Web-Based Intervention for Physical Activity and Fruit and Vegetable Intake Among Chinese University Students: A Randomized Controlled Trial

Yan Ping Duan, Julian Wienert, Chun Hu, Gang Yan Si, Sonia Lippke, Yan Ping Duan, Julian Wienert, Chun Hu, Gang Yan Si, Sonia Lippke

Abstract

Background: Ample evidence demonstrates that university students are at high risk for sedentary behaviors and inadequate fruit and vegetable intake (FVI). Internet-based interventions for multiple health behavior appear to be promising in changing such unhealthy habits. Limited randomized controlled trials have tested this assumption among Chinese university students.

Objective: Our objective was to test the efficacy of an 8-week Web-based intervention compared with a control group condition to improve physical activity (PA) and FVI in Chinese university students. The intervention content was based on the health action process approach, and developed on the basis of previous evidence from the Western hemisphere. We evaluated self-reported data including PA and FVI, stages of change for PA and FVI, and motivational (risk perception, outcome expectancies, self-efficacy), volitional (action planning, coping planning, social support), and distal (intention, habit) indicators for PA and FVI, as well as perceived mental health outcomes (quality of life, depression).

Methods: In a randomized controlled trial, we recruited 566 university students from one university in the central region of China during their general physical education class. After random allocation and exclusion of unsuitable participants, we assigned 493 students to 1 of 2 groups: (1) intervention group: first 4 weeks on PA and subsequent 4 weeks on FVI, (2) control group. We conducted 3 Web-based assessments: at the beginning of the intervention (T1, n=493), at the end of the 8-week intervention (T2, n=337), and at a 1-month follow-up after the intervention (T3, n=142). The entire study was conducted throughout the fall semester of 2015.

Results: Significant time ⨯ group interactions revealed superior intervention effects on FVI; motivational, volitional, and distal indicators of FVI; and PA behavior changes, with an effect size (η2) ranging from .08 to .20. In addition, the overall intervention effects were significant for stage progression to the action group from T1 to T2 in PA (χ21=11.75, P=.001) and FVI (χ21=15.64, P=.03). Furthermore, the intervention effect was seen in the improvement of quality of life (F3,492=1.23, η2=.03, P=.02).

Conclusions: This study provides evidence for the efficacy of a Web-based multiple health behavior intervention among Chinese university students tested with different outcome variables. Future research should address the high dropout rate and optimize the most effective components of this intervention.

Trial registration: Clinicaltrials.gov NCT01909349; https://ichgcp.net/clinical-trials-registry/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6pHV1A0G1).

Keywords: Web-based intervention; fruit and vegetable intake; motivational indicators; physical activity; university students; volitional indicators.

Conflict of interest statement

Conflicts of Interest: None declared.

©Yan Ping Duan, Julian Wienert, Chun Hu, Gang Yan Si, Sonia Lippke. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 10.04.2017.

Figures

Figure 1
Figure 1
Flowchart of participant progress throughout the study phases.
Figure 2
Figure 2
Example of individual and normative feedback relating to time spent engaging in physical activity.
Figure 3
Figure 3
Performed physical activity (vigorous: left panel; moderate: middle panel; and walking: right panel) of the intervention group and the control group, in minutes per week, at 3 measurement points (T1: baseline; T2: end of intervention; and T3: 1-month follow-up).
Figure 4
Figure 4
Fruit and vegetable intake (FVI) at T1 (baseline), T2 (end of intervention), and T3 (1-month follow-up) in the intervention group and the control group (portions per day).
Figure 5
Figure 5
Mean scores for quality of life (QoL) at T1, T2, and T3 in the intervention group and the control group.
Figure 6
Figure 6
Mean scores for depression at T1, T2, and T3 in the intervention group and the control group.

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