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Parent healthful eating attitudes and motivation are prospectively associated with dietary quality among youth with type 1 diabetes
Abstract
A family-based behavioral nutrition intervention grounded in social cognitive and self-determination theories showed an increased intake of whole plant foods. This study examined (1) whether the intervention changed parent diet-related attitudes/beliefs, (2) whether these attitudes/beliefs were associated with youth diet quality, and (3) the moderating roles of youth age and parent nutritional knowledge. Youth with type 1 diabetes and their parents (n = 136, mean ± SD youth age = 12.6 ± 2.8 years) participated in an 18-month trial targeting intake of whole plant foods. Parents reported attitudes/beliefs (self-efficacy, outcome expectations, perceived barriers, autonomous and controlled motivation) for providing healthy food to their families, and type 1 diabetes-specific nutrition knowledge at 6, 12, and 18 months. Whole Plant Food Density (WPFD; cup or ounce equivalents per 1000 kcal of whole grains, fruit, vegetables, legumes, nuts,and seeds) was calculated from 3-day youth food records. Linear mixed models estimated the intervention effect on parent attitudes/beliefs, associations of parent attitudes/beliefs with youth WPFD, and the moderating roles of parent nutrition knowledge and youth age. There was no effect of the intervention on parent attitudes/beliefs. Across groups, higher parent self-efficacy and autonomous motivation were positively associated with youth WPF. Parent-perceived barriers and negative outcome expectations were inversely associated with youth WPFD, especially when parents had higher nutrition knowledge. Youth age did not modify any associations. Parent diet-related attitudes/beliefs were associated with youth diet quality, highlighting the importance of parent psychosocial factors across this age range. Despite a positive effect on youth diet, the intervention did not affect parent attitudes/beliefs, suggesting it worked through a different mechanism.
... Following the eligibility criteria, a total of 23 references reporting on 12 different studies were included in the systematic review. From these, 9 were RCT [16][17][18][19][20][21][22][23][24], 11 were post-hoc studies from these RCT [25][26][27][28][29][30][31][32][33][34][35], and 3 were pre-post intervention studies [36][37][38]. The PRISMA flow chart is provided in Fig. 1. ...
... In terms of DSMES, a post-hoc analyses of a RCT performed to assess the relationship between parent attitudes and youth diet quality, described no effect of the intervention on parent attitudes or beliefs [30]; however, a higher parent self-efficacy and autonomous motivation were positively associated with those youth with a higher adherence to a WPFD diet. Furthermore, a secondary data analysis from this RCT found that a behavioral intervention to improve dietary quality did not increase disordered eating behaviors in adolescents [29]; nevertheless, a greater adherence to diabetes self-management was associated with lower diabetes eating problems in adolescents with type 1 diabetes [29]. ...
... In terms of DSMES, only two post-hoc analyses from a RCT addressed this issue [29,30]. The authors found that a higher adherence to a WPFD diet was associated with a higher parent self-efficacy and motivation [30]. ...
BACKGROUND
Medical nutrition therapy (MNT) has an integral role in overall diabetes management. During adolescence, consideration of physiological and psychosocial changes is essential for implementing an optimal diabetes treatment.
OBJECTIVES
Our aim was to identify, summarize, and interpret the published literature about MNT in adolescents with type 1 diabetes.
METHODS
The Medline (PubMed) and EMBASE databases were searched from January 1959 to December 2021. The inclusion criteria were interventional studies with MNT in adolescents with type 1 diabetes with a disease duration over 1 year, including the following outcomes: dietary intake and daily eating patterns (assessed with validated tools, two or more 24 h dietary recall or 3-day dietary records), the diabetes self-management education and support (DSMES), glycemic control, lipid profile and body mass index (BMI). The exclusion criteria were studies without a control group (except for pre-post studies), the lack of randomization and those studies that assessed only a single nutrient, food or meal consumption, as well as reviews, and in-vitro/in-vivo studies. The risk of bias assessment was performed using the Cochrane risk-of-bias tool for randomized trials. A narrative synthesis was performed to present the results. The quality of evidence was assessed with the GRADE guidance.
RESULTS
From a total of 5377 records, 12 intervention studies (9 RCT and 3 pre-post intervention studies) were included. The data were assessed in order to perform a meta-analysis; however, the studies were too heterogeneous. The studies showed conflicting results about the effectiveness of MNT on dietary pattern, DSMES, glycemic control, lipid profile and BMI.
CONCLUSIONS
Clinical research studies on the effectiveness of MNT in adolescents with type 1 diabetes are scarce. The limited number of studies with a high risk of bias precludes establishing robust conclusions on this issue. Further research is warranted.
... In our study, a statistically significant relationship was found between perceived helicopter parenting attitudes and mothers' attitudes toward nutrition, which led to a statistical increase in "Attitudes towards Nutrition". This finding is in line with studies on the effects of parental attitudes and knowledge on children's feeding behaviors and nutritional knowledge [19][20][21]. Parents play an important role in shaping their children's understanding of food and nutrition [20]. Moreover, studies have shown a significant association between parents' healthy eating attitudes, nutritional knowledge, and diet quality of preschool children [19]. ...
... This supports the idea that interventions targeting parents and children can improve attitudes towards nutrition. In addition, the literature has emphasized that parents' healthy eating attitudes and motivations are significantly related to the nutritional quality of young people, further emphasizing Hierarchical Regression Analysis * the relationship between parental attitudes and children's nutrition [21]. In conclusion, the existing literature supports a significant difference between parental attitudes and knowledge about nutrition and children's attitudes and behaviors towards food. ...
Background
This study aimed to examine the effect of helicopter parental attitude and psychological well-being level on Attitude towards nutrition in adolescent students.
Methods
This study was designed with the relational-cross-sectional-descriptive model and was conducted with 652 adolescent students studying in a province in eastern Turkey between 16.05 and 10.07 2024. Data were analyzed using SPSS 25.0 and G*Power 3.1 statistical package programs.
Results
Based on the results of Model 1, the Psychological Well-Being level explained 3.5% of the total variance in Attitude Towards Nutrition level (R²=0.035, F(1,650) = 23.878, p = 0.001) and it was determined that the increase in Psychological Well-Being level significantly increased the attitude towards nutrition (t = 4.886, p < 0.001). In Model 2, Psychological Well-Being and Perceived Helicopter Parental Attitude-Mother variables together explained 12.2% of the total variance (R²=0.122, F(2,649) = 44.912, p = 0.001), it was found that an increase in both variables led to a significant increase in nutrition attitude (Psychological Well-Being: t = 5.601, p < 0.001; Mother Attitude: t = 7.978, p < 0.001). In the results of Model 3, Psychological Well-Being and Perceived Helicopter Parental Attitude-Mother/Father variables explained 12.6% of the total variance (R²=0.126, F(3,648) = 31.266, p = 0.001), Psychological Well-Being (t = 5.864, p < 0.001) and Mother Attitude (t = 5.416, p < 0.001) significantly affected the nutritional attitude, while the effect of Father Attitude was not significant (t = 1.900, p = 0.058).
Conclusions
In this study, it was found that Psychological Well-Being and Perceived Helicopter Parental Attitude (especially mother attitude) levels had significant effects on individuals’ Attitudes Towards Nutrition. In addition, the strong effect of the mother’s attitude on eating habits was noted, but it was determined that the father’s attitude did not have a significant effect on this relationship.
... With regard to children with chronic illnesses, parents with higher PSE are more likely to have positive attitudes towards the treatment and care of their child, to actively obtain information related to the disease and management of routine treatment, and to engage in positive problem-solving when facing challenges in the process of caring for the child. Parents with higher PSE can facilitate healthy eating habits for children with type 2 diabetes (Eisenberg, Lipsky, Gee, Liu, & Nansel, 2017), can more efficiently conduct critical tasks in the management of children with asthma and lower the child's incidence of asthma attacks and sick leave (Grus et al., 2001), and can conduct more effective management of medicalrelated routines and reduce difficult behavior in children with atopic dermatitis (Mitchell, Fraser, Morawska, Ramsbotham, & Yates, 2016). ...
Purpose
Little attention has been put to parental self-efficacy (PSE) on the home care management and its impact on the health-related outcome in children with Hirschsprung disease (HD) after surgery. The purpose of this study was to investigate the association between PSE and post-operative outcome and quality of life (QoL) in children with HD.
