Health Promotion International, 2017, 1–8

doi: 10.1093/heapro/dax080
Article

Effects of a healthy-eater self-schema and

nutrition literacy on healthy-eating behaviors
among Taiwanese college students
Chia-Kuei Lee1, Li-Ling Liao2,*, I-Ju Lai3, and Li-Chun Chang4
1
Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan,
2
Department of Health Management, I-Shou University, Kaohsiung City 82445, Taiwan, 3Department of
Nutrition, I-Shou University, Kaohsiung City 82445, Taiwan and 4Department of Nursing, Chang Gung
University of Science and Technology, Tao-Yuan 33303, Taiwan
*Corresponding author. E-mail: hililin@isu.edu.tw

Summary
Unhealthy eating behaviors contribute to obesity and chronic illness. This study examined the relative
contributions of a healthy-eater self-schema (a self-conception as a healthy eater) and nutrition liter-
acy on healthy-eating behaviors and whether nutrition literacy was a mediator among Taiwanese col-
lege students. A total of 1216 undergraduate students from six universities in Taiwan participated in
the study from April to June 2016. Healthy-eating behaviors, nutrition literacy, healthy-eater self-
schema and known determinants of eating behaviors (e.g. nutrition-related information, health status,
nutrition knowledge needs, sex, year in college and residence) were measured by a self-report ques-
tionnaire. A hierarchical multiple regression and mediation analysis were conducted with the known
determinants of eating behaviors as covariates. Results showed that a healthy-eater self-schema and
nutrition literacy explained 9% and 12% of the variance in healthy-eating behaviors, respectively, and
both had unique effects on healthy-eating behaviors. The effect of a healthy-eater self-schema on
healthy-eating behaviors was partially mediated through nutrition literacy. Findings suggest that both
a healthy-eater self-schema and nutrition literacy should be considered when promoting healthy-
eating behaviors. Additionally, nutrition literacy interventions should be tailored to the healthy-eater
self-schema status and emphasize the personal relevance of being a healthy-eater to improve the in-
tervention’s effectiveness.

Key words: identity, nutrition, literacy, college students, eating behavior

INTRODUCTION (Anding et al., 2001; Hiza and Gerrior, 2002; Racette

College is a critical period of lifestyle change and for the
formation of health behaviors, including dietary pat-
terns. College students often display unhealthy-eating
behaviors and consume too much fat, sodium and calo-
ries, while consuming too few fruits and vegetables
et al., 2005). This contributes to weight problems, poor
nutrition and negative health consequences (Hu et al.,
2000; Van Duyn and Pivonka, 2000; Bazzano et al.,
2002; Racette et al., 2005). The American
College Health Association–National College Health

