School-based Nutrition Education Intervention Research Articles

Gamification in nutrition education: the impact and the acceptance of digital game-based intervention for improving nutritional habits

AbstractAs school-based nutrition education interventions have become increasingly popular in recent years, they have proven effective in raising children awareness and responsibility toward good eating habits as well as improving their knowledge, skills, and attitudes. The aim of this work is to evaluate whether a gamification approach, using a digital application developed in AdobeXD, could be an appropriate strategy for increasing attention span toward nutrition education messages when compared to a classical didactic approach. The study involved 126 children aged 7 to 8 years, divided into control group (lesson with nutrition expert supported by slides) and intervention group (interactive lesson via application). A questionnaire was then administered to all participants to assess the knowledge they gained regarding basic nutrition education concepts. An additional questionnaire was distributed to the intervention group for the prototype digital evaluation based on the Technology Acceptance Model (TAM) framework. The results show that the digital application has the potential to be an effective tool for producing significant improvements in nutrition knowledge. The greater rating on the usefulness of the content, rather than on other intrinsic features of the prototype, demonstrates that the use of a digital approach can play a key role in capturing new concepts of nutrition education.

Feasibility and impact of school-based nutrition education interventions on the diets of adolescent girls in Ethiopia: a non-masked, cluster-randomised, controlled trial.

Adolescence is a critical period of physical and psychological development, especially for girls, because poor nutrition can affect their wellbeing as well as that of their children. We aimed to assess the feasibility and impact of a package of nutrition education interventions delivered through public primary schools on the diets of adolescent girls in Ethiopia. In this non-masked, cluster-randomised, controlled trial, primary schools (clusters) in the Southern Nations, Nationalities, and People's Region and Somali region of Ethiopia were randomly allocated to the intervention group (nutrition information provided during flag ceremonies, classroom lessons, school club meetings, peer group mentoring, BMI measurement and counselling, and parent-teacher meetings) or the control group (standard academic curriculum on health and nutrition) by use of computer-generated pseudo-random numbers. Duration of the school-based interventions was 4 months, and the key messages were related to dietary diversity (eating a variety of foods), energy adequacy (eating breakfast and healthy snacks), and healthy food choices (avoiding junk foods). Adolescent girls were eligible for participation if aged 10-14 years and enrolled in grades 4-8 in a study school. Data were collected with two independent cross-sectional surveys: baseline before the start of implementation and endline 1·5 years later. The primary outcome of impact was dietary diversity score, defined as the number of food groups (out of ten) consumed over the previous 24 h using a list-based method, and minimum dietary diversity, defined as the proportion of girls who consumed foods from at least five of the ten food groups, in the intention-to-treat population. We also assessed intervention exposure as a measure of feasibility. We estimated intervention effects using linear regression models for mean differences at endline, with SEs clustered at the school level, and controlled for adolescent age, region, household food security, and wealth. The trial is registered with ClinicalTrials.Gov, NCT04121559, and is complete. 27 primary schools were randomly allocated to the intervention group and 27 to the control group. Between March 22 and April 29, 2021, 536 adolescent girls participated in the endline survey (270 in the intervention group and 266 in the control group), with median age of 13·3 years (IQR 12·1-14·0). At endline, the dietary diversity score was 5·37 (SD 1·66) food groups in the intervention group and 3·98 (1·43) food groups in the control group (adjusted mean difference 1·33, 95% CI 0·90-1·75, p<0·0001). Increased minimum dietary diversity was also associated with the intervention (182 [67%] of 270 in the intervention group vs 76 [29%] of 266 in the control group; adjusted odds ratio 5·37 [95% CI 3·04-9·50], p<0·0001). 256 (95%) of 270 adolescent girls in the intervention group were exposed to at least one of the five in-school intervention components. Integrating nutrition interventions into primary schools in Ethiopia was feasible and increased dietary diversity incrementally among adolescent girls, but could be limited in changing other food choice behaviours, such as junk food consumption, based on nutrition education alone. Bill & Melinda Gates Foundation.

The Effects of a Multi-Component School-Based Nutrition Education Intervention on Children's Determinants of Fruit and Vegetable Intake.

