Nutrition Education Methods Research Articles

Reaching low-income families: Focus group results provide direction for a behavioral approach to WIC services

Supplemental Nutrition Program for Women, Infants, and Children (WIC) families were asked to identify motivators and barriers to health behavior change and preferred approaches to nutrition education in WIC. Six focus groups involved a total of 41 English-speaking WIC participants and addressed parenting, family meals, food preparation, and physical activity. The discussions were audiotaped, transcribed, and analyzed using NUD∗IST software (Non-Numerical Unstructured Data Indexing, Searching, and Theorizing, version 4.0. Thousand Oaks, CA: Sage Publications Software, 1997). Key barriers to behavior change included inadequate parenting skills, lack of knowledge, unhealthy social environments, lack of time, and lack of social or financial support. Key motivators included feelings of responsibility, concern for child health and development, and positive social support. Participants identified facilitated discussions, support groups, cooking classes, and a WIC Web site as preferred methods of nutrition education. Results provided the foundation for the Healthy Habits nutrition education modules implemented in the Washington State WIC program and can be used to improve future nutrition education in WIC.

Counseling latina mothers of preschool children about weight issues: Suggestions for a new framework

Objective To assess Latina mothers’ health beliefs and attitudes regarding early childhood weight issues and to use the information to update current nutrition education methods. Design Data were collected in eight focus group sessions using a semistructured questionnaire. Subjects/Setting Forty-three Latina mothers (and grandmothers) with children aged 2 to 5 years were recruited at five different Special Supplemental Nutrition Program for Women, Infants, and Children sites in California. Analysis Transcripts of focus groups were imported into QSR NUD∗IST software, facilitating in-depth iterative analysis of emergent themes. Results Fifteen emergent themes were identified and organized into four functional domains relevant to nutrition education: health beliefs surrounding weight, impact and cause of overweight, life values and concerns, and strategies for making changes in children’s eating and activity patterns. Information from this qualitative study demonstrates that the traditional nutrition counseling paradigm may not be effective with Latina mothers. In addition, cultural beliefs can be barriers to successful prevention and treatment of overweight. To ensure that culturally competent services are provided, educators must be prepared to adjust education approaches according to the cultural background of the clients. Key among the issues was mothers’ difficulty acknowledging overweight among their children and their perception that health and weight were poorly associated. Certain cultural values were identified as barriers to adopting healthful behaviors. Mothers were able to identify specific ways in which nutrition education could be improved. Applications/conclusions Our findings suggest that nutrition education efforts targeting Latina mothers of young children can be reframed to better address the belief system and cultural framework of the population, like identifying positive eating behaviors rather than focusing on a child’s weight.

Innovative use of cluster analysis to evaluate social marketing strategies to control vitamin a deficiency

An innovative approach such as the social marketing strategy (SMS) can be useful for promoting the vitamin A status of the community. A community-based study undertaken in Southern India assessed the feasibility and effectiveness of SMS in raising the awareness of the community concerning vitamin A, in changing attitudes, and in improving dietary behaviors. The SMS was adopted in the experimental area for nutrition communication. The conventional method of nutrition education was employed in the positive control area. To study changes over time, a negative control area was selected where there was no intervention. After one year of implementation, the intervention program was evaluated using quantitative indicators such as vitamin A status and vitamin A intake as well as qualitative parameters like knowledge, attitudes, and practices (KAP). Cluster analysis, a multivariate technique, was applied to analyze the KAP data to assess the effectiveness of SMS on the KAP of the community. The analysis clearly segregated the entire population from the three areas into two distinct clusters, these were good having higher mean scores, and poor with lower mean scores. A bivariate analysis between clusters and the type of intervention revealed that higher proportion of respondents in the good cluster belonged to the area employing the SMS.

Economic Analysis of Bilingual Interactive Multimedia Nutrition Education

Context Interactive multimedia (IMM) provides a means to deliver accurate, consistent, and convenient nutrition education. Objective To compare direct costs of bilingual IMM and peer nutrition education methods. Design Cost per unit of nutrition education for each delivery method was calculated. Setting Touch-screen computer kiosk systems in food assistance programs. Participants Approximately 727 low-income and Hispanic persons. Intervention Bilingual IMM and nutrition education classes taught by peer educators. Main Outcome Measure(s) Cost per unit of nutrition education delivered. Analysis Descriptive: to compare costs and determine break-even points. Results Initially, costs for both methods dropped and then nearly leveled for the peer method at a break-even point of 633 units, whereas those for IMM continued to decrease. Conclusion(s) Interactive multimedia is a cost-effective method of delivering nutrition education, especially to large numbers of people. Implication(s) Use of this technology could reach additional low-income persons at decreasing costs.