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 2 C. K. Lee et al.
Assessment, 2015 report revealed that approximately
97% of college students did not consume five or more
servings of fruits and vegetables (the daily recommended
amount) and 39% were overweight/obese (American
College Health Association, 2016). In Taiwan, accord-
ing to a 2011 national survey, 17% of college students
were overweight/obese and less than 10% of college stu-
dents met the daily dietary recommendations (Lin et al.,
2011). Moreover, college students’ eating behaviors
commonly varied by sex, residence, year in college and
perceived health status (Brevard and Ricketts, 1996;
Wardle et al., 2004; Driskell et al., 2005; Racette et al.,
2005; Davy et al., 2006; Kim et al., 2008; Papier et al.,
2015; Yahia et al., 2016).
One’s self-conception (referred to as self-schema) has
become increasingly recognized for its importance in
regulating health behaviors, including eating behaviors
(Stein and Markus, 1996; Kendzierski, 2007; Wheeler
et al., 2007). A self-schema is an elaborated knowledge
structure about the self that contains the relevant seman-
tic (e.g. abstraction or generalization memory), episodic
(e.g. memory of specific episodes) and procedural
knowledge (e.g. action-based memory including skills
and strategies) (Kihlstrom et al., 2005; Ghosh and
Gilboa, 2014). A self-schema in a specific content do-
main reflects not only self-descriptiveness, but also an
important aspect of the self, which enhances the process-
ing of schema-congruent information and motivates
schema-congruent behaviors (Kendzierski, 1990;
Markus, 1977; Markus et al., 1987; Stein and Corte,
2007). Each individual has a unique collection of
self-schemas in different content domains, which are de-
rived from personal experiences, values and social con-
texts (Markus, 1977; Markus and Wurf, 1987).
Researchers have demonstrated the link between a
healthy-eater self-schema and healthier dietary intake
among female college students and middle-aged working
adults: those with a healthy-eater self-schema consumed
more carbohydrates (e.g. fiber, fruits and vegetables),
less total fat (or cholesterol) and less junk food than
those without a healthy-eater self-schema (Kendzierski
and Costello, 2004; Noureddine and Stein, 2009; Allom
and Mullan, 2012; Holub et al., 2012). Though a
healthy-eater self-schema has been identified as playing
an important role in dietary intake/behaviors, self-
schema approaches have not commonly been applied in
healthy-eating intervention studies.
In addition to self-schemas, researchers have sug-
gested that health literacy is an important factor in
the context of nutrition behaviors or dietary intake
(Silk et al., 2008; Cha et al., 2014). Nutrition literacy is
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an extension of health literacy (IOM, 2004) that con-
cerns dietary performance, which reflects the compe-
tence of healthy-eating and has been shown to influence
healthy-eating behaviors. Cha and colleagues (2014)
found that young adults with low health literacy were
less likely to use food labels and had lower dietary qual-
ity than those with high health literacy. Another study
showed that higher health literacy was associated with
higher healthy-eating index scores and less consumption
of sugar-sweetened beverages (Zoellner et al., 2011).
Although a growing body of research has focused on the
development and implementation of health literacy in-
terventions in promoting health behaviors (Taggart
et al., 2012; Wei et al., 2013), these interventions have
focused on enhancing people’s abilities—emphasizing
the improvement of relevant knowledge, attitude and
skills—but did not take into account the individual dif-
ferences in people’s cognitive structures about the self.
Further exploration of how nutrition literacy functions
with a healthy-eater self-schema would contribute to the
development of effective intervention strategies.
Considering competence (i.e. literacy) in a domain
may require a domain-specific self-schema to facilitate
the development and use of relevant abilities in a given
domain (Cross and Markus, 1994), a healthy-eater self-
schema may be contingent on strengthening nutrition lit-
eracy by enhancing learning and encoding nutrition
knowledge and skills, which promotes adherence to
healthy-eating behaviors. Accordingly, this study ex-
tended previous work about the role of the self in
healthy-eating behaviors by incorporating nutrition lit-
eracy. We aimed to determine (1) the relative contribu-
tions of a healthy-eater self-schema and nutrition
literacy on healthy-eating behaviors and (2) whether nu-
trition literacy mediates the effects of a healthy-eater
self-schema on healthy-eating behaviors among under-
graduate students.
METHODS
Participants and procedure
A convenience sample of participants was drawn from
three national and three private 4-year comprehensive
universities in northern, central and southern Taiwan
(one national and one private university in each region).
To obtain a diverse group of participants and avoid the
influence of students’ majors on nutrition knowledge
and eating behaviors (Hong et al., 2016), 220 under-
graduate students were recruited from each school with
a maximum of 45 students from each academic
 Effects of a healthy-eater self-schema and nutrition literacy on healthy-eating behaviors
discipline. In addition, in each school, the total number
of students with medical, public health and nutrition re-
lated majors were limited to 45 students to avoid sample
bias, because students from those majors may have
higher awareness of healthy eating.
The trained research assistants approached students
on campus wherever they could be found (e.g. class-
rooms, school hallways, or college dorms), provided in-
formation about the study, and invited them to
participate (April–June, 2016). Upon obtaining written
informed consent, students were asked to complete a
self-administered questionnaire individually, which con-
tained measures of nutrition literacy, healthy-eating be-
haviors, self-schemas, known determinants of
eating behaviors and demographic information. The
questionnaire took approximately 30 min to complete.
Participants were also informed that they could with-
draw at any stage without adverse personal conse-
quences. A small gift was provided in compensation
after the successful completion of the questionnaire.
All study procedures were approved by the university’s
Human Research Ethics Committee. Of the question-
naires distributed (N ¼ 1320), 1216 completed
questionnaires that contained sufficient information
for primary measures were returned (92.1% valid
response rate).
Measures
Healthy-eating behaviors were measured by a 13-item
frequency rating scale on healthy eating practices,
including a balanced diet (8 items), processed food
consumption (1 item), nutrition label usage (3 items)
and healthy-eating choices (1 item). Response options
ranged from 1 (never) to 5 (always). A sum score was
computed, with a higher score indicating better
healthy-eating behaviors. In the pilot testing with 492
college students, the Cronbach’s alpha was 0.87 and
the average content validity index (CVI) was 0.99.
Additionally, in a random subsample (N ¼ 119) of
these college students, the intra-class correlation coeffi-
cient (ICC) of the 2-week test-retest reliability was
0.49 (p < 0.001). Cronbach’s alpha was 0.86 in the
current study.
Nutrition literacy was measured by an 8-item scale
on capacities regarding nutritional information in five
dimensions: ‘obtain’ (i.e. having the capacity to search
for, find, and acquire nutrition information; 2 items),
‘understand’ (i.e. having basic nutrition knowledge and
the capacity to understand general nutrition informa-
tion; 2 items), ‘analyse’ (i.e. having the capacity to dis-
criminate and analyse nutrition information in a given
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3
situation; 1 item), ‘appraise’ (i.e. having the capacity to
judge and assess nutrition information in terms of per-
sonal needs; 2 items) and ‘apply’ (i.e. having the capacity
to apply nutrition information to daily life in order to
achieve a healthy diet; 1 item), based on the definition of
nutrition literacy (Nielsen-Bohlman et al., 2004; Silk
et al., 2008; Aihara and Minai, 2011). Response options
ranged from 1 (very difficult) to 4 (very easy). A sum
score was computed, with a higher score reflecting
higher nutrition literacy. In the pilot testing with 492
college students, the Cronbach’s alpha was .87 and aver-
age CVI was 1. Additionally, in a subsample (N ¼ 119)
of these college students, the ICC of the 2-week test-
retest reliability was 0.53 (p < 0.001). The Cronbach’s
alpha was 0.85 in the current study.
The healthy-eater self-schema was rated on an
11-point scale addressing three key phrases: healthy
eater, someone who eats in a nutritious manner and
someone who is careful about what they eat, according
to self-descriptiveness and importance separately
(Kendzierski and Costello, 2004). A rating of at least
two of the three descriptors as both very descriptive
(8  11 points) and very important (8  11 points) was
considered to indicate the presence of a healthy-eater
self-schema. The appropriate psychometric properties
for this measure have been demonstrated in college stu-
dents and middle-aged working adults (Kendzierski and
Costello, 2004; Noureddine and Stein, 2009).
Known determinants of eating behaviors were mea-
sured to control for alternative explanations of the
relationship of nutrition literacy and a healthy-eater self-
schema with healthy-eating behaviors. Nutrition-related
information/education was measured by a question,
‘How frequently do you receive nutrition-related infor-
mation from course work, outreach activities, or mass
media during your college years?’ Responses ranged
from 1 (never) to 5 (always). Health status was mea-
sured by an item on perceived current health status,
ranging from 1 (very good) to 5 (very bad). Nutrition
knowledge needs were measured by an item rating from
1 (no need) to 4 (definitely need), based on the demands
of nutrition-related knowledge. Sex, year in college and
residence (living on or off campus during the semester)
were also measured.
Statistical analysis
Descriptive statistics were conducted to provide infor-
mation about participants’ characteristics. T-tests and
chi-square tests were used for comparisons between un-
dergraduate students with and without a healthy-eater
self-schema. A hierarchical multiple regression with
 4 C. K. Lee et al.