Evidence suggests that multi-component school-based health-promoting interventions have great potential to improve children’s fruit and vegetable intake. However, interventions that combine classroom-based curricula with experiential learning strategies (e.g., cooking) are relatively seldom described. This study investigates the short-term and longer-term effects of a multi-component school-based nutrition education intervention combining classroom-based and experiential learning strategies on children’s determinants of their fruit and vegetable intake (knowledge, taste preferences, attitudes, and intention). Using a comparative quasi-experimental study design, data were collected, via child-reported questionnaires, at the baseline, directly after the intervention, and three months after the intervention from 4 control and 15 intervention classes from Dutch primary schools. A total of 192 children in grades three and four (aged 8–10 years) constituted the participants. After correction for the baseline, sex, age, and the fruit or vegetable product assessed in the questionnaire; the intervention group showed a significant increase in knowledge (p = 0.001; standardized effect size (ES = 0.60), taste preference (p = 0.002; ES = 0.52), attitude towards the assessed fruit or vegetable product (p = 0.004; ES = 0.48), and general attitude towards healthy products (p = 0.01; ES = 0.39) over the short term, when compared to the control group. The effects of the intervention did not continue to be significant over the longer term. The findings implicate short-term intervention success, although more research and intervention adaptations are recommended to increase the impact of such programs, especially over the long term.

Designing a Scalable Nutrition Education Package to Improve Diets of Adolescent Girls Through Primary Schools in Ethiopia

ObjectivesImproving adolescent girls’ nutrition is a high priority for the government of Ethiopia due to its immediate benefits for girls’ education and foundational role in protecting the productive and reproductive lives of women. Alive and Thrive (A&T) aimed to develop and implement an effective nutrition education package for scaling up by government education and health authorities. MethodsWe applied the socio-ecological model of social behavior change to systematically develop and test contextualized nutrition interventions in Southern Nations, Nationalities, and Peoples’ (agrarian) and Somali (pastoralist) regions. Using multiple sources of data and information we identified gaps in dietary practices, barriers, motivations; influential persons; and channels of communication for reaching adolescent girls in primary schools and influential persons, at high coverage and with frequent contacts. Region specific interventions, protocols, tools, and materials were field tested and tailored to fit the contact points and capacity of schools. ResultsThree dietary practices were selected based on evidence of gaps and potential benefits, 1) dietary diversity through promotion of locally available foods and food groups missing from adolescent girls’ diets by region, 2) frequency of meals and 3) reducing the consumption of unhealthy foods. Teachers, parents and peers were found to have the greatest influence on adolescent girls’ dietary practices. Community leaders (including religious leaders in Somali) and health extension workers were influential among parents, and school principals and supervisors were important for motivating teachers. ConclusionsSystematically targeting priority behaviors, engaging key influential persons, achieving high coverage and frequency through existing multiple contact points, and utilizing communication channels available through in-classroom and other activities were critical for developing a feasible and scalable package of school-based nutrition education interventions. Using data to design interventions and streamline implementation strategies facilitated the scale up of an effective intervention package for schools. Funding SourcesBill & Melinda Gates Foundation, through A&T, managed by FHI Solutions.

Using predicted marginal effects to assess the impact of rurality and free and reduced lunch eligibility on a school-based nutrition intervention

PurposeTo estimate the impact of a school-based nutrition education intervention in rural schools and schools with high free and reduced lunch (FRL) eligibility rates. MethodsAs part of the evaluation of the Healthy Schools Healthy Students intervention, 20 schools were randomized to control and intervention conditions. Pre (October 2017) and posttest (April 2018) data were analyzed using multi-level linear regression models to estimate the intervention effect for multiple outcomes controlling for school-level demographic characteristics. We report the predicted marginal effect overall and specifically for rural; high FRL; and rural, high-FRL schools. ResultsWe observed at least one significant intervention effect for food group knowledge, liking to eat fruit, beliefs about how healthy fruits are, non-taste test fruit preferences, liking to eat vegetables, beliefs about how healthy vegetables are, and taste test vegetable preferences. We observed differential intervention effects for all outcomes except taste test vegetable preferences based on rural and high-FRL status. ConclusionsInterventions do not necessarily have the same impact on all participants. Sub-analyses can reveal these important differential effects, as they have important implications for policymakers, program implementers, and evaluators. Resources and interventions should be allocated where they will have the greatest impact.

