Pediatric Adapted Liking Survey (PALS) with Tailored Nutrition Education Messages: Application to a Middle School Setting

Abstract

We tested the feasibility of a school-based, liking-based behavioral screener (Pediatric Adapted Liking Survey (PALS)) and message program to motivate healthy diet and activity behaviors. Students, recruited from middle- (n = 195) or low-income (n = 310) schools, online-reported: likes/dislikes of foods/beverages and physical/sedentary activities, scored into healthy behavior indexes (HBI); perceived food insecurity; and sleep indicators. Students received tailored motivating or reinforcing messages (aligned with behavior change theories) and indicated their willingness to improve target behaviors as well as program feasibility (acceptability; usefulness). Although HBIs averaged lower in the lower versus middle-income school, frequencies of food insecurity were similar (39–44% of students). Students in both schools reported sleep concerns (middle-income school—43% reported insufficient hours of sleep/night; low-income school—55% reported excessive daytime sleepiness). Students across both schools confirmed the PALS acceptability (>85% agreement to answering questions quickly and completion without help) and usefulness (≥73% agreed PALS got them thinking about their behaviors) as well as the tailored message acceptability (≥73% reported the messages as helpful; learning new information; wanting to receive more messages) and usefulness (73% reported “liking” to try one behavioral improvement). Neither message type nor response varied significantly by food insecurity or sleep measures. Thus, this program feasibly delivered students acceptable and useful messages to motivate healthier behaviors and identified areas for school-wide health promotion.

Can Assessing Physical Activity Liking Identify Opportunities to Promote Physical Activity Engagement and Healthy Dietary Behaviors?

“…Emerging evidence from our laboratory suggests that motivating and reinforcing health promotion messages can be delivered online to college students based on their reported liking of diet and physical activities; these messages are reported to be relevant and useful [67]. This evidence expands the tailored message program that we previously conducted with children and parents [68,69]. These tailored messages can highlight specific areas of change prior to an intervention or counseling session and promote motivation and self-efficacy to change health behaviors [67,70,71].…”

Feasibility of a Theory-Based, Online Tailored Message Program to Motivate Healthier Behaviors in College Women

“…This online tailored message program utilized the IMB framework to adapt an evidence-based program, originally conducted with children their parents/caregivers [ 31 ] or children in a middle school setting [ 32 ], for college students. The program consisted of a validated survey assessing liking/disliking of usual diet and physical activity behaviors [ 46 , 82 , 83 ], questions assessing current health knowledge and behaviors [ 72 , 84 , 85 , 86 , 87 , 88 ], and tailored messages driven by response to the liking survey (food and physical activity), intuitive eating, stress, and sleep.…”

“…Tailoring health information incorporates methods that personalize communication for the intended receiver, assisting in the reading, remembering, and relevancy of information to the participant [ 27 , 28 ]. Tailored communications, versus generalized and generic communications, have demonstrated greater participant benefit to promote and support health behavior change through increased intention and motivation [ 28 , 29 , 30 , 31 , 32 ]. Tailoring of health information to college women may be key in successful marketing of physical activity and dietary messages to motivate healthier behaviors.…”

“…Acknowledging preference and incorporating tailoring into physical activity and nutrition interventions has helped to encourage physical activity engagement [ 48 , 49 , 50 , 51 ], increase preference of healthy foods [ 44 , 52 , 53 , 54 , 55 ], and decrease preference for less healthy foods [ 56 , 57 ]. Acceptability and usability of liking surveys with evidenced based tailored messages has been demonstrated in promoting behavior change in children and adolescents [ 31 , 32 ].…”

Determinants of Preference and Consumption of Healthy Food in Children

“…Hildrey et al [ 14 ] tested the suitability of an online survey technology with repeated exposure to tailored health promotion messaging in a school-setting. The approach, adapted from a clinical setting, was found to be acceptable and useful in assessing diet quality and physical activity among low-income students aged 10–14 years.…”