Table 1: Descriptive statistics by healthy-eater self-schema groups

All With a healthy-eater Without a healthy-eater t p

self-schema self-schema

(n 5 268, 22.04%) (n 5 948, 77.96%)

Variable Mean (SD) Ranges Mean (SD) Ranges Mean (SD) Ranges

Nutrition literacy 22.41 (3.66) 8–32 23.98 (3.66) 8–32 21.97 (3.54) 11–32 –8.17 <0.001
Healthy-eating behaviors 39.97 (7.73) 17–65 45.52 (6.71) 17–65 38.36 (7.18) 17–58 –4.61 <0.001

Freq. Percent Freq. Percent Freq. Percent v2 p

Sex 13.84 <0.001

Male 559 45.97 150 26.83 409 73.17
Female 657 54.03 118 17.96 539 82.04
Residence 0.00 0.945
On campus 642 52.80 141 21.96 501 78.04
Off campus 574 47.20 127 22.13 447 77.87
Year in college 2.23 0.526
Freshman 225 18.50 43 19.11 182 80.89
Sophomore 466 38.32 107 22.96 359 77.04
Junior 324 26.64 77 23.77 247 76.23
Senior 201 16.53 41 20.40 160 79.60
Nutrition information 25.64 <0.001
Never 76 6.25 15 19.74 61 80.26
Rarely 410 33.72 69 16.83 341 83.17
Sometimes 496 40.79 105 21.17 391 78.83
Often 169 13.90 57 33.73 112 66.27
Always 65 5.35 22 33.85 43 66.15
Health status 168.37 <0.001
Very good 550 45.23 213 38.73 337 61.27
Good 220 18.09 30 13.64 190 86.36
Fair 371 30.51 21 5.66 350 94.34
Poor 71 5.84 4 5.63 67 94.37
Very bad 4 0.33 0 0.00 4 100.00
Nutrition knowledge needs 10.13 0.017
No need 42 3.45 7 16.67 35 83.33
Not really need 292 24.01 56 19.18 236 80.82
Need 722 59.38 155 21.47 567 78.53
Definitely need 160 13.16 50 31.25 110 68.75

