifested in self-identity operationalizations that often conflate the construct with attitudinal or normative measures. Therefore, establishing whether self-identity has added value in the Reasoned Action Approach first requires synthesis of the used operationalisations to develop an operationalization that captures self-identity but not attitude and perceived norm. Method In this systematic review we identified 153 articles through the PsycINFO database and descendency approach using Google Scholar. In total, 342 of the operationalisations of self-identity were identified in studies operationalizing it as a potential Reasoned Action Approach extension. Results and conclusions After analyzing the full item pool to eliminate duplicates and items that did not measure selfidentity, (also) measured attitudes or norms, did not allow tailoring formulations to target, action, context and time, were not applicable to a wide variety of behaviors, or were ambiguous, seven prototypical items remained. These items lend themselves well for further psychometric study to establish the conceptual independence of self-identity from other Reasoned Action Approach constructs such as attitude and perceived norms.
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Affiliation(s)
- Marwin H M Snippe
- Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | | | - Gerjo Kok
- Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
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Harrington MR, Ickes M, Bradley K, Noland M. The Theory of Planned Behavior and the USDA Summer Food Service Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:944-951. [PMID: 33039022 DOI: 10.1016/j.jneb.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Examine the impact of the Summer Food Service Program (SFSP) on the intentions to positively change fruit and vegetable consumption in a rural, low-income adolescent population using the Theory of Planned Behavior. DESIGN Quantitative data collected via a pre-post intervention survey to determine predictors of positive nutrition behaviors and changes in self-reported fruit and vegetable consumption. SETTING A mid-sized university. PARTICIPANTS Fifty-seven high school students. Participants were primarily female (n = 36) and white (n = 56). INTERVENTION Participants followed the standards of the SFSP for 5 weeks and were provided with mandatory and optional nutrition education sessions. MAIN OUTCOME MEASURE Intentions to change nutrition behaviors. ANALYSIS Multiple regression. RESULTS Paired-sample t test showed a significant increase in knowledge from pretest (mean [M] = 11.18, SD = 1.68) to posttest (M = 12.91, SD = 1.76); t[56] = -8.09, P < 0.001; (t[56] = -8.09, P < 0.001) and in self-reported fruit and vegetable intake from pretest (M = 13.96, SD = 4.23) to posttest (M = 16.80, SD = 5.42); (t[56] = -3.20, P = 0.002). Regression demonstrated that all constructs of the Theory of Planned Behavior were significant (F[4, 52] = 14.56, P < 0.001 with an R2 of 0.53) for their effects on behavior intentions with perceived behavioral control being the most salient predictor. CONCLUSIONS AND IMPLICATIONS Opportunities for shaping adolescent nutrient intake and eating behaviors during enrollment in the SFSP exist. Reinforcing positive attitudes, subjective norms, and perceived behavioral control may help to increase nutrition behavioral intentions and nutrition behaviors.
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Affiliation(s)
| | - Melinda Ickes
- Department of Kinesiology and Health Promotion, College of Education, University of Kentucky, Lexington, KY
| | - Kelly Bradley
- Department of Educational Policy Studies and Evaluation, College of Education, University of Kentucky, Lexington, KY
| | - Melody Noland
- Department of Kinesiology and Health Promotion, College of Education, University of Kentucky, Lexington, KY
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Vaillancourt C, Bédard A, Bélanger-Gravel A, Provencher V, Bégin C, Desroches S, Lemieux S. Promoting Healthy Eating in Adults: An Evaluation of Pleasure-Oriented versus Health-Oriented Messages. Curr Dev Nutr 2019; 3:nzz012. [PMID: 31020059 PMCID: PMC6470394 DOI: 10.1093/cdn/nzz012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/29/2019] [Accepted: 02/18/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Existing initiatives to promote healthy eating remain largely ineffective as individuals struggle to adhere to dietary recommendations. Therefore, challenging the strategies currently used is of significant importance. Recent studies have indicated the potential of an approach oriented towards eating pleasure to promote the consumption of healthy foods. OBJECTIVES The aim of this study was to compare perceptions and the potential effect of pleasure-oriented and health-oriented messages promoting healthy eating among French-Canadians. METHODS Two leaflets similar in all respects, except for the message orientation (pleasure or health), were developed. Perceived message orientation and effectiveness, perceptions towards healthy eating as well as emotions, attitude towards healthy eating, and intention to eat healthily were evaluated. A total of 100 adults (50% women; mean ± SD age 45.1 ± 13.0 y) were randomly assigned to read 1 of the 2 leaflets (pleasure: n = 50; health: n = 50). Questionnaires were completed online and data were also collected at a visit made to the Institute of Nutrition and Functional Foods. RESULTS The difference in message orientation (pleasure compared with health) was well perceived by participants (P ≤ 0.01). The pleasure-oriented message was successful in inducing the perception that eating healthy can be pleasurable (pre- compared with post-reading; P = 0.01). Perceived message effectiveness and induced emotions in response to reading were similar between leaflets. Both messages significantly improved global attitude towards healthy eating (P ≤ 0.01) and increased intention to eat healthily (P < 0.001). Additional analyses showed that the affective attitude towards healthy eating increased more after reading the pleasure leaflet than the health leaflet (P = 0.05), whereas the health message tended to improve cognitive attitude more than the pleasure leaflet (P = 0.06). CONCLUSIONS These findings suggest that the leaflets would be appropriate to promote healthy eating through 2 distinct approaches (health and pleasure paradigms) and propose that different effects on attitude could be observed from these 2 approaches.
