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Pilot Intervention Using Food Challenges and Video Technology for Promoting Fruit and Vegetable Consumption

      Abstract

      Objective

      To evaluate the feasibility of a Social Cognitive Theory-based intervention on cognitive, affective, and behavioral outcomes in a college nutrition course.

      Design

      A pre-post quasi-experimental design.

      Setting

      Large metropolitan university.

      Participants

      College students (n = 138) aged 18–40 years.

      Interventions

      Students participated in weekly food challenges during a 15-week nutrition course to apply nutrition knowledge, develop self-efficacy and promote positive behavior change. Food challenges were implemented by a guided goal-setting strategy. Cooking videos, which modeled important nutrition-related skills, accompanied each challenge. Students independently selected 2-goal options to implement weekly and wrote a reflection about their experiences.

      Main Outcome Measures

      Cognitive outcomes (nutrition and cooking self-efficacy), affective outcome (cooking attitudes), and behavioral outcomes (fruit and vegetable consumption).

      Analysis

      Descriptive statistics and paired sample t tests.

      Results

      Analyses showed significant increases in cognitive outcomes (produce consumption self-efficacy [P = 0.004], cooking self-efficacy [P = 0.002], using fruit/vegetables and seasoning self-efficacy [P = 0.001]) and behavioral outcomes (fruit consumption [P < 0.001], and vegetable consumption [P < 0.001]).

      Conclusion and Implications

      This pilot study suggested a framework for behavioral change, grounded in constructs central to Social Cognitive Theory, that simplified the goal-setting process (by using guided goal setting) and used video technology to decrease the cost of implementation.

      Key Words

      INTRODUCTION

      Obesity in the US is a significant risk factor for numerous chronic diseases.

      Centers for Disease Control and Prevention. Overweight & Obesity. Obesity Basics. Causes of Obesity.https://www.cdc.gov/obesity/basics/causes.html. Accessed June 23, 2022.

      Consumption of fast food and away-from-home meals is associated with lower diet quality and obesity in adults.
      • Bowman SA
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      In the quest to positively affect adult nutrition behavior and obesity rates in the US, young adulthood presents a critical time frame for establishing healthy eating habits. Many young adults are newly independent and responsible for making their own dietary choices, often for the first time.
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      Given this window of opportunity for aiding adults in establishing healthy eating habits, dietary interventions focused on young adulthood are vital to the long-term health of the nation.
      College students comprise a large portion of the young adult population,

      US Bureau of Labor Statistics. College enrollment and work activity of recent high school and college graduates summary. https://www.bls.gov/news.release/hsgec.nr0.htm. Accessed August 2, 2021.

