Socioeconomic Status and the Prediction of Health Promoting Dietary Behaviours: A Systematic Review and Meta-Analysis Based on the Theory of Planned Behaviour

Dietary Knowledge and Preference Among Middle-Aged and Older Chinese Couples

This study investigates the interdependence of dietary knowledge and preference and potential rural-urban differences among middle-aged and older Chinese couples. Couple-level data from the 2015 China Health and Nutrition Survey were included (N = 2933). Structural Equation Model examined the actor and partner effects of dietary knowledge on dietary preferences. Findings indicated that greater dietary knowledge was associated with one's healthier diet preferences among both rural and urban residents (P < .01). In rural areas, ones' dietary knowledge was associated with their partners' dietary preferences (P < .01). However, in urban areas, husbands' dietary knowledge was not associated with their wives' dietary preferences (P = .58), whereas wives' dietary knowledge was associated with their husbands' dietary preferences (P < .05). The rural-urban difference indicates the greater decision-making power of men in rural households. A couple-based approach is suggested for dietary interventions and guidelines promoting healthy eating in China, particularly in rural regions.

Structural equation models of health behaviour, psychological well-being, symptom severity and quality of life in abdominal bloating

Background

The objective of this study was to investigate the inter-relationship between psychosocial variables and their impact on symptom severity and quality of life (QoL) concerning abdominal bloating.

Methods

The study adopted a cross-sectional design with purposive sampling. Participants who consented and met the criteria for bloating based on the Rome IV classification completed designated questionnaires. Independent variables comprised health beliefs, intentions, health-promoting behaviors, social support, depression, and anxiety, while dependent variables included bloating severity (general and within 24 h) and QoL. Structural Equation Modeling (SEM) was conducted utilizing Mplus 8.0 to analyze the relationships between these factors.

Results

A total of 323 participants, with a mean age of 27.69 years (SD = 11.50), predominantly females (64.7%), volunteered to participate in the study. The final SEM model exhibited good fit based on various indices (CFI = 0.922, SRMR = 0.064, RMSEA (95% CI) = 0.048 (0.041-0.054), p-value = 0.714), with 15 significant path relationships identified. The model explained 12.0% of the variance in severity within 24 h, 6% in general severity, and 53.8% in QoL.

Conclusion

The findings underscore the significant influence of health beliefs, intentions, behaviors, social support, depression, and anxiety on symptom severity and QoL in individuals experiencing abdominal bloating.

Effects of safety interventions toward workers' behaviors using the theory of planned behavior in the rubber wood processing industry

Objectives. Rubberwood manufacturing has a wide range of occupational safety hazards. Workers' safety behaviors are substandard. This quasi-experimental study aimed to determine the factors affecting safety behaviors using the theory of planned behavior (TPB) and compare the effects of safety intervention programs on workers' behaviors. Methods. The sample comprised workers from a rubberwood processing factory. Exploratory and confirmatory factor analyses were performed to validate the TPB constructs. The constructs were also analyzed before and after the interventions using structural equation modeling to confirm the observed variables. The interventions included conducting job safety analysis, establishing safety standard operation procedures and launching a behavioral promotion campaign. A t test was used to compare the constructs' intervention effects. Results. The structural equation model adequately fit the data and confirmed that the constructs were aligned with the TPB. Most path coefficients were statistically significant after the interventions were implemented. 'Attitude' and 'perceived behavioral control' directly and significantly affected 'intention'. 'Intention' was an essential mediator to 'behaviors'. The improvement in workers' behaviors was evident. Conclusions. According to the TPB, safety program interventions helped enhance workers' behaviors. Hence, based on participatory approaches, sustainable safety interventions should be maintained for all levels of personnel in the organization.

Influence of mental health on information seeking, risk perception and mask wearing self-efficacy during the early months of the COVID-19 pandemic: a longitudinal panel study across 6 U.S. States

BACKGROUND

Understanding factors that influence information seeking, assessment of risk and mitigation behaviors is critical during a public health crises. This longitudinal study examined the influence of self-reported mental health during the early months of the COVID-19 pandemic on information seeking, risk perception and perceived mask wearing ability. Mental health screener items included fear, anger, and hopelessness in addition to avoidance, diminished functional ability and global distress. Theoretical models inform hypotheses linking mental health items and outcomes.