Design and methods
This study adopted a cross-sectional study design. Children diagnosed with HD who had surgery during 2015 and 2018, and their parents were included. Parental self-efficacy, children's post-operative fecal continence and QoL were evaluated with validated questionnaires; post-operative readmission and adverse events were extracted from electronic medical record system.
Results
Of the eligible families, 69.6% (96/138) responded to the follow-up. The median children's age at surgery and current age were 16 (interquartile range: 10–32) and 45 (interquartile range: 39.7–57) months, respectively. The mean PSE score is 8.78 points, with the lowest score in the bowel habit training dimension (7.88 ± 2.28), followed by getting social support dimension (8.07 ± 2.64). Multivariable linear regression showed that PSE was associated with fecal continence (β = 0.043, 95% CI 0.013–0.072), pediatric QoL total score (β = 0.210, 95% CI 0.011–0.409) and social score (β = 0.273, 95% CI 0.022–0.525). No associations were observed between PSE and weight z-score, height z-score, readmission or adverse events.
Conclusions
PSE is correlated with fecal continence and QoL of children with HD.
Practice implications
PSE should be considered when designing a parental education program, with the focus on bowel habit training and getting social support.
... According to Montigny and colleagues' concept analysis of parental self-efficacy (PSE), PSE in managing the home care of children with HD or AM refers to parents' perceived beliefs in their capabilities to provide home care for their child [8]. Several studies have highlighted the importance of PSE in the management of children's chronic conditions [9][10][11], as well as in facilitating parents to feel more capable of dealing with their child's challenging problems and coping with their own overwhelming feelings [12]. Grano and colleagues reported that selfefficacy contributes to improving the mental health outcomes of adult patients with AM [13], yet little attention has been paid to PSE in the home care of children with HD or AM. ...
Objective
This study aimed to develop a scale specifically to measure parental self-efficacy (PSE) in managing the home care of children with Hirschsprung's disease (HD) or anorectal malformation (AM) (the PSE-HDAM scale), and to validate its psychometric properties.
Methods
The PSE-HDAM Scale was developed through focus group with parents and Delphi questionnaire responses of experts. A total of 230 parents of children with HD or AM were recruited to fill the PSE-HDAM, the Chinese version of the Tool to Measure Parenting Self-Efficacy (TOPSE), and the Holschneider Criteria. Content validity was measured using the Content Validity Index. Principal Component Analysis was conducted to identify dimensions of the scale. Cronbach's Alpha and Guttman's Split-Half Reliability Coefficient were used to evaluate the internal consistency of the scale. External validity was measured using the Pearson correlation coefficient between PSE-HDAM, and the Chinese version of the TOPSE and Holschneider Criteria.
Results
Principal Component Analysis identified five domains of the PSE-HDAM scale. The final version of the scale consisted of 19 items. The content validity was 0.89. The correlations between items and the total scale ranged between 0.75 and 0.87. The overall scale and subscales have good to excellent internal consistency (Cronbach ɑ ranged 0.67 to 0.91), and the Split-Half Coefficient of the whole scale is 0.85. The correlation between PSE-HDAM score and the TOPSE and the Holschneider Criteria was 0.68 and 0.32 respectively (p < .001).
Conclusions
The PSE-HDAM is a reliable and valid scale to evaluate PSE in managing home care of children with HD or AM.
... Although considerable discussion has focused on the influence of parental nutrition knowledge, less research has focused on the effects of parenting attitudes on their offspring's food consumption, nutritional habits, and diet quality. Our findings agree with a recently published randomized controlled trial of a family-based behavioral nutrition intervention [20] in children with type 1 diabetes that concluded that parents' diet-related attitudes and beliefs were linked to their children's diet quality, remarking on the essential role of parental psychosocial factors. ...
Parental nutrition knowledge and attitudes play a fundamental role in their children’s food knowledge. However, little is known about their influence on their children’s diet quality and micronutrient intake. Thus, we aimed to assess the association of parental nutrition knowledge and healthy-eating attitudes with their children’s adherence to the Mediterranean dietary pattern and micronutrient adequacy. Parental healthy-eating attitudes and knowledge of the quality of their child’s diet as well as anthropometric, lifestyle, and nutrient intake characteristics were recorded with a basal questionnaire that included a 140-item-food frequency-questionnaire. A total of 287 pre-school children were included in the analyses. Intake adequacy was defined using the Estimated Average Requirements (EAR) cut-off point method. We developed a parental nutrition knowledge and healthy-eating attitudes scores and evaluated whether they were independently associated with 1) children’s inadequate intake (probability of failing to meet ≥3 EAR) of micronutrients, using logistic regression analyses, and 2) children’s diet quality (adherence to the Mediterranean Diet according to a Mediterranean Diet Quality Index for children and adolescents, the KIDMED index), using multiple linear regression models. A higher score in the parental healthy-eating attitudes score was associated with lower risk of failing to meet ≥3 EAR compared with the reference category (odds ratio (OR): 0.3; 95% confidence interval (CI) 0.12–0.95; p for trend: 0.037) and a higher adherence to the Mediterranean diet in the most adjusted model (β coefficient: 0.34; 95% CI 0.01–0.67; p for trend: 0.045). Our results suggest a positive association of parental healthy-eating attitudes with nutritional adequacy and diet quality in a sample of Spanish preschoolers. Public health strategies should focus on encouraging parental healthy-eating attitudes rather than simply educating parents on what to feed their children, recognizing the important influence of parental behavior on children’s practices.
Many children with type 1 diabetes do not meet nutritional guidelines. Little is known about how caregivers perceive the necessity of registered dietitian (RD) visits or how satisfied they are with nutrition care. This study aimed to evaluate nutrition experiences and perceptions of care among caregivers of children with type 1 diabetes at an academic medical center. We analyzed 159 survey responses. Using multivariable logistic regression, we assessed factors associated with the perception of need for annual nutrition visits, satisfaction with RD care, and encouragement from a nurse or doctor to meet with an RD. Covariates included age (<13 vs. ≥13 years), type 1 diabetes duration (≤3 vs. >3 years), sex, race/ethnicity, and insulin pump and continuous glucose monitoring use. More than half of caregivers (56%) considered annual visits necessary. Shorter type 1 diabetes duration (odds ratio [OR] 1.92, 95% CI 1.02–3.63) was associated with this finding. Less than half (46.5%) reported satisfaction with nutrition care; higher satisfaction was also correlated with shorter type 1 diabetes duration (OR 2.20, 95% CI 1.17–4.15). Although 42% reported meeting with an RD in the past year, less than two-thirds (62%) reported receiving a medical provider recommendation for nutrition care. Leading reasons for not meeting with an RD were: “I am knowledgeable in nutrition and do not need to see an [RD]” (41%) and “I had a past visit with an [RD] that was not helpful” (40%). Our findings suggest that satisfaction with and perceived need for nutrition care may wane with longer type 1 diabetes duration. Improved strategies for therapeutic alliance between caregivers and RDs and engagement of families at later stages of type 1 diabetes are needed.
The objective of this scoping review was to identify and characterize studies examining the effect of nutrition management interventions and effectiveness of medical nutrition therapy to improve nutrition-related outcomes in children and adolescents with type 1 diabetes. An in-depth electronic search was conducted by a medical librarian in six databases: Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, The Cumulative Index to Nursing and Allied Health Literature, and Web of Science Core Collection. The literature search resulted in 5,122 records, and five records were identified through hand search. Of these 5,127 records, 22 articles and eight systematic reviews met our inclusion criteria. An equal number of the studies were experimental (ie, randomized or nonrandomized controlled trials, or noncontrolled trials) (n = 11) and observational (cohort, case-control, and cross-sectional) (n = 11) with the remaining studies being systematic reviews/meta-analyses (n = 8). Most of these studies were conducted in United States or Europe. Based on this scoping review, the majority of studies focus on either carbohydrate counting or evaluation of dietary intake patterns with little emphasis on tailored patient education/counseling services specifically designed to meet a young child’s or his/her family's individual needs. Indeed, only four studies in this scoping review used dietary counseling and/or medical nutrition therapy. As such, there remains a significant gap in the literature as it relates to the efficacy and long-term management implications of tailored nutrition interventions in young children with type 1 diabetes.
