Chinese Residents’ Healthy Eating Intentions and Behaviors: Based on an Extended Health Belief Model
Abstract
:1. Introduction
2. Theoretical Framework and Research Hypothesis
2.1. Perceived Susceptibility and Perceived Severity
2.2. Perceived Benefits and Perceived Barriers
2.3. Self-Efficacy
2.4. Health Consciousness
2.5. Healthy Eating Intentions
2.6. Moderating Effect of Perceived Barriers
2.7. Mediating Effect of the Healthy Eating Intentions
3. Data Source
3.1. Data Collection and Study Sample Design
3.2. Survey Instrument
4. Result and Discussion
4.1. Common Method Variance
4.2. Reliability and Validity Analysis
4.2.1. Reliability Analysis
4.2.2. Validity Analysis
4.3. Explanatory Power of Model
4.4. Path Analysis
4.5. Mediation Analysis
4.6. Multi-Group Analysis
4.7. Importance Performance Matrix
5. Conclusions and Suggestions
5.1. Conclusions
5.2. Suggestions
5.3. Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Constructs and Measurement Items
Construct | Items | Source |
Perceived Susceptibility | Unhealthy eating can happen to anyone | [51,52] |
In order to prevent disease, healthy eating should be carried out | ||
Everyone suffers from various diseases due to unhealthy eating | ||
Perceived Severity | Unhealthy eating can have a negative impact on life | [15] |
Unhealthy eating is very harmful | ||
Unhealthy eating is a serious health issue | ||
Perceived Benefits | Healthy eating can reduce your risk of illness | [53] |
Healthy eating can improve your overall physical condition | ||
Healthy eating can prevent certain diseases (such as hypertension) | ||
Perceived Barriers | You do not know what healthy eating behaviors are | [53,54] |
You do not have the time and effort to improve eating behavior | ||
It is difficult for you to eat healthier | ||
Self-Efficacy | You have sufficient experience to ensure that your eating is healthy | [53,55] |
Healthy eating is easy for you | ||
Healthy eating is within your capabilities | ||
Health Consciousness | You think you take health very seriously in your life | [56] |
You often notice and worry about your health | ||
You will do things that are good for health | ||
Healthy Eating Intentions | You expect to eat a healthy eating in the future | [57,58] |
Your chances of switching to a healthy eating are high | ||
You will reduce unhealthy eating and increase healthy eating | ||
Healthy eating will be the main dietary pattern for you in the future | ||
Healthy Eating Behaviors | You eat fruits and vegetables almost every day | [59] |
You eat fairly lightly | ||
You basically have a plan for what you eat every day | ||
You eat almost at the same time every day | ||
You eat 3 meals almost daily | ||
