Nutrition Education Materials Research Articles

Increasing Nutrition Literacy: Testing the Effectiveness of Print, Web site, and Game Modalities

To examine the effectiveness of three modalities for delivery of nutrition education. Between-subjects, repeated-measures design. Data were collected at community agencies or during home visits. Low-income, European American and African American mothers (N = 155). Participants were exposed to nutrition education material in 1 of 3 modalities (a computer game, The Fantastic Food Challenge; Web site; or pamphlet). Likeability, nutrition knowledge, intention to use, and demographic measures followed the intervention at T1 and T2. 5-point Likert-type scales measured likeability (5 items), and 33 multiple-choice questions measured knowledge. Data were analyzed using analysis of variance (ANOVA) and analysis of covariance (ANCOVA) procedures using SPSS version 15.0 (SPSS Inc., Chicago, IL) software, P < .05. Overall, the Web site was liked more than the other conditions with this audience of women. Significant differences in attention, understanding, and intent to use the information existed across modalities. The Web site performed better than other modalities on knowledge outcomes, with no differences in knowledge retention from T1 to T2. The Web site modality performed best with this audience of women, indicating that interactive computer games may not confer greater benefits than traditional modes of information delivery for all audiences, particularly those with low computer skills.

Chinese Nutrition Educational Materials for Renal Patients

Nutrition resources in Chinese have been developed for the patients in St. Paul's Hospital's Renal Program. The goal was to support this patient subgroup to understand and practice the complicated diet guidelines within their own language and cultural contexts.

Development of a Tool Measuring Patient Satisfaction With Nutrition Education Materials and Methods, and Projected Satisfaction With a Variety of Educational Media and Content

Development of a Tool Measuring Patient Satisfaction With Nutrition Education Materials and Methods, and Projected Satisfaction With a Variety of Educational Media and Content

Evaluating Implementation and Impact of Local School Wellness Policies

TEXT: The Child Nutrition Act of 2004 requires all local education agencies to establish comprehensive wellness policies for their districts by June 30, 2006. Establishment of the local school wellness policy is only the first step in the school wellness story. One component of these policies that is particularly important is the evaluation piece that will determine best practices and justify additional nutrition promotion measures in the future. Dietetics professionals can play a key role in ensuring implementation and evaluation of these local school wellness policies. Dietitians at Sodexho and the American Dietetic Association partnered to develop a pilot evaluation tool that was tested by Sodexho dietitians in 5 school districts. The evaluation tool focuses on implementation of the nutrition components of the local wellness policy and utilizes numerous resources, including purchase records and use of Sodexho-developed nutrition education materials, as part of the ongoing impact evaluation. This presentation will focus on the lessons learned from development and pilot testing of the evaluative tool. Preliminary results from the implementation evaluation will be presented.

P123: Young Adults' Preferences for Stages of Change-Based Nutrition Educational Materials

P123: Young Adults' Preferences for Stages of Change-Based Nutrition Educational Materials

P22: Adapting a Printed Nutrition Education Brochure for Presentation as a Web Page: Tracking User Profiles and Measuring Stakeholder Impacts

Design, content, and usability play major roles in the success or failure of nutrition education materials. Web-based publications pose special challenges to develop pages that consistently display across a wide variety of users' computer platforms. Using noninvasive user profiles, which are collected as standard practice on most Web servers, allows the developer to present a richer, more responsive website that results in greater end-user satisfaction and higher hit counts. User hardware, software, and habits usually dictate much of the performance of Web sites.

P99: Motivation toward Consumer Messages from the Dietary Guidelines for Americans among College Students

The motivational interviewing process focuses on strategies to improve motivation and build commitment to behavior change. This process builds on the Stages of Change Model and has been used previously in nutrition interventions. The purpose of this research project was to explore motivation toward four statements from the 2005 Dietary Guidelines for Americans consumer pamphlet among college students, ages 18-30 years. Selected statements included: focus on fruits, vary your vegetables, get your calcium-rich foods, and make half your grains whole. Using a scale of 1 (not motivated) to 12 (highly motivated), 344 college students attending general health or nutrition classes were presented with each of the four statements and asked to describe their motivation toward each statement. Students were classified into 3 levels of motivation based on the Motivational Nutrition Counseling Algorithm; level 1 (not motivated/Pre-contemplation Stage), level 2 (unsure/Contemplation Stage), and level 3 (motivated/ Preparation or Action Stage). The percentage of individuals falling into level 3 for the fruit, vegetable, whole grain, and calcium messages were surprisingly high or 47%, 47%, 49%, and 50%, respectively. The percentages of the sample classified as level 1 for the four messages was low or 8%, 9%, 13%, 16%, respectively. A large percentage of college students participating in nutrition and health classes were highly motivated toward reaching goals set by the Dietary Guidelines for Americans. These students would benefit from tailored nutrition education materials directed toward individuals in the preparation or action stage from the Stages of Change Model.

