Digital Healthy Diet Literacy and Self-Perceived Eating Behavior Change during COVID-19 Pandemic among Undergraduate Nursing and Medical Students: A Rapid Online Survey
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Sample
2.3. Instruments and Measurements
2.3.1. Sociodemographics and Clinical Parameters
2.3.2. Health Literacy and Digital Healthy Diet Literacy
2.3.3. Eating Behavior and Other Lifestyle Changes
2.4. Ethical Consideration
2.5. Data Analysis
2.5.1. Psychometric Properties of Digital Healthy Diet Literacy
2.5.2. Health Literacy, Digital Healthy Diet Literacy, and Eating Behavior Changes
3. Results
3.1. Students’ Characteristics
3.2. Psychometric Properties of Digital Healthy Diet Literacy
3.3. Associations of HL and DDL with Eating Behavior Changes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
BMI | body mass index |
COVID-19 | coronavirus disease-2019 |
S-COVID-19-S | suspected coronavirus disease-2019 symptoms |
SD | standard deviation |
HL | health literacy |
HLS-SF12 | a 12-item short-form health literacy survey questionnaire |
DDL | digital healthy diet literacy |
OR | odds ratio |
CI | confidence interval |
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Geographic Location | Hospital/Health Center | Academic Field | Possible Participants | Studied Participants |
---|---|---|---|---|
North | ||||
Ha Noi | 1. Hanoi Medical University | Medical | 3386 | 844 |
Nursing | 285 | 166 | ||
2. Vietnam Military Medical University | Medical | 3034 | 1198 | |
3. Vietnam National University-School of Medicine and Pharmacy | Medical | 444 | 385 | |
Thai Nguyen | 4. Thai Nguyen University of Medicine and Pharmacy | Medical | 2830 | 742 |
Nursing | 579 | 200 | ||
Hai Duong | 5. Hai Duong Medical Technical University | Nursing | 697 | 379 |
Hai Phong | 6. Haiphong University of Medicine and Pharmacy | Medical | 3153 | 800 |
Nursing | 317 | 145 | ||
Center | ||||
Thua Thien Hue | 7. Hue University of Medicine and Pharmacy | Medical | 3800 | 425 |
Nursing | 594 | 265 | ||
Da Nang | 8. Da Nang University of Medical Technology and Pharmacy | Nursing | 718 | 311 |
South | ||||
Ho Chi Minh | 9. Pham Ngoc Thach University of Medicine | Medical | 5510 | 473 |
Nursing | 424 | 203 | ||
Can Tho | 10. Can Tho University of Medicine and Pharmacy | Medical | 6580 | 898 |
Nursing | 281 | 182 | ||
Subtotal | Medical | 28,737 | 5765 | |
Nursing | 3895 | 1851 | ||
Total | 32,632 | 7616 |
Eating Behavior | Overall Sample | Nursing Students | Medical Students | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Total (N = 7616) | Unchanged or Less Healthy (N = 4353) | Healthier (N = 3263) | Subtotal (N = 1851) | Unchanged or Less Healthy (N = 924) | Healthier (N = 927) | Subtotal (N = 5765) | Unchanged or Less Healthy (N = 3429) | Healthier (N = 2336) | ||||
n (%) | n (%) | n (%) | p * | n (%) | n (%) | n (%) | p * | n (%) | n (%) | n (%) | p * | |
Age, year | 0.002 | 0.946 | 0.024 | |||||||||
19–20 | 2834 (37.2) | 1554 (35.7) | 1280 (39.2) | 957 (51.7) | 477 (51.6) | 480 (51.8) | 1877 (32.6) | 1077 (31.4) | 800 (34.2) | |||
21–27 | 4782 (62.8) | 2799 (64.3) | 1983 (60.8) | 894 (48.3) | 447 (48.4) | 447 (48.2) | 3888 (67.4) | 2352 (68.6) | 1536 (65.8) | |||
Gender | <0.001 | 0.016 | <0.001 | |||||||||
