Examining the links between hydration knowledge, attitudes and behavior

  • Jennifer C. VeilleuxEmail author
  • Aaron R. Caldwell
  • Evan C. Johnson
  • Stavros Kavouras
  • Brendon P. McDermott
  • Matthew S. Ganio
Original Contribution



This study aimed to examine the psychological factors (knowledge, barriers and facilitators) that can contribute to hydration-related behaviors (i.e., fluid intake) in the general population and how these relate to physical health.


A structured survey was developed to examine the links between hydration knowledge (29 items), attitudes about hydration (80 items), and fluid intake behavior (8 items) among US adults. Survey data from Phase 1 (n =301, US adults) psychometrically evaluated the items via item analysis (knowledge and fluid behavior) and factor analysis (attitudes). Phase 2 survey data (n =389, US adults and college students) refined and validated the new 16-item hydration knowledge measure, 4-item fluid intake behavior index, and 18-item attitude measure (barriers and facilitators of hydration-related behaviors) alongside indices of physical health (BMI and exercise behaviors).


Participants had a moderate level of hydration knowledge (Phase 1: 10.91 ± 3.10; Phase 2: 10.87 ± 2.47). A five-factor measure of attitudes which assessed both facilitators (social pressure and attention to monitoring) and barriers (lack of effort, physical barriers and lack of a fluid container) to hydration demonstrated strong internal consistency (αs from 0.75 to 0.90). Attitudes about hydration—most notably barriers to hydration—were associated with indicators of health and with fluid intake behaviors, whereas hydration knowledge was not.


Increasing hydration knowledge may be necessary for people who hold inaccurate information about hydration, but attitudes about hydration are likely to have a larger impact on fluid intake behaviors and health-related outcomes.


Hydration Fluid intake Attitudes Knowledge 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

394_2019_1958_MOESM1_ESM.docx (48 kb)
Supplementary material 1 (DOCX 48 kb)


