Deliens et al.

BMC Public Health 2014, 14:53

http://www.biomedcentral.com/1471-2458/14/53

RESEARCH ARTICLE Open Access

Determinants of eating behaviour in university

students: a qualitative study using focus group
discussions
Tom Deliens1*, Peter Clarys1, Ilse De Bourdeaudhuij2 and Benedicte Deforche1,2

Abstract
Background: College or university is a critical period regarding unhealthy changes in eating behaviours in students.
Therefore, the purpose of this study was to explore which factors influence Belgian (European) university students’
eating behaviour, using a qualitative research design. Furthermore, we aimed to collect ideas and
recommendations in order to facilitate the development of effective and tailored intervention programs aiming to
improve healthy eating behaviours in university students.
Methods: Using a semi-structured question guide, five focus group discussions have been conducted consisting of
14 male and 21 female university students from a variety of study disciplines, with a mean age of 20.6 ± 1.7 yrs.
Using Nvivo9, an inductive thematic approach was used for data analysis.
Results: After the transition from secondary school to university, when independency increases, students are
continuously challenged to make healthful food choices. Students reported to be influenced by individual factors
(e.g. taste preferences, self-discipline, time and convenience), their social networks (e.g. (lack of) parental control,
friends and peers), physical environment (e.g. availability and accessibility, appeal and prices of food products), and
macro environment (e.g. media and advertising). Furthermore, the relationships between determinants and university
students’ eating behaviour seemed to be moderated by university characteristics, such as residency, student societies,
university lifestyle and exams. Recommendations for university administrators and researchers include providing
information and advice to enhance healthy food choices and preparation (e.g. via social media), enhancing self-discipline
and self-control, developing time management skills, enhancing social support, and modifying the subjective as
well as the objective campus food environment by e.g. making healthy foods price-beneficial and by providing
vending machines with more healthy products.
Conclusions: This is the first European study examining perceived determinants of eating behaviour in university
students and collecting ideas and recommendations for healthy eating interventions in a university specific
setting. University characteristics (residency, exams, etc.) influence the relationships between individual as well as
social environmental determinants and university students’ eating behaviour, and should therefore be taken into
account when designing effective and tailored multilevel intervention programs aiming to improve healthy eating
behaviours in university students.
Keywords: Determinants, Eating behaviour, University students, Focus groups

* Correspondence: [email protected]
1
Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel,
Pleinlaan 2, 1050 Brussels, Belgium
Full list of author information is available at the end of the article

© 2014 Deliens et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
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Background during the last decades, whereas opportunities to eat

