Date of Award


Level of Access Assigned by Author

Campus-Only Dissertation

Degree Name

Doctor of Philosophy (PhD)


Food and Nutrition Sciences


Adrienne A. White

Second Committee Member

Richard A. Cook

Third Committee Member

Dorothy Klimis-Zacas


Most college-age women fail to consume the recommended 400 micrograms of folic acid, the B vitamin needed to prevent birth defects affecting the neural tube in unborn babies. The study objective was to examine the effectiveness of a web-based, stage-tailored folic acid intervention based on the Transtheoretical Model (TTM) compared to non-stage tailored folic acid education. Subjects were drawn from a random sample of female college students (n=408), (mean age±SD=20.8 ± 2.58, ranging from 18-29 years). Using a pre-/post-test, interventionlcontrol design, subjects were randomly assigned to either 1) the non-tailoredcontrol group, who received non-stage tailored folic acid education; or 2) the tailored treatment group, who received stage-tailored folic acid education. To evaluate the intervention, TTM-based instruments were administered at baseline (week one) and at post-test (week six). Subjects were assessed for 1) stage of change for readiness to consume a multivitamin containing folic acid; 2) self-efficacy; 3) decisional balance, the pros and cons of changing behavior; and 4) dietary folate intake, based on a food frequency questionnaire. Of the 99% who completed the study, significantly more of the staged-tailored group advanced in stage at post-test compared to the non-tailored group (OR=2.45; 95% CI=1.52, 3.99; p=.0003). Movement from precontemplation to a later stage occurred significantly more often in the tailored group than in the non-tailored group (OR=2.48; 95% CI=1.33,4.63; p=.004). Among subjects who were not taking a multivitamin at pretest, therefore staged in pre-action, the tailored group was significantly more likely to be taking a multivitamin at post-test, therefore staged in action, compared to the non-tailored group (0R32.27; 95% CI=1.28,4.01; p=.005). The stage-tailored group also had greater increases in self-efficacy and pros, from pre- to post-intervention, than the non-tailored group (p<.05). Regardless of group, most subjects did not meet recommended levels for dietary folate at pre- or post intervention, nor did intake differ by stage of change for multivitamin intake. Web-based, stage-tailored folic acid education was a successful means of improving college women's stage of readiness to consume the recommended amount of folic acid from a multivitamin. Funding was provided by the Maine State Chapter of the March of Dimes.

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