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Affiliation(s)
- Caroline Vaillancourt
- Institute of Nutrition and Functional Foods, Laval University, QC, Canada
- School of Nutrition, Laval University, QC, Canada
| | - Alexandra Bédard
- Institute of Nutrition and Functional Foods, Laval University, QC, Canada
| | - Ariane Bélanger-Gravel
- Department of Information and Communication, Laval University, QC, Canada
- Quebec Heart and Lung Institute, QC, Canada
| | - Véronique Provencher
- Institute of Nutrition and Functional Foods, Laval University, QC, Canada
- School of Nutrition, Laval University, QC, Canada
| | | | - Sophie Desroches
- Institute of Nutrition and Functional Foods, Laval University, QC, Canada
- School of Nutrition, Laval University, QC, Canada
| | - Simone Lemieux
- Institute of Nutrition and Functional Foods, Laval University, QC, Canada
- School of Nutrition, Laval University, QC, Canada
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Calvert S, Dempsey RC, Povey R. Delivering in-school interventions to improve dietary behaviours amongst 11- to 16-year-olds: A systematic review. Obes Rev 2019; 20:543-553. [PMID: 30550629 DOI: 10.1111/obr.12797] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 11/29/2022]
Abstract
Childhood obesity is a global health concern, which has both short- and long-term health consequences for the individual, and is a potential burden on health care services and the wider economy. The school environment is a setting where changes can be applied to dietary behaviours, as schools have direct and intensive contact with children. This systematic review evaluated school-based interventions designed to improve dietary behaviours among adolescents (11- to 16-year-olds). The aims were to review types of interventions delivered, dietary behaviours targeted, and interventions' effectiveness in improving dietary behaviour and associated intervention components. Twenty-nine school-based interventional studies with this population were identified for review. The data were synthesized by identifying and comparing individual studies' results, intervention components, and characteristics. Interventions appeared more effective when they involved peers, used educational media to deliver health messages, increased availability of healthy foods in school, and incorporated computer-based individualized feedback with normative information on eating behaviours. A limitation of the review was the lack of description in certain reviewed studies and the nonfeasibility of conducting a meta-analysis owing to study heterogeneity. Future interventions with this population could consider including the aforementioned components, gender-specific feedback, and both short- and long-term follow-ups as change may not be apparent immediately and to determine if changes are sustained.
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Affiliation(s)
- Sian Calvert
- The Staffordshire Centre for Psychological Research and Centre for Health Psychology, Staffordshire University, Stoke-on-Trent, UK
| | - Robert C Dempsey
- The Staffordshire Centre for Psychological Research and Centre for Health Psychology, Staffordshire University, Stoke-on-Trent, UK
| | - Rachel Povey
- The Staffordshire Centre for Psychological Research and Centre for Health Psychology, Staffordshire University, Stoke-on-Trent, UK
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Lane H, Porter KJ, Hecht E, Harris P, Kraak V, Zoellner J. Kids SIP smartER: A Feasibility Study to Reduce Sugar-Sweetened Beverage Consumption Among Middle School Youth in Central Appalachia. Am J Health Promot 2018; 32:1386-1401. [PMID: 28731385 PMCID: PMC5993639 DOI: 10.1177/0890117117715052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To test the feasibility of Kids SIP smartER, a school-based intervention to reduce consumption of sugar-sweetened beverages (SSBs). DESIGN Matched-contact randomized crossover study with mixed-methods analysis. SETTING One middle school in rural, Appalachian Virginia. PARTICIPANTS Seventy-four sixth and seventh graders (5 classrooms) received Kids SIP smartER in random order over 2 intervention periods. Feasibility outcomes were assessed among 2 teachers. INTERVENTION Kids SIP smartER consisted of 6 lessons grounded in the Theory of Planned Behavior, media literacy, and public health literacy and aimed to improve individual SSB behaviors and understanding of media literacy and prevalent regional disparities. The matched-contact intervention promoted physical activity. MEASURES Beverage Intake Questionnaire-15 (SSB consumption), validated theory questionnaires, feasibility questionnaires (student and teacher), student focus groups, teacher interviews, and process data (eg, attendance). ANALYSIS Repeated measures analysis of variances across 3 time points, descriptive statistics, and deductive analysis of qualitative data. RESULTS During the first intervention period, students receiving Kids SIP smartER (n = 43) significantly reduced SSBs by 11 ounces/day ( P = .01) and improved media ( P < .001) and public health literacy ( P < .01) understanding; however, only media literacy showed between-group differences ( P < .01). Students and teachers found Kids SIP smartER acceptable, in-demand, practical, and implementable within existing resources. CONCLUSION Kids SIP smartER is feasible in an underresourced, rural school setting. Results will inform further development and large-scale testing of Kids SIP smartER to reduce SSBs among rural adolescents.
