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The theory of planned behavior and implementation intentions to describe and improve fruit and vegetable intake in women of low socioeconomic status

OBJECTIVE: The Theory of Planned Behavior (TPB) and implementation intentions have been used effectively to explain and influence diet in middle-class, but not exclusively low SES populations. Furthermore, dietary research among low SES populations requires intake measures that are feasible and acceptable. Using three lines of research we evaluated 1) the utility of the TPB to explain fruit and vegetable (FV) intake, 2) efficacy, feasibility and acceptability of an implementation intention intervention to improve FV intake, and 3) agreement, feasibility, and acceptability of 2 dietary intake measures of FV intake in low SES women. DESIGN: Participants were adult female residents of Boston Public Housing. Study 1: Using a cross-sectional survey (n=144), we evaluated the utility of the TPB to explain FV intake. Study 2: We conducted a pilot randomized controlled implementation intention intervention to promote FV intake (n=20), and semi-structured interviews to evaluate feasibility and acceptability of the intervention (n=8). Study 3: We administered 2 24-hour recalls, a food frequency questionnaire (FFQ), and structured interviews (n=36) to determine agreement, feasibility and acceptability dietary intake measures. RESULTS: Study 1: The TPB construct perceived behavioral control significantly predicted intention to consume FV (OR=2.55,95%CI:1.23,5.27) and with BMI, FV intake (βPBC=0.37,t(1)=2.29,p=0.0235; βBMI= -0.02,t(1)= -2.41,p=0.0174; R2=.08,F[2,130]=5.72,p=0.0042). Study 2: Feasibility goals were met for retention and days to follow up, but not recruitment. Participants characterized the intervention as enjoyable. Limited hypothesis testing showed no significant increase in mean FV intake within (control (n=11):+0.50, 95% CI:-0.56,1.58 servings; intervention (n=9):+0.17, 95% CI:-0.85,1.20 servings) or between groups (control group +0.33, 95% CI:-1.06,1.73 servings). Study 3: Feasibility targets were met for contacts and retention, but not for enrollment. There was no significant association between 24-hr recall and FFQ measures for fruit (r=0.32, p=0.09) or vegetable (r=0.16, p=0.40) intake and no marked preference for method (35% FFQ; 31% 24-hour recall). CONCLUSION: The TPB may be useful to explain FV intake. Although acceptable, an implementation intention intervention may not be feasible or effective to influence FV intake. We demonstrated limited feasibility and association but generally equal preference between dietary measures of FV intake in low SES women

The theory of planned behavior and implementation intentions to describe and improve fruit and vegetable intake in women of low socioeconomic status

OBJECTIVE: The Theory of Planned Behavior (TPB) and implementation intentions have been used effectively to explain and influence diet in middle-class, but not exclusively low SES populations. Furthermore, dietary research among low SES populations requires intake measures that are feasible and acceptable. Using three lines of research we evaluated 1) the utility of the TPB to explain fruit and vegetable (FV) intake, 2) efficacy, feasibility and acceptability of an implementation intention intervention to improve FV intake, and 3) agreement, feasibility, and acceptability of 2 dietary intake measures of FV intake in low SES women. DESIGN: Participants were adult female residents of Boston Public Housing. Study 1: Using a cross-sectional survey (n=144), we evaluated the utility of the TPB to explain FV intake. Study 2: We conducted a pilot randomized controlled implementation intention intervention to promote FV intake (n=20), and semi-structured interviews to evaluate feasibility and acceptability of the intervention (n=8). Study 3: We administered 2 24-hour recalls, a food frequency questionnaire (FFQ), and structured interviews (n=36) to determine agreement, feasibility and acceptability dietary intake measures. RESULTS: Study 1: The TPB construct perceived behavioral control significantly predicted intention to consume FV (OR=2.55,95%CI:1.23,5.27) and with BMI, FV intake (βPBC=0.37,t(1)=2.29,p=0.0235; βBMI= -0.02,t(1)= -2.41,p=0.0174; R2=.08,F[2,130]=5.72,p=0.0042). Study 2: Feasibility goals were met for retention and days to follow up, but not recruitment. Participants characterized the intervention as enjoyable. Limited hypothesis testing showed no significant increase in mean FV intake within (control (n=11):+0.50, 95% CI:-0.56,1.58 servings; intervention (n=9):+0.17, 95% CI:-0.85,1.20 servings) or between groups (control group +0.33, 95% CI:-1.06,1.73 servings). Study 3: Feasibility targets were met for contacts and retention, but not for enrollment. There was no significant association between 24-hr recall and FFQ measures for fruit (r=0.32, p=0.09) or vegetable (r=0.16, p=0.40) intake and no marked preference for method (35% FFQ; 31% 24-hour recall). CONCLUSION: The TPB may be useful to explain FV intake. Although acceptable, an implementation intention intervention may not be feasible or effective to influence FV intake. We demonstrated limited feasibility and association but generally equal preference between dietary measures of FV intake in low SES women

