Sharma Manoj, Johansen Christopher, Batra Ravi, Dai Chia-Liang, Kapukotuwa Sidath, Assoumou Bertille, Batra Kavita
Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA.
Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA.
Int J Environ Res Public Health. 2024 Jan 20;21(1):115. doi: 10.3390/ijerph21010115.
Eating outside-of-home (EOH) is one of the main changes in lifestyle that occurred worldwide in the past few decades. Given that EOH behavior is influenced by individual and contextual factors, the utilization of a theory seems to be suitable in analyzing this health behavior. The fourth-generation theory multi-theory model (MTM) is designed exclusively for health behavior change at the individual and community levels. Therefore, the purpose of this analytical cross-sectional study was to investigate EOH behavior by using the MTM among a nationally representative sample in the United States (US). Data for this study were collected from April-May 2023 via a 61-item psychometric valid, web-based, structured survey disseminated via Qualtrics. Chi-square/Fisher's exact tests were used to compare categorical data, whereas the independent-samples -test was used to compare the mean scores of MTM constructs across groups. Pearson correlation analysis was performed for the intercorrelation matrix between the MTM constructs and hierarchical regression models were built to predict the variance in the initiation and sustenance by certain predictor variables beyond demographic characteristics. The values in the multiple comparisons were calculated by using adjusted residuals. Among a total of 532 survey respondents, 397 (74.6%) indicated being engaged in EOH at least twice a week, whereas 135 (25.4%) reported not being engaged in EOH. People who were engaged in EOH were younger (mean age = 42.25 ± 17.78 years vs. 55.89 ± 19.43 years) African American, (15.9% vs. 6.7%, = 0.01), single or never married, (34.0% vs. 23.0%, = 0.02), had a graduate degree (9.6% vs. 3.7%, = 0.03), and were employed (72.0% vs. 34.8%, < 0.001) as opposed to those who reported not being engaged in eating outside the home. Among the MTM constructs of initiation, "behavioral confidence" and "changes in the physical environment" were the significant predictors of initiating a reduction in EOH behavior and explained 48% of the variance in initiation. Among the MTM constructs of sustenance, "emotional transformation" and "changes in the social environment" were the significant predictors of sustaining a reduction in EOH behavior and explained 50% of the variance in sustenance. This study highlights a need to design MTM-based educational interventions that promote in-home eating instead of frequent EOH for health, family bonding, economic, and other reasons.
外出就餐是过去几十年来在全球范围内出现的主要生活方式变化之一。鉴于外出就餐行为受个体和环境因素影响，运用一种理论似乎适合分析这种健康行为。第四代理论多理论模型（MTM）专为个体和社区层面的健康行为改变而设计。因此，这项分析性横断面研究的目的是在美国全国代表性样本中运用MTM来调查外出就餐行为。本研究的数据于2023年4月至5月通过一项由Qualtrics传播的、基于网络的、包含61个项目且心理测量有效的结构化调查问卷收集。卡方检验/费舍尔精确检验用于比较分类数据，而独立样本t检验用于比较各群体间MTM构念的平均得分。对MTM构念之间的相互关联矩阵进行了皮尔逊相关分析，并构建了分层回归模型，以预测除人口统计学特征外某些预测变量在启动和维持方面的方差。多重比较中的p值通过调整后的残差计算得出。在总共532名调查对象中，397人（74.6%）表示每周至少外出就餐两次，而135人（25.4%）报告未外出就餐。外出就餐的人更年轻（平均年龄=42.25±17.78岁，而未外出就餐者为55.89±19.43岁）、非裔美国人比例更高（15.9%对6.7%，p=0.01）、单身或从未结婚的比例更高（34.0%对23.0%，p=0.02）、拥有研究生学位的比例更高（9.6%对3.7%，p=0.03）且就业比例更高（72.0%对34.8%，p<0.001），与那些报告未外出就餐的人形成对比。在启动的MTM构念中，“行为信心”和“物理环境变化”是启动减少外出就餐行为的显著预测因素，解释了启动方面48%的方差。在维持的MTM构念中，“情感转变”和“社会环境变化”是维持减少外出就餐行为的显著预测因素，解释了维持方面50%的方差。本研究强调需要设计基于MTM的教育干预措施，出于健康、家庭关系、经济及其他原因，促进在家就餐而非频繁外出就餐。