      and national data suggest that college students’ diets are high in overall fat intake and inadequate in key food groups such as low-fat dairy, whole grains, fruits, and deep yellow and green vegetables.
      US Department of Health and Human Services, US Department of Agriculture
      Dietary Guidelines for Americans 2015–2020.
      Specifically, Dingman and colleagues
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      Factors related to the number of fast food meals obtained by college meal plan students.
      found that many college-aged students’ diets largely consisted of fast or convenience foods. Barriers to healthy eating for this group includeed a lack of nutrition and culinary knowledge, financial instability, inadequate access to healthy food options, and time.
      • Reicks M
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      Larson and colleagues
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      Food preparation by young adults is associated with better diet quality.
      also noted that low self-efficacy and inadequate cooking skills could pose barriers to healthy meal preparation.
      College courses present an opportunity to address barriers to a healthy diet. However, traditional college nutrition programs tend to focus on knowledge acquisition and nutrition assessment skills.
      National Commission for Health Education Credentialing
      Areas of Responsibility. Competencies and Sub-Competencies for Health Education Specialist Practice Analysis II 2020 (HESPA II 2020).
      Skinner
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      found that traditional nutrition classes increased nutrition knowledge but did not change dietary behavior. Although a necessary element of behavior change, research shows that knowledge and nutrition assessment skills should be supplemented with behavioral self-efficacy to prompt lifestyle change.
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      Nutrition education programs grounded in the Social Cognitive Theory (SCT) are particularly effective in changing dietary behavior because of their focus on self-efficacy and behavior-oriented programmatic elements.
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      Specifically, Anderson and colleagues
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      Social cognitive mediators of change in a group randomized nutrition and physical activity intervention: social support, self-efficacy, outcome expectations and self-regulation in the guide-to-health trial.
      and Doerksen and McAuley
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      Social cognitive determinants of dietary behavior change in university employes.
      showed that important SCT constructs (eg, self-efficacy, outcome expectations) could effectively improve adults’ diets. Poddar and colleagues
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      Web-based nutrition education intervention improves self-efficacy and self-regulation related to increased dairy intake in college students.
      presented evidence that self-efficacy and outcome expectations are correlated with maintaining college students’ healthy dietary patterns. In addition, interventions targeting specific nutrition behavior in college students, such as fruit and vegetable (F&V) consumption, have effectively improved diet.
      • Ha EJ
      • Caine-Bish N.
      Effect of nutrition intervention using a general nutrition course for promoting fruit and vegetable consumption among college students.
      Ha and Caine-Bish
      • Ha EJ
      • Caine-Bish N.
      Effect of nutrition intervention using a general nutrition course for promoting fruit and vegetable consumption among college students.
      showed increases in F&V consumption among college students following an intervention in a general nutrition course using strategies on the basis of SCT. Conventional education materials were combined with goal-oriented activities, which encouraged students to use their dietary behavior and lifestyle choices as a framework to learn course materials. Class activities included introducing simple F&V recipes, home cooking assignments, and tasting healthful snacks. In addition, key learning opportunities included dietary analysis and goal setting to motivate students to change their eating habits.
      Research shows that including the SCT concepts of goal setting and self-monitoring and nutrition education can be an essential component for interventions addressing college students’ diets.
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      Systematic review of dietary interventions with college students: directions for future research and practice.
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      Dietary interventions among university students: a systemic review.
      As such, Kelly and colleagues
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      suggested incorporating diet-related interventions into preexisting courses for this population. Schnoll and Zimmerman
      • Schnoll R
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      Self-regulation training enhances dietary self-efficacy and dietary fiber consumption.
      found course integration to be an effective approach, noting that dietary change did not occur with self-monitoring alone but when goal setting and self-monitoring were combined in a college nutrition course. O'Donnell and colleagues
      • O'Donnell S
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      The effect of goal setting on fruit and vegetable consumption and physical activity level in a web-based intervention.
      reported that F&V consumption increased with weekly goal setting and self-monitoring in a web-based intervention with college students, and subjects who met a majority of their goals consumed more F&Vs. Guided goal setting, in which individuals are given choices from a collection of practitioner-developed major and minor goals with attributes necessary for optimal goal effectiveness: specificity, proximity, difficulty, and attainability, has been successful with adolescents in affecting positive behavior change.
      • Shilts MK
      • Horowitz M
      • Townsend MS.
      Guided goal setting: effectiveness in a dietary and physical activity intervention with low-income adolescents.
      • Shilts MK
      • Townsend MS.
      A goal intervention positively impacts adolescents’ dietary behaviors and physical activity self-efficacy.
      • Strecher VJ
      • Seijts GH
      • Kok GJ
      • et al.
      Goal setting as a strategy for health behavior change.
      Goal monitoring and feedback focusing on accomplishments have been shown to enhance self-efficacy.
      • Locke LA
      • Latham G.
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      In addition to goal setting and self-monitoring, nutrition interventions for college students that include nutrition education and hands-on cooking components show promise for eating behavior changes and self-efficacy for cooking.
      • Warmin A
      • Sharp J
      • Condrasky MD.
      Cooking with a chef: a culinary nutrition program for college aged students.
      • McMullen J
      • Ickes M.
      The influence of a campus-based culinary, nutrition education program, “College CHEF,” on college students’ self-efficacy with cooking skills and nutrition behaviors.
      • Matias SL
      • Rodriguez-Jordan J
      • McCoin M.
      Evaluation of a college-level nutrition course with a teaching kitchen lab.
      The challenge of integrating interventions that include hands-on cooking components into preexisting courses is that a kitchen facility is usually unavailable. Moreover, purchasing ingredients for hands-on class experiences can be financially burdensome for students and wasteful, as unused ingredients cannot easily be saved for future use. There is a need for a less costly, more sustainable way of providing cooking instruction to develop self-efficacy for healthy cooking and nutritious dietary consumption.
      One promising option for addressing the pitfalls of in-class experiences is video technology. A wide range of short instructional cooking videos is available on the internet. With the advent of low-cost video production and editing equipment, instructors can also prepare theory-based demonstrations that can be watched and followed at home. Brown and colleagues
      • Brown KN
      • Wengreen HJ
      • Vitale TS
      • Anderson JB.
      Increased self-efficacy for vegetable preparation following an online, skill-based intervention and in-class tasting experience as a part of a general education college nutrition course.
      explored the use of vegetable preparation videos with vegetable tasting experiences in a nutrition class and found that this was an effective method for increasing self-efficacy for vegetable preparation and readiness to increase vegetable intake of college students. Given the success of research by Brown and colleagues,
      • Brown KN
      • Wengreen HJ
      • Vitale TS
      • Anderson JB.
      Increased self-efficacy for vegetable preparation following an online, skill-based intervention and in-class tasting experience as a part of a general education college nutrition course.
      the purpose of this study was to evaluate the feasibility of integrating the outcome expectations, observational learning, goal setting, self-monitoring, and self-efficacy constructs of the SCT with instructional cooking videos modeling specific cooking skills (ie, for home practice and development of self-efficacy) in 2 modalities of a college nutrition course, asynchronous online and in-person. Attitudes toward cooking, cooking and nutrition self-efficacy, and F&V consumption behavior were assessed for change over time. The logic model for this pilot study is shown in the Figure to summarize how inputs and activities (instruction, food challenges, and modeling) should function to create outputs (knowledge, goal setting, self-regulation) that are hypothesized to lead to cognitive (cooking and nutrition self-efficacy), affective (attitudes) and behavioral (F&V consumption) outcomes.
      Figure
      FigureLogic model for a nutrition behavior change pilot intervention developed using Social Cognitive Theory, a preliminary framework for explaining the relationship between intervention activities and outcomes in a college-student sample.

      METHODS

      Research Design and Intervention

      Research design

      We used a quasi-experimental pre-post 1-group design to investigate changes in students’ attitudes toward cooking, cooking self-efficacy, nutrition self-efficacy, and F&V consumption resulting from a 15-week pilot intervention for nursing, health, and exercise science majors at a large metropolitan university. We collected survey data from students in a human nutrition course (both in-person and asynchronous online) during the first and last weeks of a 15-week semester using Qualtrics. The same instructor taught all course sections.

