Volume 25, Issue 5 (December & January 2022)                   J Arak Uni Med Sci 2022, 25(5): 760-771 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

MohammadniaMotlaghh K, Shamsi M, Roozbahani N, Karimy M, Moradzadeh R. Factors Affecting Consumption of Healthy Foods Among Prediabetic Women in Arak City in 2019: The Application of the Planned Behavior Theory. J Arak Uni Med Sci 2022; 25 (5) :760-771
URL: http://jams.arakmu.ac.ir/article-1-6661-en.html
1- Department of Health Education and Health Promotion, School of Health, Arak University of Medical Sciences, Arak, Iran.
2- Department of Health Education and Health Promotion, School of Health, Arak University of Medical Sciences, Arak, Iran. , mohsen_shamsi1360@yahoo.com
3- Department of Public Health, School of Nursing and Midwifery, Saveh University of Medical Sciences, Arak, Iran.
4- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran.
Full-Text [PDF 6917 kb]   (239 Downloads)     |   Abstract (HTML)  (1038 Views)
Full-Text:   (576 Views)
Diabetes Type 2 is the most common metabolic disease, and its prevalence is increasing [3]. Unhealthy foods and a sedentary lifestyle often lead to prediabetes and overt diabetes [7]. Since about 5% to 10% percent of people with glucose intolerance each year develop type 2 diabetes [12], they are apposite in diabetes prevention plans. The theory of planned behavior is one of the models for studying health behavior that has been widely used and can be used to prevent and control diseases and health problems [16].
Therefore, according to the above cases and the influential role of women in improving family lifestyle, the present study aimed to assess the factors affecting the consumption of healthy foods (CHF) based on the food pyramid among prediabetic women based on the Theory of Planned Behavior (TPB).
Materials and Methods 
This cross-sectional study was conducted in 2019 on 99 prediabetic women selected from comprehensive healthcare centers in Arak City to assess the need for an intervention study.
Arak City was divided into 5 classes based on socioeconomic status in each center and randomly selected two health centers from each section. The samples were entered into the study by the purposive method.
A questionnaire was used to collect the information, including demographic variables, a food consumption checklist retrieved from the sib automation of the Ministry of Health, as well as the constructs of the TPB regarding diet [1718].
Attitude-related questions, Subjective norm, Perceived behavioral control, and the intention was classified using a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Dietary behavior was assessed using 10 questions between zero and two scores (completely undesirable/moderate/favorable). Data were analyzed using SPSS software version 26 and by calculating descriptive statistical indicators, Spearman correlation test, and linear regression using the BackWard method. In addition, the data distribution was obtained the abnormal using Kolmogorov-Smirnov test.
A total of 99 prediabetic women entered the study (Mean±SD age: 47.40±7.64), and 96% were married. The Mean±SD fasting blood sugar and Body Mass Index (BMI) were 107.59±6.56 and 30.96±4.33, respectively. Among these people, 65% reported their financial situation as average and 15% as weak. Education level, 39% of people had elementary, and 32% had a diploma. About 53% of people were familiar with the early signs of diabetes. Also, 17% of people considered obesity, 20% sugar intake, 20% sedentary lifestyle, and 19% stress the leading cause of diabetes (Table 1, 2).

The Mean±SD of diet behavior was 1.34±0.28 (in the possible range of 0-2). Around 41% of participants consumed sugary foods such as sweets and chocolate at least once a week and 35% at least once a month (Table 3).

Although 51% did not add salt to their food when eating, 23% used the salt shaker on the table most of the time. Daily consumption of fruits (50%), vegetables (59%), and dairy products (60% of people) were less than optimal. The correlation coefficient between the constructs of attitude perceived behavioral control and intention with diet reports significant and positive relationships.
Regression analysis shows that by increasing a standard deviation in the behavioral intention score, the behavior score of a healthy diet will increase by 0.22 standard deviation (P<0.05).
Our results showed that behavioral intent predicts diet, which is consistent with the Rahmati study [19]. In the study of Rezabigi [20] and White [21], the intention was to have the highest level of predictive for healthy behavior, and perceived behavioral control was the subsequent  predictor. Attitude perceived behavioral control and intention had the most positive and significant relationship with behavior. Also consistent with our findings, in the study of Gholami [22], eating habits, attitude and intention had the most direct effect on consumption behavior. There was a significant relationship between attitude, subjective norm, and perceived behavioral control with intention [20]. After behavioral intention, the highest mean was related to the subjective norm construct. Although a weak relationship was found between Subjective norm and behavior, due to its connection with intention, it can indirectly affect behavior. Therefore, a person may want to do something under the influence of important people, but it does not lead to conduct due to obstacles. 
During this study, some mothers complained about the unhealthy eating habits of their children and spouses and considered this to be the cause of misbehavior, which is consistent with the results of the Keshavarz [26] study. Therefore, in this case, the role of education in promoting healthy behavior is evident. Finally, it can be concluded that the emphasis on strengthening individual motivation to make the right decision and ultimately the consumption of healthy foods can be considered in the educational planning of health officials to reduce the incidence of diabetes. And since the members of each family have different roles during the day, it is necessary to get the required training in their workplace and establish the intention and then the healthy behavior in the person.