P32: Interactive Training Tool for Paraprofessionals

This project developed and evaluated an interactive learning tool that improves the method of training for new and experienced nutrition education paraprofessionals. Nutrition education experts helped to formulate an instructional strategy for the design of nutrition education materials. The curriculum addresses the different leaning styles and educational levels of nutrition education paraprofessionals. It also includes a mastery test to provide immediate feedback to learners and afford them an opportunity to return and review the lesson for any incorrect responses before proceeding. The project produced an interactive, multimedia CD-ROM designed for self-paced, individual instruction for nutrition education paraprofessionals. The training CD-ROM was pilot tested to assess user acceptance and instructional viability. A total of 35 respondents nutrition education paraprofessionals from the San Francisco Bay Area and the Los Angeles Basin were accrued for this study and were administered a questionnaire to assess their experience and perceptions about the training tool. The learner ratings for each of 23 rating scales were analyzed to determine the extent to which respondents were engaged by the interactive, multimedia prototype lesson and gained nutrition knowledge. The results of the pilot test indicate that the interactive training tool was engaging and acceptable to nutrition education paraprofessionals, that it improved command of nutrition basics, and increased their command of the subject. The findings of the pilot test suggest that an interactive nutrition education training tool designed for individualized, self-paced instruction is acceptable and effective.

Parental Perceptions of Preschool Overweight: A Qualitative Examination

Previous research conducted by this group indicated 17% of Hartford’s children (2-3 YO) are overweight with an additional 17% at risk for overweight. Anecdotally, parents in the community expressed dissatisfaction with standard clinical preschool overweight (POW) assessment and nutrition education. This study sought to identify responsive strategies to educate families in POW prevention. Researchers conducted 10 focus groups (ave. size = 8 people) with low-resource, minority parents of preschoolers at daycare centers and community agencies in Hartford. Eighteen of the focus group participants also participated in an individual semi-structured in-depth follow-up interview. Using content analysis, two researchers coded transcripts for emergent themes with critical evaluation from a third researcher. The team then developed a theoretical model for POW. Dominant themes focused on the importance and definition of health, the uniqueness of the child, and a detached approach to extreme POW. 1) Parents wanted their children to be healthy and happy; however, weight was not included in their definition of health. 2) Viewing every child as unique, parents considered the growth chart an unacceptable diagnostic tool that groups children together without accounting for the complexity of the individual. 3) Parents discussed extreme POW in the third person, finding fault with others’ parenting practices but not their own. Attempting to prevent POW, this research team will develop nutrition education materials focusing on preventing negative health outcomes. Additionally, this group will work with healthcare professionals to create a tool for evaluating POW that is accepted by parents. (Funding: USDA National Needs Fellowship, FSNE#04DSS4712AY)

Feeding Infants and Toddlers Study (FITS): Development of the FITS Survey in Comparison to Other Dietary Survey Methods

Objective This article describes the steps in the planning and development of the 2002 Feeding Infants and Toddlers Study. Methods We describe the study’s rationale, sampling methodology, survey questionnaire development, dietary methodology, field data collection, and data processing and analysis. A brief review of existing national nutrition surveys and studies of infants and toddlers, and available study designs and dietary methods, is also included. Subjects/Setting Most national studies have been cross-sectional and assessed breastfeeding rates, dietary intake, and nutritional status among general and high-risk populations. Other specialized studies have been longitudinal and tracked dietary intake and nutritional status from infancy to the preschool years, or focused on studying a specific research topic, such as the relationship between fluoride intake and dental caries. Conclusions The 2002 Feeding Infants and Toddlers Study has advanced the knowledge base on infant and toddler nutrition by using state-of-the-art methodology and by providing researchers with updated information to develop further research questions. Our findings can be used by child health and nutrition organizations to develop dietary recommendations and improved nutrition education materials. Clinicians and practitioners in the fields of public health and wellness can use the information to provide practical advice to parents in a variety of settings to help give children a more healthful start.

