Background Recent government policy has placed increasing emphasis on changing health behaviours through interventions that work at the environmental level by ‘nudging’ people to make healthier choices. Many argue that individual socioeconomic and psychological factors must also play a role in determining health behaviours but there is little evidence of how individual and environmental factors work together to influence health behaviour. This study aimed to take a multi-level approach in relation to diet, examining how a range of environmental and individual factors predicted the dietary quality of mothers with young children.
Methods A validated food frequency questionnaire was used to generate a standardised dietary quality score for 829 mothers with young children in Hampshire. Mothers were asked about their psychological and demographic characteristics, and perceptions of food access and affordability. Three nutrition environmental factors were assessed: healthfulness of the supermarket where women did their main food shop, based on price, placement and promotion of healthy and less healthy foods to create a healthfulness score; spatial access to food outlets using activity spaces; the nutrition environment of Sure Start Children’s Centres (SSCC) visited frequently by the women, assessed with a questionnaire administered to SSCC staff. A theoretical model linking environmental factors to dietary behaviours through individual factors was tested using Structural Equation Modelling.
Results Complete data were available for 753 (91%) women. The healthfulness of the in-store environment of mothers’ main supermarket was indirectly related to their dietary behaviours through psychological and perceived affordability factors. Shopping at supermarkets classified as having a healthier in-store environment was associated with cognitive factors associated with healthy eating (standardised regression weight b = 0.14, p = 0.02) and fewer food affordability concerns (b = -0.14, p = 0.01), which in turn were associated with healthier dietary behaviours (b = 0.55, p < 0.001 and b = -0.15, p = 0.01 respectively). The three environmental factors were not directly associated with dietary behaviour (p > 0.1). The overall model fit was good (CFI = 0.91, RMSEA = 0.05 [0.05, 0.06]).
Conclusion These findings provide evidence that mothers’ dietary quality is influenced both by their individual characteristics and the environment of the supermarkets where they shop. Our previous work has shown that the dietary quality of mothers of lower socioeconomic status may be particularly susceptible to environmental influences. Interventions to improve health behaviours need to influence both environmental and individual factors to be maximally effective. The greater susceptibility of people of lower socioeconomic status to environmental influences suggests that this multi-level approach has the potential to address health inequalities.
- Health behaviours
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