      Intervention

      Outcome expectations, observational learning, goal setting, self-monitoring, and self-efficacy were incorporated into the course curriculum (Table 1) .
      • Bandura A.
      Health promotion by social cognitive means.
      Each week, the instructor's lecture introduced a topic (eg, carbohydrates). The lecture emphasized knowledge and outcome expectations and incorporated skill-based activities (eg, how to read an ingredient list for main ingredients) that could aid in achieving nutrition goals (eg, increase consumption of whole grains). Online students received the same course content through the electronic learning management system (LMS) course. Cooking videos were selected to specifically model nutrition-related skills and behavior relevant to the week's topic (eg, how to make overnight oats). The videos were shown during face-to-face class time (for in-person sections) or sent via university email to each student in the online section. In addition, the videos were posted to the course's online video library in the LMS for unlimited access throughout the course. Online viewing behavior was tracked by the LMS. One or 2 videos (3–7 minutes each) were presented/posted each week. Students were offered an opportunity to ask questions and seek clarification about important concepts presented in the videos during class meetings or on the online course discussion board. In this way, the videos and class conversations focused on skills required for students to develop cooking and nutrition self-efficacy.
      Table 1Intervention-Based Operationalization of Social Cognitive Theory Constructs
      ConstructsDescriptionOperationalization of the Constructs
      Outcome expectationsBeliefs about the likelihood and value of the consequences of behavior choices
      • Instructional lectures provided information about behavior-health links. Information was shared about the health consequences of poor dietary choices over time, and the health benefits of good nutrition were stressed during instruction
      • Food challenge activities required students to set weekly topic-based goals, directing students’ cognitive focus on specific outcomes and allowing them to adjust personal expectations
      • Weekly reflection papers encouraged students to address the success/challenges of meeting weekly goals
      Goal settingIdentification of SMART statements of behavior or accomplishment• Weekly food challenges presented students with a guided goal-setting activity• Students selected 2 minor goals from a list of 10–15 goals pertinent to the week's instructional unit/topic• Students were then encouraged to create personalized SMART goals for themselves each week using their 2 selected minor goals
      Observational learningLearning is acquired by watching similar individuals or role models perform a behavior and observing the outcome• How to instruction was modeled or demonstrated for a specific behavior (eg, cooking skills, spice and seasoning choice):• Demonstration videos from the internet specific to the week's topic of instruction were provided to all sections)• The instructor performed a behavior (in-person or video recorded) specific to a selected goal (eg, reading a food label)
      Self-efficacyConfidence or belief in one's ability to perform a given behavior
      • Instructional lectures provided information about the nutritional content and food options to help students expand their nutrition knowledge
      • The weekly food challenges encouraged students to cook meals at home to practice nutrition and cooking skills. Each skill was broken down instructionally into small measurable steps• Cooking videos and supplemental resources were provided virtually to all students as support for weekly instruction
      Self-monitoringControlling oneself through self-regulation, feedback, and social support
      • The instructor prompted self-monitoring of behavior by requiring participants to keep records of their eating and cooking behavior and writing reflection papers to identify small successes (eg, changes in attitudes and behavior) along the path to larger behavior changes
      • The instructor provided encouragement, feedback, and praise during reviewing weekly food challenge reflection papers
      • Students in all sections posted weekly reflections to a section-specific virtual discussion board for peers’ support/feedback
      • A final course reflection paper assignment challenged participants to review assumptions, barriers, and changes in behavior over the semester and to set future goals
      SMART indicates specific, measurable, attainable, realistic, and time-bound.
      To help apply new knowledge, increase self-efficacy, and positively affect behavior, students participated in at-home food challenges that aligned with each week's instructional topic. Posted to a private class-based virtual discussion board and linked to the online library of resources pertinent to specific skills, food challenge topics included: observe hunger and fullness, control portion size, get more F&V in your diet, go with whole grains and decrease added sugar, choose healthy fats, implement mindful snacking, shake the salt habit, increase your calcium, and cook with herbs and spices.
      The food challenges were coordinated with a guided goal setting technique (Table 2) that used behavioral strategies identified by Shilts and Townsend.
      • Shilts MK
      • Townsend MS.
      A goal intervention positively impacts adolescents’ dietary behaviors and physical activity self-efficacy.
      Guided goal setting, instead of self-set goals, was used as a pedagogical tool to support course learning outcomes and help students learn how to translate general goals into specific and measurable ones using specific, measurable, attainable, realistic, and time-bound (SMART) criteria.
      • Ogbeiwi O.
      Why written objectives need to be really SMART.
      Thus, each course topic/unit and corresponding food challenge were coupled with 10–15 minor goals
      • Shilts MK
      • Horowitz M
      • Townsend MS.
      Guided goal setting: effectiveness in a dietary and physical activity intervention with low-income adolescents.
      ,
      • Shilts MK
      • Townsend MS.
      A goal intervention positively impacts adolescents’ dietary behaviors and physical activity self-efficacy.
      from which students were required to independently select 2 to focus on that week, guided on how to rework them into the SMART format, and asked to apply at home. Students were also required to write a weekly reflection tracking their progress against their stated SMART goals. The instructor provided encouragement to support goal achievement, such as “Good job!” or “Keep it up!” If students had trouble implementing strategies to achieve their goals, the instructor provided suggestions or helped them revise their goals to better fit the achievable criteria inherent in SMART goals. Research has shown that learning can be reinforced through reflective activities and positive feedback.
      • Harvey M
      • Coulson D
      • McMaugh A.
      Towards a theory of the ecology of reflection: reflective practice for experiential learning in higher education.
      Table 2Alignment of Instructional Units with Food Challenges, Guided Goal-Setting Examples, and Relevant Cooking Videos
      Instructional UnitsFood ChallengesExamples of Minor GoalsExamples of Cooking Videos
      MindfulnessObserve hunger and fullnessUse the Hunger and Fullness Scale before you eat and during the meal. Stop eating when you reach a comfortable level of fullness (6 or 7).