METHODS

The research employed a longitudinal 6-state 3-wave online panel survey, with an initial sample of 3,059 participants (2,232 included in longitudinal analyses). Participants roughly represented the states' age, race, ethnicity, and income demographics.

RESULTS

Women, those who identified as Hispanic/Latinx, Black Americans and lower income participants reported higher overall rates of distress than others. Information seeking was more common among older persons, Democrats, retirees, those with higher education, and those who knew people who had died of COVID-19. Controlling for such demographic variables, in multivariable longitudinal models that included baseline mental health measures, distress and fear were associated with increased information seeking. Distress and fear were also associated with increased risk perception, and feelings of hopelessness were associated with lower reported mask-wearing ability.

CONCLUSIONS

Results advance understanding of the role mental health can play in information seeking, risk perception and mask wearing with implications for clinicians, public health practitioners and policy makers.

Patient satisfaction and behavioural intention in using the home medication delivery service in an ambulatory oncology centre

BACKGROUND

The COVID-19 pandemic has increased usage of medication delivery service (MDS) significantly. MDS improves adherence to medication and clinical outcomes.

OBJECTIVES

To study behavioral change factors that affect adoption of MDS, determine existing patient satisfaction level, and make recommendations to improve MDS adoption.

METHODS

A single-institution, cross-sectional survey was conducted at the outpatient pharmacy of the largest ambulatory cancer centre in Singapore. The survey consisted of sections on demographics, Theory of Planned Behavior constructs and patient satisfaction questions. Descriptive analysis and logistic regression were used.

RESULTS

A total of 881 patients responded. Respondents were mostly Chinese, female and subsidized patients, with a mean age of 62.4 years old. MDS use is strongly predicted by favourable attitude (OR 3.54, 95%CI 2.64-4.75; p < 0.001) and subjective norm (OR 3.07, 95%CI 2.30-4.09; p < 0.001) towards its use and greater perceived behavioral control (OR 2.48; 95%CI 1.86-3.30; p < 0.001). Being ill or frail has been identified as facilitators, while absence of face-to-face consultation and cost of delivery were barriers to the adoption of MDS. Encouragingly, the satisfaction level of our existing patients was generally high (80.2, SD16.7). Recommendation to improve MDS adoption targets facilitators and barriers identified and aims to further elevate patient satisfaction level. Establishment of a centralised pharmacy for MDS together with a call centre would be essential in the long run.

CONCLUSIONS

MDS is becoming increasingly important, in line with our national strategy. Implementation of suggested short-term and long-term measures will encourage its use.

Drivers of young adults' voluntary compliance with COVID-19 protective measures: results from a multi-method study

BACKGROUND

With the easing of governmental COVID-19 restrictions, promoting voluntary public compliance with protective measures becomes essential for the pandemic evolution. A highly relevant target group for such health promotion are adolescents and young adults since they showed a strong decline in compliance throughout the pandemic. Building on an extended version of the Theory of Planned Behavior, this article investigates drivers of young people's intentions to engage in voluntary COVID-19 measures in phases of re-opening.

METHODS

We conducted a sequential multi-method study among 14- to 29-year-olds in Germany: (1) a semi-standardized online survey (N = 88) to examine underlying beliefs and (2) a standardized online survey (N = 979) to identify influencing factors of compliance. The pre-study addressed the respondents' perceptions about wearing a mask, social distancing, and avoiding crowded locations (open-ended questions). Responses for all protective measures were aggregated to identify general behavioral, normative, and control beliefs about COVID-19 protective measures. In order to gain generalizable insights into the factors determining voluntary compliance intentions in younger adults, we conceptualized the model constructs in the subsequent standardized online survey as formative measures based on their underlying beliefs. PLS-SEM was used to examine the effects of attitudes, subjective norms, perceived behavioral control, risk perceptions, and knowledge on young people's intentions to comply (main study). Furthermore, a multi-group analysis was conducted to investigate differences between compliers and non-compliers.

RESULTS

The pre-study revealed that young people's instrumental attitudes not only cover reasons of protection but also aspects of self-presentation (e.g., being a role model). The main study showed that besides knowledge and perceived severity of illness, instrumental attitude is the strongest predictor of intention to comply. The influence is even stronger in the group of non-compliers.

CONCLUSION

This article highlights the importance of theory-based campaign planning and provides practical guidance to health communicators on how to increase voluntary compliance with COVID-19 protective measures in adolescents and young adults. The findings demonstrate the great potential of combining the Theory of Planned Behavior with risk perception and knowledge to gain deeper insights into the feelings and thoughts of younger target groups during a health crisis.

