Perception of King Khalid University students regarding the benefits, barriers, self-efficacy, knowledge, and practices related to healthy eating: a cross-sectional study

Introduction

Healthy eating is vital for maintaining both overall physical and mental health, as it provides essential nutrients, supports various bodily functions, and helps prevent diseases such as obesity, thereby improving quality of life (QoL) (Almoraie et al., 2024; Cerqueira Sousa et al., 2022). The World Health Organization (WHO) emphasized that a balanced diet rich in nutrient-dense foods, while limiting processed foods, sugars, and unhealthy fats, significantly reduces premature death and improves QoL (World Health Organization, 2013). Promoting healthy dietary habits throughout life is an individual and societal responsibility, and respecting each region’s cultural heritage (Cena & Calder, 2020). Saudi Arabia’s rapid growth and urbanization have shifted diets from traditional foods to Western-style fast food, worsening dietary quality, raising the risks of overweight and obesity, and related health issues (Alhusseini et al., 2024; Alluhidan et al., 2022; Cena & Calder, 2020; Jalloun & Maneerattanasuporn, 2021) In Saudi Arabia, obesity is a major challenge, with a prevalence of 35% and an obesity-related death rate of 116.7 per 100,000 that far exceeds the global averages of 13% and 60 per 100,000, respectively (Salem et al., 2022). The problem is particularly significant among Saudi Arabia’s 1.7 million university students, a vulnerable population during this transitional phase of life (ICEF Monitor, 2025).

The transition to university marks a significant life stage that involves substantial lifestyle changes, especially in dietary habits, as students often struggle to maintain healthy diets when making independent food choices (Almoraie et al., 2024; Cerqueira Sousa et al., 2022; Yun, Ahmad & Quee, 2018). During this period, many students tend to skip meals, neglect breakfast, eat fewer fruits and vegetables, and rely more heavily on fried or fast foods, a pattern widely reported among European and Saudi university populations and linked to adverse health outcomes and weight gain (Alluhidan et al., 2022; Jalloun & Maneerattanasuporn, 2021; Yun, Ahmad & Quee, 2018). The university campus environment further exacerbates these unhealthy dietary choices through abundant fast-food outlets, vending machines, with limited healthy options alongside academic stressors, and sedentary lifestyles, which actively encourage reliance on ready-to-eat meals over nutritious home-cooked alternatives that may shape long-term health trajectories during this critical period (Almoraie et al., 2024; Cena & Calder, 2020; Yun, Ahmad & Quee, 2018). One recent Saudi research reported an alarming prevalence of overweight at 24.6% and obesity at 17.1% among Hail University students, linked to poor dietary and lifestyle patterns (Alrubaiee et al., 2025). This underscores the urgent need for Saudi Arabia’s Ministry of Health to implement targeted interventions, including university-based dietary guidelines and nutrition education programs aimed at promoting healthier eating among university students (Moradi-Lakeh et al., 2017). Nevertheless, the dietary behaviors and challenges faced by students at King Khalid University (KKU) in Saudi Arabia’s southern region remain underexplored. Understanding these dietary patterns is essential, as regional cultural and environmental influences may uniquely shape students’ eating habits. Therefore, investigating the factors influencing their dietary choices is vital to significantly improving their eating habits (Al Mulhem, El Alaoui & Pilotti, 2023; Cheikh Ismail et al., 2024).

In this context, nutritional knowledge is a key determinant of students’ dietary behaviors, as it is considered the foundation for making informed and healthy dietary choices. Assessing students’ understanding is crucial for gauging its impact on their eating habits and for designing effective university health promotion strategies (Almoraie et al., 2024; Cena & Calder, 2020; Moschonis, Magriplis & Zampelas, 2021). Research has consistently shown that higher nutritional knowledge significantly enhances university students’ ability to make healthier dietary choices (Ferrão et al., 2018; Guiné et al., 2023). However, another study found that while many undergraduates value a balanced diet, they often lack practical nutrition knowledge, such as understanding portion sizes and micronutrients, with the long-term effects of poor nutrition often persisting (Deshpande, Basil & Basil, 2009).