      Eat when you are hungry, not because of external cues.
      How to Practice Mindful Eating

      https://www.youtube.com/watch?v=3zK5RGTaFMM&list=RDLVm7gOGd3Yr8w&index=4

      Mindful Eating: The Raisin Exercise (Mindfulness-Based Cognitive Therapy)

      https://www.youtube.com/watch?v=1umGZ8S8tHo
      MyPlateControl portion sizeUse smaller plates and serving spoons.

      Wait 10 min before you reach for seconds.

      Serve dinner by the plate, rather than family style.
      Portion Control for Heart-Healthy Living

      https://www.youtube.com/watch?v=duBhKTTM1WE

      Meal Planning for Beginners

      https://www.youtube.com/watch?v=r1OSDnCDoGQ
      Menu planningGet more fruits and vegetables in your dietAdd a salad to your lunch or dinner and include dark green lettuce and vegetables with low-fat dressing.

      Make your smoothies at home with bananas, berries, and a little nonfat milk.
      Basic Knife Skills

      https://www.youtube.com/watch?v=arOHmHYhEaY

      How to Stir Fry

      https://www.youtube.com/watch?v=8bEBVO1jiXU
      CarbohydratesGo with whole grains and decrease added sugarChange your bread or cereal to contain more whole grain. The first ingredient should be whole grain instead of enriched. This change will help increase your fiber intake.

      Buy fresh fruit instead of cookies and pastries.
      Quinoa 101: How To Make, Use, and Store Quinoa

      https://www.youtube.com/watch?v=F7uvygMiwfo

      Overnight Oats

      https://m.facebook.com/CleanAndDeliciousWithDaniSpies/videos/600609880447802/
      LipidsChoose healthy fatsEat salmon or tuna, which are good sources of omega-3 fatty acids.

      Add slices of avocado to salads and sandwiches.
      Classic Tuna Salad

      https://z-p3-upload.facebook.com/CleanAndDeliciousWithDaniSpies/videos/442805153820148/

      How to Cut an Avocado

      https://www.youtube.com/watch?v=Whp4ktlUeXw
      Energy balanceImplement mindful snackingLimit distractions. Turn off the TV, video games, and cell phones and turn your attention to your snack so you can be in the moment.

      Savor your food. Use all of your senses to appreciate the flavor, texture, appearance, and aroma of your snack.
      How To Cut Pineapple

      http://allrecipes.com/video/8/how-to-cut-pineapple/

      Chia Pudding

      https://pt-br.facebook.com/CleanAndDeliciousWithDaniSpies/videos/chia-pudding-4-ways/721087278404732/
      MineralsShake the salt habitBuy unsalted nuts and snacks.

      Cook at home! Prepare your food and experiment with herbs and spices instead of table salt.
      Spice it Up

      https://www.youtube.com/watch?v=i3GAkHn_F24

      Roasted Vegetables

      https://www.youtube.com/watch?v=PxJRhNzDwYY
      MineralsIncrease your calciumAdd good sources of calcium such as green leafy vegetables, fortified foods such as almond or soy milk, orange juice (fortified with calcium) or cereal, almonds, salmon, or sardines with bones.

      Cook your oatmeal or other hot cereal in fat-free or low-fat milk instead of water.
      How to Make a Smoothie Recipe Guide: Easy, Tasty, and Healthy

      https://www.youtube.com/watch?v=9LvYYJemzNY

      Asparagus and Herb Omelet

      https://www.youtube.com/watch?v=dLlhv2TZ6Pg
      Self-efficacyCook with herbs and spices

      Celebration meal with family/friends
      Plan a menu that you will cook to share with 1 or more friends.

      Find recipes for an entrée and vegetable containing at least 3 spices or herbs, which limit salt, sugar, butter, or cheese.
      How to Make Chicken Fajitas

      https://www.youtube.com/watch?v=btYv3Pv_I-g

      Grilled Salmon With Mango Salsa

      https://www.youtube.com/watch?v=EAK5GfW5q6w
      In addition to the course videos, supplemental information about shopping tips, cooking techniques, food science concepts, use of herbs and spices, and healthy recipes were posted to the course webpage in the LMS. Online access to the videos and additional cooking library resources was tracked via the LMS to ensure program fidelity. Students accessed 15 videos (approximately 1 per week) and 30 supplemental resources (approximately 2 per week) across the 15-week semester. All of the students accessed the videos and resources.

      Participants

      University students (n = 142) registered for an introductory human nutrition course participated in the study. Students in 3 sections of the course (2 in-person and 1 online) participated in the study. Each in-person section was filled and accommodated 45 students, whereas the online section accommodated 70, but only 69 students registered. Most students taking the course enrolled in the study, which was approved by the University of Louisville‘s Institutional Review Board by expedited review. Consent was provided by an unsigned preamble consent document.