The magnitude and importance of perceived health dimensions define effective tailor-made health-promoting interventions per targeted socioeconomic group

Recent insights and developments on health and society urge a critical look at the positive relationship between socioeconomic status (SES) and health. We challenge the notions that it is sufficient to distinguish only between two groups of SES (low and high) and that only overall health is taken into account. A new grouping of SES was developed based on both income and education, resulting in six SES groups. Health was defined in terms of a new positive health concept, operationalized into six health dimensions generating a measure of total general health (TGH). Next, six socioeconomic and demographic determinants of health were included. Linear regression, T-tests and one-way ANOVA were applied to investigate the relationships in a Dutch sample. A subjective way to measure health was applied: self-rated health (SRH). As a result, four out of six dimensions of health determined TGH: bodily functions, daily functioning, quality of life, and social and societal participation. Three out of six socioeconomic and demographic determinants impacted TGH: housing situation, age, and difficulties meeting financial obligations. While this is the general picture for the entire sample, there were interesting similarities and differences between the six SES groups. The similarities lie in the positive impact of the evaluation of bodily functions and daily functioning on TGH in all SES groups. The other dimensions affected TGH in some groups, and some dimensions only in one SES group. None of the socioeconomic and demographic determinants affected TGH in all SES groups. New insights on health inequalities are provided. It is concluded, first that the well-known positive relationship between SES and health is confirmed in this study. Second, further refining the health concept into six dimensions provides more detailed insights on which dimensions impact health the most. The subjective approach applied offers more refined information to better understand which health issues really matter to people. This yields new insights to develop tailor-made interventions aimed at increasing healthy behaviour in specific societal groups.

Uncovering the Role of Mindfulness in Autonomous Motivation across Physical Education and Leisure Time: Extending the Trans-Contextual Model

Mindfulness is assumed to foster the ability to consistently act in line with one's authentic self; a skill which has been found to enhance students' autonomous motivated behavior in the educational context. However, evidence regarding how mindfulness can be integrated into existing conceptual frameworks such as the trans-contextual model is scarce. Therefore, the present study aimed to evaluate the role of mindfulness in students' autonomous motivation in the school and leisure time contexts. Overall, N = 1877 students (M = 14.74 years, SD = 2.63) indicated their self-reported mindfulness, their perceived need for support in physical education, their autonomous motivation during physical education and leisure time, as well as their perceived behavioral control, attitude, subjective norm, and intention toward physical activity. Physical activity was additionally measured physiologically for n = 240 students using accelerometers. Path model analyses revealed that the inclusion of mindfulness substantially improved the trans-contextual model fit. Perceived autonomy support positively predicted mindfulness, which, in turn, predicted autonomous motivation in physical education and leisure time, attitude, subjective norm, and perceived behavioral control. Furthermore, mediation analyses revealed the significant indirect effects of mindfulness on physiological and self-reported physical activity. Based on these results, mindfulness can be considered a key factor in fostering students' motivation to become physically active.

Association of body mass index and its classifications with gray matter volume in individuals with a wide range of body mass index group: A whole-brain magnetic resonance imaging study

Aim

To examine the association of body mass index (BMI) [kg/m²] and its classifications (underweight [BMI < 18.5], normal [18.5 ≤ BMI < 25], overweight [25 ≤ BMI < 30], and obese [BMI ≥ 30]) with brain structure in individuals with a wide range of BMI group.

Materials and methods

The participants included 382 right-handed individuals (mean age: 46.9 ± 14.3 years, 142 men and 240 women). The intelligence quotient was assessed using the Japanese Adult Reading Test. Voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) were performed to analyze the association of BMI and its classifications with gray and white matter structures, respectively.

Results

According to VBM, BMI was significantly and negatively correlated with the bilateral cerebellum exterior volumes. In group comparisons, the right cerebellum exterior volume was significantly lower in the overweight or obese group than in the underweight or normal group, while the bilateral cuneus and calcarine cortex, left cuneus, and left precuneus volume was significantly lower in the underweight group than in the non-underweight group. Sex-related stratification analyses for VBM revealed that BMI was significantly and negatively correlated with the bilateral cerebellum exterior volumes only in women. In group comparisons, the left cerebellum exterior volume was significantly lower in obese women than in non-obese women. The left thalamus proper and the right cerebellum exterior volumes were significantly lower in overweight or obese group than in underweight or normal group in men and women, respectively. The bilateral cuneus and calcarine cortex, left cuneus and carcarine cortex, and bilateral cuneus volume was significantly lower in underweight men than in non-underweight men. In contrast, there were no notable findings on DTI.