Food Numeracy: Definition and Application Across the Australian Secondary School Curriculum

Introduction: The poor dietary intake among adolescents and the consequential health, economic and environmental concerns associated with poor intakes have been established in the literature. This calls for strengthening of school-based food and nutrition education interventions as recommended in the Australian National Action Plan for the Health of Children and Young People (2020-2030). One researched intervention, by the authors, is the integration of food literacy and food numeracy (FL&amp;FN) across Australian secondary school curriculum. Aim: Food numeracy is a newly introduced term by the authors; this paper provides its substantiated definition, key elements, and an example pedagogy as an approach for integration and application across the curriculum. Methods: Methodologically, a review of scholarly peer-reviewed and grey litearture, and thematic analysis of all secondary school curriculum documents (years 7-10) have been conducted. Results: Food numeracy is defined as the ability to use mathematical skills effectively to partake of daily requirements and be aware of its value from farm to fork. Additionally, two food numeracy key elements of food production and food consumption with several sub-elements with their corresponding curriculum descriptors have been deduced from the curriculum documents. Finally, practical application and integration of food numeracy across all subjects has been demonstrated using deduced food numeracy and relevant numeracy elements from the Australian curriculum. Conclusion/future implication: It is anticipated that integration of food numeracy across the curriculum can strengthen adolescents’ knowledge and skills in both food and nutrition, and numeracy which has a direct correlation with enhanced health status. Introduction and application of food numeracy aligns with contemporary teaching practices which aim to inspire students to use analytical thinking to solve food-related problems and become conscientious global citizens.

Integration of Food Literacy and Food Numeracy Across Australian Secondary Schools’ Curriculum: Teachers’ Opinions in a Mixed Method Study

Objective: This article reports the findings from a convergent parallel mixed method study, aiming to ascertain the opinions of New South Wales (Australia) government secondary school teachers on integration of food literacy and food numeracy (FL&amp;FN) across secondary school curriculum. Methods: Participants were invited to take part in an anonymous survey and a semi-structured interview [n (email invitations) =401 schools, duration of study=17 weeks]. Their opinions were sought on the integration of FL&amp;FN within their own subject, in all subjects, in whole school programs and as an additional cross-curriculum priority. The collected qualitative and quantitative data were analysed separately, using analytic software programs, and discussed together. Results: Participants in quantitative and qualitative components [n (surveys received) =200, (valid surveys) =118, n (interviews conducted) =14] reported higher feasibility rates in lower secondary grades and stated several barriers and enablers for this integrative pedagogy. Conclusion: If FL&amp;FN is to become an integral part of secondary school curriculum, a collaborative approach by secondary and tertiary education sectors is required to address two main barriers i.e., provision of teacher training and teaching resources. Implications for public education: The reported poor dietary intake among Australian adolescents and its impact on public health, cognitive development, economy, and environment requires further strengthening of school-based food and nutrition education interventions such as the proposed integration of FL&amp;FN across secondary school curriculum. This study provides an initial insight into the feasibility of this proposal.

School-based nutrition education improves breakfast-related personal influences and behavior of Indonesian adolescents: a cluster randomized controlled study.

BACKGROUND/OBJECTIVESMany adolescents in developing countries skip breakfast. Innovative nutrition education (NE) strategies are needed to enhance knowledge and skills related to the breakfasts of adolescents in a low socioeconomic setting. The objective was to evaluate short- and long-term effects of a multi-strategy, school-based NE intervention on adolescents' breakfast-related personal influences and behaviors.SUBJECTS/METHODSAn intervention study with a cluster randomized controlled trial design was conducted in 4 senior high schools in Makassar, Indonesia. The multi-strategy NE intervention was delivered for 3 months. Data were collected using a self-administered questionnaire and a 3-day breakfast recall (face-to-face interview). Wilcoxon, McNemar, and Mann-Whitney tests were used to determine intra- and intergroup differences.RESULTSUnlike knowledge, improvement was observed in attitude and self-efficacy scores in the intervention groups (IGs) (P < 0.01); however, no significant changes were observed in the control group (CG). More students showed improved motivation in the IG than in the CG (P > 0.05). Changes in breakfast frequency and macronutrient intake from breakfast were greater in the IG than in the CG (P < 0.05).CONCLUSIONSA multi-strategy NE intervention is effective in producing positive changes in breakfast-related attitude, self-efficacy, and motivation of adolescents from a low-middle socioeconomic setting. The intervention improved breakfast frequency and nutrient intake. This intervention has promise for sustaining the observed changes over the long-term.