      Instrumentation

      The instruments utilized in this study were previously developed and tested for reliability and validity for college-aged students.
      • Warmin A
      • Sharp J
      • Condrasky MD.
      Cooking with a chef: a culinary nutrition program for college aged students.
      ,
      • McMullen J
      • Ickes M.
      The influence of a campus-based culinary, nutrition education program, “College CHEF,” on college students’ self-efficacy with cooking skills and nutrition behaviors.
      ,
      • Condrasky MD
      • Williams JE
      • Catalano PM
      • Griffin SF.
      Development of psychosocial scales for evaluating the impact of a culinary nutrition education program on cooking and healthful eating.
      ,
      • McMullen J
      • Ickes M
      • Noland M
      • Helme D.
      Evaluation of “College CHEF,” a campus-based, culinary nutrition education program.
      The survey consisted of a cooking attitudes scale, 3 self-efficacy scales, 2 universal items to measure F&V consumption, and participant demographic questions. Internal consistency estimates are provided for the scales measured before and after the intervention (Table 4).
      Table 4Descriptive Statistics, Inferential Statistics, and Reliability Measures for Cooking Attitudes, Cooking and Nutrition Self-Efficacy, and Eating Behaviors Scales and Items
      PreinterventionPostinterventionPre-Post Comparison
      Scale/ItemMSDαMSDαt(137)PCohen's d
      Cooking Attitudes Scale3.80.60.783.80.60.840.930.350.08
       I do not like to cook because it takes too much time
      Item was reverse coded
      3.61.13.51.1
       Meals made at home are affordable4.10.84.10.8
       Cooking is frustrating
      Item was reverse coded
      3.70.93.61.0
       I like trying new recipes4.10.84.00.8
       It is too much work to cook
      Item was reverse coded
      3.51.03.51.0
       Make meals at home helps me to eat more healthfully4.30.74.40.7
       I find cooking tiring
      Item was reverse coded
      3.51.03.51.0
      Produce Consumption Self-Efficacy Scale3.01.00.813.20.80.762.910.004
      Statistically significant at P = 0.008 (Bonferroni adjustment calculated as 0.05/6).
      0.25
       Eat fruits and vegetables at every meal, every day3.01.23.31.0
       Eat fruits or vegetables as a snack, even if everybody else was eating other snacks3.31.13.51.0
       Eat the recommended 9 half-cup servings of fruits and vegetables each day2.61.22.91.0
      Cooking Self-Efficacy Scale3.80.80.864.00.60.873.230.002
      Statistically significant at P = 0.008 (Bonferroni adjustment calculated as 0.05/6).
      0.28
       Cook from basic ingredients3.61.24.00.9
       Follow a written recipe4.01.04.10.8
       Prepare dinner from items you currently have in your pantry and refrigerator3.91.04.00.9
       Use knife skills in the kitchen3.81.04.00.8
       Plan nutritious meals3.41.23.90.8
       Use basic cooking techniques4.10.94.20.7
      Using Fruits, Vegetables, and Seasonings Self-Efficacy Scale3.40.80.873.60.70.883.490.001
      Statistically significant at P = 0.008 (Bonferroni adjustment calculated as 0.05/6).
      0.30
       Fresh or frozen green vegetables3.91.04.00.8
       Root vegetables3.81.03.90.9
       Fruit4.20.74.20.6
       Herbs3.31.23.71.0
       Spices3.51.13.80.9
       Vinegars2.81.23.11.2
       Citrus juice3.11.23.31.1
       Citrus zest2.91.23.21.1
       Hot sauces3.21.33.31.2
      How often do you consume at least 5 servings of fruit/d?2.31.2N/A2.71.1N/A4.51< 0.001
      Statistically significant at P = 0.008 (Bonferroni adjustment calculated as 0.05/6).
      0.38
      How often do you consume at least 5 servings of vegetables/d?2.41.3N/A2.91.2N/A5.51< 0.001
      Statistically significant at P = 0.008 (Bonferroni adjustment calculated as 0.05/6).
      0.47
      M indicates mean; N/A, not applicable.
      a Item was reverse coded
      b Statistically significant at P = 0.008 (Bonferroni adjustment calculated as 0.05/6).

      Cooking attitudes

      McMullen and colleagues’
      • McMullen J
      • Ickes M
      • Noland M
      • Helme D.
      Evaluation of “College CHEF,” a campus-based, culinary nutrition education program.
      cooking attitudes scale consist of 7 statements that measure how participants feel about cooking using a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). In our survey, item scores were reverse coded for negatively worded statements when appropriate.

      Self-efficacy

      Three self-efficacy scales were used to evaluate cooking and nutrition-related self-efficacy. Response options for the self-efficacy scales were based on a 5-point Likert scale ranging from 1 (not at all confident) to 5 (extremely confident). The Cooking Self-Efficacy scale
      • McMullen J
      • Ickes M.
      The influence of a campus-based culinary, nutrition education program, “College CHEF,” on college students’ self-efficacy with cooking skills and nutrition behaviors.
      consisted of 6 statements measuring confidence in culinary skills and food preparation techniques, such as planning nutritious meals, cooking with basic ingredients, using basic cooking techniques, and using knife skills. The Self-Efficacy Produce Consumption scale
      • McMullen J
      • Ickes M.
      The influence of a campus-based culinary, nutrition education program, “College CHEF,” on college students’ self-efficacy with cooking skills and nutrition behaviors.
      consisted of 3 statements measuring confidence in eating fruits and vegetables as a snack, at every meal, or consuming 9 half-cup servings per day. The Self-Efficacy for Using Fruits, Vegetables, and Seasonings scale
      • McMullen J
      • Ickes M.
      The influence of a campus-based culinary, nutrition education program, “College CHEF,” on college students’ self-efficacy with cooking skills and nutrition behaviors.
      consisted of 9 statements measuring confidence in cooking with vegetables, fruits, herbs, spices, and other seasonings.