University students’ healthy dietary choices are also strongly influenced by perceived benefits and barriers, key constructs of the Health Belief Model (Miller & Steinle, 2020). These constructs are crucial for understanding how students weigh options when choosing healthy eating behaviors. Perceived benefits refer to an individual’s beliefs of positive outcomes of engaging in a behavior, such as increased energy and improved health through healthy eating. Conversely, perceived barriers represent the individual’s view of the obstacles that hinder behavior change (Rosenstock, 1974). University students face multiple barriers that hinder the adoption of healthy eating habits. These obstacles include the high cost of nutritious foods, limited time for meal preparation, and a lack of appealing healthy options, all exacerbated by social influences such as peer pressure and cultural food traditions (Almoraie et al., 2024; Jalloun & Maneerattanasuporn, 2021; Wongprawmas et al., 2022). European narrative review (2024) highlighted busy schedules, stress, limited healthy food access, social pressure, and unaffordable options as major obstacles to students maintaining healthys diets (Almoraie et al., 2024). Additionally, high food prices and poor food environment governance were also found to be significant barriers to healthy eating among Australian university students (Keat, Dharmayani & Mihrshahi, 2024) Furthermore, limited nutrition knowledge, combined with academic stress, further makes it even harder to adopt healthy dietary habits (Cena & Calder, 2020; Wongprawmas et al., 2022).

Importantly, a persistent gap exists between perceived benefits and barriers among university students regarding healthy eating, which helps explain why some students, even with sufficient knowledge, fail to translate that knowledge into healthy behaviors (Sogari et al., 2018). Research shows that university students recognize health benefits but undervalue them compared to perceived dietary barriers, a pattern observed across different cultural contexts, including North American, European, and Asian university populations (Deshpande, Basil & Basil, 2009; Sogari et al., 2018; Wongprawmas et al., 2022). In the Saudi context, cultural norms, gender roles, and campus food environments further influence their perceptions of barriers; however, high awareness of health issues, the perceived benefits are not strongly internalized among University students (Almoraie et al., 2024; Jalloun & Maneerattanasuporn, 2021). This gap between knowledge and behavior is partly explained by the concept of self-efficacy, which reflects a student’s confidence in their ability to select, prepare, and consume healthy foods under various circumstances (Cha et al., 2014; Cheikh Ismail et al., 2022; Deshpande, Basil & Basil, 2009). Bandura’s social theory suggests that individuals with high self-efficacy are more likely to adopt and maintain healthy eating habits, even when facing barriers, as it is crucial for encouraging behavioral change (Bandura, 1977; Cha et al., 2014). Research has shown that high self-efficacy is linked to healthier eating habits, whereas low self-efficacy is connected to dependence on convenient but unhealthy fast food options that can lead to disordered eating patterns. (Bouwman et al., 2020; Ebrahim et al., 2019). Notably, self-efficacy can be influenced by external factors such as the availability of cooking facilities and supportive environments that facilitate the practice of healthy behaviors (Al Mulhem, El Alaoui & Pilotti, 2023). Thus, addressing barriers, bridging knowledge gaps, and enhancing self-efficacy collectively constitute critical components in promoting healthy eating during university years. This intertwined perspective underscores the complexity of dietary behavior and the need for multifaceted interventions that account for psychosocial and environmental factors (Sogari et al., 2018). Despite dietary self-efficacy, a key predictor of nutrition behavior change, it remains understudied among Saudi students, particularly at KKU. Investigating self-efficacy in this unique context, characterized by gender-segregated dining and communal eating, can provide critical insights for developing culturally effective dietary education strategies (Al Mulhem, El Alaoui & Pilotti, 2023; Cheikh Ismail et al., 2022).

Unhealthy eating behaviors not addressed during university can persist in adulthood, potentially leading to long-term health consequences (Almoraie et al., 2024; Salem et al., 2022; Yun, Ahmad & Quee, 2018). While maintaining healthy dietary habits is crucial, there is a lack of research on how nutritional knowledge, self-efficacy, perceived benefits, and perceived barriers collectively influence students’ eating behaviors in southern Saudi Arabia. This region’s distinct cultural, environmental, and socioeconomic context may further influence dietary patterns, yet remains underexplored. To fill this gap, this study aimed to examine the dietary habits of KKU students through the theoretical frameworks of the Health Belief Model and Social Cognitive Theory. By integrating these models, this research identifies key factors that influence healthy food choices. It also helps develop targeted interventions to promote healthy dietary habits and mitigate diet-related disease risks in this population.