Purpose:
Among adolescents with type 1 diabetes, disordered eating behaviors (DEBs) are more prevalent and have more serious health implications than in adolescents without diabetes, necessitating identification of modifiable correlates of DEB in this population. This study hypothesized that (1) autonomous motivation and (2) controlled motivation for healthy eating (i.e., eating healthfully because it is important to oneself vs. important to others, respectively) are associated with DEB among adolescents with type 1 diabetes. The third hypothesis was that baseline healthy eating self-efficacy moderates these associations.
Methods:
Adolescents with type 1 diabetes (n = 90; 13-16 years) participating in a behavioral nutrition intervention efficacy trial reported DEB, controlled and autonomous motivation, and self-efficacy at baseline, 6, 12, and 18 months. Linear-mixed models estimated associations of controlled and autonomous motivation with DEB, adjusting for treatment group, body mass index, socioeconomic status, age, and gender. Separate models investigated the interaction of self-efficacy with each motivation type.
Results:
Controlled motivation was positively associated with DEB (B = 2.18 ± .33, p < .001); the association was stronger for those with lower self-efficacy (B = 3.33 ± .55, p < .001) than those with higher self-efficacy (B = 1.36 ± .36, p < .001). Autonomous motivation was not associated with DEB (B = -.70 ± .43, p = .11).
Conclusions:
Findings identify controlled motivation for healthy eating as a novel correlate of DEB among adolescents with type 1 diabetes and show that self-efficacy can modify this association. Motivation and self-efficacy for healthy eating represent potential intervention targets to reduce DEB in adolescents with type 1 diabetes.
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
Diets of children with type 1 diabetes are low in fruits, vegetables, and whole grains, and high in foods of minimal nutritional value, increasing risk for future adverse health outcomes. This 18-month randomized clinical trial tested the effect of a family-based behavioral intervention integrating motivational interviewing, active learning, and applied problem-solving on the primary outcomes of dietary intake and glycemic control among youth with type 1 diabetes.
A parallel-group study with equal randomization was conducted at an outpatient, free-standing, multidisciplinary tertiary diabetes center in the United States. Eligible youth were those age 8-16 years with type 1 diabetes diagnosis ≥1 year and hemoglobin A1c (HbA1c) ≥6.5% and ≤10.0%. Participants were 136 parent-youth dyads (treatment n = 66, control n = 70). The intervention consisted of 9 in-clinic sessions delivered to the child and parent; control condition comprised equivalent assessments and number of contacts without dietary advice. Dietary intake was assessed using 3-day diet records at 6 time points across the 18-month study. Dietary outcomes included the Healthy Eating Index-2005 (HEI2005; index measuring conformance to the 2005 United States Dietary Guidelines for Americans) and Whole Plant Food Density (WPFD; number of cup or ounce equivalents per 1000 kcal of whole grains, whole fruit, vegetables, legumes, nuts, and seeds consumed). HbA1c was obtained every 3 months. Overall comparison of outcome variables between intervention and usual care groups was conducted using permutation tests.
There was a positive intervention effect across the study duration for HEI2005 (p = .015) and WPFD (p = .004). At 18 months, HEI2005 was 7.2 greater (mean ± SE 64.6 ± 2.0 versus 57.4 ± 1.6), and WPFD was 0.5 greater (2.2 ± 0.1 versus 1.7 ± 0.1) in the intervention group versus control. There was no difference between groups in HbA1c across the study duration.
This behavioral nutrition intervention improved dietary quality among youth with type 1 diabetes, but did not impact glycemic control. Findings indicate the potential utility of incorporating such strategies into clinical care, and suggest that improvement in diet quality can be achieved in families living with this burdensome disease.
Clinicaltrials.gov registration number: NCT00999375.
Constructs based on Social Cognitive Theory have shown utility in understanding dietary behavior; however, little research has examined these relations in youth and parents concurrently. Unique demands of dietary management among families of youth with type 1 diabetes (T1D) suggest the importance of investigation in this population. The purpose of this study was to develop and evaluate youth and parent measures of self-efficacy, outcome expectations, and barriers for healthful eating, and parent modeling of healthful eating, in a sample of youth with type 1 diabetes and their parents.
Youth (n=252) ages 8--18 years with diabetes duration >=1 year and parents completed self-report measures of healthful eating attitudes including self-efficacy, perceived barriers, positive and negative outcome expectations; youth reported parent modeling of healthful eating. Youth dietary intake from 3-day diet records was used to calculate the Healthy Eating Index 2005 and the Nutrient Rich Foods 9.3 index, measures of overall diet quality. The relations among parent and youth healthful eating attitudes, parent modeling, and youth diet quality were examined using structural equation modeling.
Internal consistency and test-retest reliability of the measures were acceptable. The structural equation model demonstrated acceptable fit (CFI/TLI=0.94/0.94; RMSEA=0.03), and items loaded the hypothesized factors. Parent modeling beta^=.27,p=.02 and attitudes toward healthful eating (latent variable comprised of self-efficacy, barriers, outcome expectations) beta^=.16,p=.04 had direct effects on youth diet quality. Parent modeling had a direct effect on youth attitudes beta^=.49,p<.001; parent attitudes had an indirect effect on youth attitudes through parent modeling beta^=.12,p,<.001. Youth attitudes were not associated with youth diet quality. Overall, the model accounted for 20% of the variance in child diet quality.
Parent diet-related behaviors demonstrated an impact on youth attitudes and diet quality, suggesting the importance of family-based clinical and public health efforts to improve diet.
It continues to be essential that individual outcomes from MNT be monitored so that appropriate changes in the overall management plan for diabetes can be implemented. There are many aspects of MNT for diabetes that require additional research.
The purpose of this study was to test a model of the regulation of eating behaviors that could help to better understand the processes by which body dissatisfaction could be either associated with dysfunctional eating behaviors or with healthy eat- ing behaviors. Based on Self-Determination Theory (Deci & Ryan, 1985; Ryan & Deci, 2000, it appears that women's general level of self-determination in life may help protect against pressures about body image and endorsement of society's be- liefs about thinness and obesity. Findings also suggest that women's general level of self-determination is positively associated with an autonomous regulation of eating behaviors (AREB) and negatively associated with a controlled regulation of eating behaviors (CREB). In turn, the AREB is positively associated with healthy eat- ing while CREB is positively associated with dysfunctional eating. Overall, it ap- pears that body dissatisfaction resulting from pressures about body image and endorsement of society's beliefs about thinness and obesity may be more closely associated with a controlled regulation of eating behaviors, which may explain its relation with eating pathology.
Self determination theory proposes that behavior change will occur and persist if it is autonomously motivated. Autonomous motivation for a behavior is theorized to be a function both of individual differences in the autonomy orientation from the General Causality Orientations Scale and of the degree of autonomy supportiveness of relevant social contexts. We tested the theory with 128 patients in a 6-month, very-low-calorie weight-loss program with a 23-month follow-up. Analyses confirmed the predictions that (a) participants whose motivation for weight loss was more autonomous would attend the program more regularly, lose more weight during the program, and evidence greater maintained weight loss at follow-up, and (b) participants' autonomous motivation for weight loss would be predicted both by their autonomy orientation and by the perceived autonomy supportiveness of the interpersonal climate created by the health-care staff. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Social-cognitive theory (SCT) was used to explain the fruit and vegetable intake of 1,398 3rd graders. SCT variables assessed included self-efficacy, outcome expectations, preferences, social norms, asking skills, and knowledge. Fruit and vegetable intake was assessed with 7-day records. Bivariate correlations with fruit and vegetable intake ranged from .17 for asking skills to .29 for fruit and vegetable preferences. In analyses controlling for school-level clustering, only preferences and positive outcome expectations remained significantly associated with fruit and vegetable intake, accounting for approximately 10%–11% of the variance. Limitations in the conceptualization, scope, and measurement of the variables assessed may have contributed to the weak associations observed. Models incorporating factors other than individual-level social-cognitive variables may be required to more fully explain children's dietary behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Excess gestational weight gain (GWG) is an important risk factor for long term obesity in women. However, current interventions aimed at preventing excess GWG appear to have a limited effect. Several studies have highlighted the importance of linking theory with empirical evidence for producing effective interventions for behaviour change. Theorists have demonstrated that goals can be an important source of human motivation and goal setting has shown promise in promoting diet and physical activity behaviour change within non-pregnant individuals. The use of goal setting as a behaviour change strategy has been systematically evaluated within overweight and obese individuals, yet its use within pregnancy has not yet been systematically explored. AIM OF REVIEW: To explore the use of goal setting within healthy lifestyle interventions for the prevention of excess GWG.
