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Kothe - International Society of Nutritional Psychiatry - 2014

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Do good intentions lead to healthy food choices? Background: Emerging research shows a clear link between dietary choice and physical and mental health outcomes. As such, there is a need for interventions to improve the dietary choices of individuals. However, interventions will only be successful if they address the psychosocial factors that are responsible for poor dietary choices. This research considered the extent to which individuals who intend to engage in healthy food choices are able to translate that intention into action. Method: Three studies considered the extent to which individuals’ were able to translate dietary intentions into action across a range of contexts including: adherence to dietary guidelines among pregnant women (Study 1), gluten-free diet adherence among individuals with coeliac disease (Study 2), and young adults’ consumption of breakfast (Study 3). In each study individuals indicated their intention to engage in the relevant dietary behaviour and reported their corresponding dietary behaviour at the same (Study 2) or subsequent time-points (Study 1 & 3). Results: Intention to engage in healthy dietary choices was very high across all samples. However, data from all three studies showed that highly motivated people often failed to translate good dietary intentions into healthy food choices. This “intention-behaviour gap” was seen across a range of contexts. Conclusion: Difficulty in achieving healthy diet cannot be accounted for by a lack of motivation within these samples. It appears that intention may be a necessary but not sufficient determinant of healthy diet. These findings suggest that interventions that attempt to change dietary behaviour by increasing motivation will have limited impact. There is a clear need to consider potential moderators of the intention-behaviour relationship in order to achieve desired changes in dietary behaviour.
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Do good intentions lead to healthy food choices? Emily Kothe School of Psychology, Deakin University @emilyandthelime
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Page 1: Kothe - International Society of Nutritional Psychiatry - 2014

Do good intentions lead to healthy food choices? Emily KotheSchool of Psychology, Deakin University@emilyandthelime

Page 2: Kothe - International Society of Nutritional Psychiatry - 2014

People consistently fail to translate good intentions into

good behaviour

Inclined abstainers Inclined actors

Disinclined abstainers Disinclined actors

Page 3: Kothe - International Society of Nutritional Psychiatry - 2014

People consistently fail to translate good intentions into

good behaviour

Inclined abstainers Inclined actors

Disinclined abstainers Disinclined actors

Page 4: Kothe - International Society of Nutritional Psychiatry - 2014

People consistently fail to translate good intentions into

good behaviourAcross behaviours, median proportion of people who intend to act and then fail to do so is 47% (Sheeran, 2002)

57% of women who indicate they intend to undergo cervical cancer screening fail to do so within 1 year (Orbell & Sheeran, 1998)46% of people who intend to exercise, do not (Rhodes & de Bruijn, 2013)

The extent to which intention to engage in dietary behaviours translates to adherence to dietary behaviours has not been systematically investigated.

Page 5: Kothe - International Society of Nutritional Psychiatry - 2014

Inclined abstention within dietary behaviour

Study 1: adherence to dietary guidelines among pregnant women Study 2: gluten-free diet adherence among individuals with coeliac disease Study 3: young adults’ consumption of breakfast

Page 6: Kothe - International Society of Nutritional Psychiatry - 2014

Motivated abstention in pregnant women

250 pregnant women reported motivation to engage in a healthy diet (18 weeks) and adherence to dietary guidelines (32 weeks).Motivation was operationalized as scoring above neutral on measures of importance, confidence, and readiness.Adherence to dietary guidelines was assessed using a FFQ.