      Fruit and vegetable consumption

      Two single 5-point items assessed how often participants separately consumed at least 5 servings of fruit and at least 5 servings of vegetables per day (1 = not at all; 5 = about every day).
      • McMullen J
      • Ickes M
      • Noland M
      • Helme D.
      Evaluation of “College CHEF,” a campus-based, culinary nutrition education program.
      Higher score responses to the F&V consumption items reflected more frequent consumption of F&Vs.

      Demographic questions

      Gender response options included male and female. Race/ethnicity response options included White (not of Hispanic origin), Black (not of Hispanic origin), Hispanic/Latino, Asian or Pacific Islander, American Indian/Alaskan Native, and Mixed/Other.

      Data Analysis

      Initially, descriptive statistics were computed for each item and total scalar composite scores (calculated as a scaled average). All item and composite scores were checked for normality. Skewness and kurtosis were also below an absolute value of 3.0.
      • Hu LT
      • Bentler PM.
      Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives.
      In addition, no outliers (> or < 3.0 SD from the mean) were identified. After the descriptive examination of the data, scalar internal consistency was assessed using Cronbach alpha coefficients,
      • Cronbach LJ.
      Coefficient alpha and the internal structure of tests.
      which were calculated separately for pre-intervention and postintervention scalar survey responses, and all fell within an acceptable range (see Table 4).
      Finally, to assess the feasibility of the intervention, a series of paired t tests were calculated for students’ cooking attitudes, self-efficacy scores, and F&V consumption data. Although some differences in gender and race/ethnic identity distributions were noted across course modality, segmenting the data by course mode-demographic group resulted in sample sizes too small for adequately powered complex inferential analyses (eg, n = 5 for male students enrolled in the online section). Furthermore, Bonferroni-adjusted independent group t tests between course modalities for the study's 6 outcome measures showed no significant differences in pretest or posttest data. Data from the asynchronous online and in-person sections were combined for final analysis, and a Bonferroni adjustment was calculated and applied to future analyses (0.05/6 = P < 0.008) to account for inflated type I error rates across multiple paired t tests.
      • Armstrong RA.
      When to use the Bonferroni correction.
      Statistical analyses were conducted using SPSS (version 27.0, IBM Corp, 2020).

      RESULTS

      Across the in-person sections, 84 students enrolled in the study and 77 completed the study; 68 students in the online section enrolled in the study and 61 completed the study. Study attrition was low (10%) and did not vary by teaching mode (P = 0.33). A total of 138 students completed the study. Participants who provided usable data for analysis were aged 18–40 years (mean [M], 20.2; SD, 3.0). Most student participants were sophomores (59%), followed by freshmen (20%), juniors (16%), and seniors/others (5%). Almost 82% of the participants identified as female (n = 113). Nearly three-quarters (74%) identified their race/ethnicity as White, and 13 participants (9%) identified as Black. The remaining 23 participants (17%) identified as either Asian/Pacific Islander, Hispanic/Latino, or mixed/other. Demographic distributions across age, class rank, and past food service work experience did not vary significantly by in-person or online section. All students had access to a kitchen, which enabled them to practice cooking at home (Table 3) .
      Table 3Descriptive Statistics by Course Modality
      Online (n = 61)In-Person (n = 77)Total (n = 138)
      Variablesn% of Category Totaln% of Category Totaln% of Category Total
      Average age, y20.419.920.2
      Gender
       Male58.22026.02518.1
       Female5691.85774.011381.9
      Ethnicity
       White5183.65065.810173.7
       Black69.879.2139.5
       Hispanic11.667.975.1
       Other34.91317.11611.7
      Education level
       Freshman1016.41722.12719.6
       Sophomore3760.74558.48259.4
       Junior1118.01114.32215.9
       Senior23.333.953.6
       Other11.611.321.5
      Foodservice work experience
       Yes3862.33950.77755.8
       No2337.73849.46144.2
      Overall, participants reported low levels of fruit (M, 2.3; SD, 1.2) and vegetable consumption (M, 2.4; SD, 1.3) before the intervention, substantiating the need for intervention. Self-efficacy scores ranged by specific skill, with the lowest average scores noted for produce consumption self-efficacy both before and after the intervention (pretest: M, 3.0; SD, 1.0; posttest: M, 3.2; SD, 0.8), followed by self-efficacy for using fruit, vegetables, and seasonings (pretest: M, 3.4; SD, 0.8; posttest: M, 3.6; SD, 0.7). Higher average scores were noted for cooking self-efficacy (pretest: M, 3.8; SD, 0.8; posttest: M, 4.0; SD, 0.6) and cooking attitudes (pretest: M, 3.8; SD, 0.6; posttest: M, 3.8; SD, 0.6). Table 4 provides additional detail regarding average scores for each outcome measure.
      The results of the paired t tests between pretest and posttest scores showed a significant increase in cognitive outcomes (Table 4). Specifically, participant's produce consumption self-efficacy was significantly higher after the intervention compared with before the intervention (t[137] = 2.91; P = 0.004; Cohen's d = 0.25). Participant's cooking self-efficacy was also significantly higher after the intervention compared with before the intervention (t[137] = 3.23; P = 0.002; Cohen's d = 0.28). Finally, self-efficacy related to fruits, vegetables, and seasonings for cooking was significantly higher after the intervention than before the intervention (t[137] = 3.49; P = 0.001; Cohen's d = 0.30). For each of these self-efficacy scales, Cohen's d results indicated a small effect size related to the intervention. Although positive attitudes toward cooking were noted at both data collection time points, as evidenced by mean scores above the scale midpoint, no significant attitudinal change occurred in this study (t[137] = 0.93; P = 0.35).
      For F&V consumption behavior, the data show a significant increase from pretest to posttest. By posttest, reported fruit consumption had increased significantly (posttest: M, 2.6; SD, 1.1; t[137] = 4.51; P < 0.001; Cohen's d = 0.38) (a small intervention effect). Reported vegetable consumption had also increased after the intervention (posttest: M, 2.8; SD, 1.3; t[137] = 5.51; P < 0.001; Cohen's d = 0.47) (a small-to-medium intervention effect). Thus in this pilot test, the intervention seems to have positively affected self-efficacy and behavior despite a lack of effect on attitudes toward cooking.
      Qualitatively, a cursory post hoc review of students’ written reflections throughout the semester reflected the positive behavioral outcomes noted in the quantitative analysis results from this intervention. Frequent comments included mentions of meal planning before shopping, preparing meals on weekends, taking lunch to school, and using herbs and spices.

