Context
Physical activity and healthy eating are essential elements in mitigating the risk of various noncommunicable diseases. However, evidence indicates a lack of adequate physical activity among young adults in China, including more than half of university students. The effectiveness of web-based healthy lifestyle interventions to help reduce the risk of developing noncommunicable diseases has shown to have several advantages to promote behavioral change in young adults, but has rarely been studied outside of Western societies. In this paper, researchers tested the effectiveness of a web-based intervention in changing exercise and nutrition behaviors in a group of Chinese university students attending a physical education course in 2015.
Intervention
The study used a web-based program that targeted social-cognitive processes and changes in physical activity (PA) and fruit and vegetable intake (FVI). Students were asked to use the program once a week for eight weeks and received regular reminders via text message and from physical education teachers about the intervention. Content was packaged into weekly 20-minute sessions, each presenting different components of the behavior change process, such as risk perception, goal setting, motivation, and action planning. Students were emailed the link for each session. The first four weeks focused on PA, and the last four weeks on FVI, as PA content was usually favored by users in previous studies, and literature suggests that PA behaviors influence FVI. Each session consisted of various self-reported questionnaires on physical activity and dietary intake, with an additional focus on stages of behavioral change. They also received weekly individualized feedback, based on their performance from self-report questionnaires, to guide their expectations, goal setting, action plans, and adjustments. As a participation incentive, students were offered bonus points on their course’s final exam.
Evaluation
Design: Students attending a general physical education class in an undergraduate university in central China were recruited. Participating students were randomly assigned to the intervention or control group (randomized controlled trial). The main outcomes were captured using electronic questionnaires that students received through email and completed at the beginning of the study (T1), after eight weeks (T2), and one month after the intervention period (T3). Physical activity was assessed using a short version of the International Physical Activity Questionnaire and FVI was assessed by asking students to record their intake for the past seven days. A Likert scale was used to evaluate students’ status along the behavior change process: not intending to change behavior, intending to change behavior, or already changing behavior. Secondary outcomes included measures of mental health (quality of life and depression) and social-cognitive indicators of behavior change, including motivational (risk perception, outcome expectancies, and self-efficacy), volitional (action planning, coping planning, and social support), and distal (intention and habit) indicators.
Sample: Out of 566 students who were initially contacted, 493 (87%) were randomly assigned to a study group: 270 in the intervention and 223 in the control group. Those who were excluded either declined to participate, were collegiate athletes, or had food or exercise restrictions. About 32% of the students dropped out before the end of the eight-week intervention, and an additional 40% did not complete the post-intervention questionnaire. Ultimately, 88 students in the intervention group and 54 in the control group completed the trial. Participants had a mean age of 19.3 and an average BMI of 20.13 kg/m2 (normal). Most were female (71%).
Results
The authors reported a significant intervention effect on FVI and on the motivation, volitional, and distal behavior change indicators over time. Students who completed the intervention consumed more fruits and vegetables over time compared to their control counterparts. They were also more likely to shift from not intending or intending to change their PA and FVI behavior to changing the behavior. In terms of FVI, there was a significant change in those who were previously inactive becoming active between T1 and T2. Students who were previously classified as active in T1 did not significantly shift their behaviors at T3, suggesting that the program was effective due to a more significant change in previously inactive students compared to previously active ones.
Limitations:
Study limitations include the high proportion of students who failed to complete the study, a relatively brief follow-up period, the use of self-report questionnaires, over- or underreporting, and a lack of investigation into how exactly the treatment encouraged multiple health behavior changes.
Conclusion
The authors were able to show that a web-based intervention program promoting exercise and healthy nutrition could be effective at improving food intake behaviors among Chinese university students. Although the same positive change was not replicated in students’ physical activity levels, the results are still promising and warrant further research that addresses the current study’s limitations to continue to build the evidence base for such interventions outside of Western societies.
