Fruit and vegetable (F&V) consumption in Bulgaria is critically low—among the lowest in the European Union. This study applied the Theoretical Domains Framework (TDF) to identify key barriers and facilitators of F&V intake among 306 Bulgarian adults. A cross-sectional survey measured TDF-derived beliefs and self-reported F&V consumption. Multiple regression analysis revealed that beliefs about consequences and peer social influences were the strongest predictors of intake frequency. Participants who recognised the health benefits of F&V and perceived healthy eating as common among their friends reported higher consumption. These findings were systematically mapped onto the Behaviour Change Wheel (BCW) to guide the development of future interventions. The results underscore the importance of addressing both individual beliefs and social norms when designing public health strategies. A theory-driven, context-sensitive approach may help increase F&V intake and reduce the burden of diet-related disease in Bulgaria and similar settings.
AlmeidaCAzevedoJFogelA, et al. (2024) Effectiveness of nudge interventions to promote fruit and vegetables’ selection, purchase, or consumption: A systematic review. Food Quality and Preference116: 105122. https://doi.org/10.1016/j.foodqual.2024.105122
2.
AtkinsLFrancisJIslamR, et al. (2017) A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implementation Science: IS12(1): 77. https://doi.org/10.1186/s13012-017-0605-9
3.
BanduraA (1977) Social Learning Theory. Prentice Hall.
4.
BanduraA (1986) Social Foundations of Thought and Action: A Social Cognitive Theory. Prentice Hall.
5.
BriazuRAMasoodFHuntL, et al. (2024) Barriers and facilitators to healthy eating in disadvantaged adults living in the UK: A scoping review. BMC Public Health24(1): 1770. https://doi.org/10.1186/s12889-024-19259-2
6.
BrugJ (2008) Determinants of healthy eating: Motivation, abilities and environmental opportunities. Family Practice25(Suppl_1): i50–i55. https://doi.org/10.1093/fampra/cmn063
7.
CaneJO’ConnorDMichieS (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science: IS7(1): 37. https://doi.org/10.1186/1748-5908-7-37
8.
ConnerMNormanP (2021) Predicting long-term healthy eating behaviour: Understanding the role of cognitive and affective attitudes. Psychology and Health36(10): 1165–1181. https://doi.org/10.1080/08870446.2020.1832675
9.
DevirgiliisCGubertiEMisturaL, et al. (2024) Effect of fruit and vegetable consumption on human health: An update of the literature. Foods13(19): 3149. https://doi.org/10.3390/foods13193149
10.
DulinARisicaPMMelloJ, et al. (2018) Examining neighborhood and interpersonal norms and social support on fruit and vegetable intake in low-income communities. BMC Public Health18: 455. https://doi.org/10.1186/s12889-018-5356-2
11.
FrancisJJStocktonCEcclesMP, et al. (2009) Evidence-based selection of theories for designing behaviour change interventions: Using methods based on theoretical construct domains to understand clinicians’ blood transfusion behaviour. British Journal of Health Psychology14(Pt 4): 625–646. https://doi.org/10.1348/135910708X397025
12.
GBD 2017 Diet Collaborators (2019) Health effects of dietary risks in 195 countries, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet393(10184): 1958–1972. https://doi.org/10.1016/S0140-6736(19)30041-8
13.
GeorgeLDavisonJ (2024) Using the behaviour change wheel and theoretical domains framework to identify factors related to increasing fruit and vegetable consumption in children to guide future intervention development. Public Health Nutrition27(1): e253. https://doi.org/10.1017/s1368980024002362
14.
GonçalvesDCoelhoPMartinezLF, et al. (2021) Nudging consumers toward healthier food choices: A field study on the effect of social norms. Sustainability13(4): 1660. https://doi.org/10.3390/su13041660
15.
GradyAJacksonJKLumM, et al. (2022) Barriers and facilitators to the implementation of healthy eating, physical activity and obesity prevention policies, practices or programs in family day care: A mixed method systematic review. Preventive Medicine157: 107011. https://doi.org/10.1016/j.ypmed.2022.107011
HiggsS (2015) Social norms and their influence on eating behaviours. Appetite86: 38–44.
18.
HuijgJMGebhardtWADusseldorpE, et al. (2014) Measuring determinants of implementation behavior: Psychometric properties of a questionnaire based on the theoretical domains framework. Implementation Science: IS9: 33. https://doi.org/10.1186/1748-5908-9-33
19.
HuitinkMPoelmanMPvan Den EyndeE, et al. (2020) Social norm nudges in shopping trolleys to promote vegetable purchases: A quasi-experimental study in a supermarket in a deprived urban area in the Netherlands. Appetite151: 104655. https://doi.org/10.1016/j.appet.2020.104655
20.
JabbariMNamaziNIrandoostP, et al. (2024) Meta-analysis of community-based interventions on fruits and vegetables consumption in adults. Nutrition & Food Science54(1): 164–191. https://doi.org/10.1108/nfs-05-2023-0115
21.
LazarovaSPetrova-AntonovaD (2025) Health-promoting behaviors in Bulgaria: A cross-sectional study on non-communicable diseases and lifestyle. Societies15(1): 15.
22.
MichieSAtkinsLWestR (eds) (2014) The Behaviour Change Wheel: A Guide to Designing Interventions, 1st edn. Silverback Publishing.
23.
MichieSvan StralenMMWestR (2011) The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science: IS6: 42.
24.
O'MalleyCL (2019) Characterising the determinants of fruit and vegetable consumption in pre-school children. Doctoral Dissertation, Durham University. Durham E-Theses. Available at: http://etheses.dur.ac.uk/13214/
25.
OECD/European Observatory on Health Systems and Policies (2025) Bulgaria: Country Health Profile 2025, State of Health in the EU. OECD Publishing/European Observatory on Health and Policies, Brussels.
26.
OjoSOBaileyDPBrierleyML, et al. (2019) breaking barriers: Using the behavior change wheel to develop a tailored intervention to overcome workplace inhibitors to breaking up sitting time. BMC Public Health19(1): 1126. https://doi.org/10.1186/s12889-019-7468-8
27.
PayneCRNiculescuMJustDR, et al. (2015) Shopper marketing nutrition interventions: Social norms on grocery carts increase produce spending without increasing shopper budgets. Preventive Medicine Reports2: 287–291. https://doi.org/10.1016/j.pmedr.2015.04.007
28.
PorterLChaterAMHaycraftE, et al. (2023) Role-model, reoffer, reward: A thematic analysis and TDF mapping of influences on families’ use of evidence-based vegetable feeding practices. Appetite189: 106764. https://doi.org/10.1016/j.appet.2023.106764
29.
RaineKD (2005) Determinants of healthy eating in Canada: An overview and synthesis. Canadian Journal of Public Health96(S3): S8–S15.
30.
RobinsonEThomasJAveyardP, et al. (2014) What everyone else is eating: A systematic review and meta-analysis of the effect of informational eating norms on eating behavior. Journal of the Academy of Nutrition and Dietetics114(3): 414–429.
31.
WestRMichieS (2021) A brief introduction to the COM-B model of behaviour and the PRIME theory of motivation. Qeios3(5): 1. Available at: https://www.qeios.com/read/WW04E6.3
32.
WolfendenLBarnesCLaneC, et al. (2021) Consolidating evidence on the effectiveness of interventions promoting fruit and vegetable consumption: An umbrella review. International Journal of Behavioral Nutrition and Physical Activity18: 11. https://doi.org/10.1186/s12966-020-01046-y