New Concepts for Nutrition Education in an Era of Welfare Reform

In response to welfare reform and the Food Stamp Nutrition Education Program's (FSNEP) goal of increasing clients' self-sufficiency, a literature review and small exploratory study were conducted to gain insight into a potential approach that would go beyond current nutrition education methods. Interviews with 17 FSNEP participants showed a widespread willingness to share food-related skills that others wanted to learn, some interest in cooperating on food-related projects, and frequent cases of social and geographic isolation. Based on these preliminary findings, we suggest the development and evaluation of nutrition education programs that appreciate and build on existing abilities of participants, provide opportunities for self-directed learning and activities, and build social support, social networks, and trust among participants while linking them to the broader community.

What We Think They Think

ABSTRACT This qualitative study examined nutritional beliefs and practices of older women from two vantage points. Nine focus groups were held with N = 49 low-income women and N = 25 providers and health professionals who work with older women in two regions of a rural Southern state. Discussions covered influences on food choices, supple ment use and meal frequency; problems with buying, preparing and storing food; participation in food assistance programs; nutrition information sources; and preferred methods of nutrition education. Health profession als differed from elderly women clients in their views of perceptions con cerning women's eating patterns; social and cultural influences of food choices; major barriers to buying and preparing food; challenges of nutritional compliance for women with chronic disease; and older women's complementary medicine practices. Issues concerning long-term vs. short-term benefits of food choices and use of dietary supplements were also presented.

Nutritional Beliefs, Attitudes and Practices of Elderly, Rural, Southern Women

Six focus groups were held with 49 rural southern women, 92% of whom were over 65 years of age. Discussions covered influences on food choices, supplement use and meal frequency; problems with buying, preparing and storing food; participation in food assistance programs; nutrition information sources; and preferred methods of nutrition education. Data analysis revealed six major themes: food preferences based upon taste and childhood familiarity; beliefs about benefits and detriments of eating certain foods; influence of health conditions on food choices; perceived barriers to purchasing, preparing and consuming certain foods; cues to action regarding food selection, supplement use and meal patterns; and nutrition information needs.

Nutrition Fair: An Effective Nutrition Education Tool in the WIC Setting

LEARNING OUTCOME: To quantify changes in nutritional knowledge in the WIC population when an alternative method of nutrition education was used. Nutrition education is a very important component of WIC program. It is aimed to further the nutritional knowledge of WIC participants resulting in improving general health of the entire family. New methods of nutrition education that involve an active participation of the clients may enhance their knowledge gained in the class. One such technique, nutrition fair was conducted three times and compared with three conventional nutrition education classes in Prince Georges County, MD during 1995-96.150 participants each were selected during six voucher pickups and they were tested with questionnaires before and after classes (pre and post tests during each of the three fairs and the corresponding conventional education to assess the nutrition knowledge gained, formed the basis of quantitative analysis). Each fair consisted of several stations and at each station consisted of an educational activity or a game along with nutrition information. Participants were encouraged to attend all the stations and successful participants received several incentives. An overall increase of 15% in nutritional knowledge was found and within certain stations upto 30% increase in knowledge was found in the nutrition fair setting over the conventional education provided. Overall, the results indicate enthusiastic interest in the nutritional fair participation over the conventional education. A larger scale study may be initiated throughout the county soon. These results show that such studies will be very beneficial in urgent dissemination of current nutrition information and especially for larger groups of clients.

Nutrition Education is as Effective as Calorie Restricted Diets in Promoting Weight Loss