The internet and nutrition education: challenges and opportunities

To review the possibilities of using the Internet and especially the World Wide Web (WWW) in nutrition education. A healthy existence is partly dependent on dietary behaviours. One way to promote health-promoting dietary habits is nutrition education. In the last decades several potentially important new channels for health communication and nutrition education have emerged, with the Internet and its WWW as the most striking example. The introduction and growth of the WWW has enabled swift and inexpensive distribution of nutrition education expertise and materials. Furthermore, the WWW has also been used for tailoring nutrition education to the personal characteristics of the user. Only few studies have investigated the effects of generic web-based nutrition education, while web-based computer-tailored nutrition education has been studied in randomised controlled trials, with promising but mixed results. Two important challenges for web-based nutrition education interventions are to realise sufficient exposure and to ensure sufficient source reliability and credibility. Next to the great opportunities, there are many challenges for web-based nutrition education. Some evidence for effects of web-based computer-tailored nutrition education has been reported, but more research is needed to obtain evidence for the effectiveness in real-life situations.

Needs and Preference Assessment for an In-Home Nutrition Education Program Using Social Marketing Theory

Nutrition education programs for elder caregivers (CG) and their elder care recipients (CR) are important in preventing malnutrition. Using Social Marketing Theory, this study assessed the needs and preferences for nutrition education in elder CGs and their CRs in Guilford County, NC. Thirty-two pairs of community-residing elder CGs/CRs and three focus groups (FGs) participated. Health and diet questionnaires were administered to all CGs/CRs during in-home interviews. CGs/CRs and FGs evaluated nutrition education materials. Questionnaires were analyzed using SPSS v9. Ethnograph v5.0 was used to code the interviews regarding the education materials. The CGs were middle age (58.9 years), overweight (BMI = 28.8) Caucasian women. The CRs were old (79.4 years), overweight (BMI = 26.0) Caucasian women. Identified malnutrition risk factors of CGs and CRs included inadequate fluid and dietary intake, polypharmacy, and chronic disease. Identified nutrition needs and education preferences of CGs/CRs were similar. Perceived nutrition education preferences of the FGs did not reflect the interests of the CGs/CRs. This information is being used to revise the education materials and develop an in-home nutrition education program for CGs and CRs in Guilford County, NC.

PREDICTED VERSUS ACTUAL NUTRIENT CONSUMPTION IN THE DIET OF UNIVERSITY STUDENTS

College students may not understand the nutrient content of their diet. The study objective was to assess students' knowledge regarding the amount of individual nutrients in their diet. Subjects consisted of nutrition and nonnutrition undergraduates and graduates. Students received information on the actual dietary standards for each nutrient. Students completed a twenty-four hour diet record and then predicted their intake of seventeen nutrients, based on dietary recommendations. Predicted intake was measured as a percentage of recommendations on a 0% to 200% linear scale using 10% intervals. Nutrition recommendations were compiled from the DRI's, RDA's, and the USDA Dietary Guidelines. The subjects' food records were analyzed using Nutritionist V (First DataBank 1998) and compared to predicted values. The results of the study found that college students do not correctly estimate the nutrient content of their diets. Subjects consumed significantly more (P<0.05) than predicted for protein, total fat, saturated fat, fiber, calcium, iron, sodium, phosphorus, vitamin A, vitamin C, thiamin, riboflavin, and niacin. Subjects consumed significantly less (P<0.05) than predicted for polyunsaturated fatty acid, potassium, and cholesterol. University foodservice operators can help educate students by listing the nutrient content of the food items they serve. Nutrition education materials must focus on teaching the nutrient content of specific foods in order for students to benefit from published nutrition recommendations. It may be more effective to educate college students in proper nutrition by utilizing food groups rather than teaching about individual nutrients.

Demonstrating the Impact of Nutrition Intervention in a Heart Failure Program

Outpatient heart failure centers using a multidisciplinary approach to management of heart failure are recognized as essential to decreasing costs of treating heart failure. These centers do not typically employ registered dietitians. With hospital foundation funding, our objective was to develop the role of the dietitian and to evaluate the impact of nutrition intervention in a multidisciplinary heart failure program. Based on a needs assessment, the dietitian developed and tested a medical nutrition therapy protocol, education materials, and special education projects. Unannounced 24-hour recalls at 3 points in time were used to determine changes in sodium and fluid intakes. An outcome tracking system was implemented. Intake data were analyzed for patients who were in the program 9 or more months (n=79). Patients’ sodium and fluid intakes at 2 to 3 months and 6 to 9 months were compared with their baseline intakes using paired t test. The sodium decrease of 0.5g at 2 to 3 months and 6 to 9 months and the fluid decrease of 15oz at 2 to 3 months and 12 oz at 6 to 9 months were all highly significant (P<.001). Patients active in year 3 (n=82) completed the Minnesota Quality of Life Questionnaire. Compared with baseline, quality of life scores improved by 6.7 points (P<.003) at 3 months and by 5.9 points (P<.04) at 6 months. Of 83 patients hospitalized over 3 years, 6 hospitalizations were the result of an excessive sodium intake. At the completion of the project, the center provided funding for the dietitian to become a permanent team member. These positive findings indicate dietitians should seek involvement in heart failure centers. J Am Diet Assoc. 2002;102:1790-1794.

