Development of eHealth-Based Behavior Change Support for Young Adults Using the Nine Principles Framework

Published:November 11, 2022DOI:


      Implementing behavior strategies into nutrition research requires consideration. The Nine Principles framework was used to develop an eHealth behavior change support (BCS) program to enhance young adults’ adherence to (1) eating healthily and (2) recording dietary intake when participating in a randomized control trial. The Theory of Planned Behavior and qualitative focus group data informed a 10-week pilot of the BCS delivered on Facebook and texts. The BCS appeared to support optimal dietary recording and maintained dietary behaviors, suggesting using a framework underpinned by theory and user-centered design may be a promising avenue to enhance adherence in randomized control trials.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access

      SNEB Member Login

      SNEB Members, full access to the journal is a member benefit. Login via the SNEB Website to access all journal content and features.


      Subscribe to Journal of Nutrition Education and Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Esposito K
        • Maiorino MI
        • Bellastella G
        • Chiodini P
        • Panagiotakos D
        • Giugliano D.
        A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses.
        BMJ Open. 2015; 5: 8222
        • Siervo M
        • Lara J
        • Chowdhury S
        • Ashor A
        • Oggioni C
        • Mathers JC.
        Effects of the dietary approach to stop hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis.
        Br J Nutr. 2015; 113: 1-15
        • Atkins L
        • Michie S.
        Changing eating behaviour: what can we learn from behavioural science?.
        Nutr Bull. 2013; 38: 30-35
        • Michie S
        • Abraham C
        • Eccles MP
        • Francis JJ
        • Hardeman W
        • Johnston M.
        Strengthening evaluation and implementation by specifying components of behaviour change interventions: a study protocol.
        Implement Sci. 2011; 6: 10
        • Dombrowski SU
        • Sniehotta FF
        • Avenell A
        • Johnston M
        • MacLennan G
        • Araújo-Soares V.
        Identifying active ingredients in complex behavioural interventions for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities: a systematic review.
        Health Psychol Rev. 2012; 6: 7-32
        • Michie S
        • Fixsen D
        • Grimshaw JM
        • Eccles MP.
        Specifying and reporting complex behaviour change interventions: the need for a scientific method.
        Implement Sci. 2009; 4: 40
        • Suls J
        • Mogavero JN
        • Falzon L
        • Pescatello LS
        • Hennessy EA
        • Davidson KW.
        Health behaviour change in cardiovascular disease prevention and management: meta-review of behaviour change techniques to affect self-regulation.
        Health Psychol Rev. 2020; 14: 43-65
        • Celis-Morales C
        • Lara J
        • Mathers JC.
        Personalising nutritional guidance for more effective behaviour change.
        Proc Nutr Soc. 2015; 74: 130-138
        • Darnton A.
        Practical guide: an overview of behaviour change models and their uses.
        Government Social Research Unit. 2008; (Accessed October 24, 2022.)
        • Michie S
        • van Stralen MM
        • West R.
        The behaviour change wheel: A new method for characterising and designing behaviour change interventions.
        Implement Sci. 2011; 6: 42
        • Skivington K
        • Matthews L
        • Simpson SA
        • et al.
        A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance.
        BMJ. 2021; 374: n2061
        • Braakhuis A
        • Gillies N
        • Worthington A
        • et al.
        A modern flexitarian dietary intervention incorporating web-based nutrition education in healthy young adults: protocol for a randomized controlled trial.
        JMIR Res Protoc. 2021; 10: e30909
        • Ashton LM
        • Sharkey T
        • Whatnall MC
        • et al.
        Effectiveness of interventions and behaviour change techniques for improving dietary intake in young adults: a systematic review and meta-analysis of RCTs.
        Nutrients. 2019; 11: 825
      1. König LM, van Emmenis M, Nurmi J, Kassavou A, Sutton S. Characteristics of smartphone-based dietary assessment tools: a systematic review [published online ahead of print December 21, 2021]. Health Psychol Rev. .

