Who may convince technical college students to eat healthily? An exploratory sequential mixed methods study

Socio-economic inequality in youth health is transferred into adulthood. Therefore, promoting healthy eating at vocational college is a priority and challenge for public authorities. Information campaigns often fail reaching the target group, who may be more receptive to ‘alternative’ strategies of health promotion, such as social norms. Social norms influence behavior, but very few studies discriminate between sources of influences, beyond family and peers. The purpose of this study was to explore the perceived acceptability and effectiveness of direct social influence on healthy eating by students attending technical college.

An exploratory sequential mixed methods design was applied, in which results of focus group studies were used to feed into the design of a survey study, integrating results of both studies. First, students (n=36) at four different schools participated in focus groups. Participants discussed barriers and facilitators to healthy eating, and reflected on the influence of persons varying in proximity to the student, and on mass media campaigns. Secondly, students (n=1095) participated in an online survey which included an experimental set-up in which participants were presented with one of five decision situations, varied in terms of a ‘sender’ (teacher/close friend/partner; overweight/not overweight) encouraging a fictive technical college student to eat more healthily. Students evaluated the perceived acceptability and effectiveness of the health promotion attempt by the ‘sender’. Descriptive norms were also measured.

Proximity of the source of social influence appears to be central for encouraging healthy eating; students reported to be more responsive to a partner than to a teacher, while the sender’s weight status did not seem to matter (but the respondent’s weight status mattered). Also, parental role modelling is important. Though social influence was self-reported, the projective approach and convergence of qualitative and quantitative data support the importance of close others for healthy eating habits.