Conceptualizing university students’ food choices based on theory of planned behavior

Introduction

Students pursuing higher education frequently utilize residential facilities provided by their colleges and universities. While residing in a novel environment, students experience significant alterations in their lifestyle, deviating from the established habits maintained in their home environments.¹ The transition to university frequently encompasses forming new social connections, exposure to novel experiences, and personal growth. Significantly, this transition coincides with a critical period for establishing enduring habits,² including a crucial change in dietary preferences.¹ An individual’s dietary practices and beliefs during their tertiary education years can significantly influence their habits in adulthood, potentially affecting the probability of developing obesity and associated conditions, such as diabetes and cardiovascular diseases.³ Students opting for more economical dining options in proximity to campus choose to consume meals outside the campus facilities. This behavior, which predisposes them to potential nutrient deficiencies, is corroborated by a study highlighting that insufficient intake of nutritious food ranks among the top six health risk behaviors reported among university students.⁴

A report by the WHO (2015a)⁵ states that “healthy diets optimize growth and development over the short and long term. They are characterized by being sufficient and balanced in quantity and quality, containing a diversity of nutrient-dense foods including vegetables, fruits, whole grain cereals, fish, legumes, nuts, modest amounts of animal-source foods, limited in foods and drinks high in saturated and trans fats, added sugars, and salt”.⁵ A past study⁶ has reported that students rarely practice WHO guidelines with respect to dietary habits during their stay on campus. A study conducted in Kansas in the United States of America revealed that a significant proportion of university students were classified as obese, and their dietary patterns necessitated modification to incorporate more nutritionally dense foods, particularly those rich in fruits, vegetables, and dietary fiber.⁷ Furthermore, a low proportion of fruit and vegetable consumption and a high proportion of food containing elevated levels of calories, saturated fats, alcohol, and added sugar were reported among a significant number of university students.⁸ Many past studies have pointed out that university students do not follow nutritionally rich lifestyles.⁹ Further, students find choosing food challenging;¹ hence, they gradually move away from healthy food habits.⁴ Studies also show that only 4% of students consume 30% or less of energy from fat and 10% or less from sugar daily.⁷ Therefore, there is a pressing need to cultivate healthy eating habits among students, particularly considering the increasing prevalence of lifestyle diseases. It is imperative to promote nutrient-rich food behaviors among students, encourage them to select whole grains over processed food, incorporate fruits and vegetables into their daily diet, and avoid health-compromising food choices.¹⁰

A review study in the Indian context revealed that a substantial percentage of young people have unhealthy food habits, which affect their overall progress. The issues of failure in achieving academic goals are on a rise, mostly interconnected to unhealthy food habits, and are likely to intensify in the future. This study considers prime unhealthy habits as “under and over-nutrition, common mental issues, non-communicable diseases (NCDs), and stress and anxiety commonly associated with current “nutrition and epidemiological transition.”¹¹

