Acceptability and feasibility of an email-based nutrition intervention using the theory of planned behaviour in Australia : Fresh Facts

This study investigated feasibility and acceptability of a new email-delivered intervention promoting fruit and vegetable consumption in a university based population of Australian young adults. The study explored whether there are differences in the reported feasibility and acceptability between demographic groups within the population of interest and at three levels of intervention intensity. The email-delivered intervention program consists of an implementation intention ‘planning task’ and between 3 and 15 short email messages over a 15 day study period. The intervention program was developed using the Theory of Planned Behaviour and was designed to modify perceived behavioural control. One hundred and ten participants (mean age = 19.21 years, 25.6% male) completed the feasibility and acceptability questionnaire at Day 15. This questionnaire contained items about all intervention components. High acceptability and feasibility scores were found for all intervention parts and at all levels of intervention intensity. There were few significant differences in the reported acceptability of items between key demographic sub-groups, and no differences in reported acceptability at different levels of intervention intensity. These results suggest that this email-delivered intervention is an acceptable and feasible tool for promoting fruit and vegetable consumption for participants in the target population. The World Health Organisation recommends a daily intake of fruit and vegetables of at least 400g in order to maintain good health (FAO/WHO, 2003). In Australia, the Dietary Guidelines for Australian Adults recommend that adults consume at least two servings of fruit and five servings of vegetables each day (National Health and Medical Research Council, 2003), this is approximately equivalent to a total fruit and vegetable intake of 675g. However, despite the well documented health benefits of fruit and vegetable consumption (FAO/WHO, 2003), and wide-spread public health efforts to increase consumption (Elliot & Walker, 2007), most adults do not consume adequate quantities of fruit and vegetables. In the most recent Australian survey more than 47% of Australian adults reported eating less than 2 servings of fruit each day, and almost 70% reported eating less than 4 servings of vegetables (Australian Bureau of Statistics, 2003). Research both in Australia, and from around the world, indicates that young adults are less likely than older adults to consume adequate quantities of fruit and vegetables (Australian Bureau of Statistics, 1997; Joint Health Surveys Unit, 2008) suggesting a clear need for intervention in this population. While some interventions have successfully increased fruit and vegetable consumption (Knai, Pomerleau, Lock, & McKee, 2006; Pomerleau, Lock, Knai, & McKee, 2005), few have specifically targeted the fruit and vegetable consumption of young adults. Theoretical accounts of behaviour suggest that predictors of fruit and vegetable consumption are likely to be partly population specific (Ajzen, 1991; Fisher & Fisher, 2002). As such, interventions aimed at the general population may not adequately meet the needs of young adults. For example, the Australian public health initiative Go for 2&5 has been widely considered to be a successful campaign, resulting in increased awareness of Australian dietary guidelines and an increase in adherence to those guidelines (Elliot & Walker, 2007). However, recent research into the fruit and vegetable knowledge of Australian young people shows that many young people cannot correctly report the Australian dietary guidelines for fruit and vegetable consumption and that even relatively educated young adults hold misconceptions which are likely to lessen their ability to successfully consume adequate quantities of fruits and vegetables (Kothe & Mullan, In Press). Young adults can also be difficult to access through traditional intervention channels. In particular, the majority of fruit and vegetable interventions have been implemented in workplaces or schools (Ammerman, Lindquist, Lohr, & Hersey, 2002; Knai, et al., 2006; Pomerleau, et al., 2005). However, a large number of young adults are not currently enrolled or secondary schooling or working in paid employment (Australian Bureau of Statistics, 2009), meaning that interventions delivered through these channels have a limited capacity to reach young adults. However, over 40% of 18-25 year olds are currently enrolled in tertiary education (Australian Bureau of Statistics, 2009); making higher education settings, such as universities, one possible setting for increasing intervention reach for this age group. With regard to how to best disseminate interventions aimed at this group, researchers have suggested that internet based programs have the most potential to be successful in younger, more internet savvy participants (Weinstein, 2006), and have recommended more web-based research with this population. Such an approach has resulted in improvements across a range of health domains (Wantland, Portillo, Holzemer, Slaughter, & McGhee, 2004). In light of the research suggesting both a need for nutrition interventions designed for young adults, recognition of universities as a possible setting for fruit and vegetable interventions for young adults, and the growing push for web-based intervention programs for this population, the Fresh Facts intervention program was developed. This approach to intervention design calls for the involvement of all interested parties in intervention design (Bartholomew, Parcel, Kok, & Gottlieb, 2001). Specifically, those for whom the intervention is designed should be active participants in intervention development (Bartholomew, et al., 2001). Fresh Facts intervention materials for this project have been developed through a series of focus groups. Findings from the development phase of this project have been published elsewhere (Kothe & Mullan, 2010). In addition to the involvement of the target population in intervention design, researchers have also called for extensive feasibility and acceptability testing of any intervention prior to full-scale implementation (Bartholomew, et al., 2001; Tones & Tilford, 2001). Comprehensive pre-testing increases the likelihood that the intervention is seen as comprehensive, relevant, memorable, credible, and acceptable to participants (Bartholomew, et al., 2001; Tones & Tilford, 2001). These factors are thought to be pre-requisites for successful behaviour change (Weinreich, 1999). Pre-testing also allows researchers to determine optimal levels of intervention intensity, this is a crucial feature of the design and implementation of any intervention (Campbell et al., 2000). However, on the basis of current literature, the impact of intervention intensity on the acceptability of an intervention to participants is unknown. The main aim of this study is to investigate feasibility and acceptability of the program ‘Fresh Facts’. A secondary aim of the study is to explore whether there are differences in reported feasibility and acceptability of the intervention between individuals of different ages and genders, and at different levels of intervention intensity. The current study will explore the feasibility and acceptability of the intervention at three levels of intervention intensity.