  1. 1.
    Popkin BM, D’Anci KE, Rosenberg IH (2010) Water, hydration, and health. Nutr Rev 68:439–458. CrossRefGoogle Scholar
  2. 2.
    Lafontan M (2014) H4H—hydration for health. Obes Facts 7:1–5. CrossRefGoogle Scholar
  3. 3.
    Cheuvront SN, Kenefick RW (2014) Dehydration: physiology, assessment, and performance effects. Compr Physiol 4:257–285. CrossRefGoogle Scholar
  4. 4.
    Armstrong LE, Ganio MS, Casa DJ et al (2012) Mild dehydration affects mood in healthy young women. J Nutr 142:382–388. CrossRefGoogle Scholar
  5. 5.
    Ganio MS, Armstrong LE, Casa DJ et al (2011) Mild dehydration impairs cognitive performance and mood of men. Br J Nutr 106:1535–1543. CrossRefGoogle Scholar
  6. 6.
    Masento NA, Golightly M, Field DT et al (2014) Effects of hydration status on cognitive performance and mood. Br J Nutr 111:1841–1852. CrossRefGoogle Scholar
  7. 7.
    Benton D, Burgess N (2009) The effect of the consumption of water on the memory and attention of children. Appetite 53:143–146. CrossRefGoogle Scholar
  8. 8.
    D’Anci KED, Constant F, Rosenberg IH, D’Anci KE (2006) Hydration and cognitive function in children. Nutr Rev 64:457–464. CrossRefGoogle Scholar
  9. 9.
    Suhr JA, Hall J, Patterson SM, Niinistö RT (2004) The relation of hydration status to cognitive performance in healthy older adults. Int J Psychophysiol 53:121–125. CrossRefGoogle Scholar
  10. 10.
    Coe S, Williams R (2011) Hydration and health. Nutr Bull 36:259–266CrossRefGoogle Scholar
  11. 11.
    Chang T, Ravi N, Plegue MA, et al (2016) Inadequate hydration, BMI, and obesity among US adults: NHANES 2009–2012. Ann Fam Med 320–324.
  12. 12.
    Kenney EL, Long MW, Cradock AL, Gortmaker SL (2015) Prevalence of inadequate hydration among US children and disparities by gender and race/ethnicity: National Health and Nutrition Examination Survey, 2009–2012. Am J Public Health 105:e113–e118. CrossRefGoogle Scholar
  13. 13.
    Goodman AB, Blanck HM, Sherry B et al (2013) Behaviors and attitudes associated with low drinking water intake among US Adults, Food Attitudes and Behaviors Survey, 2007. Prev Chronic Dis 10:120248. CrossRefGoogle Scholar
  14. 14.
    Morin C, Gandy J, Moreno LA et al (2018) A comparison of drinking behavior using a harmonized methodology (Liq. In 7) in six countries. Eur J Nutr 57:101–112. CrossRefGoogle Scholar
  15. 15.
    Douglas P, Ball L, McGuffin L et al (2015) Hydration: knowledge, attitudes, and practices of UK dietitians. J Biomed Educ 2015:1–6. CrossRefGoogle Scholar
  16. 16.
    Chia M, Mukherjee S, Huang D (2015) Thirst for drink knowledge: how Singaporean youth athletes measure up in an exercise hydration knowledge questionnaire. Int J Sports Sci Coach 10:841–850. CrossRefGoogle Scholar
  17. 17.
    Decher NR, Casa DJ, Yeargin SW et al (2008) Hydration status, knowledge, and behavior in youths at summer sports camps. Int J Sports Physiol Perform 3:262–278. CrossRefGoogle Scholar
  18. 18.
    Esa NH, Saad HA, Phing CH, Karppaya H (2015) Knowledge, attitudes and behaviours regarding hydration and hydration status of malaysian national weight category sports athletes. J Phys Educ Sport 15:452–459. Google Scholar
  19. 19.
    Nichols PE, Jonnalagadda SS, Rosenbloom CA, Trinkaus M (2005) Knowledge, attitudes, and behaviors regarding hydration and fluid replacement of collegiate athletes. Int J Sport Nutr Exerc Metab 15:515–527. CrossRefGoogle Scholar
  20. 20.
    Judge LW, Kumley RF, Bellar DM et al (2016) Hydration and fluid replacement knowledge, attitudes, barriers and behaviors of NCAA Division 1 American football players. J Strength Cond Res 30:11–19CrossRefGoogle Scholar
  21. 21.
    Tyrwhitt-Drake R, Ferragud MA, de Andres RU (2014) Knowledge and perceptions of hydration: a survey among adults in the United Kingdom, France and Spain. Rev Española Nutr Comunitaria 20:128–136Google Scholar
  22. 22.
    Shaheen NA, Alqahtani AA, Assiri H et al (2018) Public knowledge of dehydration and fluid intake practices: variation by participants’ characteristics. BMC Public Health 18:1346CrossRefGoogle Scholar
  23. 23.
    McCauley LR, Dyer AJ, Stern K et al (2012) Factors influencing fluid intake behavior among kidney stone formers. J Urol 187:1282–1286. CrossRefGoogle Scholar
  24. 24.
    Rimal RN (2000) Closing the knowledge—behavior gap in health promotion: the mediating role of self-efficacy. Health Commun 12:219–238. CrossRefGoogle Scholar
  25. 25.
    Schwarzer R (2008) Modeling health behavior change: how to predict and modify the adoption and maintenance of health behaviors. Appl Psychol 57:1–29. Google Scholar
  26. 26.
    Clark LA, Watson D (1995) Constructing validity: basic issues in objective scale development. Psychol Assess 7:309–319. CrossRefGoogle Scholar
  27. 27.
    Hurley AMYE, Scandura TA, Chester A et al (1997) Exploratory and confirmatory factor analysis: guidelines, issues, and alternatives. J Organ Behav 18:667–683CrossRefGoogle Scholar
  28. 28.
    Litman L, Robinson J, Abberbock T (2017) a versatile crowdsourcing data acquisition platform for the behavioral sciences. Behav Res Methods 49:433–442. CrossRefGoogle Scholar
  29. 29.
    Ware J, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233 [author (s): John E. Ware, Jr., Mark Kosinski and Susan D. Keller Published by : Lippincott Williams & Wilkins Stable. http://www.jstor]
  30. 30.
    Cohen-Mansfield J, Marx MS, Guralnik JM (2003) Motivators and barriers to exercise in an older community-dwelling population. J Aging Phys Act 11:242–253CrossRefGoogle Scholar
  31. 31.
    Craig CL, Marshall AL, Sjöström M et al (2003) International physical activity questionnaire: 12-Country reliability and validity. Med Sci Sports Exerc 35:1381–1395. CrossRefGoogle Scholar
  32. 32.
    Fogelholm M, Malmberg J, Suni J et al (2006) International Physical Activity Questionnaire: validity against fitness. Med Sci Sports Exerc 38:753–760. CrossRefGoogle Scholar
  33. 33.
    Watkins MW (2005) Determining parallel analysis criteria. J Mod Appl Stat Methods 5:344–346. CrossRefGoogle Scholar
  34. 34.
    Flake JK, Pek J, Hehman E (2017) Construct validation in social and personality research: current practice and recommendations. Soc Psychol Pers Sci 8:370–378. CrossRefGoogle Scholar
  35. 35.
    Ajzen I (1991) The theory of planned behavior. Orgnizational Behav Hum Decis Process 50:179–211. CrossRefGoogle Scholar
  36. 36.
    Schwarzer R, Luszczynska A (2008) How to overcome health-compromising behaviors: the health action process approach. Eur Psychol 13:141–151. CrossRefGoogle Scholar
  37. 37.
    Gandy J (2015) Water intake: validity of population assessment and recommendations. Eur J Nutr 54:S11–S16. CrossRefGoogle Scholar
  38. 38.
    Hooper L, Bunn DK, Downing A et al (2016) Which frail older people are dehydrated? The UK DRIE study. J Gerontol Med Sci 71:1341–1347. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jennifer C. Veilleux
    • 1
    Email author
  • Aaron R. Caldwell
    • 2
  • Evan C. Johnson
    • 3
  • Stavros Kavouras
    • 4
  • Brendon P. McDermott
    • 2
  • Matthew S. Ganio
    • 2
  1. 1.Department of Psychological ScienceUniversity of ArkansasFayettevilleUSA
  2. 2.Department of Health, Human Performance, and RecreationUniversity of ArkansasFayettevilleUSA
  3. 3.Division of Kinesiology and HealthUniversity of WyomingLaramieUSA
  4. 4.College of Health SolutionsArizona State UniversityTempeUSA

Personalised recommendations