Prevention of overweight and obesity, and its related energy-dense foods are omnipresent. Egger et al. [17]
diseases [1], has become a worldwide challenge [2]. Ac- suggested that the increasing obesogenic environment is
cording to US literature, university is a critical period the driving force for the increasing prevalence of obesity
for weight gain [3-5]. During the transition from sec- rather than any ‘pathology’ in metabolic defects or gen-
ondary school to university, students need to adapt to a etic mutations within individuals. Individuals interact in
new environment [6,7]. When students fail to adapt ad- a variety of micro-environments or settings (e.g. schools,
equately this could have negative consequences towards workplaces, homes, (fast food) restaurants) which, in
their health behaviours and subsequent weight status turn, are influenced by the macro-environments or sec-
[7]. Eating behaviour (next to physical activity and sed- tors (e.g. food industry, government, society’s attitudes
entary behaviour) is an important factor influencing stu- and beliefs) [18]. Ecological models consider the connec-
dents’ weight. According to studies conducted in US tions and the continuous interactions between people
universities, students were not eating the recommended (intrapersonal) and their (sociocultural, policy and phys-
amount of fruit and vegetables, and were consuming in- ical) environments [19-21]. Based upon the latter two
creasing amounts of high-fat foods [8-10]. Furthermore, theories Story et al. [19] proposed a framework including
Butler et al. [9] reported significant decreases in the individual (intrapersonal), social (interpersonal) environ-
amount of bread and vegetables consumed during the mental, physical environmental and macro levels, to
first year of university and significant increases in understand factors influencing eating behaviours.
percentage fat intake and alcohol consumption in US Only few qualitative studies, using focus group discus-
students. Unhealthy eating and excessive alcohol con- sions, have examined determinants of eating behaviour
sumption may contribute significantly to energy intake in university students. Lack of discipline and time, self-
and may therefore facilitate student weight gain [11]. control, social support, product prices (costs) and limited
The same pattern of weight gain in university students budgets, and the availability of and access to (healthy)
is emerging in Europe [12]. However, European litera- food options were reported as important influencing fac-
ture on dietary intake in university students is scarce. In tors of students’ eating behaviours [22-25]. All of these
a Greek study [13] university students showed signifi- studies were conducted in the US and either not included
cantly higher intake of total and saturated fat and lower students of all study disciplines [22,23] or did not specify
intake of poly and monounsaturated fat, folate, vitamin students’ study backgrounds [24,25]. In addition, all stud-
E and fibre, compared to the American Heart Associ- ies included predominantly freshman students. However,
ation guidelines. Crombie et al. [3] warned that these including students of all study disciplines as well as stu-
health behaviours may not only occur during the years dents with more university experience (i.e. older students)
at university but may remain throughout adulthood as could contribute to a wider range of experiences and
well. Therefore, prevention programs countering un- opinions. Furthermore, no previous studies have included
healthy eating habits in university students are needed, questions asking for recommendations towards interven-
in order to prevent an increasing prevalence of over- tion strategies aiming to improve healthy eating behav-
weight and obesity in later life. iours in university students. To the best of our knowledge,
To develop effective obesity prevention strategies it is no European (qualitative or quantitative) studies on deter-
important to get insight into factors influencing eating minants of eating behaviour in university students have
behaviours in university students. Early theories explain- been conducted so far. Many differences in lifestyle, envir-
ing health behaviour mostly focused on the individual onment and culture (e.g. fast food culture) can be ob-
within its social context [14,15]. According to Ajzen’s served between North-American and European students.
Theory of Planned Behaviour [14], behaviour can be ex- Continental differences as such might not only influence
plained through intention. These intentions are being students’ eating behaviour but also the enablers and bar-
determined by attitudes toward the behaviour, social or riers to engage in healthy eating practices. Hence, there is
subjective norms and perceived behavioural control [14]. a need for European studies investigating determinants of
The Social Cognitive Theory of Bandura [15] on the eating behaviour in university students. Therefore, the
other hand, focuses on the interaction between personal purpose of this study was to explore which factors influ-
(self-efficacy), behavioural (expected result) and social ence Belgian (European) university students’ eating (incl.
(modelling and social support) factors to explain health drinking) behaviour, using a qualitative research design.
behaviours such as eating behaviour. Next to these psy- Furthermore, we aimed to collect ideas and recommenda-
chosocial determinants, many researchers [16-18] are tions in order to facilitate the development of effective
convinced of the uttermost importance of the environ- and tailored intervention programs aiming to improve
mental influence on eating behaviours. According to healthy eating (incl. drinking) behaviours in university
Brug et al. [16] the environment has obviously changed students.
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Methods informed consent (in which participants’ anonymity and

Participants confidentiality were assured) was signed by each partici-
In this qualitative study focus group discussions were pant. Each focus group lasted between 90 and 120 mi-
used for data collection. To ensure sufficient diversity of nutes (including questions about physical activity and
opinion, students from the second till fifth year of uni- sedentary behaviour which were not included in this
versity from different study disciplines were recruited paper) and was facilitated by a moderator and an assist-
using snowball sampling, a purposive nonprobability ap- ant moderator (observer), who took notes during the
proach that is often used in qualitative research and in discussions and made sure the moderator did not over-
which the researcher recruits a few volunteers who, on look any participants trying to add comments. All focus
their turn, recruit other volunteers. No first year stu- group discussions were audiotaped with permission of
dents were included because of their ‘limited’ experience the participants. Drinks and snacks were provided dur-
as a university student. The aim was to recruit between ing the focus group discussions. Afterwards, all students
six and ten participants per focus group [26]. An over- received an incentive (a lunch voucher). The study was
recruitment of one or two participants was pursued in approved by the Medical Ethical Commission of the uni-
case there were ‘no-shows’. versity hospital.

