Demographic-contingent pathways to weight control intentions in adolescents: implications for tailored nursing interventions

PURPOSE: To examine the cognitive mechanisms underlying weight control intentions in adolescents using the Theory of Planned Behavior (TPB), specifically focusing on how demographic factors and underlying beliefs influence these pathways to inform tailored nursing interventions. DESIGN AND METHODS: This cross-sectional study recruited 104 Taiwanese adolescents (aged 12-18 years) who had attempted weight control within six months. Participants completed a TPB-based questionnaire. Data were analyzed using Confirmatory Factor Analysis (CFA) to identify belief structures, followed by Generalized Additive Models (GAM) and path analyses to examine linear and non-linear relationships among TPB constructs. RESULTS: = 0.35-0.65). Two distinct belief factors emerged: behavioral beliefs (BB) and combined normative-control beliefs (NCB). Overweight adolescents showed significantly higher intentions (p = 0.008) and subjective norms (SN) (p < 0.001). Crucially, the pathways from Attitude and Subjective Norms to Intention were not universal but varied significantly by gender-weight status combinations. Subjective Norms emerged as a potential exploratory switching mechanism with distinct patterns across demographic subgroups. CONCLUSIONS: While partially supporting TPB, findings reveal that adolescent weight control intentions are shaped by demographic-contingent mechanisms rather than uniform psychological processes. The traditional "one-size-fits-all" theoretical assumption may not apply to adolescents actively attempting weight control. PRACTICE IMPLICATIONS: Pediatric nurses should move beyond generic counseling and stratify assessments by gender and weight status. Interventions should strategically target the identified belief factors and leverage the potential switching role of subjective norms to promote healthy weight management intentions specific to the adolescent's demographic profile. These implications require replication before clinical adoption.