Conclusion

Our results suggest association of continuous BMI, being overweight or obese, and being underweight with decreased gray matter volume in individuals with a wide range of BMI group. Furthermore, sex-related differences are seen in the association of BMI and its classifications with regional gray matter volume reductions. Abnormally high or low BMIs may have a negative influence on regional gray matter volumes.

Predicting Construction Workers’ Intentions to Engage in Unsafe Behaviours Using Machine Learning Algorithms and Taxonomy of Personality

Dynamic environmental circumstances can sometimes be incompatible with proactive human intentions of being safe, leading individuals to take unintended risks. Behaviour predictions, as performed in previous studies, are found to involve environmental circumstances as predictors, which might thereby result in biased safety conclusions about individuals’ inner intentions to engage in unsafe behaviours. This research calls attention to relatively less-understood worker intentions and provides a machine learning (ML) approach to help understand workers’ intentions to engage in unsafe behaviours based on the workers’ inner drives, i.e., personality. Personality is consistent across circumstances and allows insight into one’s intentions. To mathematically develop the approach, data on personality and behavioural intentions was collected from 268 workers. Five ML architectures—backpropagation neural network (BP-NN), decision tree, support vector machine, k-nearest neighbours, and multivariate linear regression—were used to capture the predictive relationship. The results showed that BP-NN outperformed other algorithms, yielding minimal prediction loss, and was determined to be the best approach. The approach can generate quantifiable predictions to understand the extent of workers’ inner intentions to engage in unsafe behaviours. Such knowledge is useful for understanding undesirable aspects in different workers in order to recommend suitable preventive strategies for workers with different needs.

Exploring Psychosocial Determinants of Eating Behavior: Fruit and Vegetable Intake Among Brazilian Adolescents

In most Western countries, children and adolescents do not eat the recommended amount of fruits and vegetables (FVs). Theoretical frameworks on social psychology of eating, such as the Reason Action Approach, Social Cognitive Theory, and Theory of Normal Conduct have been applied to understand how psychosocial variables can explain FV intake. However, considering those predictors is still rare on the understanding of FV intake among adolescents (particularly in Brazil) despite its importance within eating behavior. Therefore, this study explored important psychosocial determinants of weekly frequency of FV intake among Brazilian adolescents in a model testing socioeconomic status (SES) and body mass index (BMI). A cross-sectional design was performed with 429 students (58% female), mean age 14.45 (SD 1.86). Key variables of theoretical framework on social psychology of food were investigated by structural equation modeling. The model included self-efficacy, attitudes, and social norms (with its subcomponents descriptive and injunctive) as psychosocial predictors of weekly frequency of FV intake along with SES and BMI. An instrument developed for Brazilian Portuguese was used to collect psychosocial variables as well as to verify FV reported intake. The total model explained 45.5% of weekly frequency of FV intake, and self-efficacy was the only significant psychosocial determinant (λ = 0.51, p = 0.001). SES also showed an important effect on the model (λ = 0.21, p = 0.001), while for BMI no significance was observed. In conclusion, the model was adequate to understand psychosocial determinants of weekly frequency of FV intake for Brazilian adolescents, with self-efficacy and SES as the major determinants of this eating behavior.

