A feasibility study of a WhatsApp-delivered transtheoretical model-based intervention to promote healthy eating knowledge and habits for firefighters in Hong Kong: A cluster randomized controlled trial

Abstract

Background: Firefighters' health is often affected by a high prevalence of obesity and cardiovascular diseases, which are common risk factors for sudden cardiac death. The aim of this study was to investigate the feasibility of enhancing healthy eating habits and knowledge in firefighters through an education programme. Method: This will be a cluster randomized control trial study. The participants will be assigned randomly into either control (health promotion pamphlet) or intervention (health promotion pamphlet and education materials through WhatsApp) groups. Changes in healthy eating habits and knowledge will be assessed by a self-administrative questionnaire (Appendix III) and anthropometric measurements at three different time points. Discussion: More education is required in order to improve firefighters' eating habits and knowledge Background Obesity and overweight have many adverse effects on the health of the population in general.Worldwide, around 17.6 million people lost their lives due to cardiovascular diseases (CVDs) worldwide in 2012 (1, 2). Obesity or being overweight are key factors that can increase the risk of CVDs (3,4). A high number of firefighters in the United States (US), United Kingdom (UK) and Hong Kong (HK) (5-7) have been identified as overweight or obese. Numerous studies have investigated obesity-related CVD risk factors in firefighters and the results have illustrated this group to be particularly prone to fatal cardiac events (6,(8)(9)(10)(11)(12), compared to other professional groups. This is despite the fact that firefighters need to be in good physical condition as their work is hazardous. In the US, approximately 45% of on-duty deaths arise from sudden cardiac death (SCD) (13-15), with 90% of these related to coronary heart disease (CHD) (6,11). No data have been found to identify a relationship between CVD and obesity in HK firefighters, however about 40% have been classified as overweight or obese (16). Therefore, this issue should be considered seriously.A study identified that, with nearly 75% of all deaths were attributed to CVDs, the major cause was unhealthy eating, such as inadequate intake of fruit and vegetables (17). This phenomenon is worsening across the world. The long working hours and shift work impact upon the amount of fruit and vegetables firefighters eat (18). Their working conditions are special, as they have 24-hours work