Emotional experiences of reading health educational manga encouraging behavioral changes: a non-randomized controlled trial.

OBJECTIVE: Educational health manga are used to promote health behavior change. This study thus seeks to achieve the following objectives: identify the emotional experience of reading educational health manga, understand the effects of facilitating the psychological mediators of behavior change through emotional experiences, and compare the effectiveness of educational health manga with conventional materials. DESIGN: A non-randomized controlled trial with six conditions was conducted. Target behaviors were physical activity and healthy diet. Individuals aged 20-69 years (n = 1,680) were assigned three manga intervention conditions and three control conditions (visual image-based, narrative text, and general text material). MAIN OUTCOME MEASURES: Participants were asked about their emotional experience while reading either intervention material or control material and its perceived positive influence on enhancing psychological mediators. RESULTS: Four factors relevant to emotional experiences were identified: risk perception, familiarity, satisfaction, and realism. Emotional experience strongly predicted the psychological mediators of behavior change. Analysis of differences among the six conditions revealed that exposure to educational health manga led to greater satisfaction and increased knowledge. Participants assigned manga conditions experienced superior emotional experiences and outcomes. CONCLUSIONS: Those assigned manga conditions experienced superior emotional experiences and outcomes. The efficacy of educational health manga in encouraging psychological mediators of change was confirmed.Trial registration: UMIN Japan identifier: UMIN000034369.

Cross-cultural validity of the theory of planned behavior for predicting healthy food choice in secondary school students of Inner Mongolia.

AIMS: Unhealthy eating behavior is a serious health concern among secondary school students in Inner Mongolia. To predict their healthy food choices and devise methods of correcting unhealthy choices, we sought to confirm the cross-cultural validity of the theory of planned behavior among Inner Mongolian students. MATERIALS AND METHODS: A cross-sectional study, conducted between November and December 2014. Overall, 3047 students were enrolled. We devised a questionnaire based on the theory of planned behavior to measure its components (intentions, attitudes, subjective norms, and perceived behavioral control) in relation to healthy food choices; we also assessed their current engagement in healthy food choices. RESULTS: A principal component analysis revealed high contribution rates for the components (69.32%-88.77%). A confirmatory factor analysis indicated that the components of the questionnaire had adequate model fit (goodness of fit index=0.997, adjusted goodness of fit index=0.984, comparative fit index=0.998, and root mean square error of approximation=0.049). Notably, data from participants within the suburbs did not support the theory of planned behavior construction. Several paths did not predict the hypothesis variables. However, attitudes toward healthy food choices strongly predicted behavioral intention (path coefficients 0.49-0.77, p<0.01), regardless of demographic characteristics. CONCLUSION: Our results support that the theory of planned behavior can apply to secondary school students in urban areas. Furthermore, attitudes towards healthy food choices were the best predictor of behavioral intentions to engage in such choices in Inner Mongolian students.

Validity and reliability of physical activity questionnaire for Japanese students.

BACKGROUND: Self-administered questionnaires about physical activity are useful for collecting data to develop public health policies. There is currently no validated physical activity questionnaire, however, for Japanese children and adolescents. The purpose of the present study was to evaluate the validity and reliability of self-administered, physical activity questionnaires for Japanese students. METHODS: Fifth- and eighth-grade students were asked to complete two questionnaires that estimated the intensity and time of moderate-to-vigorous physical activities in which they participated, and the frequency and duration spent performing sports activities. Students also wore triaxial accelerometers to compare their actual activity levels to their estimates, to investigate the validity and reliability of the questionnaires. RESULTS: The intensity and time spent performing moderate-to-vigorous physical activity that were estimated from the questionnaire were higher than those measured by accelerometry (9-161% of accelerometry). Questionnaire data were highly correlated with accelerometer data for eighth graders (Spearman correlation, 0.642-0.754), but the correlations were lower for fifth graders (≤ 0.331). Furthermore, there was higher repeatability in the data collected from eighth graders (intraclass correlation, 0.625-0.645) than from fifth graders (0.136-0.194). CONCLUSIONS: Questionnaires may be useful in epidemiological studies for ranking physical activity levels of adolescents, such as a confounding factor for other lifestyle surveys, but these surveys are less accurate for younger children.