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Multicenter Study
. 2016 Mar;14(2):109-16.
doi: 10.1370/afm.1886.

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

Robert L Ferrer  1 , Sandra K Burge  2 , Raymond F Palmer  2 , Inez Cruz  2 ; RRNeT Investigators
Collaborators, Affiliations
Multicenter Study

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

Robert L Ferrer et al. Ann Fam Med. 2016 Mar.

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.

Results: In 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.

Keywords: capability approach; diet; physical activity; socioeconomic factors.

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Figures

Figure 1a
Figure 1a
Structural equation model predicting physical activity from CADA factors. CADA = capability assessment for diet and activity; ε = correlated error Note: Activity resources and activity conversion are scales from CADA instrument. Activity intentions is defined as the number of days the respondent intends to get physical activity in next week. Moderate/vigorous activity minutes = sum of moderate+vigorous activity minutes as measured by the International Physical Activity Questionnaire. n = 717 aP <.05 bP <.01 cP = .001 Model fit: Overall R2: 0.208. The model is just identified, so other fit statistics could not be calculated.
Figure 1b
Figure 1b
Structural equation model predicting diet quality from CADA factors. CADA = capability assessment for diet and activity; STC = Starting the Conversation diet instrument; ε =correlated error Note: Diet resources and diet conversion are scales from CADA instrument. Diet intentions is defined as the number of days the respondent intends to a eat healthy diet in next week. n = 181 aP <.05 bP <.01 cP <.001 dP >.05 Model fit: Likelihood ratio for model vs saturated: χ2(10) = 10.74; P = .38. Root mean square error of approximation: 0.020 CI (0.000-0.085) Comparative Fit Index: 0.994 Overall R2: 0.130
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