Effectiveness of tailored and non‐tailored educational materials to promote nutrition label reading

A randomized field trial compared the effectiveness of three types of printed educational materials designed to increase nutrition label reading. Adult primary care patients (n=915) from four health centers in Missouri were recruited from the lobby while waiting to see a doctor. Participants completed a baseline assessment and were randomly assigned to one of three intervention groups or to a control group. A three‐month follow‐up questionnaire was mailed to participants’ homes. Printed materials were either tailored and personalized, general and personalized, or general and non‐personalized. Main outcome measures were patients’ recall and ratings of the nutrition education materials, and self‐reported use of nutrition labels. Chi‐square analyses compared rates of recall and ratings of the materials across the four study groups. Multiple logistic regression was used to identify group differences on each outcome. Results and conclusions are discussed.

Are general nutrition messages understood by the general public?

In the preceding study, the authors conclude, “cognitive interview techniques can be used to improve surveys and messages designed for lower-income populations, for whom standard nutrition communications may have limited effectiveness.” According to Susan Algert, PhD, RD, these techniques “are particularly effective tools in the development of nutrition education and research materials because they are client or respondent-centered. This method provides us with a tool for addressing potential research biases and assumptions related to how dietary messages are communicated. Dietitians would benefit from knowledge of [these] techniques as a method to target or personalize nutrition messages.”

Culturally Relevant Nutrition Education Improves Dietary Quality Among WIC-Eligible Vietnamese Immigrants

Objective To provide culturally appropriate nutrition education to improve the diets of Vietnamese women. Design A total of 152 homemakers were recruited to participate in a nutrition education project, with 76 receiving the intervention and 76 serving as the control group. Subjects/Setting Non–English-speaking women eligible for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) with incomes below 185% of the poverty level living in 5 California counties. Intervention Bicultural, bilingual Vietnamese-American nutrition education assistants taught 5 to 7 lessons in the Vietnamese language using nutrition education materials written in the Vietnamese language by 2 bilingual, bicultural nutritionists. Main Outcome Measures Twenty-four-hour food recalls were obtained before and after the 8-week interval on the treatment and control groups. Statistical Analysis To examine if there were changes over time in nutrient intake and nutrient density within groups, matched pair t tests were done. Analysis of covariance techniques determined differences between groups. McNemar tests determined if, within groups, there were changes over time in food groups consumed. Chi-square techniques determined changes between groups. Results Over time, the number of treatment group participants who had at least one serving from each food group ( P < .01), and who had the recommended number of servings from each food group ( P < .05), significantly increased in comparison to the control group. Over time, the dietary nutrient density of calcium, riboflavin, and vitamin B 6 ( P < .05), as well as potassium ( P < .01), of treatment group participants significantly improved in comparison to the control group. Implications With training, bilingual, bicultural women can effectively deliver culturally relevant nutrition education to their peers.

Editorial

Editorial

Nutrition Education Materials from the National Institutes of Health: Development, Review, and Availability

Many of the institutes, centers, and offices (ICOs) within the National Institutes of Health (NIH) develop and disseminate nutrition education materials for the general public. These materials provide information about the relationship of diet to health and about associations between diet and specific diseases. The materials, which are drafted by the NIH or contract science writers, go through pretesting (for literacy level and appropriateness for target audiences) and ICO clearance (for scientific accuracy). To further ensure scientific and technical accuracy and consistency with the Dietary Guidelines for Americans, the materials then go through a two-tiered governmental review system. The first review is through the Nutrition Education Subcommittee (NES) of the NIH Nutrition Coordinating Committee. The second review, which is required for federal nutrition education materials, is conducted jointly by the Department of Health and Human Services (DHHS) Nutrition Policy Board Committee on Dietary Guidance and by the US Department of Agriculture (USDA) Dietary Guidance Working Group. The review process helps ensure consistency in nutrition messages within the NIH ICOs and among government agencies. The pretesting, ICO clearance, NES review, and joint DHHS/USDA review result in materials for nutrition educators that are high in quality, low in cost or free, easily accessible, appropriate for the intended target audience, and consistent with the Dietary Guidelines for Americans.

Nutrition for older adults' health: A web-basedresource of nutrition education materials for elderly nutrition programs

Nutrition for older adults' health: A web-basedresource of nutrition education materials for elderly nutrition programs