You can reasonably arrange the consumption of different types of food in each meal |
Appendix B. Harman’s Single Factor Test
Total Variance Explained | |||||||||
Initial Eigenvalues | Extraction Sums of Squared Loadings | Quadratic Sums of Rotational Loadings | |||||||
Total | % of Variance | Cumulative% | Total | % of Variance | Cumulative% | Total | % of Variance | Cumulative% | |
1 | 9.597 | 34.275 | 34.275 | 9.597 | 34.275 | 34.275 | 5.426 | 19.380 | 19.380 |
2 | 3.488 | 12.458 | 46.733 | 3.488 | 12.458 | 46.733 | 3.941 | 14.075 | 33.455 |
3 | 2.145 | 7.660 | 54.393 | 2.145 | 7.660 | 54.393 | 3.293 | 11.760 | 45.215 |
4 | 1.446 | 5.164 | 59.557 | 1.446 | 5.164 | 59.557 | 2.984 | 9.657 | 54.872 |
5 | 1.213 | 4.332 | 63.889 | 1.213 | 4.332 | 63.889 | 2.245 | 7.018 | 61.890 |
6 | 1.211 | 3.331 | 67.220 | 1.211 | 3.331 | 67.220 | 2.101 | 4.443 | 66.333 |
7 | 1.119 | 3.014 | 70.234 | 1.119 | 3.014 | 70.234 | 1.212 | 3.508 | 69.841 |
8 | 1.109 | 2.105 | 72.339 | 1.109 | 2.105 | 72.339 | 1.110 | 2.498 | 72.339 |
Appendix C. Common Method Variance Analysis
Constructs | Items | Substantive Factor Loading (R1) | R12 | Method Factor Loading (R2) | R22 |
Perceived Susceptibility | SUS1 | 0.801 | 0.642 | 0.190 | 0.036 |
SUS2 | 0.829 | 0.687 | 0.055 | 0.003 | |
SUS3 | 0.788 | 0.621 | 0.093 | 0.009 | |
Perceived Severity | SEV | 0.880 | 0.774 | −0.030 | 0.001 |
SEV | 0.929 | 0.863 | 0.144 | 0.021 | |
SEV | 0.923 | 0.852 | 0.009 | 0.000 | |
Perceived Benefits | BEN1 | 0.882 | 0.778 | −0.009 | 0.000 |
BEN2 | 0.899 | 0.808 | −0.025 | 0.001 | |
BEN3 | 0.893 | 0.797 | −0.041 | 0.002 | |
Perceived Barriers | BAR1 | 0.829 | 0.687 | 0.007 | 0.000 |
BAR2 | 0.869 | 0.755 | 0.820 | 0.672 | |
BAR3 | 0.871 | 0.759 | 0.007 | 0.000 | |
Self-Efficacy | SE1 | 0.862 | 0.743 | −0.044 | 0.002 |
SE2 | 0.892 | 0.796 | −0.041 | 0.002 | |
SE3 | 0.891 | 0.794 | 0.010 | 0.000 | |
Health Consciousness | HC1 | 0.865 | 0.748 | −0.037 | 0.001 |
HC2 | 0.853 | 0.728 | −0.061 | 0.004 | |
HC3 | 0.891 | 0.794 | −0.070 | 0.005 | |
Healthy Eating Intentions | HEI1 | 0.696 | 0.484 | 0.182 | 0.033 |
HEI2 | 0.741 | 0.549 | −0.035 | 0.001 | |
HEI3 | 0.744 | 0.554 | 0.029 | 0.001 | |
HEI4 | 0.728 | 0.530 | 0.050 | 0.003 | |
Healthy Eating Behaviors | HEB1 | 0.731 | 0.534 | 0.017 | 0.000 |
HEB2 | 0.801 | 0.642 | −0.066 | 0.004 | |
HEB3 | 0.803 | 0.645 | 0.004 | 0.000 | |
HEB4 | 0.866 | 0.750 | 0.033 | 0.001 | |
HEB5 | 0.896 | 0.803 | 0.026 | 0.001 | |
HEB6 | 0.893 | 0.797 | −0.015 | 0.000 | |
Average | 0.841 | 0.711 | 0.043 | 0.029 | |
Ratio | 24.517 |
Appendix D. The Exploratory Factor Analysis Results of the Measures, Test of KMO, and Bartlett
Constructs | Items | Factor 1 | Factor 2 | Factor 3 | Factor 4 | Factor 5 | Factor 6 | Factor 7 | Factor 8 |