Socio-ecological Factors Associated with Snacking Behaviors of Basic School Students in Nepal

Consumption of unhealthy snack foods among young children in low-and-middle-income countries is high and Nepal is no exception. A quantitative cross-sectional study was conducted among 259 students to investigate their snacking behaviors and examine factors that influence the behavior from a socio-ecological Framework. The study used self-reported questionnaires, food recall diaries, and participant observation forms to collect data. Students' snacking behavior was the dependent variable where as age, sex, grade, parent's education, parent's sources of income, religion, ethnicity, family type, and living arrangements were the independent variables. Chi-square test and logistic regression were applied to analyze the results. The main findings of the study indicate that 89 percent of students consumed school snacks regularly, including unhealthy snacks, which were either commercially prepared junk foods bought from nearby vending shops and grocery stores or deep-oil-fried snacks food prepared at the school canteen. Bivariate analysis shows that age, grade, father's education, and the student's religion were significantly associated with snacking behaviors of students. The multivariate analysis indicates that grade (aOR= 0.259, P &lt; .05) and religion (aOR= 0.373, P &lt; .05) were the significant predictors. The snacking behaviors among basic level students are influenced by multilevel factors, which is consistent with the socio-ecological model. The study's findings further suggest that comprehensive and effective school-based nutrition education interventions are necessary to promote healthy snack consumption behaviors of students.

Long-term impact of a school-based nutrition intervention on home nutrition environment and family fruit and vegetable intake: A two-year follow-up study.

Long-term data on maintenance of intervention effects of health promotion programs targeting fruit and vegetable (F&V) intake in children is lacking. We conducted a two-year follow-up of Brighter Bites, a school-based nutrition education and food co-op intervention found to be effective in increasing child intake of F&V. A one-group, pre-post evaluation design was used to assess the two-year post intervention impact of the program on child and parent dietary intake and home nutrition environment. In 2016–2017 school year, we conducted a follow up of 262 parent-child dyads who had previously participated in Brighter Bites in a 2013–2015 evaluation study in six low-income Texas elementary schools. Child dietary intake was measured using a parent-reported food frequency questionnaire, and surveys measured parent F&V intake, and home nutrition environment. Results of a multi-level regression analysis showed that, two years post-intervention, as compared to baseline, there was a significant increase in child intake of fruit, vegetable, and fiber, and significant decreases in total fat intake and percent daily calories from sugary beverages (p < 0.05). Parent dietary data showed significant increases in fruit intake, and intake of F&V combined (p < 0.05). Changes in home nutrition environment included: increased frequency of cooking behaviors, increased usage of nutrition facts labels in making grocery purchasing decisions, and increased food availability of F&V (p < 0.05). This study demonstrates potential long-term sustained impact of a comprehensive school-based intervention among low-income children and their families.

Primary school-based nutrition education intervention on nutrition knowledge, attitude and practices among school-age children in Ghana.

This study was performed to evaluate the effect of a six-week nutrition education intervention on the nutrition knowledge, attitude, practices, and nutrition status of school-age children (aged 6-12 years) in basic schools in Ghana. Short-term effects of nutrition education training sessions on teachers and caregivers were also assessed. Pre-post controlled design was used to evaluate the program. Intervention groups had significantly higher nutrition knowledge scores (8.8 ± 2.0 vs. 5.9 ± 2.1, P < 0.0001) compared to controls in the lower primary level. A higher proportion of children in the intervention group strongly agreed they enjoyed learning about food and nutrition issues compared to the control group (88% vs. 77%, P = 0.031). There was no significant difference in dietary diversity scores (4.8 ± 2.0 vs. 5.1 ± 1.4, P = 0.184) or in measured anthropometric indices (3.6% vs. 8.2%, P = 0.08). A marginally lower proportion of stunted schoolchildren was observed among the intervention group compared to the control group (3.6% vs. 8.2%, P = 0.080). Nutrition knowledge of teachers and caregivers significantly improved (12.5 ± 1.87 vs. 9.2 ± 2.1; P = 0.031) and (5.86 ± 0.73 to 6.24 ± 1.02, P = 0.009), respectively. Nutrition education intervention could have positive impacts on knowledge and attitudes of school children, and may be crucial in the development of healthy behaviors for improved nutrition status.

