Psychosocial Mediators of Web-Based Interventions for Promoting a Healthy Lifestyle Among Chinese College Students: Secondary Analysis of a Randomized Controlled Trial

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

Abstract

Background: Web-based multiple health behavior change (MHBC) interventions have demonstrated effectiveness in promoting physical activity (PA) and fruit and vegetable consumption (FVC) among Chinese college students. However, there is limited research examining their effects on promoting a healthy lifestyle (ie, adhering to both PA and FVC behavioral recommendations) among Chinese college students. In addition, the salient psychosocial mediators of successful MHBC interventions need to be researched.

Objective: This study aims to examine the effectiveness of a previous 8-week web-based MHBC program for promoting a healthy lifestyle and enhancing the psychosocial determinants (intention, self-efficacy, planning, and social support) of behavior change among Chinese college students. Furthermore, the study aims to identify whether changes in these psychosocial determinants mediate intervention effectiveness on the immediate and sustained lifestyle changes.

Methods: This was a secondary analysis for a 3-arm randomized controlled trial. Chinese college students (N=552) were randomly assigned to 1 of 3 groups: a PA-first group (4-week PA intervention followed by 4-week FVC intervention), an FVC-first group (4-week FVC intervention followed by 4-week PA intervention), and a placebo control group. The intervention content was designed based on the health action process approach model. Data for analyses were collected at baseline (T0), postintervention assessment (T1), and 12-week follow-up assessment (T2).

Results: At baseline, 13.9% (77/552) of the participants maintained a healthy lifestyle. After 8 weeks, more (200/552, 36.2%) participants achieved a healthy lifestyle. PA-first and FVC-first groups were, respectively, 3.24 times and 5 times more likely to adopt a healthy lifestyle than the control group at T1. After 12 weeks, 35.5% (196/552) of the participants adopted a healthy lifestyle. Intervention groups were approximately 2.99 times (PA first) and 4.07 times (FVC first) more likely to adopt a healthy lifestyle than the control group at T2. Intervention effects favored both intervention groups in self-efficacy and planning for PA and in intention and planning for FVC compared with the control condition. In addition, changes in PA self-efficacy and FVC intention mediated intervention effectiveness on the immediate lifestyle change after 8 weeks. Changes in FVC intention were identified as a salient mediator for facilitating sustained lifestyle change after 12 weeks.

Conclusions: This study provides empirical evidence for the effectiveness of an 8-week theory- and web-based MHBC intervention program on promoting a healthy lifestyle, self-efficacy and planning for PA, and intention and planning for FVC among Chinese college students. These research findings add new knowledge to the underlying psychosocial mechanisms of successful MHBC interventions. Overall, this study has considerable implications for future web-based MHBC research and practice in terms of addressing PA self-efficacy and FVC intention and helping students to adopt and maintain a healthy lifestyle independently of whether PA or FVC is addressed first.

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

Keywords: RCT; college students; fruit and vegetable consumption; lifestyle; mobile phone; physical activity; psychosocial mediators; randomized controlled trial; web-based intervention.

Conflict of interest statement

Conflicts of Interest: None declared.

©Wei Liang, Yanping Duan, Yanping Wang, Sonia Lippke, Borui Shang, Zhihua Lin, Hagen Wulff, Julien Steven Baker. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 07.09.2022.

Figures

Figure 1
Figure 1
Descriptive information of lifestyle indicator from baseline assessment (T0) to follow-up assessment 12 weeks after baseline assessment (T2). FVC: fruit and vegetable consumption; PA: physical activity; T1: postintervention assessment 8 weeks after baseline assessment.
Figure 2
Figure 2
Marginal mean values of psychosocial determinants of physical activity (PA) change for 3 groups from baseline assessment (T0) to follow-up assessment 12 weeks after baseline assessment (T2). (A) Intention for PA. (B) Self-efficacy for PA. (C) Planning for PA. (D) Social support for PA. FVC: fruit and vegetable consumption; T1: postintervention assessment 8 weeks after baseline assessment.
Figure 3
Figure 3
Marginal mean values of psychosocial determinants of fruit and vegetable consumption (FVC) change for 3 groups from baseline assessment (T0) to follow-up assessment 12 weeks after baseline assessment (T2). (A) Intention for FVC. (B) Self-efficacy for FVC. (C) Planning for FVC. (D) Social support for FVC. PA: physical activity; T1: postintervention assessment 8 weeks after baseline assessment.
Figure 4
Figure 4
Mediation model of intervention effects on immediate lifestyle change at T1 (postintervention assessment 8 weeks after baseline assessment). CG: control group; FVC: fruit and vegetable consumption; PA: physical activity. *P<.05, **P<.01, ***P<.001.
Figure 5
Figure 5
Mediation model of intervention effects on sustained lifestyle change at T2 (follow-up assessment 12 weeks after baseline assessment). CG: control group; FVC: fruit and vegetable consumption; PA: physical activity. *P<.05, **P<.01, ***P<.001.

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