Procedure Question guide

Focus groups were held until saturation of new informa- According to recommended focus group methodology
tion was reached, as in qualitative research sample size [27], a semi-structured question guide (see Table 2) was
can never be pre-determined [26]. To be sure we did not developed by the research team, aiming to identify fac-
miss any ‘new’ information, one additional focus group tors influencing university students’ health and weight
session was held after theoretical saturation was esti- related behaviours (including eating (and drinking) be-
mated. All focus groups were organised at the Faculty of haviour, physical activity and sedentary behaviour). As
Physical Education and Physiotherapy of the Vrije Uni- mentioned before, this paper will only focus on deter-
versiteit Brussel (Brussels, Belgium) at a time and date minants of students’ eating behaviour. After intensive
convenient for the students and researchers. Before each collaboration with experts with ample focus group ex-
focus group all participants were asked to complete a perience, the questions were carefully developed using
short questionnaire, including demographics, height, appropriate literature [27]. When development was com-
weight and perceived health (see Table 1). Furthermore, pleted, the question guide was tested within and revised
explanation about the aim of the study was given and an by the research team as well as pilot-tested in a group of
ten university students. Because no major changes had
Table 1 Characteristics of focus group participants to be made, ‘pilot’ discussion results were included in
(Mean ± SD, %, n = 35) later analysis [26]. The question guide consisted of open-
Gender (% of females) 60.0 ing and introductory questions which allowed partici-
Age (yrs) 20.6 ± 1.7 pants to get acquainted and feel connected, and to start
Body Mass Index (BMI) (kg/m2) 22.8 ± 3.9 the discussion of the topic. Transition and key questions
Underweight (%) 8.8 were used to, respectively, guide the group towards the
main part of the discussion and to focus on the purpose
Normal weight (%) 61.8
of this study, i.e. identifying factors influencing students’
Overweight (%) 29.4
eating behaviour. For obvious reasons, the greatest share
Study career (yrs) 3.0 ± 1.0 of the group discussions focused on the key questions.
Study discipline Finally, students were asked to share ideas concerning
Human sciences (%) 62.9 health promotion as well as intervention strategies to
Exact and applied sciences (%) 17.1 counter unhealthy eating behaviours in university stu-
dents. During the focus group discussions the moderator
Biomedical sciences (%) 20.0
followed the question guide but asked side questions to
Residency (% living in student residence) 45.7
obtain more in-depth information about the topics, and
Smoking (% smokers) 11.4 showed enough flexibility to allow open discussions be-
Self-reported health (% reporting poor 14.3 tween students.
to very poor health status)
Perceived physical activity level 48.6 Data analysis
(% reporting little to no physical activity)
SPSS Statistics 20 was used to analyse data obtained
Perceived eating pattern quality 17.1 from the questionnaire and to calculate descriptive sta-
(% reporting poor to very poor eating pattern)
tistics of the focus group sample. Data obtained from
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Table 2 Focus group question guide

Question type Question
Opening 1. Where are you from and what’s your name?
Introduction 2. Describe a healthy person.
Transition 3. Thinking of ‘health in university students’, what comes to your mind?
4. Think back of the last year(s) being a university student. Did your body weight and/or body composition change since you
entered university?
Key 5. Did your health related habits change since you entered university?
6. Which factors have caused these changes (or which factors influence current health behaviours)? What barriers and enablers
of healthy behaviour can you identify?
7. Which of the previous mentioned factors have had the greatest influence?
Ending 8. Do you have any remarks, suggestions, additions?
9. Soon, we will try to help students make healthier choices. Can you give us some advice on how to promote healthy eating
behaviours in students?

the audio tapes where transcribed verbatim in Microsoft Individual (intrapersonal)

Word using Express Scribe and Windows Media Player. Food preferences (taste)
All quotes were encoded using the qualitative software Students reported that ‘taste’ is an important factor in-
program Nvivo9. Using an inductive thematic approach, fluencing their food choices. Taste can make students
data (quotes) were examined for recurrent instances of eat unhealthy, however it can help them make healthy
some kind, which were then systematically identified choices as well: “I choose to eat fruit because I like fruit”.
across the data set, and grouped together by means of a
coding system (= content analysis) [28]. Similar codes Self-discipline
were grouped together into more general concepts (sub- Students believed that self-discipline is related to self-
categories) and further categorised into main categories. dependency (autonomy) and may have an influence on
To ensure reliability of data interpretations, analyses were their eating behaviour: “I do think that self-discipline is
carried out independently by two researchers. Doubts or an important factor (regarding eating behaviour) when
disagreements were discussed with two other researchers you become self-dependent” (…) “You have to take care of
until consensus was reached. yourself; some can and others can’t”.

Results Values, norms, beliefs (ethical, moral)

In this study, the estimated point of saturation was ob- According to the participants, norms and values as well
served after the fourth focus group session. One additional as personal beliefs can influence students’ eating behav-
focus group discussion was conducted to be sure true sat- iours. One student explained that moral conviction had
uration was established. In total, five focus group discus- driven him to become a vegetarian: “From the moment I
sions have been conducted, consisting of five to ten became a vegetarian, it was so obvious for me that I
participants per group. The sample (n = 35) consisted of didn’t have the need to eat meat anymore (…) Yes, this
14 male and 21 female students with a mean age of 20.6 ± was a moral conviction and I didn’t have to have discip-
1.7 yrs (range = 18-26 yrs) and a mean study career of line for it because it seemed obvious to me”. Students also
3.0 ± 1.0 yrs. The majority of students (62.9%) were en- explained that they sometimes changed their eating be-
rolled in human sciences, whereas respectively 17.1% and haviours due to a feeling of guilt when eating unhealthy
20.0% were enrolled in exact and applied, and biomedical foods such as pizza.
sciences. Additional sample characteristics are described
in Table 1. State of mind (stress)
According to the ecological principles a framework of Students experienced the transition from secondary school
factors influencing eating (incl. drinking) behaviours in uni- to university as a stressful period. Participants also re-
versity students was developed based on content analysis vealed that exam periods (when academic achievement
of the focus group discussions (Figure 1). The framework pressure is highest) provide a lot of stress. Participants
consists of four major levels, i.e. individual (intrapersonal), strongly believed that eating choices during stressful pe-
social environment (interpersonal), physical environment riods can be influenced in both directions. Some tend to
(community settings), macro environment, and an add- eat healthier: “I consume more during exam periods, but I
itional level of university characteristics. The most appro- tend to eat more fruits and vegetables”. Others’ eating pat-
priate quotes were chosen to illustrate each (sub)category. terns tend to worsen when experiencing such ‘high’ stress
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Figure 1 Factors influencing eating behaviours of university students.

