Examining the links between hydration knowledge, attitudes and behavior



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.

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  1. 1.

    In this paper, the term “hydration” is used as a verb, referring to the action of consuming fluids. “Hydration” is not used as an adjective, referring to adequate total body water. The distinction is important because it is possible for an individual to consume a high volume of fluid (i.e., engages in significant hydration practices) to exist in a dehydrated state, such as it is possible for a person who consumes a low volume of fluid to exist in a euhydrated state. The intention here is to gain insight into hydration practices, not to define an individual’s hydration state.

  2. 2.

    Because this study was conducted in the US, measurements were presented in fluid ounces. In the Appendix, measures are given in both fluid ounces and liters.


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Correspondence to Jennifer C. Veilleux.

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Veilleux, J.C., Caldwell, A.R., Johnson, E.C. et al. Examining the links between hydration knowledge, attitudes and behavior. Eur J Nutr 59, 991–1000 (2020). https://doi.org/10.1007/s00394-019-01958-x

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  • Hydration
  • Fluid intake
  • Attitudes
  • Knowledge