Purpose: Cooking interventions to improve dietary intake continue to grow in popularity. Studies of cooking interventions often claim to be informed by behavioral theory. However, it is unclear how behavioral theory is used in the development, evaluation, and interpretation of these interventions. Understanding how theory is used is crucial to revealing how interventions may impact behavior change, as well as informing development of future interventions. This systematic review aimed to understand how behavioral theory is used in the development, evaluation, and interpretation of theory-based cooking interventions, and describe the impact of these interventions on dietary intake among adults.

Methods: We searched PubMed, Scopus, and CINAHL for articles published between January, 2000 to March, 2023. Both randomized and non-randomized cooking interventions for adults ages 18 years and older were included in this review if behavioral theory was mentioned. We extracted study characteristics and outcomes related to dietary intake and cooking behavior. We applied the Theory Coding Scheme (TCS) to assess theory use. Given that measures used to assess dietary intake varied greatly, we summarized results narratively and using descriptive statistics where appropriate.

Results: We identified 7,846 unique articles, of which 31 articles met inclusion criteria. On average, studies met less than 6 out of 17 criteria from the TCS. Forty-five percent of studies were based on a single theory, and 84% were informed by Social Cognitive Theory. Only twelve studies (39%) clearly identified specific theory constructs targeted by the intervention and provided evidence that these constructs were associated with behavior change. The majority (65%) of cooking interventions had a positive impact on at least one measure of dietary intake. However, just over half of studies (55%) measured cooking behavior, and less than half of these studies reported a positive impact on cooking behavior (41%).

Conclusion: Though use of behavioral theory is generally regarded as an important step in the development of behavioral interventions, overall implementation of theory was poor across studies. To better inform intervention development, future studies should link cooking intervention techniques with theoretical constructs, and evaluate whether changes in constructs mediate improvements in both cooking behavior and dietary intake.

Purpose: There is strong evidence that physical activity (PA) is effective for managing prevalent mental health conditions such as depression and anxiety. Understanding factors that influence PA among individuals with these conditions may help inform future interventions to promote PA for mental well-being. This study aimed to test a Theory of Planned Behavior (TPB) process model in a large, representative sample of adults currently in therapy and to explore potential moderators of the relationships between attitudes, subjective norms, perceived behavioral control (PBC), and intentions.
Methods: Participants (N=478, M age=31.7 years, 44.6% male) completed an online survey that included validated measures of PA attitudes, subjective norms, PBC, intentions, and behavior (Godin Leisure-Time Exercise Questionnaire). We tested a model whereby attitudes, norms, and PBC predicted PA behavior indirectly through PA intentions, controlling for age, income, gender, sexual orientation, body mass index, PA barriers, depression, anxiety, stress, loneliness, and body dissatisfaction. Control variables were also evaluated as moderators.
Results: The fully adjusted model fit the data well (χ2[282]725.27, p<.01; RMSEA=.06, CFI=.93). PBC had a significant positive bootstrapped indirect effect on PA behavior via intentions (b=13.57, 95%CI:8.51-21.96). The indirect effects of attitudes and subjective norms on PA behavior were not significant. The association between PBC and PA intention was significantly moderated by body dissatisfaction (b=.08, p=.035), such that the association was stronger among participants with high body dissatisfaction. Depression moderated the relationship between attitudes and intentions (b=-.02, p=.011), and body dissatisfaction moderated the relationship between subjective norms and intentions (b=-.05, p=.003), such that the associations were stronger among participants with low depression and low body dissatisfaction, respectively.
Conclusions: These results demonstrate that PBC strongly predicts PA intentions, and intentions predict PA behavior in a representative U.S. sample of adults in therapy. Clinicians in mental health settings may use these results to inform discussions about PA with clients. Therapists should reframe PA as daily movement and help clients identify activities they enjoy to reduce perceived barriers, which may translate to improvements in PA intentions and behavior. Therapists should also consider clients’ presenting concerns and symptoms and personalize discussions to address clients’ unique needs and preferences.

