@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2020;7(4):285-291

Background
Increasing fruit and vegetable consumption is a major public health goal that has short and long-term health effects [1].
Previous Studies
...[2-6]. According to studies, less than 20% of adolescents consume 5 or more portions of fruits and vegetables daily [7]. Studies conducted in Iran also show insufficient consumption of fruits and vegetables in teenage girls [5, 8]. Growth and development are rapid during adolescent years, and the demand for most nutrients is relatively high. Therefore, a diet rich in fruits and vegetables is essential in this period [3]. Behavioral theories such as the social cognitive theory [9, 10], planned behavior theory [11], stages of change model [12, 13], and the health belief model [14, 15] are helpful to investigating changes in adolescent eating behaviors. Evidence shows that theory-based interventions are effective in health behaviors more than non-theoretical approaches [16]. Numerous researchers have proposed a social cognitive theory to training nutritional behaviors. Applying the social cognitive theory to nutrition training interventions in schools has yielded good results in previous studies [6, 17]. …[18-22].
Aim(s)
This study aimed to determine the predictors of fruit and vegetable intake in female high school students using the social cognitive theory.
Research type
This is a cross-sectional study.
Research society, place and time
This study was carried out between 332 female middle school students in Ilam city in April- June 2017.
Sampling method and number
The sample size was calculated using Cochran's formula by multi-stage random sampling method considering the population size of 3727 students, 95% confidence interval, the measurement error of 0.05, and q=p=0.5. Of 17 girls' high schools in the first secondary grade, 5 schools were selected, randomly. The schools were chosen from 5 different areas of Ilam city. In the next step, one class from each of the first, second, and third grades were randomly selected from each school. Inclusion criteria included studying in the first secondary school, student and school officials' consent for participation in the study. Students who did not have the appropriate physical or mental condition for filling the questionnaire and students on a special diet were excluded from the study.
Used devices&materials
Data were collected using a researcher-made questionnaire in three sections include demographic information, a questionnaire based on the social cognitive theory, and a questionnaire of behaviors related to fruit and vegetable consumption. Demographic information included age, educational level, parents 'literacy level, parents' employment status, family economic status (good, average, poor), and family size. The 30-item questionnaire was based on the social cognitive theory, outcome values, perceived self-efficacy, perceived social support, and self-regulatory. Behaviors related to fruit and vegetable consumption were also assessed using a 6-item questionnaire. The face validity of the questionnaire was qualitatively confirmed by consultation with 8 experts (5 health education and health promotion specialists and 3 nutritionists). The content validity of the questionnaire was qualitatively confirmed. For this purpose, 5 specialists in health education and health promotion were asked to express their views about the simplicity and clarity, proportion of the items, the existence of ambiguity, and scoring the questions according to the aims. The questionnaire was corrected after collecting the opinions of experts. The method of internal consistency of items was used by calculating Cronbach's alpha to determine the questionnaire reliability. For this purpose, the questionnaires were filled by 32 female students, who studied in the first secondary schools of Ilam city. The questionnaires were completed by the self-report method after obtaining written consent from students and their parents. Filling a questionnaire took an average of 20 minutes. Data were analyzed using SPSS 19 software through descriptive statistics, the Pearson correlation, and multiple linear regression tests.
Findings by Text
The 332 students aged 12 to 16 years, with an average age of 13.72 ± 0.97, participated in this study. 45.2% of fathers were employees, and 78% of mothers were housewives. 52.1% of fathers had a college degree, and 36.4% of mothers had a diploma degree. The economic situation in 62.7% of households was at a good level and most households (54.6%) had a population of 5- 8 people (Table 2). The mean score and standard deviation of the constructs of the social cognitive theory as well as fruit and vegetable intake are shown in Table 1. The results of the Pearson correlation test showed that there is a positive and significant correlation between all constructs of the social cognitive theory and fruit and vegetable consumption behavior in the subjects, and the self-regulatory construct has the strongest correlation with the behavior (p=0.001; r=0.360; Table 3). The results of multiple linear regression analysis of variables in two separate models are shown in Table 4. In Model 1, the predictive variables of students' behavior in relation to fruit and vegetable consumption are analyzed. The results show that the overall model