Rimal 42 3
Rimal 42 3
Abstract
Translating the dietary knowledge among individuals into healthy behavior remains a
challenging task. This study examines the causal relationship between dietary knowledge and
behavior by including self-efficacy in the models.
A series of regression models were developed based on Baron and Kenny (1986) to assess
whether self-efficacy mediated the link between the predictor variables and dietary behavior.
Regression analyses supported the hypothesized relationships that self-efficacy mediates effects
of dietary knowledge and social influences on dietary behavior. Self-efficacy also accounted for
variance in eating behavior not explained by knowledge or demographic variables.
Corresponding author: Tel: +1 417.836.5094
Email: arbindrarimal@[Link]
W. Moon: wmoon@[Link]
S.K. Balasubramanian: siva@[Link]
D. Miljkovic: [Link]@[Link]
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Clearly, the evidence from the above studies suggests that the impact of additional information
and knowledge on actual consumer behavior is an empirical issue. This is in contrast to the
premises of the rational choice theory which is the basis for traditional neoclassical theory of
demand and consumer choice (e.g., Mas-Colell, Whinston and Green 1995). The implausibility
of the rational choice axioms has been documented by many economists including, among
others, the Nobel Prize Laureate Kahneman (1994), or more recently Miljkovic (2005).
Therefore, translating the dietary knowledge among individuals into healthy behavior remains a
challenging task for economic modelers, and in turn the food and health policy makers. Relying
on behavioral sciences theories such as the social cognitive theory (SCT), the objective of this
study is to examine the causal relationship between dietary knowledge and behavior by including
self-efficacy in the models.
A person’s health related self efficacy is influenced by his/her health knowledge and other socio-
demographic background information. Since self-efficacy itself is explained by the dietary
knowledge of individuals (Slater 1989), it is likely to play a mediating role in the relationship
between healthy behaviors and dietary knowledge. Consumers with higher levels of self-
efficacy are more likely to sustain a healthy behavior with regard to food choices compared to
those with lowers level of self-efficacy.
The hypotheses above underscore the notion of mediation. In other words, the mediation
approach recognizes that consumers’ self-control (efficacy) over diet and lifestyle can mediate
the effects of the predictor variables (dietary knowledge) on the dietary behavior (Baron and
Kenny 1986). Figure 1 (as adapted from Baron and Kenny 1986) illustrates this modeling
approach using self-efficacy as mediators of the relationship between dietary behavior and
predictor variables. The figure depicts three causal paths in a model of how overall dietary
behavior is formed: (i) the direct impact of the predictors on dietary behavior (path a); (ii) the
path from the predictors to the mediators (path b); and (ii) the impact of mediators on dietary
behavior (path c).
In this study, the mediating hypothesis is tested using the following four criteria adopted from
Judd and Kenny (1981) and Baron and Kenny (1986): a) the self-efficacy of individuals
(mediator) has a statistically significant impact on dietary behavior; b) dietary knowledge and
socio-demographic variables (predictors) have significant influence on dietary behaviors; c)
dietary knowledge exerts a significant influence on diet related self-efficacy of individuals; and
d) the effects of dietary knowledge is either diminished or no longer significant when self-
efficacy is controlled for the dietary behavior equations.
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Figure 1. Conceptual model depicting the mediating role of self-efficacy between dietary
behavior and predictor variables (adapted from Baron and Kenny, 1986).
Following Baron and Kenny (1986) and Judd and Kenny (1981), a series of regression models
were developed to assess whether self-efficacy mediated the link between the predictor variables
and dietary behavior:
Model 3: BEHAVIOR = b30 + b31 DIETARY KNOWLEDGE + b32 FFICACY +b33 AGE
+ b34 GENDER + b35 INCOME+ b36 EDUC+ b37 RACE+ b38 HOUSEHOLD SIZE + e
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remain statistically significant. This indicates that the effects of dietary knowledge are partially
mediated by efficacy.
The empirical model posits that a participant’s dietary behavior is a function of dietary
knowledge, self control (efficacy) in changing health behavior with regard to food choices and
life-style and various socio-economic characteristics of individuals. We are interested in
explaining consumption intensity with regard to fruits, vegetables, and nutrients such as
cholesterol and fat rather than number of times someone consumed them in the past. The model,
therefore, can be formally written as:
Uj = β’Zj + Ɛj
The dependent variable in the models were measured using ordinal measures (1,2,3, 4 and 5.)