Equity Effects of Dietary Nudging Field Experiments: Systematic Review

Background: Dietary behaviours are among the key modifiable risk factors for non-communicable diseases. Importantly, dietary behaviours vary substantially between groups and individuals with different socioeconomic positions, with more disadvantaged groups and individuals being exposed to more dietary risk factors. The goal of this review is to summarise the existing research on equity effects of dietary nudging interventions. Methods: Systematic review of nudging interventions conducted in a field setting that report an observable indicator of dietary behaviour, include a control group, and report effect sizes stratified by indicators of socioeconomic status as outlined in the PROGRESS-Plus framework. Two databases (scopus, Pubmed) were searched (last search June 2021), and 18 articles with 19 studies (k = 46 equity comparisons) were included. Risk of bias was assessed using the ROBINS-I tool. Due to heterogeneity in equity dimensions and study outcomes, a harvest plot was used to summarise data. Results: The majority of equity comparisons (38 out of 46) were available for cognitive nudges. Most of these (22 out of 38 comparisons) found that cognitive nudges worked equally well in more and less disadvantaged populations; however, in 12 out of the 38 comparisons, they favoured those who were less disadvantaged. Two out of four comparisons on behavioural nudges favoured more disadvantaged persons. Conclusions: The differential effects of dietary nudging interventions in this review can contribute to increases in health inequalities. At the same time, a substantial number of interventions showed no equity effects. Importantly, this review suggests that more research on nudging interventions and health equity is needed. Future interventions should report effect sizes stratified by indicators of social inequality. Systematic Review Registration: PROSPERO (CRD42019137469).

Identification of Immunosuppressive Medication Nonadherence Factors Through a Combined Theory Model in Renal Transplant Recipients: 6-12

Background: Immunosuppressive medication (IM) nonadherence is associated with poor transplant outcomes. Therefore, it is of great importance to identify predictive factors with IM nonadherence. We aimed to improve the predicted capacity of the theory of planned behavior (TPB) by adding health belief model's (HBM) variables in renal transplant patients (RTPs). Methods: This cross-sectional study distributed questionnaires to patients who had undergone renal transplant and follow-up regularly in the transplant center of Third Xiangya Hospital in China. The self-developed questionnaire collected data in three aspects: general data questionnaire, TPB, HBM-specific questionnaire, and Basel Assessment of Adherence to Immunosuppressive Medications scale. Results: A total of 1,357 of 1,480 patients completed the survey, with a participation rate of 91.69% and IM nonadherence rate of 33.53%. The marital status, household income, preoperative drinking history, the time after transplantation, and religion showed independent predictive factors with IM nonadherence (p < 0.05). Strikingly, adding HBM variables to the TPB theory model significantly increased its prediction ability to IM nonadherence (52%). Also, HBM manifested the highest coefficient of effect (-0.620). Particularly, perceived barriers and perceived seriousness, the variables of the HBM model, played a vital influence on medication nonadherence (-0.284 and 0.256). Conclusion: Our study here reveals the first investigation of the combined effects of the TPB and HBM model on IM nonadherence in Chinese RTPs, which could significantly improve the predictive ability of any single model. Meanwhile, future interventions should be conducted to both increase perceived seriousness and reduce perceived barriers for taking IM, which will effectively decrease IM nonadherence rates and improve transplant outcomes.

Customers response to online food delivery services during COVID-19 outbreak using binary logistic regression

This study aims to empirically measure the distinctive characteristics of customers who did and did not order food through Online Food Delivery services (OFDs) during the COVID-19 outbreak in India. Data are collected from 462 OFDs customers. Binary logistic regression is used to examine the respondents' characteristics, such as age, patronage frequency before the lockdown, affective and instrumental beliefs, product involvement and the perceived threat, to examine the significant differences between the two categories of OFDs customers. The binary logistic regression concludes that respondents exhibiting high-perceived threat, less product involvement, less perceived benefit on OFDs and less frequency of online food orders are less likely to order food through OFDs. This study provides specific guidelines to create crisis management strategies.

A Rebuttal-Based Social Norms-Tailored Cannabis Intervention for At-Risk Adolescents

Many past cannabis prevention campaigns have proven largely ineffective due in part to the diversity of adolescents' cannabis-relevant beliefs. The current studies evaluated the impact of a sequential multiple message approach tailored to the usage norms of adolescents expressing negative attitudes toward a cannabis prevention appeal. A multiple-message strategy was implemented-initial unfavorable message evaluations were invalidated using attitudinal rebuttal feedback prior to presenting a third tailored communication. Participants were cannabis-abstinent middle and high school students (ages 11 to 16). Study 1 (N = 808) compared effects of gain- and loss-framed messages tailored to each student's normative usage perceptions. In Study 2 (N = 391), students were randomly assigned to receive a tailored or non-tailored message after receiving feedback meant to destabilize anti-message attitudes. For at-risk adolescents in Study 1 who perceived cannabis use as normative, a tailored gain-framed message resulted in the lowest usage intentions (p < .05). In Study 2, a conditional multiple-moderated mediation model showed that for high-risk teens with normative beliefs and pro-cannabis attitudes, exposure to a tailored gain-framed communication was associated with decreased cannabis attitude certainty, and lower usage intentions 2 months later (p < .05). Findings have implications for sequential messaging utilization in mass media campaigns and support the efficacy of tailored messages over a one-size-fits-all media approach. Further, results suggest that systematically weakening resistance to persuasive communications and tailoring messages consistent with individually perceived peer norms is an effective prevention strategy.

