Introduction
Design and method
Study design
Participants
Data collection
Data analysis
Results
Participant demographics
Session number | Code | Characteristics | Number of participants | Age range (years) | Female: male | Working: studying |
---|---|---|---|---|---|---|
FG1 | B1-4 | University students in organised sports club | 4 | 19–22 | 1:3 | 0:4 |
FG2 | N1-6 | Nutrition university students | 6 | 21–25 | 6:0 | 0:6 |
FG3 | C1-3 | Undergraduate university students—1 recently finished, others mid-way through courses | 3 | 18–22 | 2:1 | 1:2 |
FG4 | R1-2 | Mixed—student in sports science and psychology and working indivdual | 2 | 18 | 0:2 | 1:1 |
FG5 | F1-2 | Full-time working individuals | 2 | 23–25 | 0:2 | 2:0 |
I1 | P1 | NEET | 1 | 22 | 1:0 | 1:0 |
I2 | S1 | College student in media | 1 | 19 | 1:0 | 0:1 |
Participants' demographics summary (n = 19) | ||
---|---|---|
Gender (number of participants) | Female (n = 11) | Male (n = 8) |
Mean age (years) | 22.18 | 20.4 |
Percentage currently studying | 72.7% | 62.5% |
Education level previously achieved | University education: 72.7% College education: 9.1% School qualifications: 18.2% | University education: 12.5% College education: 37.5% School qualifications: 50% |
Individuals with further education aspirations | 81.8% | 100% |
Number of exercise sessions per week (30 min or more) | 1–2/week: 9.1% 3–4/week: 54.5% 5+/week: 27.3% | 1–2/week: 25%% 3–4/week: 37.5% 5+/week: 37.5% |
Participants who play a sport | 27.3% | 87.5% |
Time spent sitting per day (hours) | 4 or less: 18.2% 5–8: 27.3% 9 or more: 45.5% Other: 9.1% | 4 or less: 50% % 5–8: 25% 9 or more: 12.5% Other: 0% |
Participants expressing interest in healthy foods | 100% | 100% |
Current living status | On own: 36.4% Friends: 27.3% Family: 27.3% Other: 9.1% | On own: 25% Friends: 37.5% Family: 37.5% Other: 0% |
Key emergent themes
Exposure to health messages over time
Some participants were aware of this information but did not feel it improved their knowledge:“…when we were in school we used to eat rubbish all the time at break times and to give us a better idea of what we should be eating. I think it was one of the classes to try to get us to stop eating crisps so much”. (P1f)
Health knowledge and behaviours in individuals’ current environment, at work, college, or university, was discussed. There was an awareness of HMs, but health knowledge or support for healthy behaviours was felt to be inadequate. Individuals in employment were more aware of HMs in their offices compared to participants undertaking further education:“Yeah it’s always in classrooms but they never actually talk about it”. (B3m)
“…I see that in my work…They normally just have it in canteens and if you go for your coffee breaks they have it there…every time you have a coffee, make sure you have a glass of water. They were quite good at keeping on at you for that”. (R1m)
Chain of healthy and unhealthy behaviours
Behaviours could be perpetuated or interrupted through different external influences. Factors that interrupted a healthy cycle or promoted an unhealthy cycle could be alcohol, social activities, stress, or boredom.“Because once you’ve started to be healthy…you start off really gradual and slow but once you get the hang of it you just want to stick, to continue on and stay to be healthy. You just have that motivation, that drive to be more healthy…”. (C1m)
However, whether the response to interruptions was healthy or unhealthy depended on the individual and did not differ with gender:“Yeah, it gets boring and that’s why I eat other stuff and not healthy stuff”. (P1f)
Participants discussed influential sources they deemed reliable. Sources of trust included trustworthy figures, role models, observable social norms, and other individuals they might relate to. These could motivate individuals into undertaking either healthy or unhealthy behaviours—they tended to copy the behaviour observed:“…I would feel really stressed so I actually go out and jog around…you feel less stressed as well so…exercise is a really good substitute when you’re revising for exams”. (C1m)“Or you can just eat your sorrows away”. (C2f)
“Yeah, The Rock, Hugh Jackman, people like that, they are big. Like Zac Efron, Baywatch is ripped! There are so many people that have went out, he did not look like that in ‘High School Musical’—what do you do to get to that point?” (F2m)“Do you remember like, a few months ago when like the 'Dad Bod' started kicking off…and like within…like male culture it was…like promoting an unhealthy way of living was actually seen as socially quite popular…”. (B4m).
“…I don’t necessarily go on the NHS or anything. I would go for Bodybuilding.com , Men’s Health, that kind of stuff…”. (R1m)“…if it’s not a website that I’ve known of or not NHS or something in government then you’re a bit wary because anybody can just write anything they wanted”. (P1f).
