Amore Lucia, Buchthal Opal Vanessa, Banna Jinan C
1Department of Human Nutrition, Food, and Animal Sciences, College of Tropical Agriculture and Human Resources, Agricultural Sciences 216, University of Hawaii at Manoa, 1955 East-West Road, Honolulu, HI 96822 USA.
2Office of Public Health Studies, University of Hawaii at Manoa, 1960 East-West Road, Honolulu, HI 96822 USA.
BMC Nutr. 2019 Feb 22;5:16. doi: 10.1186/s40795-019-0280-0. eCollection 2019.
To design effective nutrition education interventions for college students, research is needed to determine the factors influencing food choices. The purpose of this study was to identify perceived barriers and enablers of healthy eating in college students ages 18-24 at the University of Hawai'i at Mānoa.
Prior to conducting focus groups, an interview guide was developed based on a literature review of relevant studies. The interview guide was successfully tested in the first focus group and used in the rest of the focus groups. Eleven focus groups with group sizes of two to six were conducted ( = 44). Focus groups were audio-recorded and transcribed. Transcripts were coded in NVIVO11 using content analysis, and additional codes were added to the codebook based on emergent ideas from the transcripts. After completion of the final codebook, transcripts were recoded with the new codebook. Final code counts were used to identify overarching ideas based on the socio-ecological model of health, consisting of four levels of influence: individual (intrapersonal), social environmental (interpersonal), physical environmental (community settings), and macrosystem (societal).
The largest barriers according to level of influence in the socio-ecological model were nutrition knowledge deficit (individual), peer pressure (social environmental), unsupportive institutional environment (physical environmental), and cost (macrosystem). The largest enablers were nutrition knowledge (individual), parental influence (social environmental), an institutional environment with consistent healthy offerings (physical environmental), and social media (macrosystem). Some factors served as barriers for some participants and enablers for others, such as parental influence.
Factors such as individual knowledge and parental support were cited as having a positive influence in promoting healthy eating, while factors such as the cost of living and food availability at college serve as barriers even for motivated students. Results from this study identify potential areas of intervention, such as improving nutrition knowledge (individual), offering more healthy options (physical environmental), or reducing cost of food (macrosystem). However, more research is needed to identify which level of intervention may be most effective in changing food habits, and which barriers or enablers are deciding factors in determining this population's food choices.
为设计针对大学生的有效营养教育干预措施，需要开展研究以确定影响食物选择的因素。本研究的目的是确定夏威夷大学马诺阿分校18至24岁大学生健康饮食的感知障碍和促进因素。
在进行焦点小组讨论之前，根据相关研究的文献综述制定了一份访谈指南。该访谈指南在第一个焦点小组中成功进行了测试，并在其余焦点小组中使用。共进行了11个焦点小组讨论，每组人数为2至6人（n = 44）。焦点小组讨论进行了录音和转录。转录本在NVIVO11中使用内容分析法进行编码，并根据转录本中出现的新想法在编码手册中添加了额外的代码。在完成最终编码手册后，使用新的编码手册对转录本进行重新编码。最终的代码计数用于根据健康的社会生态模型确定总体想法，该模型由四个影响层面组成：个体（个人内部）、社会环境（人际）、物理环境（社区环境）和宏观系统（社会）。
根据社会生态模型中的影响层面，最大的障碍是营养知识不足（个体层面）、同伴压力（社会环境层面）、不支持的制度环境（物理环境层面）和成本（宏观系统层面）。最大的促进因素是营养知识（个体层面）、父母的影响（社会环境层面）、提供一致健康食品的制度环境（物理环境层面）和社交媒体（宏观系统层面）。一些因素对一些参与者来说是障碍，而对另一些参与者来说是促进因素，例如父母的影响。
个体知识和父母支持等因素被认为对促进健康饮食有积极影响，而生活成本和大学食物供应等因素即使对有积极性的学生来说也是障碍。本研究结果确定了潜在的干预领域，例如提高营养知识（个体层面）、提供更多健康选择（物理环境层面）或降低食品成本（宏观系统层面）。然而，需要更多的研究来确定哪种干预层面在改变饮食习惯方面可能最有效，以及哪些障碍或促进因素是决定该人群食物选择的决定性因素。