three steps (step 1: covariates of the known determinants
of healthy-eating behaviors; step 2: healthy-eater self-
schema and step 3: nutrition literacy) was used to
estimate the unique predictions of a healthy-eater self-
schema and nutrition literacy. Then, mediation analysis
with a bootstrapping test (Preacher and Hayes, 2008)
was conducted to determine whether nutrition literacy
mediated the effects of a healthy-eater self-schema on
healthy-eating behaviors. The significant indirect effect
was identified based on a 1000 times resampling with a
95% bias-corrected confidence interval (CI). The pro-
portion of the total effect that is mediated was also com-
puted. All analyses included the known determinants of
eating behaviors (i.e. nutrition-related information,
health status, nutrition knowledge needs, sex, year in
college and residence) as covariates.
RESULTS
Participants’ characteristics
Among the 1216 undergraduate students, 46.0% were
male. Table 1 shows the descriptive statistics for study
variables by healthy-eater self-schema groups. Over one-
third of the students (38.3%) were sophomores, fol-
lowed by 26.6% who were juniors. More than half of

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 Effects of a healthy-eater self-schema and nutrition literacy on healthy-eating behaviors
the students (52.8%) lived on campus. Twenty-two per-
cent of students were classified as having a healthy-eater
self-schema, with a significant sex difference (26.8%
male vs. 18.0% female). The average sum score of nutri-
tion literacy was 22.4 (SD ¼ 3.7), and the average sum
score of healthy-eating behaviors was 40.0 (SD ¼ 7.7).
Undergraduate students who had a healthy-eater self-
schema reported significantly higher scores of nutrition
literacy and healthy-eating behaviors compared to those
without a healthy-eater self-schema.
In terms of the known determinants, most students
reported that they had received nutrition-related infor-
mation from course work, outreach activities, or mass
media either rarely (33.7%) or sometimes (40.8%) dur-
ing their college years. Approximately two-thirds of the
students reported a good health status currently (45.2%
very good and 18.0% good), and 30.5% reported a fair
health status. With regard to the demands for nutrition-
related knowledge, more than 70% of the students re-
ported that they had needs for nutrition-related
knowledge. Overall, undergraduate students with a
healthy-eater self-schema were more likely to report
more frequent reception of nutrition-related informa-
tion, a better health status, and more needs for
nutrition-related knowledge.
Healthy-eater self-schema and nutrition literacy
on healthy-eating behaviors
The final step of the hierarchical regression
model for healthy-eating behaviors was significant;
F(8, 1207) ¼ 70.06, p < 0.001, R2 ¼ 0.32. Results indi-
cated that a healthy-eater self-schema explained 9%
of the variance in healthy-eating behaviors;
F(1, 1208) ¼ 129.58, p < 0.001, and nutrition literacy
explained an additional 12% of the variance in healthy-
eating behaviors; F(1, 1207) ¼ 207.16, p < 0.001.
Partial regression coefficients are reported in Table 2.
Results showed that undergraduate students who had a
healthy-eater self-schema and a higher level of nutri-
tion literacy were more likely to engage in healthy-
eating behaviors than others were. Figure 1 also
displays the relationships between nutrition literacy
and healthy-eating behaviors by healthy-eater self-
schema groups. Healthy-eating behaviors increased
with the improvement of nutrition literacy in both
groups (with and without a healthy-eater self-schema).
The healthy-eater self-schema group had more healthy-
eating behaviors compared to the group without a
healthy-eater self-schema.
In addition, after controlling for the known determi-
nants of eating behaviors, a mediation analysis showed
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the significant direct effect of a healthy-eater self-schema
on nutrition literacy (B ¼ 1.25, standard error
(SE) ¼ 0.25, 95% CI ¼ 0.75  1.74) and healthy-eating
behaviors (B ¼ 4.89, SE ¼ 0.48, 95% CI ¼ 3.95  5.82).
Moreover, the indirect effect of a healthy-eater self-
schema on healthy-eating behaviors through nutrition
literacy was significant (B ¼ 0.97, SE¼ 0.23, 95%
CI ¼ 0.56  1.48), with 16.5% of the total effect that is
mediated.
DISCUSSION
This study examined the relative contributions of a
healthy-eater self-schema and nutrition literacy on
healthy-eating behaviors among undergraduate students
and sought to determine whether nutrition literacy was
a mediating variable. Consistent with existing literature,
our findings showed that a healthy-eater self-schema
and nutrition literacy had positive and unique effects on
healthy-eating behaviors. Since most previous studies
were conducted in Western countries, this finding
among a Taiwanese population provides cross-cultural
evidence that a healthy-eater self-schema and nutrition
literacy are stable predictors of healthy-eating behaviors
regardless of being from a Western or an Asian culture.
Moreover, we also found that the effect of nutrition lit-
eracy on healthy-eating behaviors was stronger for un-
dergraduate students with a healthy-eater self-schema
compared to those without. This suggests that while
both a healthy-eater self-schema and nutrition literacy
contain relevant knowledge, skills and cognitive func-
tioning, they may tap into different cognitive levels in re-
lation to these knowledge and skills. Therefore, having
both a healthy-eater self-schema and nutrition literacy
would be more suitable to regulate dietary-related be-
haviors than having either one alone. Accordingly, inter-
ventions to improve healthy-eating behaviors may be
more effective if they incorporate the enhancement of
both the personal value of healthy eating and nutrition
literacy at the same time.
In addition to the direct effects on healthy-eating be-
haviors, findings also showed that the effect of a
healthy-eater self-schema on healthy-eating behaviors
was partially mediated through nutrition literacy,
though for only a small proportion of the total effect
that is mediated. Moreover, a healthy-eater self-schema
had a direct effect on nutrition literacy. Therefore, a
healthy-eater self-schema enhances the competence of
healthy-eating, nutrition literacy and in turn affects
healthy-eating behaviors. Indeed, in our sample, stu-
dents who had a healthy-eater self-schema had higher
nutrition literacy and more healthy-eating behaviors
 6 C. K. Lee et al.