Ethical Considerations
Compliance with ethical guidelines

In order to observe ethical considerations, before the research, the objectives of the study were explained to the participants and their consent was obtained by completing the form. All personal information was kept confidential and the questionnaires were analyzed anonymously. This study with the code IR.ARAKMU.REC.1398.07 has been approved by the Research Ethics Committee of Arak University of Medical Sciences.

The present study was conducted with the financial support of Arak University of Medical Sciences in the form of a master’s thesis in the field of health education.

Authors' contributions
All authors met the Standard Writing Criteria Based on the recommendations of the International Committee of Medical Journal Publishers, and all contributed equally to the writing of the article.

Conflicts of interest
The authors declared no conflicts of interest.

We would like to thank all the participants in this study and the Vice Chancellor for Research of Arak University of Medical Sciences for their financial support of this research.

  1. Miszkurka M, Haddad S, Langlois ÉV, Freeman EE, Kouanda S, Zunzunegui MV. Heavy burden of non-communicable diseases at early age and gender disparities in an adult population of Burkina Faso: World Health Survey. BMC Public Health. 2012; 12:24. [DOI:10.1186/1471-2458-12-24] [PMID] [PMCID]
  2. WHO. Noncommunicable disease [Internet]. 2021. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
  3. Mehdikhani S, Gohari MR, Banazade Z. [Determining factors affecting fasting blood sugar in patients with type 2 diabetes using Copula functions (Persian)]. Razi J Med Sci. 2014; 21(122):1-8. https://rjms.iums.ac.ir/browse.php?a_id=3278&sid=1.&slc_lang=en
  4. Koye DN, Magliano DJ, Nelson RG, Pavkov ME. The global epidemiology of diabetes and kidney disease. Adv Chronic Kidney Dis. 2018; 25(2):121-32. [DOI:10.1053/j.ackd.2017.10.011] [PMID]
  5. Vojta D, De Sa J, Prospect T, Stevens S. Effective interventions for stemming the growing crisis of diabetes and prediabetes: A national payer’s perspective. Health Aff. 2012; 31(1):20-6. [DOI:10.1377/hlthaff.2011.0327] [PMID]
  6. American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care. 2010; 33(S 1):S11-61. [DOI:10.2337/dc10-S011] [PMID] [PMCID]
  7. Saber F, Shahnazi H, Sharifirad Sh. [The survey of theory of planned behavior constructs regarding girl student’s physical activity in Naein PayameNoor University in 2012 (Persian)]. J Health Syst Res. 2013; 9(9):1014-21. http://hsr.mui.ac.ir/article-1-667-en.html
  8. Grundy SM. Pre-diabetes, metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol. 2012; 59(7):635-43. [DOI:10.1016/j.jacc.2011.08.080] [PMID]
  9. Bahmani A. [Islamic fasting and its effect on pre-diabetic population (Persian)]. Sci J Kurdistan Univ Med Sci. 2013; 18(1):40-6. https://sjku.muk.ac.ir/browse.php?a_id=1006&sid=1&slc_lang=en
  10. Thompson AM, Zhang Y, Tong W, Xu T, Chen J, Zhao L, et al. Association of inflammation and endothelial dysfunction with metabolic syndrome, prediabetes and diabetes in adults from Inner Mongolia, China. BMC Endocr Disord. 2011; 11:16. [DOI:10.1186/1472-6823-11-16] [PMID] [PMCID]
  11. Lee J-E, Jung S-C, Jung G-H, Ha S-W, Kim B-W, Chae S-C, et al. Prevalence of diabetes mellitus and prediabetes in Dalseong-gun, Daegu City, Korea. Diabetes Metab J. 2011; 35(3):255-63. [DOI:10.4093/dmj.2011.35.3.255] [PMID] [PMCID]
  12. Still O. Prediabetes and the potential to prevent diabetes. Lancet. 2012; 379(9833):2213-312. [DOI:10.1016/S0140-6736(12)60960-X]
  13. Coelho LG, Cândido APC, Machado-Coelho GL, Freitas SNd. Association between nutritional status, food habits and physical activity level in schoolchildren. J Pediatr. 2012; 88(5):406-12. [DOI:10.2223/JPED.2211] [PMID]