Perceived Susceptibility | SUS1 | 0.636 | |||||||
SUS2 | 0.704 | ||||||||
SUS3 | 0.715 | ||||||||
Perceived Severity | SEV1 | 0.816 | |||||||
SEV2 | 0.819 | ||||||||
SEV3 | 0.802 | ||||||||
Perceived Benefits | BEN1 | 0.685 | |||||||
BEN2 | 0.644 | ||||||||
BEN3 | 0.663 | ||||||||
Perceived Barriers | BAR1 | 0.838 | |||||||
BAR2 | 0.862 | ||||||||
BAR3 | 0.842 | ||||||||
Self-Efficacy | SE1 | 0.781 | |||||||
SE2 | 0.797 | ||||||||
SE3 | 0.779 | ||||||||
Health Consciousness | HC1 | 0.568 | |||||||
HC2 | 0.574 | ||||||||
HC3 | 0.639 | ||||||||
Healthy Eating Intentions | HEI1 | 0.665 | |||||||
HEI2 | 0.709 | ||||||||
HEI3 | 0.758 | ||||||||
HEI4 | 0.742 | ||||||||
Healthy Eating Behaviors | HEB1 | 0.578 | |||||||
HEB2 | 0.624 | ||||||||
HEB3 | 0.599 | ||||||||
HEB4 | 0.771 | ||||||||
HEB5 | 0.773 | ||||||||
HEB6 | 0.703 | ||||||||
Kaiser–Meyer–Olkin | 0.930 | ||||||||
Bartlett | 0.000 |
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Frequency (n) | Percentage (%) | Frequency (n) | Percentage (%) | ||
---|---|---|---|---|---|
Residence | Marital status | ||||
Urban | 924 | 72.13 | Married | 632 | 49.34 |
Rural | 357 | 27.87 | Unmarried | 649 | 50.66 |
Gender | Body mass index | ||||
Male | 571 | 44.57 | BMI < 18.5 | 156 | 12.18 |
Female | 710 | 55.43 | 18.5 ≤ BMI < 24 | 754 | 58.86 |
Age | BMI ≥ 24 | 371 | 28.96 | ||
18~25 years old | 462 | 36.07 | Employment status | ||
26~30 years old | 273 | 21.31 | Attend school | 216 | 16.86 |
31~40 years old | 281 | 21.94 | Employment | 868 | 67.76 |
41~50 years old | 168 | 13.11 | Retirement | 43 | 3.36 |
above 51 years old | 97 | 7.57 | Unemployed | 154 | 12.02 |
Education | Family income (per year) | ||||
Primary and below | 20 | 1.56 | USD < 15,780 | 646 | 50.43 |
Junior high school | 114 | 8.90 | USD 15,780~31,560 | 411 | 32.08 |
High school/secondary | 198 | 15.46 | USD 31,560~47,340 | 132 | 10.31 |
Junior College/Bachelor | 811 | 63.31 | USD 47,340~63,120 | 46 | 3.59 |
Graduate student | 138 | 10.77 | USD ≥ 63,120 | 46 | 3.59 |
Construct | Items | Loading | VIF | Cronbach’s Alpha | CR | AVE |
---|---|---|---|---|---|---|
Perceived Susceptibility (SUS) | SUS1 | 0.764 | 2.009 | 0.730 | 0.846 | 0.648 |
SUS2 | 0.847 | |||||
SUS3 | 0.801 | |||||
Perceived Severity (SEV) | SEV1 | 0.880 | 2.452 | 0.897 | 0.936 | 0.830 |
SEV2 | 0.928 | |||||
SEV3 | 0.924 | |||||
Perceived Benefits (BEN) | BEN1 | 0.879 | 2.057 | 0.871 | 0.921 | 0.795 |
BEN2 | 0.901 | |||||
BEN3 | 0.894 | |||||
Perceived Barriers (BAR) | BAR1 | 0.817 | 1.050 | 0.819 | 0.887 | 0.725 |
BAR2 | 0.816 | |||||
BAR3 | 0.918 | |||||
Self-Efficacy (SE) | SE1 | 0.859 | 1.469 | 0.857 | 0.913 | 0.777 |