Consumption of mostly reduced fat dairy Consumption of 2+ serves of dairy each dayConsumption of 2+ serves of fruit each dayConsumption of 4+ serves of vegetables each day*

Page 7: Kothe - International Society of Nutritional Psychiatry - 2014

Motivated abstention in pregnant women

78% of the pregnant women meet the criteria of “motivated”90% of motivated women failed to adhere to at least one dietary guideline

Page 8: Kothe - International Society of Nutritional Psychiatry - 2014

Inclined abstention in gluten-free diet

105 individuals with biopsy confirmed coeliac disease reported intention to strictly adhere to the gluten free diet and adherence to the diet at a single timepoint.Intention was measured using a single item from the Biagi coeliac adherence measure Gluten free diet adherence was measured using the Coeliac Dietary Adherence Test (CDAT)

Page 9: Kothe - International Society of Nutritional Psychiatry - 2014

Inclined abstention in gluten-free diet

Participants were classified as according to statusInclined abstainersReported never intentionally

consuming glutenLess than strict adherence according

to the CDAT

Inclined actorsReported never intentionally

consuming glutenStrict adherence according to the

CDATDisinclined abstainersReported intentionally consuming

glutenLess than strict adherence according

to the CDAT

Disinclined actorsReported intentionally consuming

glutenStrict adherence according to the

CDAT

Page 10: Kothe - International Society of Nutritional Psychiatry - 2014

Inclined abstention in gluten free diet

30% of adults with biopsy confirmed coeliac disease who intended to always follow the diet failed to do soInclined abstainers accounted for 90% of inadequate adherence

Page 11: Kothe - International Society of Nutritional Psychiatry - 2014

Inclined abstention in breakfast consumption

349 university students reported intention to eat breakfast (Time 1) and actual breakfast consumption (Time 2).Intention was measured on a 7 point scale where higher scores indicated stronger intention.Breakfast consumption individuals indicated the number of days in the previous week they had consumed breakfast on a self-report questionnaire

Kothe, E. J., Mullan, B. A., & Amaratunga, R. (2011). Randomised controlled trial of a brief theory-based intervention promoting breakfast consumption. Appetite,

56(1), 148-155.

Page 12: Kothe - International Society of Nutritional Psychiatry - 2014

Inclined abstention in breakfast consumption

Participants were classified as according to statusInclined abstainers

Scored 5 or above in intention at Time 1

Skipped breakfast 3 or more times a week at Time 2

Inclined actorsScored 5 or above in intention at

Time 1Ate breakfast 5 or more times a

week at Time 2Disinclined abstainersScored 5 or above in intention at

Time 1Skipped breakfast 3 or more times a

week at Time 2

Disinclined actorsScored 3 or below in intention at

Time 1Ate breakfast 5 or more times a

week at Time 2

Kothe, E. J., Mullan, B. A., & Amaratunga, R. (2011). Randomised controlled trial of a brief theory-based intervention promoting breakfast consumption. Appetite,

56(1), 148-155.

Page 13: Kothe - International Society of Nutritional Psychiatry - 2014

Inclined abstention in breakfast consumption

63% of young adults who intended to regularly consume breakfast failed to do so. Inclined abstainers made up 77% of all breakfast skippers

Kothe, E. J., Mullan, B. A., & Amaratunga, R. (2011). Randomised controlled trial of a brief theory-based intervention promoting breakfast consumption. Appetite,

56(1), 148-155.

Page 14: Kothe - International Society of Nutritional Psychiatry - 2014

Summary of resultsIntention to engage in healthy dietary choices was very high across all samples. However, all three studies showed that highly motivated people often failed to translate good dietary intentions into healthy food choices. Inclined abstention accounted for the majority of poor adherence to healthy dietary patterns across all contexts.

Page 15: Kothe - International Society of Nutritional Psychiatry - 2014

ImplicationsDifficulty in achieving healthy diet cannot be accounted for by a lack of motivation.It appears that intention may be a necessary but not sufficient determinant of healthy diet. Interventions that attempt to change dietary behaviour by increasing motivation will have limited impact.

Page 16: Kothe - International Society of Nutritional Psychiatry - 2014

My collaboratorsStudy 1

A/Prof Helen Skouteris (Deakin University)Dr Matthew Fuller-Tyszkiewicz (Deakin University)Dr Skye McPhie (Deakin University)Briony Hill (Deakin University)

Study 2A/Prof Barbara Mullan (Curtin University)Lauren Smith (University of Sydney)

Study 3A/Prof Barbara Mullan (Curtin University)


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