Searches were conducted in seven databases alongside hand searching of relevant journals and citation tracking. Studies were included if interventions used goal setting alongside modification of diet and/or physical activity with an aim to prevent excess GWG. The PRISMA guidelines were followed and a two-stage methodological approach was used. Stage one focused on systematically evaluating the methodological quality of included interventions. The second stage assessed intervention integrity and the implementation of key goal setting components.
From a total of 839 citations, 54 full-text articles were assessed for eligibility and 5 studies met the inclusion criteria. Among interventions reporting positive results a combination of individualised diet and physical activity goals, self-monitoring and performance feedback indicators were described as active components.
Interventions based on goal setting appear to be useful for helping women achieve optimal weight gain during pregnancy. However, overweight and obese women may require more theoretically-designed interventions. Further high quality, theoretically-designed interventions are required to determine the most effective and replicable components for optimal GWG.
Self-determination theory (SDT) is an empirically based theory of human motivation, development, and wellness. The theory focuses on types, rather than just amount, of motivation, paying particular attention to autonomous motivation, controlled motivation, and amotivation as predictors of performance, relational, and well-being outcomes. It also addresses the social conditions that enhance versus diminish these types of motivation, proposing and finding that the degrees to which basic psychological needs for autonomy, competence, and relatedness are supported versus thwarted affect both the type and strength of motivation. SDT also examines people's life goals or aspirations, showing differential relations of intrinsic versus extrinsic life goals to performance and psychological health. In this introduction we also briefly discuss recent developments within SDT concerning mindfulness and vitality, and highlight the applicability of SDT within applied domains, including work, relationships, parenting, education, virtual environments, sport, sustainability, health care, and psychotherapy.
The purpose of this study was to develop a survey of general and diabetes-specific nutrition knowledge for youth with type 1 diabetes and their parents and to assess the survey's psychometric properties.
A multidisciplinary pediatric team developed the Nutrition Knowledge Survey (NKS) and administered it to youth with type 1 diabetes (n = 282, 49% females, 13.3 ± 2.9 years) and their parents (82% mothers). The NKS content domains included healthful eating, carbohydrate counting, blood glucose response to foods, and nutrition label reading. Higher NKS scores reflect greater nutrition knowledge (score range is 0-100%). In youths, glycemic control was assessed by A1C, and dietary quality was determined by the Healthy Eating Index-2005 (HEI-2005) derived from 3-day diet records. Validity was based on associations of NKS scores with A1C and dietary quality. Reliability was assessed using the Kuder-Richardson Formula 20 (KR-20) and correlations of domain scores to total score.
Mean NKS scores (23 items) were 56.9 ± 16.4% for youth and 73.4 ± 12.5% for parents. The KR-20 was 0.70 for youth and 0.59 for parents, representing acceptable internal consistency of the measure. In multivariate analysis, controlling for youth age, family income, parent education, diabetes duration, and insulin regimen, parent NKS scores were associated with corresponding youth A1C (β = -0.13, P = 0.03). Both parent (β = 0.20, P = 0.002) and youth (β = 0.25, P < 0.001) NKS scores were positively associated with youth HEI-2005 scores.
The NKS appears to be a useful measure of general and diabetes-specific nutrition knowledge for youth with type 1 diabetes and their parents.
Current reporting of intervention content in published research articles and protocols is generally poor, with great diversity of terminology, resulting in low replicability. This study aimed to extend the scope and improve the reliability of a 26-item taxonomy of behaviour change techniques developed by Abraham and Michie [Abraham, C. and Michie, S. (2008). A taxonomy of behaviour change techniques used in interventions. Health Psychology, 27(3), 379-387.] in order to optimise the reporting and scientific study of behaviour change interventions. Methods: Three UK study centres collaborated in applying this existing taxonomy to two systematic reviews of interventions to increase physical activity and healthy eating. The taxonomy was refined in iterative steps of (1) coding intervention descriptions, and assessing inter-rater reliability, (2) identifying gaps and problems across study centres and (3) refining the labels and definitions based on consensus discussions.
Labels and definitions were improved for all techniques, conceptual overlap between categories was resolved, some categories were split and 14 techniques were added, resulting in a 40-item taxonomy. Inter-rater reliability, assessed on 50 published intervention descriptions, was good (kappa = 0.79).
This taxonomy can be used to improve the specification of interventions in published reports, thus improving replication, implementation and evidence syntheses. This will strengthen the scientific study of behaviour change and intervention development.
The Internet is a trusted source of health information for growing majorities of Web users. The promise of online health interventions will be realized with the development of purely online theory-based programs for Web users that are evaluated for program effectiveness and the application of behavior change theory within the online environment. Little is known, however, about the demographic, behavioral, or psychosocial characteristics of Web-health users who represent potential participants in online health promotion research. Nor do we understand how Web users' psychosocial characteristics relate to their health behavior-information essential to the development of effective, theory-based online behavior change interventions.
This study examines the demographic, behavioral, and psychosocial characteristics of Web-health users recruited for an online social cognitive theory (SCT)-based nutrition, physical activity, and weight gain prevention intervention, the Web-based Guide to Health (WB-GTH).
Directed to the WB-GTH site by advertisements through online social and professional networks and through print and online media, participants were screened, consented, and assessed with demographic, physical activity, psychosocial, and food frequency questionnaires online (taking a total of about 1.25 hours); they also kept a 7-day log of daily steps and minutes walked.
From 4700 visits to the site, 963 Web users consented to enroll in the study: 83% (803) were female, participants' mean age was 44.4 years (SD 11.03 years), 91% (873) were white, and 61% (589) were college graduates; participants' median annual household income was approximately US $85,000. Participants' daily step counts were in the low-active range (mean 6485.78, SD 2352.54) and overall dietary levels were poor (total fat g/day, mean 77.79, SD 41.96; percent kcal from fat, mean 36.51, SD 5.92; fiber g/day, mean 17.74, SD 7.35; and fruit and vegetable servings/day, mean 4.03, SD 2.33). The Web-health users had good self-efficacy and outcome expectations for health behavior change; however, they perceived little social support for making these changes and engaged in few self-regulatory behaviors. Consistent with SCT, theoretical models provided good fit to Web-users' data (root mean square error of the approximation [RMSEA] < .05). Perceived social support and use of self-regulatory behaviors were strong predictors of physical activity and nutrition behavior. Web users' self-efficacy was also a good predictor of healthier levels of physical activity and dietary fat but not of fiber, fruits, and vegetables. Social support and self-efficacy indirectly predicted behavior through self-regulation, and social support had indirect effects through self-efficacy.
Results suggest Web-health users visiting and ultimately participating in online health interventions may likely be middle-aged, well-educated, upper middle class women whose detrimental health behaviors put them at risk of obesity, heart disease, some cancers, and diabetes. The success of Internet physical activity and nutrition interventions may depend on the extent to which they lead users to develop self-efficacy for behavior change, but perhaps as important, the extent to which these interventions help them garner social-support for making changes. Success of these interventions may also depend on the extent to which they provide a platform for setting goals, planning, tracking, and providing feedback on targeted behaviors.
This study tests a model derived from Self-Determination Theory (SDT) (Deci and Ryan, 2000) to explain the mechanisms by which non-modifiable factors influence dietary self-care in adolescents with type 1 diabetes (n = 289). SEM analyses adjusted for HbA1c levels revealed that longer diabetes duration and female gender were indicative of poorer dietary self-care. This effect was mediated by contextual and motivational factors as posited by SDT. Poorer autonomy support from practitioners was predominant in girls with longer diabetes duration. Perceived autonomous motivation and self-efficacy were indicative of greater autonomy support, and led to better dietary self-care.
