Multilevel Influences on Fat, Sugar, Salt, Fruit, and Vegetable Consumption Behaviors Among Urban Indians: Application of the Social Ecological Model

Abstract

Designing effective interventions for achieving desired dietary behavior changes requires an in-depth study of people’s behaviors situated in sociocultural and interpersonal contexts. Guided by the Social Ecological Model, we explored the individual, family, and social-structural-level influences on dietary behaviors related to consumption of fat, sugar, salt, fruits, and vegetables among urban adults in India. We conducted 10 focus groups with a sample of men and women in diverse socioeconomic groups. Data were explored using framework analysis. Social Ecological Model helped in identifying multilevel influences that facilitated or hindered healthy dietary behaviors: Individual-level influences—awareness of dietary recommendations, self-efficacy, risk perception, and perceived benefits and costs; Family-level influences—family members’ preferences, family norms, family support, and the home environment; and Social-structural influences—societal norms, culture, media, cost, availability and accessibility of fruits and vegetables, and government policies. Overall, the findings indicated the need for a range of multilevel interventions that are more likely to promote and sustain healthy dietary behaviors—for example, improving awareness about dietary recommendations (individual level), promoting positive family norms through involvement of family members (family level), and restricting the use of fat, sugar, and salt in packaged food, and supportive policies for promoting consumption of fruits and vegetables (structural level).

Nutrition Literacy Mediates the Relationships between Multi-Level Factors and College Students’ Healthy Eating Behavior: Evidence from a Cross-Sectional Study

“…Existing literature indicates that NL is significantly related to sociodemographic and healthy eating behavior [28,[36][37][38][39]. Many scholars have used the socialecological model to identify multi-level factors that affect healthy eating behavior [14][15][16][17][18][19]. To our knowledge, this is the first study to explore the mediating effect of NL on the relationship between healthy eating behavior and its influencing factors, incorporating the social-ecological model.…”

“…Therefore, when examining factors influencing health behavior, various features should be considered at different levels to provide a comprehensive explanation framework [12,13]. Regarding changing individuals' dietary patterns or obesity problems, the theory of social ecology has been used by many scholars to explain, predict, and change the relationships between individuals' eating behavior and sociocultural, policy-related, and physical environments [14][15][16][17][18][19]. Several qualitative studies have examined factors influencing the dietary behaviors of college students via interviews, including multi-level barriers and enablers.…”

Effectiveness of information technology–enabled ‘SMART Eating’ health promotion intervention: A cluster randomized controlled trial

“…A detailed description of the intervention protocol has been published elsewhere [20]. Qualitative formative research, guided by the Social Ecological Model, revealed multi-level influences on dietary behaviours at individual, family, and social-structural level which facilitated the development of context-specific, culturally acceptable intervention [26]. The intervention group received IT-enabled nutrition education which had two components: 1) The interpersonal component, which included the distribution of 'SMART Eating' kitkitchen calendar, dining table mat, and measuring spoons; 2) The Information Technology (IT) Component-SMS, email, social networking app, and 'SMART Eating' website ( Table 1).…”

Identifying and characterising digital behaviour change interventions to improve fruit and vegetable intake in low-socioeconomic status primary school children: a systematic review

“…While digital interventions themselves are an individual level mechanism for improving FV consumption in children, future intervention development research in low-SES families also needs to be aware of how digital interventions may generate inequalities within the population at the public health level, and how to use these interventions to overcome other influential factors to FV consumption; such as food insecurity and poverty [74]. Therefore, it is important to consider other influences of fruit and vegetable intake, such as influences from the socioecological framework including, family-level and social-structural influences [77].…”