Hence, an ordered probit model (Long 1997; Greene 1993) was used to conduct the regression
analysis. Value of 1 indicated when a statement regarding a dietary item (e.g. I eat a lot of fresh
fruits) did not describe a participant “at all”; value of 2 indicated that it described “slightly”;
value of 3 indicated that it described “somewhat”; value of 4 indicated that it described “very
well” and value of 5 indicated that it described “extremely well.”
The Data
In the summer of 2007, a national survey among United States household was conducted. The
survey was administered online by Ipsos-Observer, a private consulting firm specializing in
consumer research and public opinion poll on socially important issue including tracking trends
in food consumption. This firm maintains an on-line panel that consists of 400,000 households.
Approximately stratified by geographic regions, income, education, and age to correspond to the
2000 US census, a sample of 9000 households were drawn out of the online panel in a manner
that is representative of the US population. A total of 3,456 households completed the surveys,
resulting in a 38.4% response rate. Sample households were sent e-mails soliciting information
regarding their food consumption behavior and household characteristics. Each e-mail included
a unique URL (keyed to the respondent’s ID) to direct the respondent to the survey website. In
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Table 2. Reported level of self-control (Efficacy) in changing health behavior with regard to
food choices and life-style (n=3056).
Percentage of Respondents
1= 2= 3= 4= 5=
How likely are you to: Extremely Unlikely Slightly Somewhat Very much Extremely Likely
Read nutritional labels on
food packages very carefully? 12.5% 19.5% 27.8% 24.6% 15.5%
Change diet to reduce the risk
of certain diseases? 23.3% 18.9% 28.9% 20.1% 8.7%
Exercise at least three times
per week? 25.9% 20.2% 19.6% 17.3% 16.9%
Prevent health problems
before feeling any symptoms 9.0% 17.9% 35.2% 27.5% 10.4%
Note. Cronbach’ s consistency test (α) was 0.85
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A knowledge of the diet health relationship was measured using an instrument similar to the one
used by Moorman and Matulich, (1993), who defined health knowledge as the extent to which
consumers have enduring health-related cognitive structures Respondents were asked to link or
match each of the eleven nutrients (i.e., sodium, calcium, vitamin A, protein, vitamin C, iron,
vitamin D, carbohydrates, saturated fat, potassium, and dietary fiber) with an appropriate health
consequence from a list: high blood pressure, strong bones, healthy eyes, amino acids, anticancer
power, oxygen, absorb calcium, conversion to sugar and fueling the body, cardiovascular
disease, and balancing sodium. An index of dietary knowledge was constructed by adding all
correct answers for each respondent. Hence, the index ranges from a minimum of 0 (representing
no dietary knowledge) to a maximum of 11 (representing highest dietary knowledge.) The mean
dietary knowledge score was 6.09 (Table 3) which means an average respondent could provide
six correct matches out of eleven.
Table 3 reports descriptive statistics for other (socio-economic) explanatory variables -including
gender, age, household income, education level of the respondent, household size and ethnic
background. Over 50% of the respondents were female. The average age of the respondent was
50 years. Household income was reported in income groups represented by numerical values.
For example, 1 represented less than $5,000 and 25 represented more than $250,000. In the
analysis, mid-points in each income group were used to obtain household income in dollars. The
average household income among the sample respondents was $67,377. Average household size
was 2.6 members. Nearly three fourths of respondents were white.
A Pearson correlation matrix including all the independent variables was generated to examin
any potential multicollinearity in the regression models. While many coefficients were
statistically significant at 0.05 level, the size of the coefficient was very small. The largest
coefficient was 0.21. Hence, it was determined that multicollinearity was unlikely in the
proposed regression models
.
Results and Implications
Ordered probit models for each of the four dietary behaviors: fresh fruits, fresh vegetables, fat
and cholesterol were run and reported in Tables 4 to 7 (see Appendix). For all models the null
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hypotheses that all parameters were jointly equal to zero were rejected using χ2 statistics at the
0.01 significance level. Based on the collinearity diagnostics (Belsley et al., 1980), no
collinearity problems were detected in the analyses. Marginal effects of the independent
variables were also estimated but not reported due to the space consideration. Initially, only
knowledge was used as the explanatory variable. Self-efficacy and socio-demographic variables
were added in subsequent runs.