Women | 4762 (62.5) | 2512 (57.7) | 2250 (69.0) | 1723 (93.1) | 847 (91.7) | 876 (94.5) | 3039 (52.7) | 1665 (48.6) | 1374 (58.8) | |||
Men | 2854 (37.5) | 1841 (42.3) | 1013 (31.0) | 128 (6.9) | 77 (8.3) | 51 (5.5) | 2726 (47.3) | 1764 (51.4) | 962 (41.2) | |||
Academic year | <0.001 | 0.756 | 0.004 | |||||||||
Year 1–2 | 3036 (39.9) | 1655 (38.0) | 1381 (42.3) | 1000 (54.0) | 496 (53.7) | 504 (54.4) | 2036 (35.3) | 1159 (33.8) | 877 (37.5) | |||
Year 3–6 | 4580 (60.1) | 2698 (62.0) | 1882 (57.7) | 851 (46.0) | 428 (46.3) | 423 (45.6) | 3729 (64.7) | 2270 (66.2) | 1459 (62.5) | |||
Academic field | < 0.001 | |||||||||||
Nursing | 1851 (24.3) | 924 (21.2) | 927 (28.4) | |||||||||
Medical | 5765 (75.7) | 3429 (78.8) | 2336 (71.6) | |||||||||
Ability to pay for medication | 0.078 | 0.385 | 0.034 | |||||||||
Very or fairly difficult | 3674 (48.2) | 2138 (49.1) | 1536 (47.1) | 1005 (54.3) | 511 (55.3) | 494 (53.3) | 2669 (46.3) | 1627 (47.4) | 1042 (44.6) | |||
Very or fairly easy | 3942 (51.8) | 2215 (50.9) | 1727 (52.9) | 846 (45.7) | 413 (44.7) | 433 (46.7) | 3096 (53.7) | 1802 (52.6) | 1294 (55.4) | |||
BMI, kg/m2 | 0.027 | 0.172 | 0.240 | |||||||||
BMI < 18.5 | 1584 (20.8) | 864 (19.9) | 720 (22.1) | 589 (31.8) | 296 (32.0) | 293 (31.6) | 995 (17.2) | 568 (16.6) | 427 (18.3) | |||
18.5 ≤ BMI < 25.0 | 5535 (72.7) | 3188 (73.3) | 2347 (72.0) | 1217 (65.8) | 600 (64.9) | 617 (66.6) | 4318 (75.0) | 2588 (75.5) | 1730 (74.1) | |||
BMI ≥ 25.0 | 492 (6.5) | 298 (6.9) | 194 (5.9) | 44 (2.4) | 28 (3.1) | 16 (1.7) | 448 (7.8) | 270 (7.9) | 178 (7.6) | |||
S-COVID-19-S ** | 0.361 | 0.705 | 0.283 | |||||||||
No | 6156 (80.8) | 3503 (80.5) | 2653 (81.3) | 1461 (78.9) | 726 (78.6) | 735 (79.3) | 4695 (81.4) | 2777 (81.0) | 1918 (82.1) | |||
Yes | 1460 (19.2) | 850 (19.5) | 610 (18.7) | 390 (21.1) | 198 (21.4) | 192 (20.7) | 1070 (18.6) | 652 (19.0) | 418 (17.9) | |||
Comorbidity | 0.029 | 0.576 | 0.021 | |||||||||
None | 7279 (95.6) | 4141 (95.1) | 3138 (96.2) | 1762 (95.2) | 877 (94.9) | 885 (95.5) | 5517 (95.7) | 3264 (95.2) | 2253 (96.4) | |||
One or more | 337 (4.4) | 212 (4.9) | 125 (3.8) | 89 (4.8) | 47 (5.1) | 42 (4.5) | 248 (4.3) | 165 (4.8) | 83 (3.6) | |||
Smoking status | 0.003 | 0.375 | 0.009 | |||||||||
Never, stopped, or smoke less | 7395 (97.1) | 4205 (96.6) | 3190 (97.8) | 1818 (98.2) | 905 (97.9) | 913 (98.5) | 5577 (96.7) | 3300 (96.2) | 2277 (97.5) | |||
Unchanged or smoke more | 221 (2.9) | 148 (3.4) | 73 (2.2) | 33 (1.8) | 19 (2.1) | 14 (1.5) | 188 (3.3) | 129 (3.8) | 59 (2.5) | |||
Drinking status | <0.001 | 0.002 | <0.001 | |||||||||
Never, stopped, or drink less | 7137 (93.7) | 4005 (92.0) | 3132 (96.0) | 1791 (96.8) | 882 (95.5) | 909 (98.1) | 5346 (92.7) | 3123 (91.1) | 2223 (95.2) | |||
Unchanged or drink more | 479 (6.3) | 348 (8.0) | 131 (4.0) | 60 (3.2) | 42 (4.5) | 18 (1.9) | 419 (7.3) | 306 (8.9) | 113 (4.8) | |||
Physical activity | <0.001 | <0.001 | <0.001 | |||||||||
Never, stopped, or exercise less | 2309 (30.3) | 1600 (36.8) | 709 (21.7) | 499 (27.0) | 311 (33.7) | 188 (20.3) | 1810 (31.4) | 1289 (37.6) | 521 (22.3) | |||
Unchanged or exercise more | 5307 (69.7) | 2753 (63.2) | 2554 (78.3) | 1352 (73.0) | 613 (66.3) | 739 (79.7) | 3955 (68.6) | 2140 (62.4) | 1815 (77.7) | |||
