The Effectiveness of Sequentially Delivered Web-Based Interventions on Promoting Physical Activity and Fruit-Vegetable Consumption Among Chinese College Students: Mixed Methods Study

Yanping Duan, Wei Liang, Yanping Wang, Sonia Lippke, Zhihua Lin, Borui Shang, Julien Steven Baker, Yanping Duan, Wei Liang, Yanping Wang, Sonia Lippke, Zhihua Lin, Borui Shang, Julien Steven Baker

Abstract

Background: Web-based interventions for multiple health behavior change (MHBC) appear to be a promising approach to change unhealthy habits. Limited research has tested this assumption in promoting physical activity (PA) and fruit-vegetable consumption (FVC) among Chinese college students. Moreover, the timing of MHBC intervention delivery and the order of components need to be addressed.

Objective: This study aims to examine the effectiveness of 2 sequentially delivered 8-week web-based interventions on physical activity, FVC, and health-related outcomes (BMI, depression, and quality of life) and the differences in the intervention effects between the 2 sequential delivery patterns. The study also aims to explore participants' experiences of participating in the health program.

Methods: We conducted a randomized controlled trial, in which 552 eligible college students (mean 19.99, SD 1.04 years, 322/552, 58.3% female) were randomly assigned to 1 of 3 groups: PA-first group (4 weeks of PA followed by 4 weeks of FVC intervention), FVC-first group (4 weeks of FVC followed by 4 weeks of PA intervention), and a control group (8 weeks of placebo treatment unrelated to PA and FVC). The treatment content of two intervention groups was designed based on the Health Action Process Approach (HAPA) framework. A total of four web-based assessments were conducted: at baseline (T1, n=565), after 4 weeks (T2, after the first behavior intervention, n=486), after 8 weeks (T3, after the second behavior intervention, n=420), and after 12 weeks (T4, 1-month postintervention follow-up, n=348). In addition, after the completion of the entire 8-week intervention, 18 participants (mean 19.56, SD 1.04 years, 10/18, 56% female) who completed the whole program were immediately invited to attend one-to-one and face-to-face semistructured interviews. The entire study was conducted during the fall semester of 2017.

Results: The quantitative data supported superior effects on physical activity, FVC, and BMI in the 2 sequential intervention groups compared with the control group. There were no significant differences in physical activity, FVC, and health-related outcomes between the 2 intervention groups after 8 weeks. The FVC-first group contributed to more maintenance of FVC compared with the PA-first group after 12 weeks. Four major themes with several subthemes were identified in the qualitative thematic analysis: PA and FVC behavior, health-related outcomes, correlates of behavior change, and contamination detection.

Conclusions: This study provides empirical evidence for the effectiveness of sequentially delivered, web-based MHBC interventions on PA and FVC among Chinese college students. The timing issue of MHBC intervention delivery was preliminarily addressed. Qualitative findings provide an in-depth understanding and supplement the quantitative findings. Overall, this study may contribute considerably to future web-based MHBC interventions.

Trial registration: ClinicalTrials.gov NCT03627949; https://ichgcp.net/clinical-trials-registry/NCT03627949.

International registered report identifier (irrid): RR2-10.1186/s12889-019-7438-1.

Keywords: college students; fruit-vegetable consumption; health action process approach; mixed methods; physical activity; qualitative research; quantitative research; web-based intervention.

Conflict of interest statement

Conflicts of Interest: None declared.

©Yanping Duan, Wei Liang, Yanping Wang, Sonia Lippke, Zhihua Lin, Borui Shang, Julien Steven Baker. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.01.2022.

Figures

Figure 1
Figure 1
CONSORT (Consolidated Standards of Reporting Trials) flow diagram. FVC: fruit-vegetable consumption; PA: physical activity; PE: physical education.
Figure 2
Figure 2
Mean values for 3 groups from timepoints T1 to T4. (A) weekly amount of physical activity (metabolic equivalent of task-min/week). (B) daily portion of fruit and vegetable consumption (portion/day). FVC: fruit-vegetable consumption; PA: physical activity.
Figure 3
Figure 3
Mean values for 3 groups from timepoints T1 to T4. (A) BMI (kg/m2). (B) Depression. (C) Quality of life. FVC: fruit-vegetable consumption; PA: physical activity.

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