levels: “During exam periods I can eat ‘everything’; I’m first step and will not automatically lead to healthier food
always hungry”. Not only academic stress, but also social choices. “When I would follow a health class tomorrow, it
stress can alter students’ eating behaviours: “Yes, when doesn’t necessarily mean I would suddenly change my
you don’t feel well, e.g. heart broken, then the cliché of eating behaviour.”
eating ice cream in front of the television becomes real-
ity”. Time and convenience
Time seems to be a very precious issue when talking about
student eating practices. Students indicated they would
Body image and self-concept rather spend time on other activities than cooking, espe-
Students spoke about their own body image and how it cially when they have to cook only for themselves. Par-
can have an effect on their eating behaviours. “When you ticipants acknowledged that ‘time’ is a relative term and
don’t find yourself attractive, consequently you think others it is often related to personal priorities: “Because here on
will think the same. That’s a vicious circle and it keeps get- campus (when living in a student residence) I always
ting worse and worse. And this can influence someone’s have something else to do instead of cooking, so I don’t
eating behaviour.” Students felt that body image is re- have time to make dinner”. Students explained that meal
lated to the socio-cultural ideal image and is, in turn, re- preparation time is of great importance: “The faster my
lated to media advertisement strategies. meal is ready, the better, so I can install myself in front
of the television”. According to the students easiness
and convenience, which is related to time, is an import-
Dietary knowledge ant factor as well: “I want it to be easy, so I don’t have to
Participants believed that a certain dietary knowledge is be cooking for one hour for myself, …, so I grab something
needed to be able to make changes in one’s eating pat- that can be warmed up quickly”. Time is mentioned to
tern. To a certain extent students seemed to be aware of be especially important during exam periods: “After
what is good for their health: “Actually, I don’t like vegeta- exam periods, you have more time to cook. When you
bles, but I know that I need it and that’s why I eat vegeta- are studying (during exam periods), you want to spend
bles”. However, they also stated that knowledge is just a as little time as possible on cooking”.
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Daily rhythm/structure “After the transition from secondary school to university,

Students indicated that many students live a rather un- parental control decreased, so consequently ‘freedom’ in-
structured life (incl. sleeping habits), especially when liv- creased, which means you become more self-dependent
ing in student residences. Hence, their eating practices and that has influenced my eating behaviour. For ex-
can suffer from this. “When you stay awake longer, the ample, in secondary school you had home prepared
urge to grab something sweet (cookies, candy, …) is bigger, sandwiches for lunch, while at university you can eat
whilst when having a good sleeping pattern, the urge may cafeteria sandwiches and dessert etc.” Moreover, alcohol
be smaller.” On the other hand, when living with their consumption was described to be more common when
parents, students felt they were subject to a certain parental control is lacking: “In student residences it is eas-
‘structure’. “When I lived at home, everything was nicely ier to play drinking games, because your parents cannot
structured and I didn’t even have to think about it, because see what you’re doing”.
the foundations had already been set by my parents.”
Home education
Past eating habits Students indicated that eating habits may depend on
Participants felt they had regular eating habits. Accord- their home education. When one is raised in a more
ing to the students these eating practices are a result of healthy environment it is more likely one consumes e.g.
eating habits created during childhood and adolescence: sufficient fruits and vegetables. “My mother made me eat
“My healthy habits didn’t change by living away from my vegetables, even though I didn’t like to.”
home (in a student residence), because already all my life
I drink 1.5 litres of water per day and I still do. I almost Social support (friends and family)
never drink Coca Cola.” Students revealed that support from family and friends
can influence their eating behaviour: “During exam pe-
Physical activity level riods I am happy that mom prepares my meal, because if
Students stated that a higher caloric intake is needed I had to make it all by myself, I would make pizza more
when exercising: “I didn’t feel safe anymore when playing often”. Living together with peers can also influence eat-
rugby, so I started eating more; more carbohydrates etc., ing behaviours: “I live together with my girlfriend, but
so I pay attention to what I eat”. Also, it was mentioned when I would live all by myself, I would pay less atten-
that some students tend to think they can eat anything tion to what I eat”. Students emphasized the importance
they want after exercising: “Some think that after they of a great social supporting network: “When you have no
have exercised, they can eat a hamburger”. friends, you can’t deal with ‘stressy’ events properly which
can have direct consequences on your personal health”.
Metabolism
Students suggested that metabolism can differ between Peer pressure
one another. Some students tend to ‘burn’ calories more Group or peer pressure was explained to be an influen-
easily than others. “(One of the students towards a student cing factor of individual food choices. “You can make
colleague:) Your metabolism is abnormal, you eat and you your own sandwiches, but then you might be the only one
drink what you want and you don’t gain weight.” in the group, so the next day chances are big you also
buy a sandwich on campus.”
Vitality
It was mentioned that when being tired, students tend to Physical environment (community settings)
eat more energy-dense foods: “When you are more tired Availability and accessibility of (healthy) foods and cooking
the urge for sugars is bigger because you want to elevate supplies
your energy level”. However, lack of vitality could also trig- When students have easy access to (on-campus) eating
ger some kind of health awareness: “I noticed that in my facilities, they seem to get tempted more easily. For ex-
first year at university I didn’t eat vegetables sufficiently ample, the student restaurant and its meal offers seem
and I felt tired and didn’t have enough energy. Therefore, I to influence students regarding their individual food
started eating vegetables and fruit. Consequently, I had lots choices. “In the student restaurant you can choose every
more energy …” day between French fries, (mashed) potatoes or rice. I
think lots of students tend to take French fries every
Social environment (interpersonal) time.” On the other hand students expressed that the
Parental control university restaurant offers a lot of meal choices and it
Students felt that parental control had a crucial role in depends on the individual whether healthy or less
their eating behaviours. When parental control is lacking healthy choices are being made. “I think we cannot com-
this can have great influences on individual food choices. plain of what is offered in the student restaurant. There
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is enough variety.” Participants also mentioned the pres- Macro environment