Although there is developmental research on the prevalence of offline self-disclosure in pre-adolescence and adolescence, it is still unknown (a) how boys' and girls'online self-disclosure develops in this period and (b) how online and offline self-disclosure interact with each other. We formulated three hypotheses to explain the possible interaction between online and offline self-disclosure: the displacement, the rich-get-richer, and the rehearsal hypothesis. We surveyed 690 pre-adolescents and adolescents (10-17 years) at three time points with half-year intervals in between. We found significant gender differences in the developmental trajectories of self-disclosure. For girls, both online and offline self-disclosure increased sharply during pre- (10-11 years) and early adolescence (12-13 years), and then stabilized in middle and late adolescence. For boys, the same trajectory was found although the increase in self-disclosure started 2 years later. We found most support for the rehearsal hypothesis: Both boys and girls seemed to use online self-disclosure to rehearse offline self-disclosure skills. This particularly held for boys in early adolescence who typically have difficulty disclosing themselves offline.
Because parental recognition of overweight in young children is poor, we need to determine how best to inform parents that their child is overweight in a way that enhances their acceptance and supports motivation for positive change. This study will assess 1) whether weight feedback delivered using motivational interviewing increases parental acceptance of their child's weight status and enhances motivation for behaviour change, and 2) whether a family-based individualised lifestyle intervention, delivered primarily by a MInT mentor with limited support from "expert" consultants in psychology, nutrition and physical activity, can improve weight outcomes after 12 and 24 months in young overweight children, compared with usual care.
1500 children aged 4-8 years will be screened for overweight (height, weight, waist, blood pressure, body composition). Parents will complete questionnaires on feeding practices, physical activity, diet, parenting, motivation for healthy lifestyles, and demographics. Parents of children classified as overweight (BMI > or = CDC 85th) will receive feedback about the results using Motivational interviewing or Usual care. Parental responses to feedback will be assessed two weeks later and participants will be invited into the intervention. Additional baseline measurements (accelerometry, diet, quality of life, child behaviour) will be collected and families will be randomised to Tailored package or Usual care. Parents in the Usual care condition will meet once with an advisor who will offer general advice regarding healthy eating and activity. Parents in the Tailored package condition will attend a single session with an "expert team" (MInT mentor, dietitian, physical activity advisor, clinical psychologist) to identify current challenges for the family, develop tailored goals for change, and plan behavioural strategies that best suit each family. The mentor will continue to provide support to the family via telephone and in-person consultations, decreasing in frequency over the two-year intervention. Outcome measures will be obtained at baseline, 12 and 24 months.
This trial offers a unique opportunity to identify effective ways of providing feedback to parents about their child's weight status and to assess the efficacy of a supportive, individualised early intervention to improve weight outcomes in young children.
Australian New Zealand Clinical Trials Registry ACTRN12609000749202.
Meta-analyses of behavior change (BC) interventions typically find large heterogeneity in effectiveness and small effects. This study aimed to assess the effectiveness of active BC interventions designed to promote physical activity and healthy eating and investigate whether theoretically specified BC techniques improve outcome.
Interventions, evaluated in experimental or quasi-experimental studies, using behavioral and/or cognitive techniques to increase physical activity and healthy eating in adults, were systematically reviewed. Intervention content was reliably classified into 26 BC techniques and the effects of individual techniques, and of a theoretically derived combination of self-regulation techniques, were assessed using meta-regression.
Valid outcomes of physical activity and healthy eating.
The 122 evaluations (N = 44,747) produced an overall pooled effect size of 0.31 (95% confidence interval = 0.26 to 0.36, I(2) = 69%). The technique, "self-monitoring," explained the greatest amount of among-study heterogeneity (13%). Interventions that combined self-monitoring with at least one other technique derived from control theory were significantly more effective than the other interventions (0.42 vs. 0.26).
Classifying interventions according to component techniques and theoretically derived technique combinations and conducting meta-regression enabled identification of effective components of interventions designed to increase physical activity and healthy eating.
This study examines a conceptual model linking individual cognitive-behavioral and familial influences to adolescents' poor diet control as a health-risk behavior. A cross-sectional survey collected data from students enrolled in the secondary schools of the Middle Transylvanian Region, Romania (N = 1977). Self-administered questionnaires were used for data collection. Logistic regression analyses revealed that future-orientation, self-regulation, life purpose, parenting style and parental support were all significant protective factors against adolescents' poor diet control. While both individual and familial variables act as protection for girls and younger adolescents, for boys and older adolescents, only parental variables are significant.
Two diabetes education programs were compared to a control condition. Seventy-eighty type II (non-insulin-dependent) diabetic outpatients were randomly assigned to nutrition education, nutrition education plus social learning intervention, or wait-list control conditions. Both interventions involved five weekly meetings that focused on reducing calorie intake, increasing dietary fiber, and decreasing fat consumption. The social learning condition also included individualized goal setting and feedback and training in problem-solving and relapse prevention. Within-group analyses and between-group comparisons generally revealed greater improvement in targeted goals (e.g., calorie intake, fat reduction) among intervention conditions than the control condition. There were few differences in more distal measures of outcome such as weight or glycosylated hemoglobin. The social learning component did not improve outcome more than the nutrition education program. Possible reasons for the observed findings and the advantages and limitations of focused time-limited diabetes education efforts are discussed.
In this study the authors examined psychosocial variables as mediators for fruit and vegetable (FV) intake in a clustered, randomized effectiveness trial conducted in African American churches. The study sample included 14 churches (8 intervention and 6 control) with 470 participants from the intervention churches and 285 participants from the control churches. The outcome of FV intake and the proposed mediators were measured at baseline and at 6-month follow-up. Structural equation modeling indicated that the intervention had direct effects on social support, self-efficacy, and autonomous motivation; these variables also had direct effects on FV intake. Applying the M. E. Sobel (1982) formula to test significant mediated effects, the authors confirmed that social support and self-efficacy were significant mediators but that autonomous motivation was not. Social support and self-efficacy partially mediated 20.9% of the total effect of the intervention on changes in FV intake. The results support the use of strategies to increase social support and self-efficacy in dietary intervention programs.
Medical nutrition therapy (MNT) is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. It is, therefore, important at all levels of diabetes prevention. MNT is also an integral component of diabetes self-management education (or training). This position statement provides evidence-based recommendations and interventions for diabetes MNT. The previous position statement with accompanying technical review was published in 2002 and modified slightly in 2004. This statement updates previous position statements, focuses on key references published since the year 2000, and uses grading according to the level of evidence available...
Purpose:
Among adolescents with type 1 diabetes, disordered eating behaviors (DEBs) are more prevalent and have more serious health implications than in adolescents without diabetes, necessitating identification of modifiable correlates of DEB in this population. This study hypothesized that (1) autonomous motivation and (2) controlled motivation for healthy eating (i.e., eating healthfully because it is important to oneself vs. important to others, respectively) are associated with DEB among adolescents with type 1 diabetes. The third hypothesis was that baseline healthy eating self-efficacy moderates these associations.
Methods:
Adolescents with type 1 diabetes (n = 90; 13-16 years) participating in a behavioral nutrition intervention efficacy trial reported DEB, controlled and autonomous motivation, and self-efficacy at baseline, 6, 12, and 18 months. Linear-mixed models estimated associations of controlled and autonomous motivation with DEB, adjusting for treatment group, body mass index, socioeconomic status, age, and gender. Separate models investigated the interaction of self-efficacy with each motivation type.
Results:
Controlled motivation was positively associated with DEB (B = 2.18 ± .33, p < .001); the association was stronger for those with lower self-efficacy (B = 3.33 ± .55, p < .001) than those with higher self-efficacy (B = 1.36 ± .36, p < .001). Autonomous motivation was not associated with DEB (B = -.70 ± .43, p = .11).
Conclusions:
Findings identify controlled motivation for healthy eating as a novel correlate of DEB among adolescents with type 1 diabetes and show that self-efficacy can modify this association. Motivation and self-efficacy for healthy eating represent potential intervention targets to reduce DEB in adolescents with type 1 diabetes.
It is commonly believed that during adolescence children become increasingly influenced by peers at the expense of parents. To test the strength of this tendency with regards to healthy eating (fruit and vegetable intake), a survey was completed by 757 adolescent-parent dyads. Our theoretical framework builds on social cognitive theory and the focus theory of normative conduct, and data are analysed by means of confirmatory factor analysis and structural equation modelling. The study reveals that when it comes to adolescents' fruit and vegetable intake, parents remain the main influencer, with what they do (descriptive norms) being more important than what they say (injunctive norms). The study contributes to a more comprehensive understanding of what influences adolescent healthy eating, including the social influence of parents and friends, while also taking adolescent self-efficacy and outcome expectations into account. No previous studies have included all these factors in the same analysis. The study has a number of important implications: (1) healthy eating interventions should aim at strengthening self-efficacy and positive outcome expectations among adolescents, (2) the family context should be included when implementing healthy eating interventions and (3) parents' awareness of their influence on children's healthy eating should be reinforced.