SE2 | 0.889 | |||||
SE3 | 0.896 | |||||
Health Consciousness (HC) | HC1 | 0.866 | 1.748 | 0.839 | 0.903 | 0.757 |
HC2 | 0.849 | |||||
HC3 | 0.894 | |||||
Healthy Eating Intentions (HEI) | HEI1 | 0.804 | 1.000 | 0.887 | 0.922 | 0.749 |
HEI2 | 0.866 | |||||
HEI3 | 0.895 | |||||
HEI4 | 0.894 | |||||
Healthy Eating Behaviors (HEB) | HEB1 | 0.732 | - | 0.835 | 0.879 | 0.547 |
HEB2 | 0.751 | |||||
HEB3 | 0.728 | |||||
HEB4 | 0.718 | |||||
HEB5 | 0.723 | |||||
HEB6 | 0.785 |
SUS | SEV | BEN | BAR | SE | HC | HEI | HEB | |
---|---|---|---|---|---|---|---|---|
Fornell–Larcker Criterion | ||||||||
SUS | 0.805 | |||||||
SEV | 0.689 | 0.911 | ||||||
BEN | 0.582 | 0.669 | 0.892 | |||||
BAR | −0.030 | −0.041 | −0.068 | 0.851 | ||||
SE | 0.164 | 0.218 | 0.280 | −0.218 | 0.882 | |||
HC | 0.357 | 0.438 | 0.477 | −0.118 | 0.540 | 0.870 | ||
HEI | 0.480 | 0.535 | 0.600 | −0.139 | 0.438 | 0.655 | 0.865 | |
HEB | 0.233 | 0.281 | 0.316 | −0.141 | 0.536 | 0.507 | 0.509 | 0.740 |
Heterotrait–Monotrait Ratio (HTMT) | ||||||||
SUS | - | |||||||
SEV | 0.843 | - | ||||||
BEN | 0.722 | 0.757 | - | |||||
BAR | 0.073 | 0.059 | 0.075 | - | ||||
SE | 0.198 | 0.248 | 0.323 | 0.237 | - | |||
HC | 0.449 | 0.506 | 0.558 | 0.122 | 0.634 | - | ||
HEI | 0.591 | 0.602 | 0.686 | 0.150 | 0.500 | 0.758 | - | |
HEB | 0.283 | 0.317 | 0.363 | 0.144 | 0.635 | 0.600 | 0.581 | - |
Hypo | Path | Beta | S.D. | p-Value | Confidence Interval | f2 | R2 | Q2 | Decision |
---|---|---|---|---|---|---|---|---|---|
H1 | SUS -> HEI | 0.110 *** | 0.027 | 0.000 | [0.056, 0.161] | 0.151 | 0.563 | 0.419 | Support |
H2 | SEV -> HEI | 0.093 * | 0.038 | 0.013 | [0.023, 0.170] | 0.212 | Support | ||
H3 | BEN -> HEI | 0.255 *** | 0.041 | 0.000 | [0.176, 0.336] | 0.173 | Support | ||
H4 | BAR -> HEI | −0.045 * | 0.019 | 0.018 | [−0.083, −0.008] | 0.204 | Support | ||
H5 | SE -> HEI | 0.108 *** | 0.026 | 0.000 | [0.058, 0.159] | 0.168 | Support | ||
H6 | HC -> HEI | 0.389 *** | 0.034 | 0.000 | [0.323, 0.453] | 0.199 | Support | ||
H7 | HEI -> HEB | 0.509 *** | 0.025 | 0.000 | [0.457, 0.554] | 0.351 | 0.358 | 0.237 | Support |
Moderating Effect of Perceived Barriers | |||||||||
H8 | Interaction item -> HEB | −0.089 *** | 0.021 | 0.000 | [−0.120, −0.042] | - | Support |
Hypo | Associations | Direct Effects | Indirect Effects | Total Effects | VAF | Decision |
---|---|---|---|---|---|---|
H9a | SUS -> HEI -> HEB | 0.014 (0.489) | 0.248 *** (11.023) | 0.262 *** (7.291) | 0.947 | Support |
H9b | SEV -> HEI -> HEB | 0.012 (0.417) | 0.269 *** (11.640) | 0.281 *** (8.754) | 0.957 | Support |
H9c | BEN -> HEI -> HEB | 0.017 (0.579) | 0.300 *** (12.437) | 0.316 *** (10.760) | 0.949 | Support |