ence of numerous candy machines on campus which Policy and legislation
might be of influence as well. On the other hand they Students recognised that they are restricted by policy
mentioned that when healthy foods are available in their and legislation which influence their drinking choices. E.g.
nearest environment, and certainly when it’s for free, alcohol consumption can be influenced by governmental
they tend to eat more healthy alternatives. “During exam regulations: “When you go out by car, you are not allowed
periods free fruit was available in the university’s study to drink and drive, so you will automatically drink less, …
hall and subsequently you could notice an increase of much less”.
fruit consumption.” Moreover, living in a student resi-
dence, where the availability of cooking supplies is often
Socio-cultural norms and values
limited, can influence meal choices as well: “Not all stu-
Students mentioned that certain eating behaviours can
dent residences have a fully equipped kitchen” (…) “Since
be region as well as society specific: “But this (eating be-
I don’t have a fryer (in the student residence) I can’t pre-
haviour) is specific to our society; nowadays, when you
pare anything fried, so I mostly eat more healthy foods”.
look at the US, for them it is normal to go eat fast food
Students also believed that a lack of cooking supplies
every day, whilst here in Europe it isn’t”. These socio-
could contribute to more unhealthy food choices.
cultural norms do not only differ geographically, but can
change over time as well: “Our culture has evolved as
such that alcohol has become a socially accepted drug”.
Appeal of foods
Students believed that the appeal of food items makes it
sometimes hard for them to make healthy choices. “In- Media and advertising
deed, the (student) restaurant is a ‘dangerous’ place, you Participants felt influenced by media and advertising:
walk into the canteen and you see others (friends) eating “When I see food on television, I am more likely to go get
lasagne and subsequently you leave your sandwiches in something from the cupboard; on the one hand because I
your bag and go get some lasagne too. In contrast to sec- feel like it, but also because I see it on television”.
ondary school, you get tempted more quickly now.”
University characteristics
Residency
Food prices (cost)
Participants felt that students living in a student resi-
Food product prices and individual budget influence
dence and being surrounded by other student peers are
students’ food choices. On the one hand, when eating
often subject to lots of stimuli influencing their eating
outdoors, they might spend more money: “If I’d buy a
behaviour. “You see a lot of students who just arrived at
sandwich every day it would become too expensive. I live
university and stay in a student residence, eating la-
currently by myself and it (money/price) becomes more
sagne, or pizza, …” (…) “I noticed that students living in
important, so I have to pay attention and eat my home
student residences eat much more unhealthy foods, go
prepared and healthier sandwiches”. On the other hand,
out more and drink more …” One students’ personal ex-
students also believed that unhealthier foods in e.g. fast
perience confirmed the latter: “I have lived in a student
food restaurants are less expensive than preparing a
residence for four years and I gained 10 kg of weight be-
healthy meal at home. “It will be more expensive when
cause of going out too much and eating unhealthy”.
you eat healthy; for example a lasagne is cheaper than
However, other participants reported no changes in eat-
buying leek, onions and carrots.” Students referred to the
ing behaviour: “I already live two years in a student resi-
American eating culture: “I think that unhealthy foods
dence and I don’t have the impression that my habits
are cheaper than healthy foods. Just look at the ‘one dol-
have changed, I still eat healthy”. The student environ-
lar menus’ in the US; this is a big problem (regarding
ment can have a positive influence on eating behaviour
public health)”. In contrast, others believed that this is
as well. Students expressed that when living in a student
not always true. “Some vegetables and fruits are cheaper
residence and cooking together (with peers) they take
than certain cookies. So, that’s also one of the reasons
their time to prepare a meal which enlarges the chances
why I sometimes buy apples (instead of cookies); because
of making a ‘healthy’ meal.
it’s cheaper.” Participants also mentioned that when living
in a student residence, one becomes more self-dependent
which also implies that price and budget become more Student societies
and more important. “When you live in a student resi- Student societies influence students’ drinking habits:
dence, you have to buy your own food, so you automatic- “When you go out with other student society members,
ally start to pay attention to product prices.” you are almost obliged to drink (alcohol)”.
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University lifestyle student restaurant should offer more healthy menu choices,
Students explained that the excitement and novelty so you actually oblige students subtly to eat healthy” (…)
when arriving at university can cause students to go out “It would be good when, for example, they (the student res-
more and ‘taste’ the university life. They also believed taurant) wouldn’t always offer French fries, because (when
first year students arriving at university can be very in- available) I tend to choose French fries very often”. Con-
fluenceable: “Many people I had never seen drinking be- cerning price and cost, it was also mentioned that “the
fore started drinking at university”. Furthermore, one of student restaurant should modify its prices, because