Experiences of LGBTQ-identifying students, interns, and practitioners of dietetics

Individuals who identify as lesbian, gay, bisexual, transgender and/or queer (LGBTQ) currently comprise over five percent of the population in America. It is unknown how many dietetics students, interns, or practitioners identify as LGBTQ as these data are not collected by the Academy of Nutrition and Dietetics nor its “sister” organizations. Research suggests that LGBTQ-identifying folx, experience higher rates of anxiety, depression, stigmatization, discrimination and isolation and many have unmet healthcare needs. This holds for LGBTQ-identified individuals studying and practicing in healthcare professions but to date there have been no studies of the dietetics profession.  To explore the experiences of LGBTQ-identifying dietetics students, interns and practitioners we conducted a mixed-methods study grounded in Feminist Standpoint theory. National convenience and snowball sampling strategies generated n=131 students, interns and professionals of ACEND-accredited programs for our survey and n=10 for our semi-structured interviews. Qualitative analyses identified themes of overt and covert “underminers” of success including heteronormative assumptions/talk, misgendering, microaggressions, self-editing and closeting, and identified a lack of adequate LGBTQ-related healthcare content in academics/training. Supporters of success included people/groups with supportive characteristics, therapists/mental health professionals, and passion for the field.  Survey data indicated significant differences between heterosexual and non-heterosexual respondents to a number of questions including homosexuality in society, awareness of LGBTQ community experiences, importance of academic content/training on nutrition assessment/care of LGBTQ-identified folx and responsibility for advocacy for LGBTQ-identifying patients/clients. Our results indicate need for better data collection, improved coursework/training on inclusion and greater content on nutrition/healthcare needs for LGBTQ-identifying patients and clients.Published versio

The role of attitude, control and intention to explain fruit and vegetable intake among racial/ethnic minority women with low socioeconomic status

OBJECTIVE: Fruit and Vegetable (FV) intake-a modi able risk factor for chronic diseases-is lower among racial/ethnic minorities and low Socio- Economic Status (SES) groups when compared to other populations. The Theory of Planned Behavior (TPB) is one theoretical model studied to explain and in uence individual health behaviors, including FV intake, in middle class populations, but not exclusively in diverse, low SES groups. This cross-sectional study evaluated the utility of select TPB variables to explain intention to consume and intake of FV in this population. DESIGN: Demographics, BMI, select TPB variables, and FV intake were measured via survey. Bivariate analyses were conducted to explore relationships between variables. Hierarchical regression analyses were used to t two models: one to explain intention and one to explain behavior with regard to FV vegetable intake. RESULTS: Participants (n=114) age 25-69 years and were mostly African American/Black and Hispanic (21.9% and 73%, respectively). The TPB variable perceived behavioral control was the only signi cant predictor of intention to consume FV (OR=2.55, 95% CI OR: 1.23, 5.27), and with BMI, FV intake (R2=0.08; F [2,130] =5.72, p=0.0042). CONCLUSION: Perceived behavioral control and BMI are the most signi cant predictors of FV intake but explain only 8% of the variability in intake in our cohort. Our results support prior research which suggests an attenuation of the intention-behavior relationship by SES, and may question the utility of the TPB as it is currently operationalized as a foundational model for future health behavior change research and programs in low SES racial/ethnic minorities

Pilot and feasibility test of an implementation intention intervention to improve fruit and vegetable intake among women with low socioeconomic status

