Liu Qijiao, Xu Huanyu, Yuan Zihao, Yu Lan, Shang Ruizhe, Tang Wanjie, Li Yuchen, Li Shiying, Liu Qiaolan
Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, P.R. China.
Longquanyi District of Chengdu Maternity and Child Health Care Hospital, Chengdu, P.R. China.
BMC Public Health. 2025 Jan 3;25(1):28. doi: 10.1186/s12889-024-21101-8.
The promotion of healthy dietary behaviors in adolescence is critical, which have long-term implications for lifelong health. Integration is an important method for improving limited theories of dietary behavior change. The present study proposes an integrated model aimed at identifying the diverse determinants of healthy dietary behaviors in adolescents and assesses its stage-specific nature as the potential for effective interventions.
A two-year prospective study was conducted in southwest China, involving a sample of 1990 adolescents (mean age: 15.06 years) from two randomly selected secondary schools. A total of 765 adolescents were exposed to the three-phase interventions while 1225 adolescents participated as the control group. The interventions aimed to promote healthy dietary behaviors in adolescents, which included health education sessions and health handbooks targeting specific constructs of the integrated model. The follow-up surveys after corresponding interventions were performed every six months. Self-reported frequency of healthy dietary behaviors, psychological constructs integrated from Health Action Process Approach, Health Belief Model, and Theory of Planned Behavior, as well as anxiety symptoms were measured.
Within structural equation modeling controlling for past behavior, the integrated model accounted for 61.7% variance of behavioral intentions and 19.1% variance of healthy dietary behaviors, and showed discontinuity patterns across behavior change phases. The pivotal constructs included outcome expectancies, perceived severity, subjective norms, action self-efficacy, behavioral intentions, action planning, and maintenance self-efficacy. Anxiety was an emotional barrier in the dietary behavior modification (β = -0.113, P < .001). Interventions within the staged integrated model, led to increased adoption of healthy dietary behaviors in intervention group compared to control group (33.40% vs. 25.70%, P < .05), indicating certain effectiveness, particularly in targeting action self-efficacy (stronger direct effects on behavioral intentions and maintenance self-efficacy, β = 0.489 to 0.704, P < .001).
The staged integrated model provides a detailed understanding of the determinants of healthy dietary behaviors in adolescence, highlighting anxiety as an emotional barrier that impedes positive cognition and healthy dietary behaviors. It provides valuable guidance for future interventions targeting specific constructs across behavior change phases, with particular emphasis on enhancing action self-efficacy.
在青少年时期促进健康的饮食行为至关重要，这对终身健康具有长期影响。整合是改善有限的饮食行为改变理论的一种重要方法。本研究提出了一个综合模型，旨在确定青少年健康饮食行为的多种决定因素，并评估其阶段特异性本质作为有效干预的潜力。
在中国西南部进行了一项为期两年的前瞻性研究，样本包括从两所随机选择的中学抽取的1990名青少年（平均年龄：15.06岁）。共有765名青少年接受了三阶段干预，而1225名青少年作为对照组参与。干预旨在促进青少年的健康饮食行为，包括针对综合模型特定结构的健康教育课程和健康手册。在相应干预后每六个月进行一次随访调查。测量了自我报告的健康饮食行为频率、从健康行动过程方法、健康信念模型和计划行为理论整合的心理结构以及焦虑症状。
在控制过去行为的结构方程模型中，综合模型解释了行为意图61.7%的方差和健康饮食行为19.1%的方差，并在行为改变阶段呈现出不连续模式。关键结构包括结果期望、感知严重性、主观规范、行动自我效能、行为意图、行动计划和维持自我效能。焦虑是饮食行为改变中的一个情感障碍（β = -0.113，P <.001）。与对照组相比，分阶段综合模型内的干预导致干预组中健康饮食行为的采用增加（33.40%对25.70%，P <.05），表明有一定效果，特别是针对行动自我效能（对行为意图和维持自我效能有更强的直接影响，β = 0.489至0.704，P <.001）。
分阶段综合模型提供了对青少年健康饮食行为决定因素的详细理解，突出了焦虑作为阻碍积极认知和健康饮食行为的情感障碍。它为未来针对行为改变阶段特定结构的干预提供了有价值的指导，特别强调提高行动自我效能。