Purpose: According to the theory of planned behavior, physical activity (PA) intention predicts PA engagement. However, intentions do not always translate into behavior, a phenomenon known as the intention-behavior gap. The intention-behavior gap is notably pronounced in PA research, where intentions to engage in PA only materialize into behavior about half of the time. A promising unexplored factor that may explain the intention-behavior gap is individual differences in exercise preference (i.e., one’s predisposition to select higher-intensity exercise) and tolerance (i.e., one’s ability to continue exercising at an imposed level of intensity). The purpose of this study was to examine whether exercise preference and tolerance moderate the within-person association between PA intention and next-day moderate-to-vigorous physical activity (MVPA) behavior using smartphone-based ecological momentary assessment (EMA) and accelerometry. Methods: The present study analyzed data from adults ages 18 to 65 years old living in the United States. Exercise preference and tolerance were assessed at baseline using the Preference for and Tolerance of Intensity of Exercise Questionnaire (PRETIE-Q). A 14-day protocol captured PA intention each evening through EMA and next-day MVPA engagement though accelerometry. Separate multilevel linear regression models (days [level 1]nested within people [level 2]) assessed the main effects of within-person PA intention on next-day MVPA engagement and cross-level interaction effects of between-person differences in exercise preference and tolerance on this association. Results/Findings: Complete data from 62 adults (Meanage =39 years old, standard deviation= 4.29 years) were included in this analysis. A negative within-persons main effect of PA intention on next-day MVPA engagement was observed (β= -.20, p<.001). Exercise preference was a significant cross-level moderator of the association between PA intention and next-day MVPA engagement (β=.04, p<.001). Specifically, evenings with greater PA intention as compared to usual were associated with greater next-day MVPA engagement among those with a stronger preference for higher-intensity exercise. However, exercise tolerance was not a significant moderator of the association. Conclusions: Exercise preference may partially explain the intention-behavior gap, such that individuals who prefer higher-intensity exercise are more likely to translate their intentions into behavioral engagement. Intervention strategies may seek to enhance individual preferences for higher-intensity exercise when tailoring interventions to improve MVPA engagement.

Title: Moderating impacts of community-built environments on a behavior intervention program for older adults in Brazil

Natalia Santos*1, Adalberto Lopes2, Fabiana Brito1, Cassiano Rech3
1. UNMC College of Public Health - Department of Health Promotion,
2. Universidade Federal de Minas Gerais, BR, 
3. Universidade Federal de Santa Catarina, BR 

*corresponding and presenting author

Purpose: To verify if the benefits obtained in behavioral variables by intervention participants of the “Active Life Improving Health” (VAMOS) program were associated with regional access to places for physical activity and healthy eating.

Methods: Street network buffer areas of 500- and 1,000-meters were created around residences of VAMOS’ participants, healthy adults older than 18 years old (n=125). Built environment's exposure variables were accounted for by the number of physical activity and healthy eating places in each buffer, and geo-referenced in Google Earth. Behavior variables focus on the primary health outcomes of VAMOS (i.e., sedentary behavior, moderate to vigorous physical activity, quality of life). We used the following definitions for built environment variables:
• Leisure Public Spaces (LPS): free open spaces which favor physical activity (i.e., parks, seaside coastal region, open gyms)
• Food retail: stores that sell a mix of both in-natura (i.e., fresh fruits and vegetables) and processed foods
• Walkability Index: pedestrian-friendliness considering sidewalk presence, street connectivity, access to public transportation, and proximity to amenities.
A Geodatabase for the development of the walkability index was created in ArcGIS Pro 3.1.3. A choropleth map was created using Manual Intervals to classify areas of negative and positive walkability (classes=2).

Results: There are significant interactions on how the presence of Leisure Public Spaces at 500m decreased sedentary behaviors (p= 0.046) and waist circumference (p=0.038), and increased physical activity levels (p=0.001) at participants from baseline to the end of the program at 12-weeks. Walkability indices did not impact behavior change for study participants. Geospatial analysis of Walkability Index within street network buffers of 500- and 1,000-meters (figure 1).

Conclusions: Having Leisure Public Spaces and food retailers that sell healthy foods closer to participants can influence positive behavior change. This study found more significant changes when built environment factors were within a 500m buffer, especially with physical activity changes around spaces LPS. Walkability levels did not directly impact behavior change, which could be a result of how participants perceive walkability in their communities, and what their threshold is for considering spaces unfit or unsafe for walking. Future studies should consider locations post-COVID and assess perception of participants on how they move around their communities.