the students explained how life at the university influ- that would motivate students to eat more healthy foods
enced her eating and drinking behaviour: “When I ar- when lower in price” (…) “Students will choose a
rived at university, I was a top athlete (swimming) and I healthy menu (e.g. vegetarian pasta) lower in price over
had a very healthy lifestyle back then. When I quit a less healthy and more expensive one (e.g. steak). At
(swimming) I practically lived on campus, so every night least, I know I would, although normally, I would ra-
I went to parties and drank and ate a lot and my body ther eat meat”. Participants also expressed that “they
experienced these changes. After my sporting career I (the government) should implement higher taxes for un-
‘discovered the world’ (in terms of drinking, eating, healthy (e.g. high-fat) foods”. Another suggestion was
friends, …) but now it has stabilised”. to display the amount of calories on every menu.
“When the student restaurant would display calories,
Exams lots of students will probably think twice when choosing
Participants reported that eating behaviours during the a dish.” Students also felt that campus vending ma-
academic year can differ (in a positive and a negative chines should contain more healthy products: “The on-
way) from those during exam periods: “During exam pe- campus vending machines are not healthy” (…) “In sec-
riods I gain weight, because I tend to quickly grab some- ondary school, they replaced all vending machine prod-
thing during a break”. In contrast, one of the students ucts by healthy foods and it led to lower consumption of
replied as follows: “I eat healthier (during exam periods) vending products, but also, students were obliged to
to maintain my personal health, and I sleep more as choose a healthy product”.
well”.
Discussion
Suggestions for interventions The purpose of this explorative study was to identify de-
Individual level terminants of eating (incl. drinking) behaviours in Belgian
Participants believed that direct (one-on-one) communi- (European) university students. Furthermore, we aimed to
cation should be used. “You have to confront students in- collect ideas and recommendations in order to facilitate
dividually (to sensitize), because ‘general’ promotion is the development of effective and tailored intervention
not as effective (…) Giving students personal feedback on programs aiming to improve healthy eating (incl. drinking)
their health status will be more effective.” Nevertheless, behaviours in university students. Similar to Story’s frame-
one student suggested to use posters: “I think using post- work [19] combining Bandura’s Social Cognitive Theory
ers displaying e.g. the ‘healthy eating pyramid’ will not [15] with Sallis’ ecological model [21] explaining health
stay unnoticed”. Furthermore it was mentioned that “all behaviour, we identified four major levels of determinants:
students should be given like one hour of information individual (intrapersonal), social environment (interper-
(about healthy eating) by means of a health class”. How- sonal), physical environment (community settings) and
ever, one of the students mentioned that “knowledge macro environment (societal). Furthermore, some univer-
helps you to make decisions, but it doesn’t force you”. sity specific characteristics were found to be influencing
Students also thought it was important to give advice via students’ eating behaviours as well.
internet and social media: “… like Facebook, you can check Similar to US literature [22-25], many self-regulatory
your messages whenever you want and you are free to processes, including intrinsic (e.g. food preferences) and
choose whether you read it or not”. Furthermore, partici- extrinsic (e.g. health awareness, guilt) motivations, self-
pants believed that promotion strategies should focus on discipline, self-control, time management, etc. have been
convenience: “Promotion strategies should be ‘easy going’ mentioned by our participants to be influencing eating be-
and convenient, don’t make it look like students have to do haviour in university students. Our results further indicate
a lot of effort to be healthy”. that these latter determinants become more important
after the transition from secondary school to university
Environmental level when independency subsequently increases. In a qualita-
When asking participants for suggestions regarding inter- tive study of Cluskey et al. [25], university students who
vention development, students believed that the student reported greater independency and more responsibility for
restaurant could provide more healthy menus: “The food and meal preparation prior to college, felt to have
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achieved more stability in their eating behaviours at col- Similar to previous research in adolescents [37], partic-
lege. Therefore, LaCaille et al. [23] suggested that future ipants felt that perceived benefits (e.g. improving health
interventions should aim at strengthening students’ self- status, higher vitality) of healthful eating behaviour can
regulation skills around eating as part of the overall influence food choices as well. Students also believed
transition to university or college. Such self-regulation that dietary knowledge should be a first step towards the
and self-management skills can help students to make awareness on healthy eating behaviour. Cluskey et al.
more healthy decisions and to maintain a healthful life- [25] mentioned that university students lack the know-
style throughout adulthood [24]. Moreover, the systematic ledge and skills to make healthful food choices as well as
review of Kelly et al. [29] evaluating the effectiveness of to prepare healthy foods, which makes it difficult to