Table 2: Healthy-eater self-schema and nutrition literacy on healthy-eating behaviors

Predictors B SE(B) b t p B SE(B) b t p B SE(B) b t p

Step 1
Nutrition information 1.61 0.23 0.20 6.94 <0.001 1.40 0.22 0.17 6.31 <0.001 0.72 0.21 0.09 3.42 0.001
Health status –1.82 0.21 –0.24 –8.71 <0.001 –1.02 0.21 –0.13 –4.82 <0.001 –0.58 0.20 –0.08 –2.95 0.003
Nutrition knowledge needs 0.52 0.31 0.05 1.69 0.092 0.27 0.30 0.20 0.90 0.367 0.13 0.27 0.01 0.46 0.645
Sex –0.37 0.42 –0.02 –0.89 0.374 –0.01 0.40 –0.00 –0.02 0.981 0.14 0.37 0.01 0.38 0.704
Year in college 0.03 0.22 0.00 0.15 0.884 –0.02 0.21 –0.00 –0.09 0.930 0.26 0.20 0.03 1.31 0.190
Residence 0.02 0.44 0.00 0.04 0.970 –0.12 0.42 –0.01 –0.29 0.773 –0.27 0.39 –0.02 –0.70 0.481
Step 2
Healthy-eater self-schema 5.85 0.51 0.32 11.38 <.001 4.91 0.48 0.27 10.23 <0.001
Step 3
Nutrition literacy 0.77 0.05 0.37 14.33 <0.001
R2 0.11 0.20 0.32
DR2 0.09 0.12
DF(df), p value F (1, 1208) ¼ 129.58, p < 0.001 F (1, 1207) ¼ 207.16, p < 0.001

