Practical Opportunities for Healthy Diet and Physical Activity: Relationship to Intentions, Behaviors, and Body Mass Index

Abstract

PURPOSE Current strategies for improving diet and activity patterns focus on encouraging patients to make better choices, but they meet with limited success. Because the choices people make depend on the choices they have, we examined how practical opportunities for diet and physical activity shape behavioral intentions and achieved behaviors.METHODS Participants included 746 adults who visited 8 large primary care practices in the Residency Research Network of Texas in 2012. We used structural equation models to confirm factor structures for a previously validated measure of practical opportunities, and then modeled achieved diet (Starting the Conversation -Diet questionnaire), physical activity (International Physical Activity Questionnaire), and BMI as a function of opportunities (classified as either resources or conversion factors that influence use of resources), behavioral intentions, and demographic covariates. RESULTSIn path models, resources (P <.001) and conversion factors (P = .005) predicted behavioral intentions for activity. Conversion factors (P <.001), but not resources, predicted diet intentions. Both activity resources (P = .01) and conversion factors (P <.001) were positively associated with weekly activity minutes. Diet conversion factors (P <.001), but not diet resources (P = .08), were positively associated with diet quality. The same patterns were observed for body mass index (BMI). Socioeconomic gradients in resources and conversion factors were evident.CONCLUSIONS Individuals' feasible opportunities for healthy diet and activity have clinically meaningful associations with intentions, achieved behaviors, and BMI. Assessing opportunities as part of health behavior management could lead to more effective, efficient, and compassionate interventions. Ann Fam Med 2016;14:109-116. doi: 10.1370/afm.1886. INTRODUCTIONG lobal shifts in diet and physical activity patterns 1 have sharply increased obesity prevalence over the past 30 years 2 and are leading causes of preventable morbidity and mortality. 3,4 Effective population and clinical interventions offer great potential to reduce this burden, yet progress has been slow because behaviors are shaped by a complex set of multilevel determinants. 5 Despite the complex genesis of behaviors, clinical assessment and intervention has narrowly focused on individuals' behavioral intentions and motivation, 6,7 with modest success. 8 As a result, clinicians have limited confidence in their ability to manage obesity and its linked behaviors, 9,10 leading to declining rates of diagnosis and treatment. 14 Evaluating opportunity is therefore necessary to an understanding of the connections among environmental contexts, personal factors, behavioral intentions, and achieved behaviors. Conversely, framing behaviors as decontextualized "lifestyles" 15 risks missing important determinants of health behavior.In previous papers, we offered a theoretical 16 and empirical case 17 for examining health behavior using the capability approach, 18 a theory of socia...

Priorities and Preferences for Weight Management and Cardiovascular Risk Reduction in Primary Care

“…16 Determining a patient's capability for health behavior change is based on an approach that emphasizes the actions and behaviors that individuals can actually do, their perceptions of the resources that are available in their community to support behavior change, and what they believe about the likelihood of being able to access them. 17,18 Ferrer and colleagues 17 demonstrated that the resources available for dietary behaviors were less predictive of intentions to eat a healthy diet relative to conversion factors that included barriers to and knowledge about healthy eating and having the time to prepare healthy meals. Both activity resources and conversion factors (eg, barriers, knowledge, and time), however, were significantly associated with intentions to be physically active.…”

Translation and Validation of the Arabic Version of the Capability Assessment for Diet and Activity (CADA) Questionnaire in Saudi University Employed Women

“…The first 14 items of the instrument are dietary items and are categorized into four subscales: diet opportunity (items 1-5), diet barriers (items 6-8), diet knowledge (items 9-11), and diet time (items [12][13][14]. Physical activity is measured by the last eleven items of the CADA questionnaire and is grouped into three subscales: physical activity convenience (items 15-17), neighborhood (items [18][19][20][21][22], and physical activity barriers (items 23-25) [19].…”

Exploring the determinants of health knowledge adoption in social media

“…The gap between health-related intentions and health behaviors is exacerbated by several complex factors. For instance, in healthy diet, physical activity, hand washing and hygienic food handling (Ferrer et al, 2016; Fulham and Mullan, 2011), such gaps are evident. The intention/behavior gap in terms of health behaviors moreover depends on language barriers, a priori knowledge, user openness and interest, and user confidence (Chirawattanakij and Vathanophas, 2016).…”