LEARNING OUTCOME: To determine if nutrition education was as effective in treating obesity, as demonstrated by improved eating habits, than calorie restricted diets without nutrition education.Obesity has many deleterious health implications, yet effective treatment remains elusive. Although the cause of high recidivism rates for weight control is multifactorial, calorie-restricted diets have been implicated as a possible culprit Teaching healthy eating habits without specifying dairy calorie intakes may improve the treatment of obesity. In comparing these two weight loss treatments, 97 mild to moderately obese female subjects, mean ages 21 to 60 years, were randomly assigned to either a nutrition education (n=52) or a calorie-restricted (n=45) intervention group. Both groups participated in a 10 week program plus a one month follow-up session. The nutrition education group received practical tips on reducing dietary fat intake. No calorie or fat level was prescribed. Subjects receiving calorie-restricted intervention were taught a 1200 calorie diet, with 24% calories from fat, using the 1989 American Dietetic/ Diabetes Association exchange list Food intake records were collected four consecutive days at 5 times throughout the treatment period and were analyzed for calorie and fat content. Subjects were weighed weekly. Pre-, post-, and one month follow-up nutrition knowledge test scores were obtained. The nutrition education group significantly improved nutrition knowledge test scores (67.9% ± 15.3) (p<0.001) as compared to the calorie-restricted group (54.6% ± 14.6). The nutrition education group significantly decreased their dietary fat intake (−7.03% ± 9.4) (p<0.05) by week 7 of the 10 week program when compared to the calorie restricted group (−2.2% ± 8.6). No significant difference between groups in weight loss or calorie intake was observed.The nutrition education method was more effective in reducing dietary fat intake and improving nutrition knowledge than prescribing a calorie-restricted diet, and as effective in promoting weight loss.

About better choices, development of nutrition education materials for pregnant adolescents

A pilot study was conducted to gain insight into the best methods for teaching nutrition and eating behaviors to pregnant African-American teenagers. A seven week community-based nutrition education program was conducted to identify needs and wants of the teens related to nutrition education techniques and materials. The program focused on goal setting and eating behavior changes within the diets of the participants. Techniques and materials used included didactic lecture, food tasting, interactive games, problem solving, food selection at a fast food restaurant, posters, handouts and computerized diet analysis. Following each class session, participants were asked to give their input on the materials and techniques used to identify the preferred methods of nutrition education. As a result of the pilot study, “Delicious Decisions-About Better Choices,” a nutrition education program to teach adolescents and adults about the importance of a healthful diet during pregnancy, gaining weight and menu planning was developed. The materials, utilizing food picture cards, a poster and six blackline masters, highlighting the food guide pyramid have been evaluated by community nutrition educators in various settings. Professionals rate the materials positively and state that the lessons and materials aid clients in developing the critical thinking skills needed to make healthy food choices. The success of this program demonstrates the need to seek input from program participants before developing materials and community nutrition education program plans.

Evaluation of a face-to-face weaning food intervention in Kwara state, Nigeria: Knowledge, trial, and adoption of a home-prepared weaning food

This paper reports on the evaluation of a pilot intervention which used nutrition education techniques to introduce a fortified, home-prepared weaning food ( eko ilera, or ‘pap for health’) in 12 communities in Kwara State, Nigeria, from June to August, 1988. The recipe added toasted cowpea flour, red palm oil, and sugar to increase the energy and protein density of the traditional maize or sorghum starch porridge used for weaning from 38 to 85 kcal and 0.8 to 2.0 g protein per 100 g. A stratified, random sample of participating ( n=295) and non-participating ( n=301) mothers from the same communities were interviewed from 2 to 8 weeks following the completion of the intervention, and their rates of knowledge, trail, and adoption of eko ilera were evaluated. Of the participating mothers, 57% (95% CI: 51%, 63%) knew the modified recipe, 48% (43%, 54%) tried it, and 17% (12%, 21%) adopted it with the intention of using it in the future. Only 2% (1%, 7%) of non-participating mothers knew about the recipe. Multivariate analyses indicated that the mothers' level of education and their perception of the cost and length of preparation time of the recipe were significantly associated with its adoption. The intervention was successful in using face-to-face nutrition education methods to introduce eko ilera to mothers in this region of Nigeria and to encourage its trial and adoption.

A nutrition survey of and recommendations for individuals with Prader-Willi syndrome who live in group homes

The purpose of this study was to describe anthropometric data and identify diet-related problems of individuals with Prader-Willi syndrome (PWS) who reside in group homes. A group home is a licensed foster care facility that provides 24-hour care for the developmentally disabled. Questionnaires were sent to dietitians (or the person responsible for nutrition care) of 25 group homes; responses from 18 homes were analyzed. The mean age of residents with PWS was 25 +/- 8.4 years and the mean height was 152.4 +/- 9.7 cm. The mean weight for 19- to 22-year-old men was 75.5 +/- 26.8 kg and that for women of the same age was 74.5 +/- 20 kg. The residents consumed a mean of 1,000 to 1,500 kcal/day. Most of the group homes (n = 16) locked their kitchens at night, and in 12 of the homes stealing and hoarding of food occurred. Pica behavior (eating of nonfoods) was reported in 7 homes. One third of all residents had success in weight loss and were on a maintenance diet, but a major problem was determination of a desirable weight goal. Our key recommendations for dietitians are weigh residents weekly; use the body mass index with prescribed zones for determination of weight goals; monitor change in circumference measurements; follow the guidelines of 7 to 8 kcal/cm of height for weight loss and 10 to 14 kcal/cm of height for weight maintenance; administer 1,000 kcal/day or more and encourage daily aerobic exercise; respect food preferences while adhering to dietary prescriptions; adhere to strict food control procedures; and use nutrition education methods and an interdisciplinary approach for behavior modification.