      DISCUSSION

      This pilot study examined a 15-week intervention incorporating food challenges and instructional cooking videos into a nutrition course to promote changes in affective (cooking attitudes), cognitive (cooking and nutrition self-efficacy), and behavioral (F&V consumption) outcomes of college students. Key SCT constructs were operationalized into the intervention by instruction about behavior/health links, modeling through cooking videos, guided goal setting, self-reflection, and review of behavioral goals. These intervention elements appeared to prompt positive changes in key cognitive and behavioral outcomes in our pilot sample. A significant increase from preintervention to postintervention was found in the college students’ self-efficacy for produce consumption, cooking, and using fruit, vegetables and seasonings. In addition, students reported eating more eating fruits and vegetables. The increase in self-efficacy of college students in this study was similar to previous hands-on culinary interventions using the same evaluation measures. Past research using hands-on interventions with college students also showed increased self-efficacy for using fruits, vegetables, and seasonings,
      • Warmin A
      • Sharp J
      • Condrasky MD.
      Cooking with a chef: a culinary nutrition program for college aged students.
      ,
      • McMullen J
      • Ickes M
      • Noland M
      • Helme D.
      Evaluation of “College CHEF,” a campus-based, culinary nutrition education program.
      ,
      • Bernardo GL
      • Jomori MM
      • Fernandes AC
      • Colussi CF
      • Condrasky MD
      • Proença RPDC.
      Positive impact of a cooking skills intervention among Brazilian university students: six months follow-up of a randomized controlled trial.
      self-efficacy for produce consumption,
      • McMullen J
      • Ickes M
      • Noland M
      • Helme D.
      Evaluation of “College CHEF,” a campus-based, culinary nutrition education program.
      ,
      • Bernardo GL
      • Jomori MM
      • Fernandes AC
      • Colussi CF
      • Condrasky MD
      • Proença RPDC.
      Positive impact of a cooking skills intervention among Brazilian university students: six months follow-up of a randomized controlled trial.
      and self-efficacy for cooking.
      • Warmin A
      • Sharp J
      • Condrasky MD.
      Cooking with a chef: a culinary nutrition program for college aged students.
      However, a strength of the present study, which incorporated the intervention into a nutrition course in both in-person and online modalities, is that a more diverse set of students can be impacted with minimal additional resources (ie, nontraditional students and students living in different geographies taking online courses). The ability to connect with students attending class from a remote location through an online LMS has important implications for health and nutrition educators during the current coronavirus disease 2019 pandemic, as online learning is growing.
      This pilot study also supports past research suggesting that behavior-based interventions increase F&V intake.
      • Matias SL
      • Rodriguez-Jordan J
      • McCoin M.
      Evaluation of a college-level nutrition course with a teaching kitchen lab.
      ,
      • Thomson CA
      • Ravia J.
      A systematic review of behavioral interventions to promote intake of fruit and vegetables.
      Behavior change is more likely to occur when education has a skill-based approach emphasizing self-efficacy and goal achievement.
      • O'Donnell S
      • Greene GW
      • Blissmer B.
      The effect of goal setting on fruit and vegetable consumption and physical activity level in a web-based intervention.
      ,
      • Lockwood P
      • Wohl R.
      The impact of a 15-week lifetime wellness course onbehavior change and self-efficacy in college students.
      In this intervention, levels of F&V consumption significantly increased among college students, corroborating findings from other intervention studies focused on F&V intake in the past.
      • Thomson CA
      • Ravia J.
      A systematic review of behavioral interventions to promote intake of fruit and vegetables.
      We also found that students participating in the study indicated that they met the goal of eating ≥ 5 servings of F&Vs per day more often postintervention than preintervention. Self-monitoring of behavior was prompted by requiring students to keep records of their eating and cooking behaviors on the basis of their SMART goals and write reflections to identify their small successes. Comments from students’ reflections supported the positive behavioral outcomes noted in the quantitative analysis results.
      Although this pilot intervention was associated with positive changes in self-efficacy and behavior, cooking attitudes did not change significantly over time. Nevertheless, attitudes remained positive throughout the semester, suggesting that students signing up for a college nutrition course may already be predisposed to positive attitudes toward healthy cooking. Interestingly, other researchers have found similar attitudinal results after hands-on cooking interventions with college students.
      • Warmin A
      • Sharp J
      • Condrasky MD.
      Cooking with a chef: a culinary nutrition program for college aged students.
      ,
      • McMullen J
      • Ickes M
      • Noland M
      • Helme D.
      Evaluation of “College CHEF,” a campus-based, culinary nutrition education program.
      Future research could explore whether the cooking attitudes of students from other majors or disciplines may be less positive, more malleable, and therefore respond better to an SCT-based cooking intervention.