Fruit and vegetable intake (FVI), a modifiable risk factor for chronic diseases, is lower in low socioeconomic status (SES) populations. Implementation intentions (a specific type of planning that extends the Theory of Planned Behavior) has been studied to improve FVI, but not exclusively with low SES groups. Using mixed methods, we evaluated the feasibility, acceptability, and preliminary efficacy of an implementation intention intervention (versus a general plan) to increase FVI in women with low SES. For the pilot randomized controlled trial, demographics, body mass index, attitude, perceived behavioral control, goal intention strength, and FVI were measured at baseline and FVI again 1-month following the intervention. Feasibility data were collected for recruitment, randomization, retention, and assessment procedures and compared to predetermined targets. Semi-structured interview data was analyzed for emergent themes regarding acceptability of the trial. Preliminary efficacy of the intervention to improve FVI was analyzed descriptively. Feasibility targets were met for randomization (100% vs. ≥80% target), retention (93.5% vs. ≥70% target) and the assessment metrics missing data points (2% vs. ≤10% target) and days from intervention to follow up (mean=69.2, sd=42.6 vs.days). Targets for recruitment were not met with the exception of participants giving informed consent (100% vs. ≥70% target). Participants described the intervention as enjoyable and reported behavioral constructs outside of those measured as important to improve FVI. Limited efficacy analysis suggested that both groups increased their FVI (experimental: +0.17 servings per day, 95% CI: -0.85, 1.20; control: +0.50 servings per day, 95% CI: -0.56, 1.58). Further research which examines interventions based upon behavior change models to improve dietary health behaviors in marginalized groups is needed

Theory of Planned Behavior and implementation intentions to improve fruit and vegetable intake in women of low socioeconomic status

Fruit and vegetable intake (FVI) is an important modifiable risk factor for chronic diseases. Low socioeconomic status (SES) populations demonstrate lower FVI and higher rates of chronic diseases than higher SES groups. Theory-based models and interventions like the Theory of Planned Behavior (TPB) and implementation intentions (II) have been used effectively to explain and influence health behaviors, including FVI, in middle class populations, but have not been evaluated in exclusively low SES populations. This research investigates the efficacy, feasibility and acceptability of the TPB and an II intervention to explain and influence FVI in women of low SES.Participants: Adult female residents of Boston Public Housing developments. TPB constructs and FVI were measuredvia survey. We conducted pilot and feasibility randomized controlled and one-group II intervention studies (n=31) to promote FVI and a qualitative analysis of semi-structured interview data (n=8) to evaluate intervention efficacy, feasibility and acceptability.Intervention and control groups did not increase FVI (intervention + 0.26 servings per day, t(17)=0.73,p=0.476; control +0.50 servings per day, t(9)=1.07,p=0.3111) and no difference in FVI between groups t(26)=0.40,p=0.6934). Feasibility goals were met for randomization (100%vs ≥80%), retention(93.5%vs ≥70%), missing data (2%vs <10%), days to follow up (mean=69.27±42.67 vs <180 days), and not for recruitment(38.1% vs≥70%). Interviewed participants characterized the intervention as “beneficial”, and reported autonomy, positive regard and having support facilitated dietary behavior change. Overall, our analysis of an II intervention suggests that simply intervening on TPB variables may not be enough to change dietary behavior and, although acceptable, participants reported constructs not included in the TPB as facilitators of dietary behavior change. Future research is needed to determine how/if the TPB and II can be used as a theoretical foundation and intervention to describe and influence dietary behavior change in women of low SES

Feasibility and acceptability of dietary intake assessment via 24-hour recall and food frequency questionnaire among women with low socioeconomic status

