The importance of decisional balance and self-efficacy in relation to stages of change for fruit and vegetable intakes by young adults

Purpose. To examine the stages of change, decisional balance, and self-efficacy constructs in relation to fruit and vegetable intakes by young adults 18-24 years old. Design. A cross-sectional project was conducted by 10 states in January-July 2000 to examine decisional balance and self-efficacy in relation to stage of change for increasing fruit and vegetable intake among young adults. Subjects. in all, 1545 usable surveys were returned (response rate = 55%). More non-respondents were men and precontemplators than respondents. Sixty-one percent of respondents were women, 90.3% were white, and 49.7% were current students. Setting. Alabama, Kansas, Maine, Michigan, Nebraska, New York, Rhode island, Oregon, South Dakota, and Wisconsin. Measures. A telephone screening interview and a self-administered mail survey. Analysis. Analysis of variance, principal components analysis, cluster analysis, and X² test. Results. From precontemplation to maintenance, a significant linear trend was found toward higher food intake and self-efficacy for fruits and vegetables. The patterns of shifts in the pros and cons across the stages resembled those of other health behaviors. The decisional balance items were further classified into five component factors that varied significantly in importance across the stages. Four subject clusters were derived (unconcerned, reluctant, exploring, and action-oriented); distribution of the clusters agreed with that of the five stages. Conclusions. This study supports applicability of the Transtheoretical Model for assessing fruit and vegetable consumption by young adults. Derivation of the four clusters implies the importance of including decisional balance and self-efficacy as outcome measures besides dietary behavior for evaluating the effectiveness of nutrition interventions.