is significant and the constructs of the social cognitive theory predicted 20.9% of the behavior variance. However, only the self-regulatory construct significantly predicted the behavior (p=0.001) and other constructs were not significant (Table 4). The results of analyzing the predictive variables of students' self-regulation in relation to fruit and vegetable consumption in model 2 also showed that the overall model is significant, and the constructs of outcome expectations, outcome values, perceived self-efficacy, and perceived social support were able to predict 44.8% of the self-regulatory variance. However, the two constructs of perceived self-efficacy and perceived social support were significant in model 2 (p=0.001) and the constructs of outcome expectations and outcome values were not significant (Table 4). The final model based on the analysis of two regression models is shown in Figure 2.
Main comparison to the similar studies
This study aimed to determine the predictors of fruit and vegetable intake in female high school students using the social cognitive theory of Bandura in Ilam city. The social cognitive theory constructs predicted 20.9% of the variance of consumption behaviors of fruits and vegetables in adolescent students. Findings from other studies show that the social cognitive theory can explain 30% of the variance in eating behaviors, including fruit and vegetable intake [1]. The level of explaining the nutritional behavior using the social cognitive theory has been different in the various studies according to the study methodology, the studied constructs, and target groups. In the study of Mirkarimi et al. self-efficacy construct, outcome expectations, outcome values, observational learning, and the availability of fruits and vegetables at home explained 26% of the variance of fruit and vegetable consumption behaviors in the subjects [23]. Salimi et al. reported the 64% effectiveness rate of the model based on the social cognitive theory in explaining the nutritional behaviors of female students [24]. Normak et al. in a study concluded the constructs of the social cognitive theory generally explained 13% and 45% of the variance in fruit and vegetable intake and the provision of fruits and vegetables at home, respectively [3]. Also, in the study of Lightel et al. the constructs of the social cognitive theory and the planned behavior theory predicted a total of 31% in the variance of fruit and vegetable intake in adolescents [1].Outcome expectations constructs, outcome values, self-efficacy, and social support together explained 44.8% of the self-regulatory variance. However, only the constructs of perceived self-efficacy and social support were significant. In previous studies, self-regulation, self-efficacy, and perceived social support have been reported as the main determinants of nutritional behaviors [10, 16, 24-26]. ...[27-31]. Although the constructs of outcome expectations and outcome values had a positive and significant correlation with the behavior, they were not significant predictors of fruit and vegetable intake. Training interventions are often provided to students by inexperienced or non-specialist educators, therefore these interventions are not very effective [10]. In this study, individuals performed only 39.2% of the behaviors related to fruit and vegetable intake.
Suggestions
Although the self-report method is a common method in data collection, observing and recording behaviors recommended to be used in future studies to collect data on nutritional behavior. It is suggested that the use of self-regulatory strategies, promotion of self-efficacy as well as perceived social support, especially family support, be prioritized in training interventions to promote the consumption of fruits and vegetables in adolescents.
Limitations
The present study had several limitations. First, this study was carried out only between adolescent girls and the results cannot be generalized to adolescent boys. Second, this study was carried out between the girl students of seventh, eighth, and ninth degrees in secondary school. The third limitation is that the behavioral data were collected by the self-reported method.
Conclusions
The social cognitive theory can be used as an appropriate theoretical framework for predicting adolescents' behaviors in fruit and vegetable intake. Self-regulation is a major determinant of fruit and vegetable consumption in the subjects. The perceived social support and self-efficacy are also indirectly effective in adolescent girls through the effect of self-regulation on fruit and vegetable intake.
Acknowledgments
We would like to thank the Vice-Chancellor for Research and Technology of Ilam University of Medical Sciences for the financial support of this study. We also thank all the students and school officials who helped us in conducting this study.
Conflict of interest
There is no conflict of interests.
Ethical Permissions
This study has been approved by the Ethics Committee of Ilam University of Medical Sciences (Ethics Code: IR.MEDILAM.REC.1398.064).
Funding Sources
This article is retrieved from the research plan approved by the Vice-Chancellor for Research and Technology of the Ilam University by financial support of the Research Assistant.

TABLES and CHARTS

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