Background: Poor beverage consumption habits pose significant health concerns. Delivering health behavior change interventions via social media is an emerging area of health research and may provide a promising way to minimize barriers such as cost, intervention delivery time, and access. However, there is limited research on online social support health behavior change delivered through Instagram. Objectives: 1) Assess the validity and reproducibility of the updated BEVQ-15, a beverage intake questionnaire; 2) Review the current literature on the availability and effectiveness of mobile phone interventions targeting sugar-sweetened beverage (SSB) consumption; and 3) Use the updated BEVQ-15 to conduct the Healthy Beverage Habits pilot study, which is an online social networking worksite intervention aimed at improving Healthy Beverage Index (HBI) scores. Methods: The Healthy Beverage Habits study was an online randomized controlled pilot trial with an 8-week intervention and a 4-week maintenance period delivered through Instagram. The materials were adapted from the in-person SIPsmartER SSB reduction intervention. Data analysis included RM-ANOVAs to test for differences in beverage intake between the Instagram intervention group and the E-mail control group. Results: For the Healthy Beverage Habits trial, no significant between group over time differences were found. However, the Instagram group demonstrated a significant reduction in total beverage kcal (mean difference±SE=-156±48; p=0.049), and increase in total HBI scores (mean difference±SE= 11.9±2.3; p=0.025) from baseline to the end of the maintenance period. No within group differences were demonstrated for the E-mail control group over the intervention or maintenance period. The study retention rate was 38%, with 39 participants initially enrolled and 15 participants completing all study visits through maintenance. Results for the validity and reproducibility of the updated BEVQ-15 and a review of the availability and effectiveness of mobile phone interventions targeting SSB consumption are presented. Conclusions: Mobile phone-delivered interventions may be a promising method for improving beverage intake quality. Technologically-based interventions targeting beverage consumption should consider utilizing multiple forms of mobile-phone contact methods. The preliminary findings from the Healthy Beverage Habits trial highlight the need for more rigorous studies that determine which technology and intervention components are most effective for mobile-delivered beverage consumption interventions. / Doctor of Philosophy / Background: Poor beverage consumption habits pose significant health concerns. Delivering health behavior change interventions via social media is an emerging area of health research and may provide a promising way to minimize barriers such as cost, intervention delivery time, and access. However, there is limited research on online social support health behavior change delivered through Instagram. Objectives: 1) Assess the validity and reproducibility of the updated BEVQ-15, a beverage intake questionnaire which estimates habitual average daily intake of 15 beverage categories as well as total sugar-sweetened beverages (SSB) and total beverages. 2) Review the current literature of the availability and effectiveness of mobile phone interventions targeting SSB consumption. 3) Use the updated BEVQ-15 to conduct The Healthy Beverage Habits pilot study, which is an online social networking worksite intervention aimed at improving Healthy Beverage Index (HBI) scores. Methods: The updated BEVQ-15 was assessed for agreement between the BEVQ-15 and dietary recalls. Researchers compared beverage intake between two BEVQ-15 administrations. The Healthy Beverage Habits pilot study was an 8-week intervention with a 4-week maintenance period. Data analysis included testing for differences in beverage intake between the Instagram group and the E-mail group. Results: The updated BEVQ-15 demonstrated moderate agreement between the BEVQ-15 and dietary recalls for total SSB intake and total beverage intake. All beverage variables were significantly correlated. For the systematic review, 11 of the 17 studies (65%) were successful in reducing SSB consumption through mobile phone delivery. The successful studies used multiple types of technology. There were no significant differences for any beverage variable between the Instagram and E-mail groups over time. However, for within group changes, Instagram significantly reduced total beverage kcals and improved total HBI score, while the E-mail group did not demonstrate any significant changes. Conclusions: Mobile phone-delivered interventions may be a promising method for improving beverage intake quality. Technologically-based interventions targeting beverage consumption should consider utilizing multiple forms of mobile-phone contact methods. The preliminary findings from the Healthy Beverage Habits pilot trial highlight the need for more rigorous studies that determine which technology and intervention components are most effective for mobile-delivered beverage consumption interventions.

Cardiovascular diseases and diabetes are increasing worldwide due to unhealthy lifestyle habits. Behavior change support systems (BCSS) are a new means of promoting a sustainable lifestyle change. These systems are more effective when behavior change theories are applied. The aim of this thesis to integrate well-known behavior change theories into a conceptual model of behavior change progress to form the basis for the BCSS. The research question of this thesis is: what parameters of behavior change should be included in a conceptual model of behavior change progress? The model was created by integrating concepts and their relationships from existing behavior change theories. Next, the model was the validated by experts in behavior change. The outcome is a conceptual framework that can be function as a tool for understanding causal relationship between behavior change concepts, for presenting feedback, and building automated assessments. Furthermore, the model extends already existing knowledge networks.

Cardiovascular diseases and diabetes are increasing worldwide due to unhealthy lifestyle habits. Behavior change support systems (BCSS) are a new means of promoting a sustainable lifestyle change. These systems are more effective when behavior change theories are applied. The aim of this thesis to integrate well-known behavior change theories into a conceptual model of behavior change progress to form the basis for the BCSS. The research question of this thesis is: what parameters of behavior change should be included in a conceptual model of behavior change progress? The model was created by integrating concepts and their relationships from existing behavior change theories. Next, the model was the validated by experts in behavior change. The outcome is a conceptual framework that can be function as a tool for understanding causal relationship between behavior change concepts, for presenting feedback, and building automated assessments. Furthermore, the model extends already existing knowledge networks. / På grund av allmänhetens ohälsosamma vanor ökar Diabetes och kardiovaskulära sjukdomar i hela världen. Olika stödsystem för beteendeförändringar (BCSS) är ett nytt sätt att främja en hållbar livsstilsförändring. Dessa system är mer effektiva då beteendeförändringsteorier tillämpas. Syftet med denna avhandling är att integrera välkända teorier om beteendeförändring i en konceptuell modell av beteendeförändringsframsteg som kan ligga till grund för BCSS. Forskningsfrågan i denna avhandling är: Vilka parametrar för beteendeförändring ska ingå i en konceptuell modell för beteendeförändringsframsteg? Modellen skapades genom att integrera koncept och deras relationer från befintliga teorier om beteendeförändring. Resultatet är ett konceptuellt ramverk som kan fungera som ett verktyg för att förstå orsakssambandet mellan beteendeförändringsbegrepp, för att presentera feedback och för att bygga automatiserade bedömningar. Dessutom utökar modellen redan befintliga kunskapsnätverk.