Stages of dietary change among nationally-representative samples of adults in the European Union

Objective: To investigate the distribution across the different stages of change for each of the 15 participating European countries, and the effect of socio-demographic variables such as sex and education on this distribution. Also to assess the relationships between stages of change and influences of food choice, and other variables. Design: A cross-sectional study in which quota-controlled, nationally-representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire. Setting: The survey was conducted between October 1995 and February 1996 in the 15 member states of the European Union. Subjects: 14 331 subjects (aged 15 y upwards) completed the questionnaire. Data were weighted by population size for each country and by sex, age and regional distribution within each member state. Subjects were divided into five different categories according to their attitudes towards 'changing their eating habits in order to eat healthier': (1) Precontemplation; do not consider any changes, (2) Contemplation; consider changes, (3) Decision; make plans to change, (4) Action; carry out the changes, and (5) Maintenance; maintained changes for more than six months. Results: 52% of the subjects were in the precontemplation stage, whereas 31% of the subjects were in the maintenance stage. Two, one, and seven percent of subjects were in the contemplation, decision and action stage, respectively. In the Mediterranean countries, and in Germany, there were more people (55-64%) in the precontemplation stage, whereas in the Scandinavian countries there were less people in precontemplation stage (20-38%). The opposite was true for the maintenance stage, whereas women and people with a higher education level tended to be more in the maintenance stage. With respect to influences on food choice, subjects in precontemplation stage found that taste was more important, whereas people in maintenance stage found that health was more important. Conclusions: The stages of change model makes a useful distinction between people with different attitudes towards nutrition and health. Nutrition education can benefit from this distinction.