The coefficients for the relationship between dietary behavior and knowledge are positive and
significant, as one may have expected, in Model 1 of the all four dietary behaviors. This result
suggests only that more dietary knowledge translates into more responsible and healthy dietary
behavior, but it does not explain or clarify the mechanism or the process which leads more
dietary knowledge to transfer into more responsible and healthy dietary behavior. This aspect of
the problem is explained in Models 2 and 3.
In Model 2, when the influence of self-efficacy was added, the impact of dietary knowledge
decreased but remained statistically significant for vegetables and fat while it became statistically
insignificant for fruits and cholesterol. The coefficients measuring the impact of the self-efficacy
on dietary behavior are all positive, statistically significant, and much larger in size than the
coefficients associated with the knowledge variable. The pseudo R-squared for each of the four
dietary items increased by a huge magnitude when self-efficacy was added to the models. All
the above results from the regression analysis of Model 2 supported the hypothesized
relationships that self-efficacy mediates effects of dietary knowledge and social influences on
dietary behavior for each of the four dietary items.
Self-efficacy also accounted for variance in eating behavior not explained by knowledge or
demographic variables. However, the effect of self-efficacy on dietary behavior in Model 3,
albeit remaining statistically significant, decreased substantially in the cases of both fat and
cholesterol. Moreover, the pseudo R-squared in these two regressions decreased when
demographic variables were added. While the impact of all demographic variables on the dietary
habits in fruit consumption behavior equation is statistically significant, and the impact of all
demographic variables but the education is statistically significant in the vegetables consumption
behavior equation, the demographic variables had almost no impact on consumption of fat
(except age) and cholesterol (except the household size).
The above results indicate that self-efficacy is the most important mechanism in impacting fat
and cholesterol consumption, while it is only one of the factors impacting the consumption of
both fruits and vegetables. This should come as no surprise: healthy nutrition implies eating
more of fruits and vegetables for most people while cutting out the consumption of fat and
cholesterol. Consuming more of anything is hardly considered a sacrifice while consuming less
of something often demands a great deal of self-control and discipline. The results in this study
are consistent with results in other studies which show that dieting, weight control and
preventive nutrition can be governed by self-efficacy beliefs. In intervention programs, clients
with higher level of self-control were less likely to relapse into their previous habit than those
with lower level of self-control (Chambliss and Murray 1979; Furhrmann and Kuhl 1998;
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Schnoll and Zimmerman 2001; Long and Stevens. 2004; Luszczynska et al. 2007). Yet there is
no clear unique solution as for what the means to inducing dietary self-efficacy may be. For
example, some studies suggest that goal setting is the most critical way to induce self-efficacy in
dietary behavior (e.g., Robinson 1999; Baldwin and Galciglia 1997). Other studies suggest that
goal setting and self-monitoring combined increase the self-efficacy scores significantly (e.g.,
Schnoll and Zimmerman 2001). Also, other aspects of self-regulation and behavioral training
such as problem identification, problem solving, self-evaluation, or reinforcement may be critical
in inducing dietary self-efficacy (Hardeman et al. 2000). Hence, interventions and health
promotion campaigns should seek to directly address factors influencing diet related self-efficacy
instead of focusing on disseminating information only. In practice, for example, we often see
healthy foods such as fruits and vegetables being introduced on the menus of school and college
cafeterias or in restaurants. The availability of healthy foods coupled with self-efficacy driven
by dietary knowledge is likely to lead to an increased consumption of healthy foods. At the same
time, most restaurants and cafeterias sell foods rich in fat and cholesterol alongside the healthy
foods. Also, while often the consumers are aware of the negative impact fat and cholesterol may
have on their health due to numerous educational activities by health and nutrition professionals,
the low cost of that food coupled with the sugar enhanced, taste improving additives proves to be
irresistible to the average consumer (Miljkovic, Nganje, and de Chastenet 2008). It has been
shown that sweetened foods, i.e., an increased consumption of sugar, leads first to sugar
addiction and second to carbohydrate addiction and increased consumption of fats (Miljkovic
and Nganje 2008). Hence unavailability of unhealthy food or its availability at higher cost due to
“fat tax,” especially to children and adolescents who develop taste for unhealthy foods at an early
age, seems to be a reasonable pro-active approach to influence diet related self-efficacy.
