Influence of Socioeconomic Status on the Effectiveness of Dietary Counselling in Healthy Volunteers

Abstract

A controlled trial was conducted in order to estimate the population uptake and effectiveness of dietary behavior change counselling in higher and lower socioeconomic status groups. Four hundred and seventy-nine volunteers were recruited by personal letter of invitation from two randomly selected population samples in an Australian city. The samples were selected in such a way as to be likely to include large numbers of people of high and low occupational prestige, which was the measure of socioeconomic status used in this study. The volunteers represented 24% of the whole sample, with 32% of those from the higher status suburbs participating compared to 20% of those from the lower status suburbs. The dietary counselling intervention was based on behavior change techniques and social learning theories. The one-time counselling session with follow-up after 3 months included personalized feedback on dietary habits, goal setting, and specific advice on dietary behavior change from a qualified dietitian. Over the intervention period, higher and lower occupational prestige groups were observed to make equivalent food group intake changes. The lower prestige group achieved a greater reduction in fat density and a greater increase in carbohydrate density, while the higher prestige group achieved a greater increase in polyunsaturated fat density, reflecting differences in initial nutrient density levels. Although response rates between prestige groups differed, the effectiveness of dietary behavior change counselling was not found to be dependent on the occupational prestige of the volunteers. It was concluded that this type of strategy is equally efficacious in volunteers regardless of their socioeconomic status, but is less effective as a public health measure in lower status groups.