Educational inequality in the Dietary Approach to Stop Hypertension diet in the UK: evaluating the mediating role of income

Apparent differences in the adoption of the Dietary Approach to Stop Hypertension (DASH) diet have been reported between less and more educated individuals. However, the mediating role of income has not been clarified. In this study, we aimed at quantifying the mediating effect of income on the relationship between education and the DASH score in the UK population. We analysed data on 4864 subjects aged 18 years and older collected in three waves of the National Diet and Nutrition Survey (2008-2016). The DASH score was calculated using sex-specific quintiles of DASH items. We carried out a counterfactual-based mediation analysis to decompose the total effect of education on DASH score into average direct effect and average causal mediation effect mediated by income. We found that the overall mediating effect of income on the relationship between education and the DASH score was only partial, with an estimated proportion mediated ranging between 6 and 9 %. The mediating effect was higher among females (11·6 %) and younger people (17·9 %). Further research is needed to investigate which other factors may explain the socio-economic inequality in the adoption of the DASH diet in the UK.

GMO Food Labels Do Not Affect College Student Food Selection, Despite Negative Attitudes towards GMOs

US Public Law 114–216 dictates that food producers in the United States of America will be required to label foods containing genetically modified organisms (GMOs) starting in 2022; however, there is little empirical evidence demonstrating how U.S. consumers would use food labels that indicate the presence or absence of GMOs. The aim of this two-phase study was to determine how attitudes towards GMOs relate to food choices and how labels indicating the presence or absence of GMOs differentially impact choices among college students—the age group which values transparent food labeling more than any other. Participants (n = 434) made yes/no choices for each of 64 foods. In both phases of the study, participants were randomly assigned to seeing GMO Free labels, contains GMOs labels, or no GMO labels. Across the two phases, 85% of participants reported believing that GMOs were at least somewhat dangerous to health (42% believed GMOs to be dangerous), yet in both studies, although eye-tracking data verified that participants attended to the GMO labels, these labels did not significantly affect food choices. Although college consumers may believe GMOs to be dangerous, their food choices do not reflect this belief.

Assessing perceptions of COVID-19 self-protective measures: a structural equation modeling (SEM) approach

Purpose

This study aimed to develop scales to assess perceptions of coronavirus disease 2019 (COVID-19) self-protective measures (SPMs) and examine the psychometric properties based on the theory of planned behavior (TPB).

Design/methodology/approach

A total of 412 participants from Bangalore, India, randomly volunteered to participate in this research. The questionnaire consisted of items related to the TPB scales and demographic details.

Findings

A structural equation model showed a reasonable model fit. In total, 70% of the individuals' behavioral intentions of following COVID-19 SPMs were predicted by perceived benefits, barriers, social norms and social influence. Participants' age impacted on perceived benefits and perceived social influence and individuals' behavioral intentions of following COVID-19 SPMs, with a 13.6% difference in model prediction.

Originality/value

The TPB can be used as a strong psychometric property to assess behavioral determinants of COVID-19 SPMs.

A theory of planned behavior-enhanced intervention to promote health literacy and self-care behaviors of type 2 diabetic patients

Background

Improved health literacy and awareness could help type 2 diabetic patients to control the disease complications.

Objective

The current study aimed to evaluate the impact of theory-based educational intervention on health literacy and self-care behaviors of type 2 diabetic patients in Tonekabon city.

Methods

This randomized controlled trial study was conducted at health care centers in Tonekabon city, Iran, from April 5, 2017, to October 22, 2018. Using multistage random sampling, 166 patients with type 2 diabetes divided into two groups: theory-based intervention (n = 83) and custom education (n = 83). The data collection tools consisted of demographic information, Theory of Planned Behavior (TPB) measures, health literacy for Iranian adults (HELIA) and summary of diabetes self-care activities (SDSCA). The five 45-minute group training sessions based on the baseline assessment and model constructs along with the targeted pamphlet and m-health strategy were designed for the experimental group. Data were analyzed using chi-square, independent and paired t-test and Analysis of covariance (ANCOVA).