Despite significant emphasis on nutrition, older children with diabetes demonstrate poor dietary quality. We tested the hypothesis that dietary quality in young children with type 1 diabetes (T1D) would be better than age-matched children in the US population. Dietary data from children with T1D (n = 67), ages 2-12 years, attending a pediatric diabetes clinic were compared to a nationally representative, age-matched sample from the National Health and Nutrition Examination Survey (NHANES, n = 1691). Multiple 24-hour dietary recalls were used. Recommended intakes were based on national guidelines, and dietary quality was assessed using the Healthy Eating Index-2005 (HEI-2005). More children with T1D were overweight or obese compared to children participating in NHANES (42% vs. 30%, p = 0.04). Greater proportions of children with T1D met daily recommendations for vegetables (22% vs. 13%, p = 0.03), whole grains (12% vs. 5%, p = 0.005), and dairy (55% vs. 36%, p = 0.001) compared to NHANES children while similar proportions met daily fruit recommendations (40% vs. 33%, p = 0.2). Less than one-third of all children limited total fat to recommended levels; children with T1D consumed more saturated fat than NHANES children (14% vs. 12% total energy intake, p = 0.0009). Fiber intakes were very low in both groups. Compared to NHANES children, children with T1D had higher HEI-2005 scores (59.6 vs. 49.7, p = 0.0006) primarily due to lower intakes of added sugars. The nutritional intake of young children with T1D remains suboptimal in the contemporary era of diabetes management. Despite focused nutrition management, young children with T1D consume high-fat, low-fiber diets comparable to youth in the general population.
In this study, we used the technique of meta-analysis to address two specific questions: First, is there a relationship between dietary intake and either a) nutrition knowledge or b) food- and nutrition-related attitudes? And second, if there is a relationship, what is the strength (effect-size) of the relationship between these variables? A review of the literature identified nine studies that met our criteria for inclusion in the meta-analysis. We coded the characteristics of each study and then analyzed the data by using two analytic techniques that combine the probability levels associated with a significance test of the relationship between the theoretical variables, and estimated the effect-size of the relationship between the variables. We found a significant relationship between nutrition knowledge and dietary intake and between food- and nutrition-related attitudes and dietary intake, but the effect-size estimates of these relationships were relatively small. These effect-size estimates may reflect a lack of consideration for the dimensionality of the theoretical variables, a lack of validity in the measurement of knowledge and attitudes, and/or a lack of correspondence between the measures of dietary intake and knowledge or attitudes.
Diet is a cornerstone of type 1 diabetes treatment, and poor diet quality may affect glycemic control and other health outcomes. Yet diet quality in children and adolescents with type 1 diabetes remains understudied.
To evaluate multiple indicators of diet quality in children and adolescents with type 1 diabetes and their associations with hemoglobin A1c and body mass index percentile.
In this cross-sectional study, participants completed 3-day diet records, and data were abstracted from participants' medical records. Diet quality indicators included servings of fruit, vegetables, and whole grains; Healthy Eating Index-2005 (HEI-2005) score; Nutrient Rich Foods 9.3 score (NRF 9.3); and glycemic index.
Children and adolescents with type 1 diabetes ≥1 year, aged 8 to 18 years, were recruited at routine clinic visits. Of 291 families enrolled, 252 provided diet data.
Associations of diet quality indicators to HbA1c and body mass index percentile were examined using analysis of covariance and multiple linear regression.
Participants demonstrated low adherence to dietary guidelines; mean HEI-2005 score was 53.4±11.0 (range=26.7 to 81.2). Intake of fruit, vegetables, and whole grains was less than half the recommended amount. Almost half of the participants' daily energy intake was derived from refined-grain products, desserts, chips, and sweetened beverages. Higher fruit (P=0.04) and whole-grain (P=0.03) intake were associated with lower HbA1c in unadjusted, but not adjusted analyses; vegetable intake, HEI-2005 score, NRF 9.3 score, and glycemic index were not associated with HbA1c. Higher fruit (P=0.01) and whole-grain (P=0.04) intake and NRF 9.3 score (P=0.02), but not other diet quality indicators, were associated with lower body mass index percentile in adjusted analyses.
Data demonstrate poor diet quality in youth with type 1 diabetes and provide support for the importance of diet quality for weight management. Future research on determinants of dietary intake and methods to promote improved diet quality would be useful to inform clinical care.
The associations among people's level of autonomy in regulating their eating behaviors, food patterns, and degree of obesity have not been investigated in a general adult population.
Our objectives were to cross-sectionally examine, in a nationally representative sample of adult New Zealand women, the associations between different styles of eating behavior regulation and body mass index (BMI), with specific food and eating habits as hypothesized mediators.
During May 2009, a sample of 2,500 New Zealand women aged 40 to 50 years was randomly selected from the nationwide electoral rolls. A 66% (n=1,601) participation rate was achieved. Potential participants were mailed a self-administered questionnaire containing the Regulation of Eating Behavior scale, questions on specific food and eating habits (frequency of binge eating, speed of eating, usual daily servings of fruits and vegetables, usual frequency of intake of several high-fat and/or high-sugar foods), and height and weight.
Univariate linear regression models were used to examine the associations among demographic, health and behavioral variables, and BMI. Multivariate linear regression models were developed to investigate the relationships between autonomous and controlled forms of eating behavior regulation and BMI, with specific food and eating habits as mediators.
After adjusting for potential confounders as well as specific food and eating habits that were potential mediators, BMI was statistically significantly lower by 2% (95% CI -2.7% to -1.4%; P<0.001) for every 10-unit increase in autonomous regulation, and statistically significantly higher by 1.4% (95% CI 0.4% to 2.3%; P=0.005) for every 10-unit increase in controlled regulation. The relationships between autonomous regulation and BMI as well as controlled regulation and BMI were only partially mediated by the specific food and eating habits measured.
Although the direction of causality requires confirmation, the results provide support for the applicability of Self-Determination Theory, and suggest that developing more autonomous motivation for eating behavior is likely to facilitate healthier food habits and lower BMI in middle-aged women.
Acknowledgments: Francesco Annan, Deborah Christie, Pamela Dyson, Tracey Parkin, Michael Riddell, Gail Spiegel. Conflicts of interest: The authors,have,declared,no,conflicts of interest. Editors of the,ISPAD Clinical Practice,Consensus,Guide- lines 2009 Compendium: Ragnar Hanas, Kim Donaghue, Georgeanna Klingensmith, and Peter Swift. This article is a chapter,in the ISPAD Clinical Practice Consensus Guidelines 2009 Compendium. The complete,set of guidelines can be found at www.ispad.org. The evidence,grading system,used,in the ISPAD Guidelines is the same,as that used,by the American
This paper addresses the issue of the self-regulation of eating from two different perspectives. One is strongly based on social cognitive theories, whereby it primarily emphasises functional and executive aspects of behaviour change, broadly named self-regulatory skills. The other assumes that humans are active and self-directed organisms and emphasises particular psychological processes associated with optimal functioning, with a special emphasis on motivation and perceived autonomy. Although these perspectives clearly do not represent opposing approaches, this article attempts to illustrate how they differ when applied to promoting health behaviour self-regulation, highlighting some implications for patient counselling. Primarily, this article demonstrates that motivation quality plays a central role in the capacity to adopt and, more importantly, to sustain healthful diets. Furthermore, it is asserted that health professionals can create more or less conducive environments to elicit patients' autonomous motivation. Long-lasting self-motivation is also described here as being closely aligned with the qualitative elements of motivation, namely the degree to which people perceive a sense of choice, find well-grounded meaning and feel volitional (i.e. make a conscious decision or choice) in their pursuits. Thus, interventions that include the essential elements of promoting a person's sense of ‘ownership’ over their eating routines, deeply valuing and identifying with the goals associated with eating choices, and displaying genuine interest in the experiences associated with selecting and preparing meals are most likely to succeed in the long-term. This paper presents empirical evidence that supports these propositions and suggests some resources for health professionals who may wish to explore these concepts further. Moving forward, it is hoped that readers may feel (volitionally!) engaged in exploring some of these ideas in future work, particularly when attempting to support patients and clients towards the successful self-regulation of their eating habits, their weight, and ultimately their health.