Cartoons as a Method of Nutrition Education

Cartoons as a Method of Nutrition Education

A nutrition education workshop for managers of nutrition centers for the elderly utilizing videotaped simulations for assessment.

As funds become increasingly scarce, an effective nutrition education method which reaches large numbers of elderly individuals is appropriate. A nutrition workshop was provided for 30 managers of government-sponsored nutrition centers for the elderly in a 5-county area. The workshop curriculum, determined after interests of both center managers and participants at the nutrition centers were assessed, was presented in a packet of materials to each workshop attendee and supplemented with explanations and demonstrations. A pre- and post-test evaluation instrument, which included videotaped simulations of typical nutritional situations encountered with elderly persons at the centers, was used to measure attitudes and knowledge before and after the workshop. As a result of the workshop, knowledge increased significantly as measured by the test instrument and 75% of the managers reported use of materials and ideas during the 5 months following the workshop.

Computerized nutrition education in the supermarket

Increased interest in health promotion and disease prevention has created new opportunities to explore novel approaches to providing nutrition-related in­ formation to the public. The supermarket has re­ cently been endorsed as an excellent place to provide nutrition information because this setting affords an opportunity to influence impulse-buying behavior (1). The Point-of-Purchase Advertising Institute re­ cently estimated that more than 50% of food pur­ chase decisions are made while individuals are in the supermarket (2). Therefore, consumers need useful in-store information to help guide their food-pur­ chasing decisions. The use of computerized super­ market nutrition education programs is one way to meet this need and to reach audiences not currently being reached by traditional nutrition education methods. Supermar.kets first introduced computers for au­ tomated check-out and inventory control; newer ap­ plications include coupon and recipe dispensing, di­ rectory assistance, and electronic marketing. Several supermarket chains that feature computerized sys­ tems designed to answer questions concerning prod­ uct location, weekly specials, and recipes (3-5) have reported consumer acceptance of computers in the supermarket. However, the use of computers as a nutrition education medium in the supermarket has not yet been demonstrated. Recent technological advances have made com­ puter use more practical and economically feasible. The benefits of using microcomputers in nutrition education include minimal cost, maximum teaching effectiveness, and flexibility to meet individual learn­ ing needs (6). A recent Food Marketing Institute survey (Note 1) indicated that the most appropriate nutrition programs for supermarket nutrition edu­ cation were those that used videocassettes, slides, and computer programs. The immediate feedback

Effect of leaflets vs. food samples on food purchasing

Attempts to influence purchases of oranges and whole wheat bread indicated that both leaflets describing the merits of the food and samples provided for testing had some degree of success in stimulating sales. The attempts were more successful for whole wheat bread than for oranges. The sustained effect of the promotions was not measured. Directing attention to specific foods may be an effective method of introducing nutritionally desirable foods into the diet and thus constitute an effective method of nutrition education.

A comparison of mass media techniques and a direct method for nutrition education in Rural Mexico

Summary A pilot study was elaborated to test the effectiveness of mass media techniques as compared to direct methods of education in transmitting the basic concepts of hygiene, health, and an adequate diet. Three different geographical areas were chosen: in one area mass media techniques were used; in a second area teachers used a direct method of nutrition education; and the third served as a control group. The three communities were homogeneous in population size and accessibility of radio, water, drainage, and job resources. The family groups were also homogeneous in age, educational level, and in number and age of children. It was found that nutrition concepts were learned equally well using the direct method of education as with mass media. The direct education group showed a 53% increase in their learning scores. In this group, the mothers increased their knowledge of infant nutritional needs by more than 70%. The mass media group showed similar results. With the mass media techniques the increment in their final learning scores was 54%. A survey to measure the changes in food habits as a result of nutrition education indicated a positive change in the food consumption of both the mass media and direct education groups. An increase in the intake offish, vegetables, and fruits was observed. The control group indicated a negative response by increasing their consumption of popular but low nutritive value foods.

A potpourri of nutrition education methods

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