Materials and Methods

Results

Table 1 reveals an overview of the demographic and lifestyle characteristics of the study participants. Among the 385 participants, the majority were female (63.4%). Most participants were aged between 18 and 25 years (78.4%). The majority (44.2%) were pursuing a bachelor’s degree. A majority (69.6%) were enrolled in health-related colleges. The majority of participants (57.7%) had a normal BMI, and the least were obese (11.4%). The presence of chronic diseases was reported by 8.8% of participants. A significant majority (74.5%) engaged in physical activity.

Table 2 depicts the participants’ perceived benefits and barriers to consuming healthy foods. The responses to the perceived benefits were measured on a Likert scale. The highest-rated benefit was “Healthy foods make me healthier and more vibrant,” and the lowest was eating healthy foods helps me lose weight effectively & eating healthy makes it easier for me to follow a balanced diet. The overall mean for perceived benefits was 4.23 (SD = 0.825). The most significant barrier reported was “Healthy foods are expensive compared to junk foods,” and the lowest was “Preparing healthy foods takes a long time”. The overall mean for perceived barriers was 3.12 (SD = 1.193).

Table 3 represents the participants’ self-efficacy regarding eating and purchasing healthy foods, with responses measured on a Likert scale. Self-efficacy in emotional contexts varied, with the highest mean reported when participants felt happy, and the lowest self-efficacy scores were observed when participants felt depressed. When purchasing healthy foods, participants demonstrated moderate self-efficacy in selecting whole grains or cereals; however, the overall mean self-efficacy score was 3.25 (SD = 1.205).

Table 4 portrays the participants’ knowledge about the healthfulness of various food items, categorized into six response options. Among the food items perceived as the healthiest, green leafy vegetables, such as cabbage and lettuce, had the highest mean score, with 75.8% of participants rating them as “Very healthy.” Conversely, processed meats such as sausages and hot dogs were rated among the least healthy, with 29.9% of participants labeling them “Very unhealthy.” Overall, the results highlight a strong awareness of the health benefits of vegetables, fruits, and legumes, whereas processed meats and certain grains are viewed with skepticism or uncertainty.

Table 5 illustrates participants’ knowledge of healthy food and supplements in disease prevention. Responses were categorized into six levels. The highest mean score was recorded for taking vitamins and minerals, with 14.8% of participants believing it “strongly prevents” diseases. However, the lowest mean score was recorded for eating less trans-fat. Overall, the results highlight a lack of awareness among participants regarding the disease-preventive benefits of healthy food and supplements.

Table 6 demonstrates the participants’ self-reported consumption patterns of various healthy food items, categorized into four responses. Among the respondents, some reported that their intake was “about right.” Conversely, processed meat had the lowest mean score, with 21.6% of participants indicating that they “should eat less of it,” reflecting awareness of its potential health risks. Overall, these findings suggest that participants generally believe their consumption of vegetables and fruits is adequate. Additionally, there is a growing recognition of the need to limit consumption.

Table 7 shows that the multiple regression model was statistically highly significant (p < 0.001), indicating that the predictors jointly influence the perceived benefits and barriers of eating healthy foods. The model explained 13% of the variance in the dependent variable (R = 0.36, R² = 0.128, adjusted R² = 0.119). This provides a clearer understanding of which variables have a strong influence on dietary behavior and helps guide targeted interventions to promote healthier eating habits. The analysis revealed that perceived barriers, self-efficacy, and beliefs about the healthfulness of foods were highly significant predictors of healthy food practices. In contrast, perceived benefits and beliefs regarding dietary supplements did not show a significant association with the outcome variable. These findings suggest that interventions to promote healthy eating should focus on reducing perceived barriers, enhancing self-efficacy, and improving individuals’ understanding of food healthfulness.