In prior research on nutrition that explored the relationship between attitudes and food consumption, Axelson et al. (1985) conducted a meta-analysis of relevant studies, identifying a minor correlation between attitudes and behavior. A comparable investigation in social psychology during the 1960s precipitated a crisis in attitude research. The late 1960s witnessed the development of numerous structured attitude models, including Ajzen & Fishbein’s (1980) Theory of Reasoned Action and its extension, the Theory of Planned Behaviour (TPB; Ajzen, 1988). These models have been extensively employed in social psychology and have recently been applied to issues concerning food choice. The Theory of Reasoned Action seeks to elucidate behavior that is under an individual’s control, whereas the TPB also endeavors to address non-volitional behaviors, goals, and outcomes that are not entirely within an individual’s control.¹² The theory of planned behavior (Ajzen, 1991, 2005, 2012) provides an alternative framework for understanding consumer decision-making processes. The theory of planned behavior (TPB) aims to offer a comprehensive model for analyzing the factors that influence specific consumer behaviors.¹³ Hence, the present study aims to apply Ajzen’s (1991) theory of planned behavior to understand and conceptualize how students can modify their dietary preferences towards healthier options during their stay at university campuses. The theory of planned behavior (TPB) proposed by Icek Ajzen in 1985 is one of the most widely used models for examining intentions and consumer behavior in various contexts, including food consumption.¹³ The TPB states that behavior is influenced by intention to participate in that specific behavior (consuming healthy food) and perceived control behavior (PCB), for instance, practicing healthy food consumption at the campus irrespective of the environment. Fishbein & Ajten’s (1975) theory of reasoned action suggests that an individual’s intentions serve as the most reliable predictor of their behavior. The intention to engage in a particular behavior is posited to be influenced by both an attitudinal component and a normative component. The latter, referred to as the subjective norm, encompasses the individual’s perception of social pressure to perform the behavior, along with their motivation to conform to these expectations (parental influence and university policy).^14,15 Intentions drive people to take conscious steps to perform a behavior. PCB is the ability of a person to control their behavior, which is in line with Bandurs’ concept of self-efficacy.¹⁶ Terry et al. conducted a study of 146 undergraduate students utilizing regression analysis and found that past behavioral experiences (feedback) significantly predicted both intentions and actual behavior.¹³ In the present qualitative study, participants had to compulsorily subscribe to UDF during their first year of undergraduate program as per university policy. Postgraduate students were not restricted by policy. The rationale for selecting qualitative methodology was that studies have demonstrated that specific societal groups exhibit diverse attitudes, motivations, and behaviors concerning healthier eating habits.¹⁷ In-depth interviews¹⁸ provide a methodological tool for investigating food choices from an individual perspective and allow for an in-depth study of the problem. The approach to investigating previous behaviors (experiences) involved examining the period during which students engaged in selecting food, commencing from their first year, and analyzing how this process contributed to the development of feedback-initiated repetitive behavior. This study uses a qualitative approach to examine this subject. In contrast, previous studies exclusively employed a quantitative approach to investigate behaviors related to food consumption.¹⁹

Methods

A private university in Udupi was selected for this study because it has four UDFs. The university has outsourced the management of four University Dining Facilities (UDFs) to a catering service company. These facilities provide four meals daily: breakfast (7:00-9:00 am), lunch (12:30-2:00 pm), an evening snack (4:30-6:00 pm), and dinner (7:30-9:30 pm). Meal timings may vary based on campus location or student class schedules. The menus are designed to accommodate regional variations and are planned according to the diverse Indian cuisines and student preferences. Meals are nutritionally balanced, incorporating proteins, carbohydrates, and dietary fibers. Given the university’s location in South India, the meals emphasize regional and seasonal produce to manage food costs effectively. During the first year of enrollment, students are required to pay an annual advance at the time of admission. From the second year onward, students have the option to make payments in advance on a weekly, monthly, or quarterly basis, according to their preferences. Universities attract students from all over the country with varied food habits. Second, first-year students dine at the UDF for one year. For this study, the duration of one year and consecutive years thereafter were considered integral to developing feedback on UDF food.

Accordingly, undergraduate students in years II to IV and postgraduate students from the university were selected. As Creswell (2018)²⁰ asserted, phenomenological studies describe the common meaning of a phenomenon being studied by all participants. “It seeks to reduce individual experiences to a description of a universal essence”.²⁰ Hence, this study employed a qualitative research method and interpretive phenomenological approach to analyze the data and gain insights. Snowball sampling was used to recruit the participants. An in-depth interview was used to gather data and provide more subjective views. The researcher had no prior contact or relationship with the participants before conducting the interviews. Students from the engineering college were initially contacted and invited to participate in this study. According to the inclusion criteria, they had to be residents of the university accommodation, with ages ranging from 18+ to 24 years, and pursuing year II through year IV of their study programs. First-year undergraduate students were excluded from the study because they were younger than 18 years old. Initially, a subset of participants was selected through purposive sampling, who subsequently recommended additional potential participants from WhatsApp groups. Undergraduate students from years II through IV and postgraduate students from years I and II of their respective study programs were invited to participate via WhatsApp. Participation was voluntary, and verbal consent was obtained before participation. The interviews were conducted in online mode. The interviews were conducted for 30-40 minutes.

Participants’ involvement was limited to data collection and transcripts were discussed exclusively within the research team.

An ethics clearance certificate was obtained from the Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee before recruiting participants for the study. The doctoral committee approved an in-depth interview guide for PhD studies, and experts from nutrition, culinary arts, and qualitative research fields validated the same. A pilot study was conducted to evaluate the interview guide, and necessary modifications were implemented based on these findings. The interview guide comprised 8 to 10 questions, with additional probes introduced based on participant responses. The questions included: 1. Demographic information (such as program, education stream, age, etc.), 2. An inquiry into their regular dietary habits while residing on campus from the first year to the final year, 3. An exploration of their perspectives on efforts made to adhere to healthy diets, 4. An examination of their food purchasing behavior both on campus and at their residence, 5. Their perspectives on the dietary habits of their peers, 6. Their behavior regarding ready-to-eat food consumption, 7. Their experiences with the university dining facility, and 8. Their perceptions of healthy dietary habits.