Unlike our findings, Holub and colleagues (2012) found

Fig. 1: Relationships of nutrition literacy with healthy-eating be-
haviors by healthy-eater self-schema groups.
than their non-schema counterparts. This suggests that a
healthy-eater self-schema may facilitate the processing
of information related to healthy-eating, which enhances
the learning of nutrition literacy and promotes the readi-
ness of engaging in healthy-eating behaviors. As such, to
increase their effectiveness, nutrition literacy interven-
tions should be tailored to the healthy-eater self-schema
status, since perceived healthy eating is important to
oneself and may promote the encoding of nutrition liter-
acy thus motivating healthy eating. Compared to those
with a healthy-eater self-schema, students without it
may need to have additional sessions or more frequent
reviews and practice of nutrition-related knowledge and
skills to implement healthy dietary habits (Kendzierski
and Costello, 2004; Kendzierski, 2007).
Moreover, we found sex differences in the prevalence
of the healthy-eater self-schema, as males had a signifi-
cantly higher proportion (27%) than females did (18%).
that a higher proportion of female college students (25%)
were classified as having a healthy-eater self-schema than
their male counterparts (9%); however, they had a rela-
tively small number of men in their sample (n ¼ 23, 18%).
Other studies also showed that females were more likely to
report more perceived importance for being a healthy eater
or held greater beliefs in the importance of healthy diets
than males did. The belief was that this was due to not
only stereotypes that healthy foods are more feminine and
unhealthy foods are more masculine, but also that there are
different stages of change in translating these perceptions
to actions (Wardle et al., 2004; Vartanian et al., 2007).
However, they did not measure a healthy-eater self-
schema. Since this is the first study to explore the healthy-
eater self-schema in Asian countries, it is unclear whether
cultural context or sex stereotypes influence the develop-
ment of a healthy-eater self-schema in males and females in
Asia. Future research is needed to verify these findings.
Furthermore, this sample showed a relatively low
prevalence of a healthy-eater self-schema compared to
other studies (Noureddine and Stein, 2009; Allom and
Mullan, 2012). This may reflect the fact that the role of
the self in relation to healthy eating is commonly over-
looked in this population as well as in the relevant inter-
ventions. Researchers have shown that college students
with a healthy-eater self-schema had shorter lapses in
healthy eating and more personal control for the causes
of lapses than those without a healthy-eater self-schema
(Holub et al., 2012). This suggests that individuals who
internalize healthy eating as being important to the self
can strengthen and sustain their behaviors. Therefore,
individuals with a healthy-eater self-schema may be

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 Effects of a healthy-eater self-schema and nutrition literacy on healthy-eating behaviors
more likely to persist or stabilize their healthy dietary in-
take regardless of the external circumstances. As such,
nutrition literacy interventions that incorporate the de-
velopment of a healthy-eater schema and enhance the
personal value of healthy eating could enhance the con-
gruence between the capacity of literacy and adherence
to healthy-eating behaviors. The possible strategies to
develop a healthy-eater schema may include working
with individuals to stimulate interest in healthy eating,
providing opportunities to think about the possibilities
of and engaging in healthy-eating practices, directing the
reflection to the risks and benefits of their own eating
practices, setting up the short-term and long-term goals
of healthy eating, developing a plan of action that in-
cludes specific tasks and a timeline to achieve healthy-
eating goals. In addition, future research is needed to
examine whether the healthy-eater self-schema status
changes throughout nutrition literacy interventions and
whether an existing healthy-eater self-schema enhances
the effectiveness of nutrition literacy interventions.
Limitations
There are a few limitations of the current study that
should be noted. Due to the cross-sectional study design,
causality could not be established. Future longitudinal
and intervention-based studies are needed to verify the
prospective relationships among healthy-eater self-
schema, nutrition literacy and healthy-eating behaviors.
Moreover, the measures of healthy-eating behavior in this
study did not cover detailed information of daily healthy-
eating practices. Future studies that use a daily diary as-
sessment or a more detailed food frequency questionnaire
to examine eating behaviors may be beneficial. Moreover,
prospective or real-time behavioral record that reduces re-
call bias may be more accurate in estimating eating behav-
iors. In addition, this study did not include the covariates
of students’ majors and their school and life events (e.g.
midterm examinations, clinical placements, club activities,
competitions, etc.), which may influence their eating be-
haviors. Future research needs to take into account those
factors in order to clarify the findings.
CONCLUSIONS
These results provide evidence for the unique effects of a
healthy-eater self-schema and nutrition literacy on
healthy-eating behaviors. In addition, nutrition literacy
partially mediated the effects of a healthy-eater self-
schema on healthy-eating behaviors. Findings indicate
that interventions to promote healthy-eating behaviors
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7
should consider both a healthy-eater self-schema and
nutrition literacy to enhance their effectiveness.
FUNDING
The authors declared receipt of the following financial
support for the research, authorship and/or publication
of this article: This work was supported by the Taiwan
Ministry of Science and Technology in 2015 [grant num-
ber MOST104-2511-S-214-001].
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