HL index, mean ± SD | 34.4 ± 6.9 | 34.0 ± 6.9 | 34.9 ± 6.9 | <0.001 | 34.4 ± 6.9 | 34.0 ± 6.9 | 34.9 ± 6.9 | <0.001 | 34.4 ± 6.9 | 34.0 ± 6.9 | 34.9 ± 6.9 | < 0.001 |
DDL index, mean ± SD | 33.9 ± 8.5 | 33.3 ± 8.6 | 34.6 ± 8.4 | <0.001 | 33.9 ± 8.5 | 33.3 ± 8.6 | 34.6 ± 8.4 | <0.001 | 33.9 ± 8.5 | 33.3 ± 8.6 | 34.6 ± 8.4 | < 0.001 |
DDL Scale | Overall Sample | Nursing Students | Medical Students |
---|---|---|---|
Factor loadings: “On a scale from very difficult to very easy, to what extent would you say it is difficult or easy to: …” | |||
1. Find reliable and accurate healthy diet information on the internet? | 0.85 | 0.82 | 0.86 |
2. Understand healthy diet information and dietary guidelines on the internet? | 0.88 | 0.86 | 0.88 |
3. Judge whether healthy diet information on the internet applied to you? | 0.86 | 0.84 | 0.86 |
4. Apply healthy diet information from the internet to your daily life to make you eat better? | 0.79 | 0.76 | 0.80 |
Percentage of variance, % | 71.32 | 67.12 | 72.47 |
Item-scale convergent validity, mean of Rho (range) * | 0.81 (0.80–0.83) | 0.78 (0.76–0.80) | 0.82 (0.81–0.84) |
Criterion validity, correlation with HL, Rho ** | 0.68 | 0.68 | 0.68 |
Internal consistency, Cronbach’s alpha | 0.86 | 0.83 | 0.87 |
Floor effects, % | 0.20 | 0.30 | 0.20 |
Ceiling effect, % | 12.00 | 7.90 | 13.3 |
Healthier Eating Behaviors * | Total Sample | Nursing Students | Medical Students | |||
---|---|---|---|---|---|---|
OR (95%CI) | p | OR (95%CI) | p | OR (95%CI) | p | |
HL index ** | ||||||
Model 1 | 1.19 (1.12, 1.26) | <0.001 | 1.28 (1.13, 1.43) | <0.001 | 1.19 (1.12, 1.27) | <0.001 |
Model 2 | 1.23 (1.15, 1.30) | <0.001 | 1.24 (1.09, 1.40) | 0.001 | 1.23 (1.15, 1.31) | <0.001 |
DDL index ** | ||||||
Model 1 | 1.17 (1.11, 1.22) | <0.001 | 1.25 (1.13, 1.37) | <0.001 | 1.16 (1.10, 1.22) | <0.001 |
Model 2 | 1.18 (1.13, 1.24) | <0.001 | 1.23 (1.10, 1.35) | <0.001 | 1.17 (1.11, 1.24) | <0.001 |
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Duong, T.V.; Pham, K.M.; Do, B.N.; Kim, G.B.; Dam, H.T.B.; Le, V.-T.T.; Nguyen, T.T.P.; Nguyen, H.T.; Nguyen, T.T.; Le, T.T.; et al. Digital Healthy Diet Literacy and Self-Perceived Eating Behavior Change during COVID-19 Pandemic among Undergraduate Nursing and Medical Students: A Rapid Online Survey. Int. J. Environ. Res. Public Health 2020, 17, 7185. https://doi.org/10.3390/ijerph17197185
Duong TV, Pham KM, Do BN, Kim GB, Dam HTB, Le V-TT, Nguyen TTP, Nguyen HT, Nguyen TT, Le TT, et al. Digital Healthy Diet Literacy and Self-Perceived Eating Behavior Change during COVID-19 Pandemic among Undergraduate Nursing and Medical Students: A Rapid Online Survey. International Journal of Environmental Research and Public Health. 2020; 17(19):7185. https://doi.org/10.3390/ijerph17197185
Chicago/Turabian StyleDuong, Tuyen Van, Khue M. Pham, Binh N. Do, Giang B. Kim, Hoa T. B. Dam, Vinh-Tuyen T. Le, Thao T. P. Nguyen, Hiep T. Nguyen, Trung T. Nguyen, Thuy T. Le, and et al. 2020. "Digital Healthy Diet Literacy and Self-Perceived Eating Behavior Change during COVID-19 Pandemic among Undergraduate Nursing and Medical Students: A Rapid Online Survey" International Journal of Environmental Research and Public Health 17, no. 19: 7185. https://doi.org/10.3390/ijerph17197185