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Appendix
Table 4. Mediation by efficacy in the relationship between dietary knowledge and fruit
consumption behavior: An Ordered Probit Model
Model1 Model2 Model3
Variables Coeff. P-value Coeff. P-value Coeff. P-value
ONE 1.399 0.000 0.265 0.000 -0.154 0.142
KNOW 0.028 0.000 0.002 0.706 -0.006 0.317
EFFICACY 0.563 0.000 0.551 0.000
AGE 0.005 0.000
GENDER 0.215 0.000
INCOME 0.001 0.005
EDUCA 0.090 0.036
RACE -0.125 0.003
HHSIZE 0.043 0.001
Mu( 1) 0.914 0.000 1.012 0.000 1.025 0.000
Mu( 2) 1.812 0.000 2.006 0.000 2.031 0.000
Mu( 3) 2.628 0.000 2.910 0.000 2.945 0.000
*
Pseudo-R-Squared 0.01 0.32 0.35
*
R2ML = 1 – exp(-G2/N), where G2 = -2 ln [L(Mα)/L(Mβ)]; Mα = restricted likelihood, Mβ = Unrestricted Likelihood,
and N=Number of observation (Maddala. 1983).
Table 5. Mediation by efficacy in the relationship between dietary knowledge and vegetable
consumption behavior: An Ordered Probit Model
Model1 Model2 Model3
Variables Coeff. P-value Coeff. P-value Coeff. P-value
ONE 1.361 0.000 0.171 0.008 -0.415 0.000
KNOW 0.041 0.000 0.016 0.005 0.007 0.286
EFFICACY 0.592 0.000 0.579 0.000
AGE 0.008 0.000
GENDER 0.246 0.000
INCOME 0.002 0.000
EDUCA 0.050 0.243
RACE -0.115 0.007
HHSIZE 0.041 0.002
Mu( 1) 0.853 0.000 0.955 0.000 0.976 0.000
Mu( 2) 1.756 0.000 1.962 0.000 2.002 0.000
Mu( 3) 2.649 0.000 2.960 0.000 3.016 0.000
*
Pseudo-R-Squared 0.03 0.36 0.39
*
R2ML = 1 – exp(-G2/N), where G2 = -2 ln [L(Mα)/L(Mβ)]; Mα = restricted likelihood, Mβ = Unrestricted Likelihood,
and N=Number of observation (Maddala. 1983).
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Table 6. Mediation by efficacy in the relationship between dietary knowledge and fat
consumption behavior: An Ordered Probit Model
Model1 Model2 Model3
Variables Coeff. P-value Coeff. P-value Coeff. P-value
ONE 1.087 0.000 -0.617 0.000 0.524 0.000
KNOW 0.055 0.000 0.019 0.002 0.025 0.000
EFFICACY 0.889 0.000 0.128 0.000
AGE 0.006 0.000
GENDER 0.034 0.368
INCOME 0.001 0.125
EDUCA 0.012 0.773
RACE -0.003 0.942
HHSIZE 0.006 0.656
Mu( 1) 0.621 0.000 0.782 0.000 0.607 0.000
Mu( 2) 1.507 0.000 1.902 0.000 1.481 0.000
Mu( 3) 2.475 0.000 3.120 0.000 2.439 0.000
Pseudo-R-Squared* 0.05 0.60 0.26
*
R2ML = 1 – exp(-G2/N), where G2 = -2 ln [L(Mα)/L(Mβ)]; Mα = restricted likelihood, Mβ = Unrestricted Likelihood,
and N=Number of observation (Maddala. 1983).
Table 7. Mediation by efficacy in the relationship between dietary knowledge and cholesterol
consumption behavior: An Ordered Probit Model
Model1 Model2 Model3
Variables Coeff. P-value Coeff. P-value Coeff. P-value
ONE 0.932 0.000 -0.662 0.000 0.384 0.000
KNOW 0.040 0.000 -0.009 0.147 0.004 0.542
EFFICACY 0.846 0.000 0.333 0.000
AGE 0.002 0.077
GENDER -0.023 0.556
INCOME 0.000 0.382
EDUCA -0.012 0.773
RACE -0.054 0.201
HHSIZE -0.038 0.004
Mu( 1) 0.598 0.000 0.748 0.000 0.590 0.000
Mu( 2) 1.413 0.000 1.768 0.000 1.416 0.000
Mu( 3) 2.265 0.000 2.839 0.000 2.279 0.000
*
Pseudo-R-Squared 0.03 0.60 0.29
*
R2ML = 1 – exp(-G2/N), where G2 = -2 ln [L(Mα)/L(Mβ)]; Mα = restricted likelihood, Mβ = Unrestricted Likelihood,
and N=Number of observation (Maddala. 1983).
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