Self-determination theory (SDT) maintains that an understanding of human motivation requires a consideration of innate psychological needs for competence, autonomy, and relatedness. We discuss the SDT concept of needs as it relates to previous need theories, emphasizing that needs specify the necessary conditions for psychological growth, integrity, and well-being. This concept of needs leads to the hypotheses that different regulatory processes underlying goal pursuits are differentially associated with effective functioning and well-being and also that different goal contents have different relations to the quality of behavior and mental health, specifically because different regulatory processes and different goal contents are associated with differing degrees of need satisfaction. Social contexts and individual differences that support satisfaction of the basic needs facilitate natural growth processes including intrinsically motivated behavior and integration of extrinsic motivations, whereas those that forestall autonomy, competence, or relatedness are associated with poorer motivation, performance, and well-being. We also discuss the relation of the psychological needs to cultural values, evolutionary processes, and other contemporary motivation theories.
This article reviewed current findings on dietary adherence in youth with type 1 diabetes mellitus (T1DM), discussed factors predicting dietary adherence, and presented directions for future research. The included studies involved youth with T1DM, presented dietary adherence data specifically, and/or described usual dietary patterns in youth. Articles that explored predictors had to focus exclusively on dietary adherence. The final sample was 23 articles. Adherence articles were organized into two categories: eating behaviors and macronutrients and dietary recommendations. Rates of adherence to eating behaviors ranged from 21% to 95%. Studies examining macronutrients and dietary recommendations revealed higher than recommended intakes of fat and saturated fat and lower than recommended intakes of fruits, vegetables, and whole grains. Six studies investigated factors predicting dietary adherence. These studies revealed associations with child behavior problems and knowledge deficits. The available literature identified many youth with T1DM struggling with adherence and not meeting dietary guidelines for their disease. Future research should examine diet in youth exclusively on intensive insulin regimens, community-based predictors of diet, and the influence of mood on dietary adherence.
Compared to students attending regular high schools, alternative high school students are more likely to be racial/ethnic minorities, have higher levels of poverty, and higher rates of risky and poor health behaviors, including weight-related behaviors like limited fruit and vegetable intake. However, little is known about fruit/vegetable intake among alternative high school students. This study examined whether perceived barriers to healthy eating mediated the association between self-efficacy to eat healthy foods and fruit/vegetable consumption among alternative high school students. The cross-sectional study population consisted of students (N=145) attending six alternative high schools in the St Paul-Minneapolis, MN, area who were participants in an obesity prevention pilot study and completed a baseline survey during fall 2006. Mixed model linear regression, adjusting for sociodemographic characteristics, was used to test a series of regression models performed according to mediation analysis procedures. Students' mean age was 17.3 years; 52% were male, 63% were low-income, and 61% were from racial/ethnic minorities. Students reported a mean fruit/vegetable intake of 3.6 servings per day, mean self-efficacy to eat healthy score of 22.2 (range 3 to 35), and mean barriers to eating healthy score of 6.9 (range 3 to 13). Perceived barriers to healthy eating fully mediated the relationship between self-efficacy and fruit/vegetable consumption (Sobel test statistic 2.7, P=0.007). Interventions targeting the dietary practices of alternative high school students should include components to decrease perceived barriers as a way to increase self-efficacy and ultimately fruit/vegetable intake.
Behavior change theories and models, validated within the field of dietetics, offer systematic explanations for nutrition-related behavior change. They are integral to the nutrition care process, guiding nutrition assessment, intervention, and outcome evaluation. The American Dietetic Association Evidence Analysis Library Nutrition Counseling Workgroup conducted a systematic review of peer-reviewed literature related to behavior change theories and strategies used in nutrition counseling. Two hundred fourteen articles were reviewed between July 2007 and March 2008, and 87 studies met the inclusion criteria. The workgroup systematically evaluated these articles and formulated conclusion statements and grades based upon the available evidence. Strong evidence exists to support the use of a combination of behavioral theory and cognitive behavioral theory, the foundation for cognitive behavioral therapy (CBT), in facilitating modification of targeted dietary habits, weight, and cardiovascular and diabetes risk factors. Evidence is particularly strong in patients with type 2 diabetes receiving intensive, intermediate-duration (6 to 12 months) CBT, and long-term (>12 months duration) CBT targeting prevention or delay in onset of type 2 diabetes and hypertension. Few studies have assessed the application of the transtheoretical model on nutrition-related behavior change. Little research was available documenting the effectiveness of nutrition counseling utilizing social cognitive theory. Motivational interviewing was shown to be a highly effective counseling strategy, particularly when combined with CBT. Strong evidence substantiates the effectiveness of self-monitoring and meal replacements and/or structured meal plans. Compelling evidence exists to demonstrate that financial reward strategies are not effective. Goal setting, problem solving, and social support are effective strategies, but additional research is needed in more diverse populations. Routine documentation and evaluation of the effectiveness of behavior change theories and models applied to nutrition care interventions are recommended.
This cross-sectional study aimed to describe parents' views regarding self-efficacy to influence children's eating and sedentary behaviours at two time points in early childhood, and to examine associations between these views and children's eating and sedentary behaviours.
Mothers of 1-year (n=60) and 5-year-old children (n=80) were recruited through Maternal and Child Health Centres and kindergartens in Victoria, Australia. Mothers reported children's dietary intake, television viewing and perceptions of their self-efficacy regarding children's eating and sedentary behaviours.
Overall, 5-year-old children consumed significantly more energy-dense food and drink and spent significantly more time viewing TV/DVD and video. Mothers of 1-year-olds were significantly more likely to report they felt confident to limit child's consumption of non-core foods/drinks, and to limit screen access (p<0.001). Measures of maternal self-efficacy were directly associated with 5-year-old children's water (p<0.05), and fruit and vegetable consumption (p<0.005), and with 1-year-old children's vegetable consumption (p<0.05), and were inversely associated with cordial and cake consumption (p<0.05). Maternal self-efficacy to limit viewing time was inversely associated with screen-time exposure in both age groups (p<0.01).
This study suggests that mother's self-efficacy regarding limiting non-core foods/drinks and limiting screen-time exposures may decline during the first few years of a child's life. Higher maternal self-efficacy was associated with children having more obesity protective eating and sedentary behaviours at both ages. Interventions to support the development of healthy lifestyle behaviours may be most effective if they target mothers' self-efficacy in these domains early in their child's life.
Identity and Self-efficacy Theories were used to examine the relationship between healthy-eater identity, self-efficacy for healthy eating and healthy eating. Measures of healthy-eater identity, perception of healthy eating, nutrition knowledge, self-efficacy for both intake of fruits and vegetables and foods of low nutritional value were completed by 101 university students and staff. Two weeks later, participants recalled recent consumption of (a) fruits and vegetables and (b) foods of low nutritional value. For both eating outcomes, healthy-eater identity was a significant predictor after controlling for nutrition knowledge. The addition of self-efficacy improved prediction in the case of both eating outcomes.
The purpose of this study is to review the literature on usual dietary intake in children with type 1 diabetes (T1D) and to discuss approaches to promote dietary change with potential efficacy.
Search strategies included a MEDLINE search for English-language articles that estimated usual dietary intake in children with T1D and a screening of the reference lists from original studies. The keywords used were diet, dietary intake, nutrition, type 1 diabetes, children, adolescents, and youth. Studies were included if they were observational, contained a sample of children with T1D, and estimated usual dietary intake.
Nine studies fulfilled the criteria (6 US, 3 European). Of the 4 studies with a control group, 3 reported that both total fat and saturated fat intake were higher in the children with T1D. Six studies examined the percent of total calories from saturated fat; mean intake ranged from 11 to 15%, exceeding ADA recommendations (< 7%). Fruit, vegetable, and fiber intakes were low among children with T1D. No prior studies have addressed dietary change in this population. The behavior-change literature suggests that nutrition education alone is unlikely to be adequate, but that incorporation of behavioral approaches offers potential efficacy in promoting healthful dietary change.