dietary interventions in college students suggested that adapt healthfully to college or university life. It was sug-
approaches involving self-regulation strategies have the gested by our participants that all students should be
potential to facilitate changes in students’ dietary intake. given a health education class.
Although in the study of Cluskey et al. [25] US stu- In this study, students mentioned that parents and
dents most agreed that intrinsic motivation was needed household influence their food intake. A review study on
for successful changes in healthful behaviour, our results environmental influences on food choices [38] indicated
indicate that the environment should be organised as that adolescents’ dietary intake is being influenced by
such, ‘forcing’ students to make healthful food choices. their family members. Parents serve as models for eating
Students’ food choices are influenced by the availability behaviour and transmit dietary attitudes throughout the
and accessibility of healthy foods and cooking supplies upbringing of their offspring [38]. The latter suggests
[22]. Therefore, our participants suggested that offering that especially university students living with their par-
more healthy menus in the student restaurant as well as ents might experience similar parental influences. Be-
providing campus vending machines with more healthy sides family influences, our participants believed that
products could contribute to making more healthful friends and peers influence their eating behaviour as
food choices. It has been shown that food availability well. Contento et al. [39] reported that attitudes, en-
and accessibility of fruits and vegetables is strongly and couragement, and behaviours of friends and peers influ-
positively related to fruit and vegetable consumption in enced adolescents’ food choices. In a natural experiment
children [30]. In addition, students in the current study assessing peer effects on weight, it was shown that the
mentioned that the appeal of (on-campus) foods often amount of weight gained during the freshman year was
determines food choices. This suggests that making strongly and negatively correlated to the roommate’s
healthy products offered around campus more appealing initial weight [40], suggesting that peers are influenced
might contribute to more healthy eating behaviours in by each other’s eating behaviours.
university students. Living arrangements (residency) and exams were men-
Students in the current study believed they are con- tioned to be influencing students’ eating behaviours. It
tinuously challenged by competing demands, including has been shown that living arrangements can affect uni-
academic responsibilities and involvement in extracur- versity students’ dietary intake [41-43]. In a study in four
ricular and social activities. As mentioned by Nelson European countries students living at parental home
et al. [24], healthy food choices may become low prior- consumed more fruit and vegetables than those who re-
ities when compared to other commitments. Therefore, sided outside of their family home [43]. In addition, in a
as described by our participants, students might be more natural experiment, Kapinos et al. [44] showed that stu-
likely to buy foods that are fast, convenient and inexpen- dents assigned to dormitories with on-site dining halls
sive. Marquis et al. [31] showed that college students gained more weight and exhibited more behaviours con-
often prioritize cost and convenience over health. More- sistent with weight gain (e.g. males consumed more
over, previous studies found that price is one of the most meals and snacks) during the freshman year as com-
influential individual factors (next to taste) in determin- pared with students not assigned to such dormitories.
ing food choice in both adults and adolescents [32-36]. Living arrangements might be moderating the relation
In our study, participants felt that offering more healthy between eating behaviour and its determinants rather
(on campus) foods at a lower cost would contribute to than causing eating behaviour as such. According to
more healthful food choices. Intervention studies in MacKinnon [45], a moderator affects the strength of the
other populations have shown that price reductions in- relation between two variables. E.g. living in a student
crease purchases of lower-fat products and fruits and residence may moderate the relation between parental
vegetables in cafeterias, workplaces and school vending influence and eating behaviour, i.e. parental control will
machines [34,36]. Given the importance of price in uni- decrease when students live away from home. Results of
versity students’ food choices, this might even be a more the current study suggest that the relation between par-
effective strategy in this population. ental control and eating behaviour might be stronger in
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students living at home compared to those living away interviews, the more ‘naturalistic’ approach (i.e. closer to
from home. Also, when living in a student residence everyday conversation), including dynamic group inter-
(and receiving a weekly based allowance) our results re- action [28], allowed us to get better insight into the
vealed that food prices become more important when mechanisms behind university students’ eating behav-
making food choices, i.e. students have to pay attention iours. On the other hand, some participants might have
to ‘what’ they buy. Thus, a stronger relationship between been intimidated by the group setting which might have
food prices and eating behaviour might be observed limited a greater sharing of their thoughts.
