- Title
- The development and evaluation of a brief web-based nutrition intervention for young adult university students
- Creator
- Whatnall, Megan
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2019
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Non-communicable diseases (NCDs) are a major cause of global mortality, including premature deaths. However, NCDs are preventable, and improving eating behaviours is one of four key modifiable risk factors that could have a substantial role in their prevention. Concerningly, the majority of the adult population have unhealthy eating behaviours. Among the adult population, young adults (17-35 years) have the highest prevalence of poor eating behaviours, and they therefore represent an at-risk population group in need of nutrition intervention. Effective nutrition interventions are needed for young adults which can overcome the challenges of reach and engagement in this group. Using the university setting and a participatory research model for intervention development show promise in this regard. Therefore, the overall aim of this thesis was to develop and evaluate a brief web-based nutrition intervention for young adult university students, using the PRECEDE-PROCEED planning model to guide intervention development. Three research studies were conducted to meet this aim, alongside a review of the literature and the establishment of and consultation with a project steering committee. The components of this thesis fit within the PRECEDE/ Planning phases and the PROCEED/Evaluation phases of the planning model. PRECEDE / Planning phases: The review of the literature of young adult and university students’ eating behaviours and health behaviour interventions identified key gaps in the evidence base and areas for further investigation. Firstly, it was identified that further observational studies among university students are needed which explore a broad range of eating behaviours and the associations between them, as well as a broader range of determinants. Further, it was identified that there is a distinct lack of observational studies of eating behaviours and their determinants in Australian university students. In terms of health behaviour interventions in young adults and university students, interventions of shorter duration (i.e. brief interventions) and using technology, such as web-based interventions, emerged as areas for further investigation. A cross-sectional analysis was conducted to explore clustering among individual eating behaviours, and explore associations between clustered eating behaviours and demographic characteristics. This involved an analysis of data from 3,062 university students from the 2017 University of Newcastle Student Healthy Lifestyle Survey. From this analysis, key eating behaviours and determinants to be targeted and considered in the development of the brief web-based nutrition intervention were identified. The low consumption of fruits, vegetables, and breakfast, and the high consumption of discretionary foods were identified as key eating behaviours. Living situation, age, gender and faculty of study were identified as key determinants. A systematic review of brief nutrition interventions in adults was undertaken to determine the effectiveness of a brief (single session) intervention approach. The finding from the 45 included randomised controlled trials was that brief nutrition interventions can improve eating behaviours in the short term, with further evaluation needed to determine their long term effectiveness. The aim of the systematic review was also to identify the behaviour change techniques (BCTs) that were associated with effective interventions. These included skill building and instructive BCTs, such as problem solving and action planning, and self-belief targeted BCTs, such as generalisation of a target behaviour and self-talk. Given the evidence supporting the effectiveness of brief interventions, the web-based intervention was developed as a brief intervention. The BCTs that were found to be effective in the review were also incorporated into intervention development. PROCEED / Evaluation phases: A pilot randomised controlled trial of the brief web-based nutrition intervention; Eating Advice To Students (EATS), was conducted. This included a sample of 124 young adult university students from the University of Newcastle, Australia. The aims of the pilot RCT were to determine the feasibility and preliminary efficacy of EATS compared with an attention control group. In terms of feasibility, recruitment methods were successful and a high retention rate of 73% was achieved at 3 month follow up. Intervention usage and acceptability (satisfaction, usability, and appropriateness) were also high. In terms of preliminary efficacy, there were no significant between group differences for diet quality, or intakes of fruit, vegetables and breakfast. However, there was a significant (p=0.012) decrease in discretionary foods of 4.8% of energy per day in intervention participants compared with control. Overall, the study findings presented in this thesis provide evidence to support that a brief web-based intervention is feasible to reach and engage young adults in the university setting. This approach is therefore worth further investigation to determine the efficacy for improving eating behaviours. The findings have important implications for health promotion practice, as well as those who work with young adults more generally, and recommendations for future research and practice are provided. Future observational studies should comprehensively explore university students’ eating behaviours and determinants over time, and these findings should be used to better inform interventions. Future nutrition interventions in university students should particularly target students with the poorest eating behaviours, and should incorporate effective behaviour change techniques. Longer term follow up studies should be conducted to determine the efficacy of brief nutrition interventions which have demonstrated short term efficacy. Importantly, more detailed reporting of intervention development and evaluation should be shared to facilitate the implementation of effective strategies to reach and engage young adults and university students. The main implications for practice are that settings based interventions and a web-based mode of delivery may be the best way to engage young adults to improve their eating behaviours.
- Subject
- eating behaviours; young adults; non-communicable diseases; NCDs; mental health; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1409008
- Identifier
- uon:35917
- Rights
- Copyright 2019 Megan Whatnall
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
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| View Details Download | ATTACHMENT01 | Thesis | 4 MB | Adobe Acrobat PDF | View Details Download | ||
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