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Affiliation(s)
- Hannah Lane
- Growth and Nutrition Division, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen J. Porter
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Erin Hecht
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | | | - Vivica Kraak
- Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic and State University, Blacksburg, VA, USA
| | - Jamie Zoellner
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
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Riebl SK, Estabrooks PA, Dunsmore JC, Savla J, Frisard MI, Dietrich AM, Peng Y, Zhang X, Davy BM. A systematic literature review and meta-analysis: The Theory of Planned Behavior's application to understand and predict nutrition-related behaviors in youth. Eat Behav 2015; 18:160-78. [PMID: 26112228 DOI: 10.1016/j.eatbeh.2015.05.016] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/13/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Efforts to reduce unhealthy dietary intake behaviors in youth are urgently needed. Theory-based interventions can be effective in promoting behavior change; one promising model is the Theory of Planned Behavior (TPB). PURPOSE The aim of this study was to determine, using a systematic literature review, how the TPB has been applied to investigate dietary behaviors, and to evaluate which constructs are associated with dietary behavioral intentions and behaviors in youth. METHODS Publications were identified by searching electronic databases, contacting experts in the field, and examining an evolving Internet-based TPB-specific bibliography. Studies including participants aged 2-18years, all TPB constructs discernible and measured with a description of how the variables were assessed and analyzed, were published in English and peer-reviewed journals, and focused on nutrition-related behaviors in youth were identified. Accompanying a descriptive statistical analysis was the calculation of effect sizes where possible, a two-stage meta-analysis, and a quality assessment using tenants from the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statements. RESULTS Thirty-four articles, including three intervention studies, were reviewed. The TPB was most often used to evaluate healthy eating and sugary snack and beverage consumption. Attitude had the strongest relationship with dietary behavioral intention (mean r=0.52), while intention was the most common predictor of behavior performance (mean r=0.38; both p<0.001). All three interventions revealed beneficial outcomes when using the TPB (e.g. η(2)=0.51 and ds=0.91, 0.89, and 0.79); extending the Theory with implementation intentions may enhance its effectiveness (e.g. η(2)=0.76). CONCLUSIONS Overall, the TPB may be an effective framework to identify and understand child and adolescent nutrition-related behaviors, allowing for the development of tailored initiatives targeting poor dietary practices in youth. However, support from the literature is primarily from observational studies and a greater effort towards examining these relationships within intervention studies is needed.
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Affiliation(s)
- Shaun K Riebl
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 338 Wallace Hall, Mail Code: 0430, 295 West Campus Drive, Blacksburg, VA 24061, United States.
| | - Paul A Estabrooks
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 338 Wallace Hall, Mail Code: 0430, 295 West Campus Drive, Blacksburg, VA 24061, United States; Department of Family and Community Medicine, Carilion Clinic, 1 Riverside Circle, Suite 104, Roanoke, VA 24016, United States; Department of Statistics, Virginia Tech, 402 Hutcheson Hall, 250 Drillfield Drive, Blacksburg, VA 24060, United States.
| | - Julie C Dunsmore
- Department of Family and Community Medicine, Carilion Clinic, 1 Riverside Circle, Suite 104, Roanoke, VA 24016, United States.
| | - Jyoti Savla
- Department of Psychology, Virginia Tech, 323 Williams Hall, Mail Code: 0436, United States.
| | - Madlyn I Frisard
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 338 Wallace Hall, Mail Code: 0430, 295 West Campus Drive, Blacksburg, VA 24061, United States.