BACKGROUND: Comprehensive evaluation of dietary interventions depends on effective and efficient measurement to quantify behavior change. To date, little is known regarding which self-reported measure of dietary intake is most feasible and acceptable for use in evaluation of the effectiveness of diet intervention studies among underserved populations. OBJECTIVE: This research focused on evaluating feasibility and acceptability of two self-report measures of diet. DESIGN: Cross-sectional. PARTICIPANTS/SETTING: Two interviewer-administered 24-hour recalls and a 110-item food frequency questionnaire (FFQ) were administered to both English- and Spanish-speaking participants (n=36) by native English- and Spanish-speaking research assistants. On completion of both dietary assessments, participants were interviewed regarding their preference of measure. MAIN OUTCOME MEASURES: Feasibility for completion of the dietary assessment measures was determined for contacts and retention. Acceptability of the measures was determined through responses to open- and closed-ended questions. RESULTS: During the 5-month trial, 36 participants were enrolled; 29 completed both intake measures, and 26 completed both measures and the interview. Participants were mainly Hispanic/Latina (72%), with a mean age of 37.0 (±7.6) years. Feasibility targets were met for contacts (1.9, 1.6, 1.8 contact attempts to complete each diet assessment measure with a target of ≤2) and for retention with 89% and 91% completing two 24-hour recalls and the FFQ, respectively. Participants indicated both diet assessment methods were generally acceptable; both positive and negative comments were received for use of the FFQ. CONCLUSION: Dietary assessment with the use of 24-hour recalls or an FFQ can be feasible and acceptable among women with low socioeconomic status, although care should be taken to address cultural appropriateness in the selection of the measurement method. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.IRG 72 001-36 - American Cancer Societ

Pilot and Feasibility Test of an Implementation Intention Intervention to Improve Fruit and Vegetable Intake Among Women with Low Socioeconomic Status

Fruit and vegetable intake (FVI), a modifiable risk factor for chronic diseases, is lower in low socioeconomic status (SES) populations. Implementation intentions (a specific type of planning that extends the Theory of Planned Behavior) has been studied to improve FVI, but not exclusively with low SES groups. Using mixed methods, we evaluated the feasibility, acceptability, and preliminary efficacy of an implementation intention intervention (versus a general plan) to increase FVI in women with low SES. For the pilot randomized controlled trial, demographics, body mass index, attitude, perceived behavioral control, goal intention strength, and FVI were measured at baseline and FVI again 1-month following the intervention. Feasibility data were collected for recruitment, randomization, retention, and assessment procedures and compared to predetermined targets. Semi-structured interview data was analyzed for emergent themes regarding acceptability of the trial. Preliminary efficacy of the intervention to improve FVI was analyzed descriptively. Feasibility targets were met for randomization (100% vs. ≥80% target), retention (93.5% vs. ≥70% target) and the assessment metrics missing data points (2% vs. ≤10% target) and days from intervention to follow up (mean=69.2, sd=42.6 vs.days). Targets for recruitment were not met with the exception of participants giving informed consent (100% vs. ≥70% target). Participants described the intervention as enjoyable and reported behavioral constructs outside of those measured as important to improve FVI. Limited efficacy analysis suggested that both groups increased their FVI (experimental: +0.17 servings per day, 95% CI: -0.85, 1.20; control: +0.50 servings per day, 95% CI: -0.56, 1.58). Further research which examines interventions based upon behavior change models to improve dietary health behaviors in marginalized groups is needed

Severity of Depressive Symptoms and Accuracy of Dietary Reporting among Obese Women with Major Depressive Disorder Seeking Weight Loss Treatment

An elevation in symptoms of depression has previously been associated with greater accuracy of reported dietary intake, however this association has not been investigated among individuals with a diagnosis of major depressive disorder. The purpose of this study was to investigate reporting accuracy of dietary intake among a group of women with major depressive disorder in order to determine if reporting accuracy is similarly associated with depressive symptoms among depressed women. Reporting accuracy of dietary intake was calculated based on three 24-hour phone-delivered dietary recalls from the baseline phase of a randomized trial of weight loss treatment for 161 obese women with major depressive disorder. Regression models indicated that higher severity of depressive symptoms was associated with greater reporting accuracy, even when controlling for other factors traditionally associated with reporting accuracy (coefficient  =  0.01 95% CI = 0.01 – 0.02). Seventeen percent of the sample was classified as low energy reporters. Reporting accuracy of dietary intake increases along with depressive symptoms, even among individuals with major depressive disorder. These results suggest that any study investigating associations between diet quality and depression should also include an index of reporting accuracy of dietary intake as accuracy varies with the severity of depressive symptoms