  14. Washi SA, Ageib MB. Poor diet quality and food habits are related to impaired nutritional status in 13-to 18-year-old adolescents in Jeddah. Nutr Res. 2010; 30(8):527-34. [DOI:10.1016/j.nutres.2010.07.002] [PMID]
  15. Najimi A, Sharifirad G, Hasanzadeh A, Azadbakht L. [Effect of nutrition education on nutritional behaviors and glycemic control indices based on BASNEF model among elderly with type 2 diabetes (Persian)]. J Isfahan Med Sch. 2011; 29(155):1247-58. https://www.sid.ir/en/journal/ViewPaper.aspx?id=236677
  16. Beiranvand S, Fayazi S, Asadizaker M, Latifi SM. [Survey of the foot care status in type II diabetic patients: Application of the theory of Planned Behavior (Persian)].  J Clin Nurs Midwifery. 2014; 3(2):57-66. http://jcnm.skums.ac.ir/article-1-91-fa.html
  17. Gholami M, Lange D, Luszczynska A, Knoll N, Schwarzer R. A dietary planning intervention increases fruit consumption in Iranian women. Appetite. 2013; 63:1-6. [DOI:10.1016/j.appet.2012.12.005] [PMID]
  18. Bassett-Gunter RL, Levy-Milne R, Naylor PJ, Downs DS, Benoit C, Warburton DE, et al. Oh baby! Motivation for healthy eating during parenthood transitions: A longitudinal examination with a theory of planned behavior perspective. Int J Behav Nutr Phys Act. 2013; 10:88. [DOI:10.1186/1479-5868-10-88] [PMID] [PMCID]
  19. Rahmati-Najarkolaei F, Pakpour AH, Saffari M, Hosseini MS, Hajizadeh F, Chen H, et al. Determinants of lifestyle behavior in Iranian adults with prediabetes: Applying the theory of planned behavior. Arch Iran Med. 2017; 20(4):198-204. [PMID]
  20. Rezabeigi Davarani E, Mahmoodi M, Khanjani N, Fadakar Davarani M. [Application of planned behavior theory in predicting factors influencing nutritional behaviors related to cardiovascular diseases among health volunteers in Kerman (Persian)]. J Health. 2018; 8(5):518-29. https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=656076
  21. White KM, Terry DJ, Troup C, Rempel LA, Norman P. Predicting the consumption of foods low in saturated fats among people diagnosed with type 2 Diabetes and cardiovascular disease. The role of planning in the theory of planned behaviour. Appetite. 2010; 55(2):348-54. [DOI:10.1016/j.appet.2010.07.011] [PMID]
  22. Gholami S, Mohammadi E, Pourashraf Y, Sayehmiri K. [Evaluating the predictors of fruit and vegetable consumption behavior in Ilam based on constructs of developed planned behavior theory (Persian)]. J Neyshabur Univ Med Sci. 2014; 2(4):8-18. https://iranjournals.nlai.ir/handle/123456789/552165
  23. Babazadeh T, Taghdisi MH, Sedghifard Z, Azam K, Vafa MR, Moradi F, et al. [Predictors of fruit and vegetable consumption in students: Using the theory of planned behavior (Persian)]. Daneshvar Med. 2015; 22(118):35-42. https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=475075
  24. Pawlak R, Malinauskas B, Rivera D. Predicting intentions to eat a healthful diet by college baseball players: Applying the theory of planned behavior. J Nutr Educ Behav. 2009; 41(5):334-9. [DOI:10.1016/j.jneb.2008.09.008] [PMID]
  25. Blanchard CM, Fisher J, Sparling PB, Shanks TH, Nehl E, Rhodes RE, et al. Understanding adherence to 5 servings of fruits and vegetables per day: A theory of planned behavior perspective. J Nutr Educ Behav. 2009; 41(1):3-10. [DOI:10.1016/j.jneb.2007.12.006] [PMID] [PMCID]
  26. Keshavarz Z, Ramezankhani A. [Effective factors on nutritional behavior of female workers based on “Integrated model of planned behavior and self-efficacy”: A qualitative approach (Persian)]. Hakim Res J. 2010; 13(3):199-209. https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=192611
Type of Study: Original Atricle | Subject: Health
Received: 2021/01/7 | Accepted: 2021/09/1

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2023 CC BY-NC 4.0 | Journal of Arak University of Medical Sciences

Designed & Developed by : Yektaweb