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. 2016 Jul;35(7):723-732.
doi: 10.1037/hea0000333. Epub 2016 Apr 7.

Mechanisms of change in diet and activity in the Make Better Choices 1 trial

Kristin L Schneider  1 , Michael J Coons  2 , H Gene McFadden  2 , Christine A Pellegrini  2 , Andrew DeMott  2 , Juned Siddique  2 , Donald Hedeker  3 , Laura Aylward  4 , Bonnie Spring  2
Affiliations

Mechanisms of change in diet and activity in the Make Better Choices 1 trial

Kristin L Schneider et al. Health Psychol. 2016 Jul.

Abstract

Objective: The Make Better Choices 1 trial demonstrated that participants with unhealthy diet and activity behaviors who were randomized to increase fruits/vegetables and decrease sedentary leisure achieved greater diet and activity improvement than those randomized to change other pairs of eating and activity behaviors. Participants randomized to decrease saturated fat and increase physical activity achieved the least diet-activity improvement. This study examined which psychological mechanisms mediated the effects of the study treatments on healthy behavior change.

Methods: Participants (n = 204) were randomized to 1 of 4 treatments: increase fruits/vegetables and physical activity; decrease saturated fat and sedentary leisure; decrease saturated fat and increase physical activity; increase fruits/vegetables and decrease sedentary leisure. Treatments provided 3 weeks of remote coaching supported by mobile decision support technology and financial incentives. Mediational analyses were performed to examine whether changes in positive and negative affect, and self-efficacy, stages of readiness to change, liking, craving and attentional bias for fruit/vegetable intake, saturated fat intake, physical activity, and sedentary leisure explained the impact of the treatments on diet-activity improvement.

Results: Greater diet-activity improvement in those randomized to increase fruits/vegetables and decrease sedentary leisure was mediated by increased self-efficacy (indirect effect estimate = 0.04; 95% bias corrected CI, 0.003-0.11). All treatments improved craving, stage of change and positive affect.

Conclusion: Accomplishing healthy lifestyle changes for 3 weeks improves positive affect, increases cravings for healthy foods and activities, and enhances readiness to make healthy behavior changes. Maximal diet and activity improvement occurs when interventions enhance self-efficacy to make multiple healthy behavior changes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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Figures

Figure 1
Figure 1
Change in Each Self-Efficacy Measure by Treatment Note.. PostTxmt= End of intervention phase. ↑FV=increase fruits/vegetables, ↑PA=Increase physical activity, ↓Fat=Decrease saturated fat, ↓Sed=Decrease sedentary leisure screen time. ** p < .01, *** p < .001
Figure 2
Figure 2
Composite Self-Efficacy Mediates the Relationship Between the Increase Fruit/Vegetable and Decrease Sedentary Leisure Treatment Contrast and the Diet-Activity Composite Score. Note. Change (Δ) was calculated as change from end of treatment – baseline. ↑FV=Increase fruits/vegetables, ↓Sed=Decrease sedentary leisure screen time **p<0.01, ****p<0.0001.
Figure 3
Figure 3
Fruit/Vegetable Self-Efficacy Mediates the Relationship between the Increase Fruit/Vegetable and Decrease Sedentary Leisure Treatment Contrast and Fruit/Vegetable Intake Note. Change (Δ) was calculated as change from end of treatment – baseline. ↑FV=Increase fruits/vegetables, ↓Sed=Decrease sedentary leisure screen time. **p<0.01, ***p<0.001, ****p<0.0001.
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