However, realisation of negative consequences from unhealthy choices could motivate an individual to be healthier:“If you see an overweight person in the gym, there is always the stereotype of guys who want to laugh at you…”. (F2m)
“…when I started to see changes in myself and when I wasn’t feeling as well, that’s when I really started thinking about reaching out for my fitness pal and stuff like that”. (C3f)
Perceptions and attitudes towards health messages
Participants discussed such messages; they could be passively observed, or the individual might actively look for them. Most were observed using the internet:“…it feels like every time I walk down the street I see messages for fast foods. I don’t really see a lot of things standing out for health, and all that, so it feels like you are just bombarded with unhealthy messages, rather than healthy messages. I guess, it’s kind of discouraging". (S1f)
Young adults discussed the role of large corporations, suggesting that they did not care about customer health, which could indirectly encourage young adults to be unhealthy:“I see them on billboards, maybe if you are in the car, or if you are walking, or on the bus, you see them going past for fast food, restaurants, even on TV…Also, when you are on your phone and when you are scrolling, like adverts pop up messages…They have adverts, it’s at the start of videos and they are very annoying”. (S1f)“You know you’ve got that men’s health Facebook page that I follow”. (B2m)
“…like advertisement agencies don’t really discriminate between 'oh this is a more important message than drinking coke'”. (B3m)
Facilitators and barriers
They felt that the HMs available did not reflect a suitable range of goals and targets for young adults, thus creating barriers. However, male participants discussed this more than the females:“But the thing with it is that leaflets like that never say anything about you can eat this, just in small quantities or just on an irregular basis, just every now and again. They need to express that it’s okay to eat that now and again…you have to treat yourself now and again”. (R1m)
Although clear barriers were discussed, many factors were viewed as being both facilitators and barriers depending on the individual. Such factors included time, cost, setting targets or goals, and competition. One example, ‘time’, was perceived as a barrier, but targeting time constraints could facilitate healthier behaviours:“So…(R1m), you’re going for lean, I’m trying to put on weight and you’re changing your muscle mass. It’s all very specific in books and posters and leaflets, it’s usually aimed at people losing weight from fat to skinny”. (R2m)
The cost of making healthier choices was a barrier. However, reference to the internet and social media for health advice, free resources, was demonstrated as a facilitator:“One thing is also finding the time cause like when I was working before I went to uni…I didn’t really have that much time to actually do any exercise. The only reason I am actually quite fit at uni is because I have buckets of time to go for runs and site train, watch what I’m eating but for like young adults who actually have a job it’s like really difficult”. (B4m)“…you’ve got like app at home like the 7 minute app or something, I feel like that helps as well cause its only 7 minutes…I know people do it because it’s…such a short time and it’s not like long like a three-hour long gym session and it feels more like achievable I guess". (B1f)
Participants discussed setting their own short-term goals to achieve healthier lifestyles. Such goals helped by breaking things into achievable tasks or short-term outcomes. However, if not achieved these could turn into barriers:“You don’t want to go and spend £12 or £13 on a book that’s going to tell you how to cook a meal when you can just Google it”. (R2m)
Participants discussed how food appearance and taste facilitated healthy choices but equally promoted unhealthy foods, again depending on the person:“I think it’s just like the little achievable tasks…like really small but you do achieve it and you feel more motivated than if you like said like I’ve just planned out my week…to run three times, got to eat this many meals like if you even start like not achieving the smallest tasks…you get so demotivated and then just almost like again it snowballs with that you just like don’t do any of it". (B4m)
The impact of competition and challenges was discussed with some being motivated into healthy behaviours:“It’s probably like, companies make their food look nicer, so it appeals to more people…I’ve never seen a fruit and vegetable company saying, 'Look at our crisp juicy apples. Mmm'…They make food look a lot better that it really does when it comes out in the store. Just entices people to come in, more people to come in and eat”. (S1f)
Others expressed no interest in competition and might even be demotivated by it.“But I do challenges with my grandma because she’s retired so I’m busy trying to keep up with her”. (P1f)
“I’m the opposite. I’m not very competitive”. (F1m)
Improving the usability of health messages
Participants discussed the messages and campaigns currently available and their perceptions of these:“…its either in like just picture style or like video style cause like I know people are lazy with…reading. I’m one of them…”. (B2m)“I know on a lot of social media platforms now there’s sponsored posts, so as you’re scrolling down one will come up…I have been occasionally stopped being like, 'Oh, what is that?'” (N3f)
Improvements for these messages were discussed. Improvements in presentation to increase memorability included eye-catching posters or theme tunes, making them more noticeable, memorable, and catchy:“…The campaign I’m really aware of is This Girl Can because they have amazing TV adverts, amazing internet, their Twitter is really good so I think it just depends how much effort is put into the promotion of that health message”. (C3f)
Other improvements suggested were to make messages that targeted perceived barriers, linking messages with usable forms, using social media for promoting health and using behaviour-specific reminders to encourage young adults to be healthier.“I think especially for students, posters are more effective because no-one would like to read a long paragraph about healthy eating so maybe if there’s a strong graphic or a slogan…”. (C1m)
Although participants felt that larger corporations often promote unhealthy behaviours, they also noted that some used positive apparently personalised messages and felt that working with these corporations would be beneficial:“…the ones that said, 'Try this for ten days and see the difference' and when you do and you’re like, 'Oh, this is actually really good' and you continue on…”. (C2f)“I usually go to like BBC GoodFood…Cause they’ve got really nice recipes…it like explains it as well like why it’s healthy sometimes…and what you should do if you’re following this particular lifestyle or something”. (B1??)“…I saw something on the news a little while ago about how Instagram has helped so many people improve their eating. I know obviously there’s lots of negatives to that, but there are groups where everybody posts everything they eat in a day and that can really help people to be inspired and be, 'Oh, they’re eating a beautiful colourful plate of food, that’s what I want to do too'. So I don’t know, maybe for our age group at least these traditional messages may be lost, but there are other ways I guess”. (N5f)“If there was something specific, I would go…and download an app to remind me if it’s water-related…to get notifications…”. (C2f)
"I think if they…worked with big companies as well like Tesco’s or Co-op…like Tesco’s has like on…the side of busses…advertising 'this is Sophie’s paella' or whatever–As like encouraging". (B2m)