Children with T1D are not meeting dietary guidelines, and in some areas their diets are less healthful than children without diabetes. As these dietary behaviors may affect the risk of long-term complications, the incorporation of behavioral approaches promoting healthy eating into routine clinical practice is warranted.
The present article presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of per- sonal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of ob- stacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from four principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. The more de- pendable the experiential sources, the greater are the changes in perceived self- efficacy. A number of factors are identified as influencing the cognitive processing of efficacy information arising from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and be- havioral changes. Possible directions for further research are discussed.
The capacity to exercise control over the nature and quality of one's life is the essence of humanness. Human agency is characterized by a number of core features that operate through phenomenal and functional consciousness. These include the temporal extension of agency through intentionality and forethought, self-regulation by self-reactive influence, and self-reflectiveness about one's capabilities, quality of functioning, and the meaning and purpose of one's life pursuits. Personal agency operates within a broad network of sociostructural influences. In these agentic transactions, people are producers as well as products of social systems. Social cognitive theory distinguishes among three modes of agency: direct personal agency, proxy agency that relies on others to act on one's behest to secure desired outcomes, and collective agency exercised through socially coordinative and interdependent effort. Growing transnational embeddedness and interdependence are placing a premium on collective efficacy to exercise control over personal destinies and national life.
By altering dietary behaviors, nutrition interventions during adolescence have the potential of affecting children at that time and later in life. The majority of interventions implemented in the teen years have occurred in schools, but other intervention sites have included after-school programs, summer camps, community centers, libraries, and grocery stores. Programs with successful outcomes have tended to be behaviorally based, using theories for the developmental framework; included an environmental component; delivered an adequate number of lessons; and emphasized developmentally appropriate strategies. One planning method that can be used in the development of nutrition interventions is Intervention Mapping. The steps of Intervention Mapping include conducting a needs assessment, developing proximal program objectives, mapping appropriate strategies and methods to address the objectives, planning the program design, planning program adoption and implementation, and evaluation. The use of intervention-planning techniques, coordination of nutrition and physical education interventions, using technological advances such as CD-ROMs, incorporation of policy changes into intervention efforts, and dissemination of effective programs are all trends that will influence the future development of effective nutrition programs for adolescents.
To provide national estimates of the frequency and determinants of adolescents' consumption of fruits, vegetables, and dairy foods.
Analyses were based on 18,177 adolescents in the first interview of the National Longitudinal Study of Adolescent Health. Multivariate logistic regressions provide estimates of the unique contribution of sociodemographic characteristics, body weight perception, and parental influences on adolescent food consumption.
Almost one in five adolescents reported skipping breakfast the previous day. A large percentage of adolescents reported eating less than the recommended amount of vegetables (71%), fruits (55%), and dairy foods (47%). Adolescents with better-educated parents had better consumption patterns than those with less-educated parents. Consumption patterns differed significantly by race. Adolescents who perceived themselves to be overweight were significantly more likely to have poor consumption patterns. Parental presence at the evening meal was associated with a lower risk of poor consumption of fruits, vegetables, and diary foods as well as the likelihood of skipping breakfast.
Parental presence at the evening meal is positively associated with adolescents' higher consumption of fruits, vegetables, and dairy foods. Nutrition and health professionals should educate parents about the role of family mealtimes for healthy adolescent nutrition.
This article examines health promotion and disease prevention from the perspective of social cognitive theory. This theory posits a multifaceted causal structure in which self-efficacy beliefs operate together with goals, outcome expectations, and perceived environmental impediments and facilitators in the regulation of human motivation, behavior, and well-being. Belief in one's efficacy to exercise control is a common pathway through which psychosocial influences affect health functioning. This core belief affects each of the basic processes of personal change--whether people even consider changing their health habits, whether they mobilize the motivation and perseverance needed to succeed should they do so, their ability to recover from setbacks and relapses, and how well they maintain the habit changes they have achieved. Human health is a social matter, not just an individual one. A comprehensive approach to health promotion also requires changing the practices of social systems that have widespread effects on human health.
Less than 50% of US adults follow dietary recommendations. Despite these figures, little research has focused on improving adherence to a therapeutic eating plan. The research utilizing self-efficacy theory has shown promise for improving behavior change and treatment adherence. This study evaluated the efficacy of a telephone-delivered, self-efficacy based intervention designed to improve adherence to a cholesterol-lowering diet among those self-reporting nonadherence. Sixty-five men and women diagnosed with hypercholesterolemia were randomized to usual care or treatment, which consisted of six intervention sessions delivered every 2 weeks by telephone and focused on how to manage eating behavior in challenging situations. There were significant between group differences post intervention in the consumption of saturated fat (P < .001) and cholesterol (P = .040) with the intervention group improving their dietary adherence. Significant change (P = .013) occurred over time in low-density lipoprotein-cholesterol (LDL-C) in the intervention group. No changes were observed in self-efficacy between groups, suggesting that self-efficacy was not a mediator of the improved adherence. The study's findings confirm that the telephone is a useful tool to deliver adherence-enhancing interventions.
Motivational interviewing (MI), a method of augmenting an individual's motivation to change problematic behaviours, is a patient-centred counselling style that seeks to help patients resolve ambivalence about behaviour change. MI has successfully been used in the field of addictions and has recently received increased interest as a means of promoting treatment adherence in physical health care settings. This systematic review is aimed to evaluate the effectiveness of MI interventions in physical health care settings.
Electronic databases were searched for articles specifying the use of 'motivational interviewing' in physical health care settings between 1966 and April 2004. Fifty-one relevant abstracts were yielded and data was extracted from eight relevant selected studies.
Eight studies were identified in the fields of diabetes, asthma, hypertension, hyperlipidaemia, and heart disease. The majority of studies found positive results for effects of MI on psychological, physiological, and life-style change outcomes. Problems with research in this area include: small sample sizes, lack of power, use of disparate multiple outcomes, inadequate validation of questionnaires, poorly-defined therapy and training.
While MI has high face validity across a number of domains in physical health care settings, the general quality of trials in this area is inadequate and therefore recommendations for its dissemination in this area cannot yet be made. More research into MI applied to health behaviour change is urgently required.
Most tests of cognitively oriented theories of health behavior are based on correlational data. Unfortunately, such tests are often biased, overestimating the accuracy of the theories they seek to evaluate. These biases are especially strong when studies examine health behaviors that need to be performed repeatedly, such as medication adherence, diet, exercise, and condom use. Several misleading data analysis procedures further exaggerate the theories' predictive accuracy. Because correlational designs are not adequate for deciding whether a particular construct affects behavior or for testing one theory against another, most of the literature aiming to test these theories tells us little about their validity or completeness. Neither does the existing empirical literature support decisions to use these theories to design interventions. In addition to discussing problems with correlational data, this article offers ideas for alternative testing strategies.
Understanding the need for and accessibility to healthier foods have not improved the overall diets of the U.S. population. Social cognitive theory (SCT) may explain how other variables, such as self-regulation and self-efficacy, may be key to integrating healthier nutrition into U.S. lifestyles.
To determine how SCT accounts for the nutritional content of food purchases and consumption among adults in a health promotion study.
Participants were 712 churchgoers (18% African American, 66% female, 79% overweight or obese) from 14 churches in southwestern Virginia participating in the baseline phase of a larger health promotion study. Data were collected on the nutrition related social support, self-efficacy, outcome expectations, and self-regulation components of SCT, as well as on the fat, fiber, fruit, and vegetable content of food-shopping receipts and food frequency questionnaires. These data were used to test the fit of models ordered as prescribed by SCT and subjected to structural equation analysis.
SCT provided a good fit to the data explaining 35%, 52%, and 59% of observed variance in percent calories from fat, fiber g/1000 kcals and fruit and vegetable servings/1000 kcals. Participants' age, gender, socioeconomic status, social support, self-efficacy, negative outcome expectations, and self-regulation made important contributions to their nutrition behavior -- a configuration of influences consistent with SCT.
These results suggest a pivotal role for self-regulatory behavior in the healthier food choices of adults. Interventions effective at garnering family support, increasing nutrition related self-efficacy, and overcoming negative outcome expectations should be more successful at helping adults enact the self-regulatory behaviors essential to buying and eating healthier foods.
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