Discussion

The findings of this research reveal the traits of the participants, as well as their perceived strengths and limitations in relation to healthy eating. The theoretical framework for dietary habits is complex, encompassing psychological constructs such as self-efficacy and emotional states, as well as environmental factors and societal beliefs about food. The interface between dietary habits and psychological constructs is a topic of much interest in health psychology.

Research suggests that adopting healthy eating habits is associated with improved mental and physical well-being (Ceylan, 2023; Mozaffarian, 2016). Boeing et al. (2012) reported that individuals with a positive view of healthy eating are more likely to practice mindful eating, which aligns with our findings that consuming healthy foods enhances energy and health. A moderate healthy food choice was observed in the present study when assessing the self-efficacy of consumption and purchasing healthy foods among participants. This level of self-efficacy plays a critical role in shaping dietary habits. According to Social Cognitive Theory, self-efficacy plays a significant role in an individual’s capacity to act under various circumstances or undergo behavioral changes (Schunk & DiBenedetto, 2020).

Considering the participants’ attitude towards healthy food, the results appear to be precisely consistent with this belief. Supplementation with vitamins and minerals reaffirms participants’ faith in their preventive ability compared to diet change. These results account for the intricacies behind public opinions regarding nutrition and health, which are likely to influence food selection and overall health status (Spronk et al., 2014). This implies the necessity for public health interventions that educate individuals on the importance of balanced eating habits and the specific functions of foods in relation to disease prevention.

This study reveals a negative relationship between physical activity and perceived benefit, which contrasts with the findings of Zhang et al. (2021), who found that physically active respondents have higher health literacy. Researchers have attributed external factors, including time availability, to discouraging participation in health-promoting behaviors (Wilcox et al., 2006).

Self-efficacy and healthy food beliefs are positively related to healthy eating behaviors and are thus considered predictors of dietary choices. Higher self-efficacy can help individuals achieve a higher-quality diet and make healthier food choices more frequently. Positive health beliefs about the healthiness of food were a significant predictor of increased fruit and vegetable consumption (Devirgiliis et al., 2024). Our findings are consistent with health behaviour interventions, which imply that people’s beliefs about their health risks and benefits are central to influencing their health behaviors (Gallagher et al., 2025). The results, perceived barriers towards healthy eating are a negative predictor, demarcating the impact on food choice; however, failure to adhere to a healthy eating regimen results from price, accessibility, and time constraints (Wansink & van Ittersum, 2013). Our results underscore the need for practical interventions, including the provision of healthy and affordable food, gender-specific strategies, targeted nutritional education, and focused programs to promote positive behavioral patterns. Further studies are needed to understand dietary patterns, emotional barriers, and the long-term impact of lifestyle interventions on student well-being. Overall, the findings highlight that the determinants of healthy eating behaviors are multifactorial.

A notable limitation of this study is the demographic profile of the sample, which was predominantly female, non-smokers, of normal weight, and from health-related colleges. This overrepresentation of specific characteristics limits the generalizability of the findings to the broader student population at King Khalid University and to Saudi Arabia as a whole. Additionally, the cross-sectional design prevents causal inferences, and the use of self-reported data may introduce reporting bias.

Conclusion

This study highlights the students’ perceptions regarding the benefits, barriers, self-efficacy, knowledge, and practices related to healthy food. Participants demonstrated growing motivation toward healthy living and increasing awareness of the benefits of healthy eating. However, affordability and taste perception hindered their consumption of healthier foods. Favorable attitudes were observed toward whole grains, fruits, and vegetables, which were primarily driven by perceived health benefits rather than knowledge, suggesting a need for targeted educational interventions. Enhancing nutritional knowledge, increasing the availability of affordable healthy food, and providing cooking skills training can support informed dietary choices and promote long-term health among young adults. Future studies should aim to include more diverse and representative samples to enhance the generalizability and applicability of their findings. Longitudinal designs are recommended to explore causal relationships between knowledge, attitudes, and dietary behaviors. Incorporating objective measures alongside self-reported data can reduce reporting bias and strengthen the validity of the results.

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