Results

After controlling for pre-test effect, there was a significant difference between the two groups in terms of mean scores of attitudes, subjective norms, perceived behavior control and intention in post-test (P < 0.001). Also, after controlling for the pre-test effect, the results showed a significant difference in the self-care domain in the post-test (P < 0.001). Finally, after controlling for the pre-test variable effect, covariance analysis reflects significant difference in total health literacy score and its dimension at posttest (P < 0.001).

Conclusions

Applying TPB based education is suggested to maintain and improve self-care behaviors and health literacy in type 2 diabetic patients and other chronic diseases.

Trends in soft drink and sugar-sweetened beverage consumption among South Australians, focusing on distribution of intake by subpopulation

OBJECTIVE

This study focused on describing local trends in sugar-sweetened beverage (SSB) consumption, including variations between subgroups, to inform equitable health policy to curb soft drink consumption.

METHODS

Weighted data were obtained from the South Australian Monitoring and Surveillance System, a state-based population health survey that monitors trends in health risk factors and chronic disease via computer-assisted telephone interviewing. From 2008 onwards, participants provided an estimate of the average amount of soft drink they consumed per day.

RESULTS

From 2008-2017, there were significant decreases in the proportion of adults who consumed any SSBs, but the mean consumption per consumer increased. High-risk dietary and lifestyle behaviours are the strongest predictors for consumption of soft drink, but there is also a significant association with socioeconomic status.

CONCLUSIONS

Population trends mask increasing inequity. There is a societal trend away from the consumption of SSBs across all subgroups, but at-risk groups who engage in clusters of unhealthy behaviours remain high consumers. Implications for public health: The identification of at-risk populations allows research to focus more precisely on the structural barriers, beliefs, attitudes and facilitators of ongoing consumption of SSB in order to inform future health promotion efforts.

Parental and Child Self-Efficacy Explaining Food Intake through Self-Regulation: A Dyadic Prospective Study

BACKGROUND

According to social cognitive theory and socio-ecological models, self-efficacy and temptation-related self-regulation (the use of distraction or suppression) are modifiable predictors of health behaviors, such as food intake. Yet, there is limited evidence explaining how these factors are interlinked among parent-child dyads. This study investigated indirect effects of parental and child self-efficacy on food intake, via parental and child self-regulation.

METHODS

The prospective study (the baseline [T1] and the 10-month follow-up [T2]) enrolled 924 parent-child dyads (1,848 individuals; 54.3% girls, aged 5-11 years, 88.9% mothers). Dyads were interviewed or completed self-report measures. Path analyses with maximum likelihood estimation were conducted.

RESULTS

Child self-efficacy and distraction (T1) mediated between parental self-efficacy (T1) and higher levels of child fruit and vegetable intake (T2). No significant mediating effects of suppression were found, nor indirect effects of parental self-efficacy (T1) on energy-dense food intake (T2).

CONCLUSION

Health promotion interventions aiming at changing fruit and vegetable intake among 5-11-year-old children should target enhancing parental and child self-efficacy that may facilitate the use of self-regulation and, in turn, healthy diet.

Effects of socio-structural variables in the theory of planned behavior: a mediation model in multiple samples and behaviors

Objective: Observed variation in health behavior may be attributable to socio-structural variables that represent inequality. We tested the hypothesis that variability related to socio-structural variables may be linked to variation in social cognition determinants of health behavior. A proposed model in which effects of socio-structural variables (age, education level, gender, income) on health behavior participation was mediated by social cognition constructs was tested. Design: Model effects were tested in correlational datasets (k = 13) in different health behaviors, populations, and contexts. Samples included self-report measures of age, highest attained education level, gender, and net household income, and constructs from the theory of planned behavior (attitude, subjective norms, perceived behavioral control, intention). Ten samples provided follow-up self-reports of health behavior. Results: Path analyses supported sample-specific indirect effects of gender and age on health behavior with comparatively few income and education level effects. Meta-analytic structural equation modeling indicated consistent indirect and total effects of gender on intentions and health behavior through social cognition constructs, and a total effect of education level on behavior. Conclusion: Results provide support for the proposed mechanism by which socio-structural variables relate to health behavior. Replication in larger samples and meta-analytic synthesis across multiple health behavior studies is warranted.