        • Simpson A
        • Gemming L
        • Baker D
        • Braakhuis A.
        Do image-assisted mobile applications improve dietary habits, knowledge, and behaviours in elite athletes?.
        A pilot study. Sports (Basel). 2017; 5: 60
        • Howes E
        • Boushey CJ
        • Kerr DA
        • Tomayko EJ
        • Cluskey M.
        Image-based dietary assessment ability of dietetics students and interns.
        Nutrients. 2017; 9: 114
        • Samdal GB
        • Eide GE
        • Barth T
        • Williams G
        • Meland E.
        Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses.
        Int J Behav Nutr Phys Act. 2017; 14: 42
      2. Research New Zealand.
        A Report on a Survey of New Zealanders’ Use of Smartphones and Other Mobile Communication Devices. Research New Zealand;. 2015; (Accessed November 12, 2020)
        • Glanz K
        • Bishop DB.
        The role of behavioral science theory in development and implementation of public health interventions.
        Annu Rev Public Health. 2010; 31: 399-418
      3. Eating and activity guidelines for New Zealand adults: updated 2020. Ministry of Health. 2020. Accessed January 15, 2021.

        • Ambrosini GL
        • Hurworth M
        • Giglia R
        • Trapp G
        • Strauss P.
        Feasibility of a commercial smartphone application for dietary assessment in epidemiological research and comparison with 24-h dietary recalls.
        Nutr J. 2018; 17: 5
        • University of Otago and Ministry of Health
        A Focus on Nutrition : Key Findings of the 2008/9 New Zealand Adult Nutrition Survey.
        Ministry of Health, 2011 (Accessed July 12, 2020)
        • Ajzen I.
        The Theory of Planned Behavior.
        Organ Behav Hum Decis Process. 1991; 50: 179-211
        • Michie S
        • Richardson M
        • Johnston M
        • et al.
        The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.
        Ann Behav Med. 2013; 46: 81-95
        • Sam CHY
        • Skidmore P
        • Skeaff S
        • Wall C
        • Bradbury KE
        • Parackal S.
        Relative validity and reproducibility of a short food frequency questionnaire to assess nutrient intakes of New Zealand adults.
        Nutrients. 2020; 12: 619
        • Wong JE
        • Haszard JJ
        • Howe AS
        • Parnell WR
        • Skidmore PML.
        Development of a healthy dietary habits index for New Zealand adults.
        Nutrients. 2017; 9: 454
        • Braun V
        • Clarke V.
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101
        • Munt AE
        • Partridge SR
        • Allman-Farinelli M.
        The barriers and enablers of healthy eating among young adults: a missing piece of the obesity puzzle: a scoping review.
        Obes Rev. 2017; 18: 1-17
        • Doran GT.
        There's a SMART way to write management's goals and objectives.
        Manag Rev. 1981; 70: 35-36
        • Perski O
        • Blandford A
        • West R
        • Michie S.
        Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis.
        Transl Behav Med. 2017; 7: 254-267
        • Chau MM
        • Burgermaster M
        • Mamykina L.
        The use of social media in nutrition interventions for adolescents and young adults-a systematic review.
        Int J Med Inform. 2018; 120: 77-91
        • Willmott TJ
        • Pang B
        • Rundle-Thiele S
        • Badejo A.
        Weight management in young adults: systematic review of electronic health intervention components and outcomes.
        J Med Internet Res. 2019; 21: e10265
        • Hackman CL
        • Knowlden AP.
        Theory of reasoned action and theory of planned behavior-based dietary interventions in adolescents and young adults: a systematic review.
        Adolesc Health Med Ther. 2014; 5: 101-114
        • Menozzi D
        • Sogari G
        • Mora C.
        Explaining vegetable consumption among young adults: an application of the theory of planned behaviour.
        Nutrients. 2015; 7: 7633-7650
        • Sung K
        • Cooper T
        • Kettley S.
        Adapting Darnton's Nine Principles framework for behaviour change: the UK upcycling case study.
        Sustainability. 2022; 14: 1919