| | - Andrea M Dietrich
- Department of Human Development, 237A Wallace Hall, Mail Code: 0426, Blacksburg, VA 24061, United States.
| | - Yiming Peng
- Civil and Environmental Engineering/Food Science and Technology, Virginia Tech, 413 Durham Hall, 1145 Perry Street, MC 0246, Blacksburg, VA 24061-0246, United States.
| | - Xiang Zhang
- Civil and Environmental Engineering/Food Science and Technology, Virginia Tech, 413 Durham Hall, 1145 Perry Street, MC 0246, Blacksburg, VA 24061-0246, United States.
| | - Brenda M Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 338 Wallace Hall, Mail Code: 0430, 295 West Campus Drive, Blacksburg, VA 24061, United States.
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Miller MK, Wickliffe J, Jahnke S, Linebarger J, Humiston SG. Views on human papillomavirus vaccination: a mixed-methods study of urban youth. J Community Health 2014; 39:835-41. [PMID: 24664875 PMCID: PMC4174729 DOI: 10.1007/s10900-014-9858-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
While the human papillomavirus (HPV) vaccine has potential to protect against the majority of HPV-associated cancers, vaccination rates in the United States remain low. Racial/ethnic and economic disparities exist for HPV vaccination completion rates. We conducted a mixed-methods study using the theory of planned behavior framework to explore attitudes and beliefs about HPV vaccination among urban, economically disadvantaged adolescents. Fifty adolescents aged 14-18 years were recruited from community-based organizations to complete a written survey and participate in a focus group. The mean age was 15.5 ± 1.3 years; 98 % were African American or mixed race; 64 % were female; 52 % reported previous sexual intercourse; 40 % reported receipt of ≥1 HPV vaccine dose. The knowledge deficit about the HPV vaccine was profound and seemed slightly greater among males. Mothers, fathers and grandmothers were mentioned as important referents for HPV vaccination, but peers and romantic partners were not. Common barriers to vaccination were lack of awareness, anticipated side effects (i.e., pain), and concerns about vaccine safety. Characteristics associated with ≥1 vaccine dose were: having heard of the HPV vaccine versus not (65 vs. 20 %, p = 0.002) and agreeing with the statement "Most people I know would think HPV vaccine is good for your health" versus not (67 vs. 27 %, p = 0.007). Our work indicates a profound lack of awareness about HPV vaccination as well as the important influence of parents among urban, economically-disadvantaged youth. Awareness of these attitudes and beliefs can assist providers and health officials by informing specific interventions to increase vaccine uptake.
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Affiliation(s)
- Melissa K. Miller
- Division of Emergency and Urgent Care, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO,
| | - Joi Wickliffe
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS,
| | - Sara Jahnke
- Center for Fire, Rescue & EMS Health Research, Institute for Biobehavioral Health Research, National Development & Research Institutes, Overland Park, KS,
| | - Jennifer Linebarger
- Division of Adolescent Medicine, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO,
| | - Sharon G. Humiston
- Division of Emergency and Urgent Care, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO,
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Hackman CL, Knowlden AP. Theory of reasoned action and theory of planned behavior-based dietary interventions in adolescents and young adults: a systematic review. Adolesc Health Med Ther 2014; 5:101-14. [PMID: 24966710 PMCID: PMC4057331 DOI: 10.2147/ahmt.s56207] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
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.
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Affiliation(s)
- Christine L Hackman
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Adam P Knowlden
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
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Mollen CJ, Miller MK, Hayes KL, Barg FK. Knowledge, attitudes, and beliefs about emergency contraception: a survey of female adolescents seeking care in the emergency department. Pediatr Emerg Care 2013; 29:469-74. [PMID: 23528510 PMCID: PMC6747693 DOI: 10.1097/pec.0b013e31828a3249] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to assess urban adolescents' knowledge of and attitudes about emergency contraception (EC) and to assess the intention to use EC in particular hypothetical situations. We hypothesized that knowledge about EC would be limited, but that adolescents would support using EC in certain situations. METHODS A cross-sectional survey of English-speaking, 14- to 19-year-old adolescent girls presenting for care at 2 urban pediatric emergency departments. The survey was based on previous research with this target population and the constructs of the theory of planned behavior. RESULTS We enrolled 223 adolescents; 56% reported a history of sexual activity. Sixty-four percent stated that they had heard of EC. Participants with a history of sexual activity were more likely to have heard of EC compared with those without (odds ratio, 2.6; 95% confidence interval, 1.4-4.7), as were those 17 years and older (odds ratio, 2.3; 95% confidence interval, 1.2-4.3). The majority of participants were concerned about potential short-term and long-term adverse effects (86% and 78%, respectively); many participants were concerned about the cost of EC (45%) and about being able to get to a doctor for a prescription (45%). Participants supported using EC in the following situations: rape (88%), the condom breaks (82%), or no birth control was used (76%). Fewer supported using EC in the following situations: missed 1 oral contraceptive pill (51%) or first sexual experience (57%). CONCLUSIONS Participants indicated that although they would support EC use in several situations, they have concerns about EC use and access. Awareness of these factors and potential influences of EC use can guide providers toward effective counseling and interventions aimed to increase adolescents' use of EC in appropriate settings.