H9d | BAR -> HEI -> HEB | −0.084 ** (3.267) | −0.071 ** (5.290) | −0.155 *** (5.704) | 0.458 | Support |
H9e | SE -> HEI -> HEB | 0.398 *** (13.471) | 0.148 *** (9.334) | 0.546 *** (22.841) | 0.271 | Support |
H9f | HC -> HEI -> HEB | 0.313 *** (9.359) | 0.199 *** (8.581) | 0.512 *** (20.803) | 0.389 | Support |
Path | Gender | Age | Education | Income | BMI | Residence | Marital Status | Employment Status |
---|---|---|---|---|---|---|---|---|
SUS -> HEI | 0.285 | 0.227 | 0.883 | 0.052 | 0.656 | 0.174 | 0.980 | 0.834 |
SEV -> HEI | 0.338 | 0.183 | 0.769 | 0.500 | 0.844 | 0.265 | 0.533 | 0.179 |
BEN -> HEI | 0.515 | 0.295 | 0.505 | 0.368 | 0.527 | 0.669 | 0.557 | 0.630 |
BAR -> HEI | 0.170 | 0.783 | 0.896 | 0.772 | 0.895 | 0.341 | 0.197 | 0.289 |
SE -> HEI | 0.857 | 0.216 | 0.219 | 0.319 | 0.931 | 0.708 | 0.700 | 0.125 |
HC -> HEI | 0.813 | 0.501 | 0.733 | 0.065 | 0.221 | 0.495 | 0.470 | 0.279 |
HEI -> HEB | 0.655 | 0.417 | 0.049 | 0.928 | 0.170 | 0.958 | 0.291 | 0.538 |
SUS -> HEI -> HEB | 0.183 | 0.385 | 0.532 | 0.398 | 0.117 | 0.538 | 0.581 | 0.864 |
SEV -> HEI -> HEB | 0.562 | 0.156 | 0.865 | 0.416 | 0.512 | 0.227 | 0.283 | 0.544 |
BEN -> HEI -> HEB | 0.871 | 0.627 | 0.191 | 0.750 | 0.331 | 0.573 | 0.614 | 0.940 |
BAR -> HEI -> HEB | 0.111 | 0.781 | 0.836 | 0.507 | 0.492 | 0.750 | 0.508 | 0.759 |
SE -> HEI -> HEB | 0.810 | 0.156 | 0.067 | 0.597 | 0.281 | 0.968 | 0.221 | 0.132 |
HC -> HEI -> HEB | 0.363 | 0.517 | 0.328 | 0.276 | 0.140 | 0.956 | 0.121 | 0.408 |
Interaction item -> HEB | 0.053 | 0.292 | 0.074 | 0.347 | 0.404 | 0.417 | 0.424 | 0.586 |
Associations | Total Effect | Performance |
---|---|---|
Perceived Susceptibility | 0.112 | 83.706 |
Perceived Severity | 0.085 | 64.680 |
Perceived Benefits | 0.086 | 83.998 |
Perceived Barriers | −0.030 | 48.228 |
Self-Efficacy | 0.352 | 74.046 |
Health Consciousness | 0.258 | 84.421 |
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Wang, Y.; Wen, X.; Zhu, Y.; Xiong, Y.; Liu, X. Chinese Residents’ Healthy Eating Intentions and Behaviors: Based on an Extended Health Belief Model. Int. J. Environ. Res. Public Health 2022, 19, 9037. https://doi.org/10.3390/ijerph19159037
Wang Y, Wen X, Zhu Y, Xiong Y, Liu X. Chinese Residents’ Healthy Eating Intentions and Behaviors: Based on an Extended Health Belief Model. International Journal of Environmental Research and Public Health. 2022; 19(15):9037. https://doi.org/10.3390/ijerph19159037
Chicago/Turabian StyleWang, Yiqin, Xiaowei Wen, Ying Zhu, Yanling Xiong, and Xuefan Liu. 2022. "Chinese Residents’ Healthy Eating Intentions and Behaviors: Based on an Extended Health Belief Model" International Journal of Environmental Research and Public Health 19, no. 15: 9037. https://doi.org/10.3390/ijerph19159037