when students live away from home in comparison to A first limitation of this study is that we used student
those living with their parents. Exams can have a similar volunteers. We have to take into account that partici-
moderating effect on the relation between e.g. time and pants were probably interested in this topic, which might
eating behaviour. Our results show that during exam pe- have resulted in a selection bias. However, sample charac-
riods students will spend as little time as possible on teristics showed sufficient variety in BMI and perceived
cooking. health status. Secondly, whereas we might expect differ-
When comparing with the limited US literature, it ences in behaviours according to gender [47] or year in
should be noticed that, despite similarities between this school, we chose to use mixed-gender focus groups in-
study and other US studies (e.g. lack of time, unorganised cluding students of different study years and disciplines,
living), some determinants can be region or culture- allowing us to create interaction between both genders
specific. For example, students in the present study re- with a variety of study experience and backgrounds, which
ferred to the abundant availability of fast food and one- in turn generated a greater diversity in opinion within
dollar-menus in the US, in comparison to Europe. Focus each focus group. Thirdly, focus groups were conducted
group discussions with US university students pointed out at one university, which has a campus outside the city
that all-you-can-eat formulas of on-campus dining facilities centre. Because of university specific environmental differ-
had a negative impact on their healthy eating behaviours ences (e.g. size, structure, region, etc.), the applicability of
[23,25]. In contrast to US universities our universities do the study’s findings to other student populations is limited
not dispose of all-you-can-eat dining possibilities. Further- to the psychosocial level, whereas future studies should
more, unlike US colleges/universities, Belgian universities further explore the physical environmental issues within a
do not have on-campus dormitory dining halls where variety of other Belgian or European universities. Finally,
campus meal plans for students are provided. because of the abovementioned setting limitation and the
Our results also indicate that what may be a barrier explorative nature of this study no conclusions can be
for one student may be perceived as an enabler by an- drawn concerning the importance of each determinant
other. For example, with regard to the physical campus and the generalizability of our results. The purpose of
environment, some students felt that the student res- using focus groups is to generate a rich understanding of
taurant was a barrier to healthful eating behaviour, participants’ experiences and beliefs [48,49] and not to
whereas others believed it enabled students to make generalize results [50]. In addition, no quantification was
healthy food choices. Therefore, with regard to future used because numbers and percentages convey the im-
intervention programs, we should modify perceptions of pression that results can be projected to a population, and
physical environment as well, rather than the objective this is not within the capabilities of qualitative research
environment on its own. [50]. Also, the issue raised most frequently is not necessar-
Furthermore, our results indicate that physical and so- ily the most important, even when it is raised by a larger
cial environments are continuously interacting with self- number of people [50]. In other words, each idea or opin-
regulatory processes and thus individual eating behav- ion should be equally appreciated. Therefore, future stud-
iours. It could be that a certain stimulation at the indi- ies, using a larger representative sample size, should focus
vidual level might not be changing one’s eating behaviour on providing quantitative evidence regarding the import-
when acting in a non-beneficial social and/or physical en- ance and value of each determinant, making it also pos-
vironment, and vice versa. Therefore, intervention strat- sible to differentiate according to gender, year in school,
egies based on multilevel approaches may be most study discipline, or other student characteristics. Subse-
effective [21]. quently, future tailored interventions could focus on those
This qualitative research methodology, using focus factors students experience as most determinative in their
groups, is an important strength of this explorative current eating behaviour.
study. As Sallis et al. [46] suggested, qualitative research
allows us to understand not only the ‘what’ but also the Conclusions
‘how’ and ‘why’. Using an inductive thematic method- To the best of our knowledge, this is the first European
ology allowed the research team to construct a student- study examining perceived determinants of eating (incl.
specific framework. Furthermore, in contrast to in-depth drinking) behaviour in university students and collecting
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ideas and recommendations in order to facilitate the Author details

1
development of effective and tailored intervention pro- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel,
Pleinlaan 2, 1050 Brussels, Belgium. 2Department of Movement and Sports
grams aiming to improve healthy eating (and drinking) Sciences, Ghent University, Ghent, Belgium.
behaviours in university students. An ecological frame-
work of determinants of university students’ eating Received: 29 July 2013 Accepted: 16 January 2014
Published: 18 January 2014
behaviour was developed. Students were found to be
influenced by individual factors, their social networks,
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