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Affiliation(s)
- Cynthia J Mollen
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Impact of a Nutrition Education Program to Increase Intake of Calcium-Rich Foods by Chinese-American Women. ACTA ACUST UNITED AC 2011; 111:143-9. [DOI: 10.1016/j.jada.2010.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 07/02/2010] [Indexed: 11/22/2022]
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Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: systematic review of published and ‘grey’ literature. Br J Nutr 2010; 103:781-97. [DOI: 10.1017/s0007114509993370] [Citation(s) in RCA: 262] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The objective of the present review was to summarise the existing European published and ‘grey’ literature on the effectiveness of school-based interventions to promote a healthy diet in children (6–12 years old) and adolescents (13–18 years old). Eight electronic databases, websites and contents of key journals were systematically searched, reference lists were screened, and authors and experts in the field were contacted for studies evaluating school-based interventions promoting a healthy diet and aiming at primary prevention of obesity. The studies were included if they were published between 1 January 1990 and 31 December 2007 and reported effects on dietary behaviour or on anthropometrics. Finally, forty-two studies met the inclusion criteria: twenty-nine in children and thirteen in adolescents. In children, strong evidence of effect was found for multicomponent interventions on fruit and vegetable intakes. Limited evidence of effect was found for educational interventions on behaviour, and for environmental interventions on fruit and vegetable intakes. Interventions that specifically targeted children from lower socio-economic status groups showed limited evidence of effect on behaviour. In adolescents, moderate evidence of effect was found for educational interventions on behaviour and limited evidence of effect for multicomponent programmes on behaviour. In children and adolescents, effects on anthropometrics were often not measured, and therefore evidence was lacking or delivered inconclusive evidence. To conclude, evidence was found for the effectiveness of especially multicomponent interventions promoting a healthy diet in school-aged children in European Union countries on self-reported dietary behaviour. Evidence for effectiveness on anthropometrical obesity-related measures is lacking.
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Mollen CJ, Barg FK, Hayes KL, Gotcsik M, Blades NM, Schwarz DF. Assessing attitudes about emergency contraception among urban, minority adolescent girls: an in-depth interview study. Pediatrics 2008; 122:e395-401. [PMID: 18676526 DOI: 10.1542/peds.2008-0009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this work was to explore the knowledge, attitudes, and beliefs of urban, minority adolescent girls about intention to use emergency contraception pills and to identify barriers to emergency contraception pill use. PATIENTS AND METHODS We conducted an in-depth, semistructured interview study of healthy, urban-dwelling, English-speaking 15- to 19-year-old black adolescents seeking care in a children's hospital emergency department. Purposive sampling was used to recruit sexually active and nonsexually active adolescents and those with and without a history of pregnancy. Enrollment continued until saturation of key themes was achieved. Participants returned after their emergency department visit for a 1-hour interview. The interview consisted of semistructured questions based on the theory of planned behavior constructs: attitudes (including knowledge), subjective norms, and perceived behavioral control, as well as demographic data collection. Interviews were recorded and transcribed. Transcripts were coded by 2 members of the study team by using a modified grounded-theory method. RESULTS Thirty interviews were required for saturation. Mean participant age was 16.4 years; 53% reported being sexually active, and 17% reported a history of pregnancy. Specific knowledge gaps exist about emergency contraception pills, including misconceptions about the recommended time frame for taking the medication. Several major themes were noted for each of the constructs. Intention to use emergency contraception pills is affected by the conflicting attitudes that the emergency contraception pill works faster than birth control pills and that those who use emergency contraception pills are irresponsible; family and friends are important influences and have uninformed but generally supportive opinions; and adolescents have a perception of limited behavioral control because of their young age and concerns about confidentiality. CONCLUSIONS Urban, minority adolescent girls have misconceptions about emergency contraception pills, are affected by the opinions of those close to them, and express concern about specific barriers. These findings can inform specific interventions aimed at addressing the barriers to emergency contraception pill use that are of most importance to this population of young women.
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Affiliation(s)
- Cynthia J Mollen
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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