Participants provided verbal consent as they were interviewed online via the MS Teams platform, and the interaction was audio-recorded with their consent. Online interviews were conducted with twenty-six students from various regions of India residing on campus. Data collection continued until saturation was achieved. Two students were unable to participate because of their commitment to the examination. The research team was present during online interviews with students who were at their places of residence because of the lockdown. The interviews were conducted in English and transcribed.

Data processing was performed using the deduction approach. Codes were identified and categorized into code families. The data were manually coded²¹ and analyzed through thematic analysis using ATLAS—ti data management software. The primary researcher and an additional research team member performed coding. Subsequently, the research team reviewed these codes. The coded data were grouped according to their relevance to establish categories. This process facilitated the development of themes and sub-themes. The derived themes were discussed with the research team members and consistency between the data and findings was established.

Results

The demographic profile of the participants revealed that they were pursuing engineering, architecture, medicine, dental, pharmacy, and forensic medicine courses. Their ages ranged from 18 to 24 years, and most of them belonged to Mumbai, Kolkata, Ahmadabad, Karkala, Ghaziabad, Bangalore, and Kochi. Table 1 shows participants’ profiles. All participants met the educational requirements for their respective programs, with undergraduate students in their second to fourth years and master’s students in their first or second years. Proficient in English.

Figure 1 shows the conceptual model of the students’ food choices that emerged after the data analysis. Systematic data analysis was used to identify the factors influencing participants’ food preferences. The themes developed through this analysis were organized to align with the principles of the theory of planned behavior and conceptualized according to the theoretical model. The model ( Figure 1) elucidated the interdependence of beliefs regarding University Dining Facility (UDF) food, leading to attitudes toward nutritious food and subsequent behavioral modifications. Influenced by feedback, this iterative process affected food choices throughout participants’ campus residences and initiated their behavior to select functional biscuits/cookies as part of their food choice process. Each component of the model is explicated with examples from the study data.

Figure 1. Conceptual model of food choice.

The developed conceptual model included the following components: 1. Individual behavior beliefs, 2. Normative beliefs, 3. Control beliefs, 4. Actual controls, and 5. Feedback. The continuous interdependency and relationship of beliefs regarding UDF food among participants led to the development of attitudes towards healthy food, which, in turn, initiated a transition in intentions to select UDF food, followed by actual behavioral changes. This cyclical process was observed throughout their campus residence, including the effect of feedback on behavior (food choice), and consequently, transitioning into food selection. Each component of the conceptual model was elucidated by using examples from the data.

Normative beliefs

Participants’ normative beliefs regarding subjective norms that promote healthy food behavior on campus encompassed university policies, parental influence, and environmental factors. These subjective norms were observed to exert a positive influence on students’ attitudes towards the UDF.

Control beliefs

The preconceived notions about food influenced the students’ transitional journey towards healthy food, irrespective of peer pressure and social circle during their stay on campus.

Discussion

The conceptual model developed for this study aligns with the theory of planned behavior (Ajzen, 1991)¹³ and is grounded in students’ perspectives on UDF food and their food choices. The model represents a comprehensive transition process in food choices as they progress through their stay at the campus. On average, the students stay on campus for two to four years, and changes in food habits were observed. Their behavioral beliefs, subjective norms, and preconceived control beliefs impact their attitude toward UDF and their perceptions of the quality of the food it serves. In the first year, the students must dine at the UDF, after which they begin exploring outside options driven by several factors. This is substantiated by the respondents who expressed that they dined at the UDF during the first two years of their study, after which many of them explored other options. Most respondents expressed dissatisfaction with the taste, which was one of the primary causes for their exploring other avenues even though they served unhealthy food.²² While the food lacked nutrition, it served as a source of relaxation. This finding is in line with that of a previous study.²³ It was also found that taste was a significant factor driving transitions in food habits. Furthermore, the study also found that taste as a sensory experience varies from one person to another.²³ Thus, taste is unique to each person. Therefore, it is difficult to identify the foods that have higher sensory attributes. Hence, sensory appreciation cannot be a means of predicting acceptance of a certain food item.²⁴