      Overall, this pilot study provides a preliminary framework for a nutrition behavior change intervention among college students grounded in SCT constructs, simplifies the goal setting process (by using guided goal setting), and uses video technology to decrease the cost of implementation. Although previous studies with college students used self-set goals and self-monitoring to promote dietary behavior change,
      • Schnoll R
      • Zimmerman BJ.
      Self-regulation training enhances dietary self-efficacy and dietary fiber consumption.
      • O'Donnell S
      • Greene GW
      • Blissmer B.
      The effect of goal setting on fruit and vegetable consumption and physical activity level in a web-based intervention.
      • Shilts MK
      • Horowitz M
      • Townsend MS.
      Guided goal setting: effectiveness in a dietary and physical activity intervention with low-income adolescents.
      • Shilts MK
      • Townsend MS.
      A goal intervention positively impacts adolescents’ dietary behaviors and physical activity self-efficacy.
      this pilot intervention is unique because it examined the feasibility and effectiveness of integrating a guided goal setting strategy to help teach SMART goal writing with instructional video technology and digital self-reflections in a traditional college nutrition course to enhance SCT constructs and affect behavior. Moreover, there is limited research to support goal setting
      • Strecher VJ
      • Seijts GH
      • Kok GJ
      • et al.
      Goal setting as a strategy for health behavior change.
      ,
      • Pearson ES.
      Goal setting as a health behavior change strategy in overweight and obese adults: a systematic literature examining intervention components.
      ,
      • Hooker SH
      • Punjabi A
      • Justesen K
      • Boyle L
      • Sherman MD.
      Encouraging health behavior change: eight evidence-based strategies.
      or video technology
      • Brown KN
      • Wengreen HJ
      • Vitale TS
      • Anderson JB.
      Increased self-efficacy for vegetable preparation following an online, skill-based intervention and in-class tasting experience as a part of a general education college nutrition course.
      ,
      • Surgenor D
      • Hollywood L
      • Furey S
      • et al.
      The impact of video technology on learning: a cooking skills experiment.
      ,
      • Nour M
      • Yeung SH
      • Partridge S
      • Allman-Farinelli M.
      A narrative review of social media and game-based nutrition interventions targeted at young adults.
      to increase outcome expectations and self-efficacy for healthy dietary behavior among young adults. This pilot intervention reviewed the feasibility of combining these 2 elements, thereby adding to the extant literature and further expanding our awareness of available methods for operationalizing SCT constructs for young adults. Moreover, the current study provides initial evidence of the viability of this intervention approach in both a traditional, in-person classroom and an online course delivery format, although further research is warranted.
      Despite its positive findings, this study had its limitations. The study was not powered on any outcome variables so any non-significant results should be interpreted with caution. Its convenience sample suggests that the study population may not represent all college students. The nature of the sample also prevented the conduct of more complex analyses that would have allowed for a better understanding of how demographic variables might interact with course modality to affect intervention outcomes. Furthermore, using self-reported outcome measures could have introduced social desirability and recall bias into the data, thereby affecting the validity of conclusions drawn here.
      • Rosenman R
      • Tennekoon V
      • Hill LG.
      Measuring bias in self-reported data.
      The positive outcomes noted in this study could also have been affected by student motivation/interest in nutrition because one of the researchers was the instructor of the classes. In addition, this pilot study did not use a control group, which limits the causal inference of the results. A larger controlled trial must be conducted comparing a traditional approach to our enhanced intervention. The long-term effects of the intervention over time were also not included in the study design. Finally, this study did not include a quantitative assessment of outcome expectations, although qualitative instructor reviews of students’ reflections support the idea that students could appropriately set outcome expectations.

      IMPLICATIONS FOR RESEARCH AND PRACTICE

      The intervention used in this pilot study provides practical ways to make a traditional college nutrition course behaviorally focused and potentially more effective at eliciting behavior change. Future goals mentioned in students’ reflective papers from this intervention included eating more F&Vs, cooking more, and eating out less, suggesting continued maintenance of healthy dietary choices and behavior over time. A mixed method approach in the future, in which qualitative reflections are systematically evaluated and used to augment quantitative data, could help further explicate behavior change processes. The intervention framework provided here could be tailored to address a variety of outcomes in dietetics, health education, or community-based programs. In the future, we recommend larger experimental studies, including a pre-post controlled trial of the intervention, to help further establish intervention effectiveness and long-term efficacy.

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