Jennifer T Gale 1*, Meredith C Peddie 1, Elaine Hargreaves 2

1 Department of Human Nutrition, University of Otago, Dunedin, New Zealand; jen.gale@postgrad.otago.ac.nz; meredith.peddie@otago.ac.nz
2 School of Physical Education, Sport and exercise Sciences, University of Otago, Dunedin, New Zealand; elaine.hargreaves@otago.ac.nz
* Corresponding and presenting author: jen.gale@otago.ac.nz
Purpose: Experimental evidence indicates interrupting evening sedentary time with regular activity breaks improves metabolism and sleep. To determine whether people with perform activity breaks in ‘real life’ it is essential to understand factors that will promote or hinder this behaviour. To date, exploration of such factors has been limited to educational and occupational settings. Therefore, this study aims to explore potentially unique barriers and facilitators that relate to an individual’s capability, opportunity, and motivation (COM-B) to perform regular activity breaks in the evening, to inform future free-living intervention development.
Methods: Individual, face-to-face, semi-structured interviews were conducted with 28 participants (female n=20, mean age 25.4 years SD 5.5) who had performed a laboratory-based, evening regular activity breaks intervention. Interview questions explored what would facilitate, and hinder participants from incorporating regular activity breaks, into their everyday lives at home in the evening. The interview transcripts were analysed first using inductive thematic analysis, and subsequently using deductive analysis using the concepts of the COM-B model to explore factors that could influence behaviour change.
Results: The perceived barriers of 1) not wanting to interrupt sedentary time, 2) general lack of motivation and 3) forgetting to do activity breaks, related to reflective and automatic motivation. Barriers relating to the social environment, such as ‘not wanting to interrupt other people’ and the physical environment, such as ‘being comfortable in bed’ could be directly mapped to opportunity. The perceived facilitators of 1) being reminded to do activity breaks, and 2) having a source of motivation such as ‘goal setting’ or ‘progress tracking’ could be mapped to automatic and reflective motivation. Additionally, participants stated that both ‘known’ and ‘experienced benefits’ could increase their psychological capability to take regular breaks. Facilitators relating to environmental factors such as ‘others in the room doing movement’ and ‘not needing a large space’ could be mapped to social and physical opportunity.
Conclusions: To promote successful reductions in evening sedentary time, future activity breaks interventions should utilise physical prompts and cues, and social support and be individually tailored to the participant, and the specific context of their evening sedentary time.

Purpose: Underpinned by Kincaid’s Ideation metatheory, the Promoting hEalthy Diet and Active Lifestyle (PEDAL) intervention was developed to improve diet and movement behaviours of primary school children in Singapore. Ideation consists of three psychosocial domains (cognitive, emotional, social) that are assumed to cumulatively influence behaviour. This study aims to validate PEDAL’s programme theory by examining the relationships between ideational factors and children’s diet and movement behaviours, including fruit and vegetable intakes, time spent on moderate-to-vigorous physical activities (MVPA) and screen time.

Methods: Data from a self-reported baseline survey of primary school student participants were used for these analyses (n=144, 47.2% girls, mean age 10.6 years ± 0.5). Ideations were asked about separately for health eating and in relation to being more active. Individual component and cross-domain composite ideational scores were derived for both behavioural grouping. Measures captured included (cognition) knowledge, attitudes; (emotions) self-efficacy, enjoyment; (social) support. We report adjusted multivariate logistic regression examining the relationships between ideation and behaviours of interest. All variables were binarized at the median.

Results: Median ideational composite scores were 3 for both healthy eating (range: 0-6) and physical activity (range: 0-7). The higher ideational composite scores for healthy eating were associated with greater likelihood of high intake of fruit (OR: 1.47, 95%CI: 1.19-1.81) and vegetables (OR: 1.51, 95%CI: 1.51-2.52). Likewise, associations with higher activity related ideations were identified for time spent on MVPA (OR: 1.20, 95%CI: 1.01-1.44), and lesser likelihood of screen time (OR: 0.78, 95%CI: 0.65-0.94).

Associations with individual components of ideations were identified for enjoyment and self-efficacy toward healthy eating; these were significantly associated with high fruit (OR: 3.76, 95%CI: 1.81-7.80 and OR: 2.72, 95%CI: 1.33-5.58) and vegetable intakes (OR: 4.39, 95%CI: 1.90-10.13 and OR: 6.56, 95%CI: 2.54-16.94), respectively. Furthermore, self-efficacy was significantly associated with higher levels of MVPA (OR: 2.17, 95%CI: 1.10-4.29), as was social support (OR: 3.68, 95%CI: 1.79-7.54).

Conclusion: These findings support PEDAL’s programme theory, indicating that the assessed ideational factors are associated with positive diet and movement behaviours among primary school children. Findings also support the intervention’s content which includes activities to improve self-efficacy, affect, and parental involvement.