In line with past studies, the current study also found that the factors that impacted food choices were taste,^25,26 prices,¹⁸ time availability,^17,27 convenience,²⁸ academic stress,²⁷ lack of knowledge about nutrition,^3,29,30 absence of display boards notifying nutrient content of each meal,³⁰ and the cheap cost of unhealthy food¹⁷ compared to healthy foods.⁸ Nevertheless, the significance of this study could be justified through its contribution to the existing literature, specifically the concern expressed by respondents regarding the absence of a nutritionist at the UDF to provide guidance and advice about the food served at the facility, as well as their limited knowledge of the food preparation methods employed. Furthermore, the students articulated their apprehensions regarding the scarcity of alternative outlets offering nutritious food options on campus. The factors contributing to deviations from nutritionally optimal food choices remained consistent across all academic years, disciplines, and genders.⁸ Moreover, the study indicates that the UDF should enhance its services under administrative guidance and foster a nutritious food environment on campus that is well-received by the student population.^31,32 This recommendation aligns with previous research, which emphasized the role of UDF in “responding to young adults’ food preferences, food service cost-effectiveness, efficiency, and students’ health considerations”.³³

The participants expressed their concerns regarding the UDF, which prompted them to explore alternative dietary options. This behavior is grounded in the Theory of Planned Behavior (Ajzen 1991), which posits that feedback is essential for effecting necessary behavioral modifications based on current practices.¹³ The conceptual model effectively illustrates the transition in food choices. According to this theory, “background factors,” such as age, education, religion, income, general attitude, and emotions, indirectly influence an individual’s intentions and behavior by affecting behavioral, normative, and control beliefs. The data analysis elucidates insights on study program duration as a background factor influencing participants’ intentions and behavior regarding food choices. The study reveals that the respondents demonstrated a positive disposition toward modifying their attitudes and adopting healthy food habits. This finding aligns with other studies that have established intentions as a precursor for accomplishing a particular behavior. Success in accomplishing behavior is not solely influenced by the intention to perform the behavior but also by other control factors, such as requisite opportunities and resources. These requisite opportunities, resources, and intention to perform behavior collectively influence a successful transition towards the desired behaviour.²⁵ This is well-illustrated in the conceptual model in which these controls are in the form of volitional controls and budgetary constraints affecting students’ intentions and behavior.

The study establishes a relationship between a healthy environment and healthy food choices³⁴ in which the environment facilitates the accessibility and consumption of fruits, vegetables and nutrient-rich food.³⁵ Students could be made aware of the need to consume healthy foods and display the nutritive value chart of the foods served in the UDF in the facility itself. Further, affirmative messages can be shared regularly in the form of posters, charts, digital boards flashing PPTs through social media and other messaging platforms, and other outreach activities.³⁶ Similar findings were noted in other studies also.³⁷

The model was conceptualized and developed based on the comprehensive understanding gained through the study, rather than the sample size. University students from various regions studying at the same campus were invited to share their food experiences to achieve this objective. The sample was not intended to represent the entire student population; instead, it aimed to identify the factors motivating students to alter their food choices during their campus tenure. Our study sample included students from diverse social backgrounds, each exposed to different food habits, with the goal of understanding their food transition trajectories. The model components depict food events that occurred throughout the participants’ stay and the role of feedback in shaping attitudes. Future research could include participants from various universities, geographical locations, and academic disciplines. Understanding the significance of UDF and its role in a student’s transitional food journey was not solely objective-oriented; it emerged through food events or actions experienced by participants. However, the influence of UDF may vary depending on the university’s geographical location. The significance of this study lies in the paucity of research in India, highlighting the importance of dietary parameters for students pursuing higher education far from their residences.

Conclusion

The conceptual model developed to elucidate food choices emphasizes the food-related behaviors exhibited by individual participants and their cumulative impact on shaping an individual’s attitude toward healthy food consumption. This model offers university decision-makers valuable insights into promoting healthy food choices among students, thereby enhancing their academic performance. Furthermore, the University Dining Facilities (UDF) must adapt their services to meet the nutritional needs of students while ensuring that taste is not compromised and no additional costs are incurred. Previous studies have demonstrated that a conducive environment fosters healthy eating habits. Universities can create an optimal environment by ensuring the easy availability and accessibility of healthy foods.^8,35 The conceptual model presented in this paper represents an initial effort to comprehend the factors influencing students’ food choices. Future research may consider diverse participants in varied settings.