Effects of a nutrition education intervention on fruit and vegetable consumption-related dietary behavioural factors among elementary school children

Objective: To increase nutrition knowledge, fruit and vegetable preference, eating and cooking self-efficacy among 3rd- to 5th-grade students after a 6-week school-based nutrition education intervention. Design: Quasi-experimental pre–post design. Setting: Title I elementary schools, South Plains, West Texas. Method: A nutrition education curriculum informed by social cognitive theory was developed and implemented in four Title I elementary schools. A total of 115 children from 3rd to 5th grade (age range: 8–11 years) participated and completed both baseline and post-intervention surveys. The intervention included class-based nutrition education for 25 minutes, and a cooking and tasting session for 20 minutes each week. Nutrition handouts on fruit and vegetable were sent to parents. Face-to-face survey questionnaires were administered on nutrition knowledge, fruit and vegetable preference, fruit and vegetable eating and cooking self-efficacy during pre- and post-surveys. Changes in mean score of nutrition knowledge, fruit and vegetable preference, fruit and vegetable eating and cooking self-efficacy were analysed using paired t-tests. Results: Participants showed significant improvements in nutrition knowledge, fruit and vegetable preference, eating and cooking self-efficacy after the intervention. Conclusion: Study results suggest that a brief 6-week multi-component and school-based nutrition education intervention had the potential to engage students and create health-promoting behaviours.

Design and Implementation of a 5-Year School-Based Nutrition Education Intervention

ObjectiveTo describe the research methods of a multicomponent nutrition education program empowering teachers to improve nutrition literacy and prevent obesity among elementary school students. DesignProspective 5-year study following a pre-post intervention design. SettingFour elementary schools in a high-needs area in Washington, DC: 2 intervention and 2 comparison schools. ParticipantsApproximately 100 teachers (25/school) and 800 students (200/school) enrolled over the study period. InterventionHealthy Schoolhouse 2.0 will engage teachers as agents of change by designing, implementing, and evaluating a structured professional development program to support the integration of nutrition concepts in the classroom. Main Outcome MeasuresChange in pre-post survey assessment of students’ nutrition literacy, attitudes, and intent; change in teachers’ self-efficacy toward teaching nutrition; fruit and vegetable consumption data collected 6 times/y in the cafeteria. AnalysisProcess evaluation throughout the study to document implementation and challenges. Multilevel mixed modeling will be used to determine the impact of the intervention.

Improving the Metabolic and Mental Health of Children with Obesity: A School-Based Nutrition Education and Physical Activity Intervention in Wuhan, China.

This study aimed to evaluate the effectiveness of a school-based nutrition education and physical activity intervention on cardiovascular risk profile and mental health outcomes among Chinese children with obesity. Two primary schools were randomly allocated to the control group (CG) and the intervention group (IG). We selected children with obesity from 1340 students in the third and fourth grades as participants. The IG received 8 months of nutrition education and physical activity intervention, while the CG was waitlisted. A generalized estimating equation model was applied to assess repeated variables over time. A total of 171 children with obesity (99 IG and 72 CG) aged 9.8 ± 0.7 years completed the post-intervention stage. Compared with baseline, significant reductions were observed within the IG for depression and fasting plasma glucose at post-intervention. After adjusting for confounders, group and time interaction effects showed that the IG achieved improvements in the risk of poor well-being (p = 0.051) and social anxiety (p = 0.029), had decreased diastolic blood pressure (p = 0.020) and fasting plasma glucose (p < 0.001), and had significantly increased high-density lipoprotein (p < 0.001) from baseline to post-intervention relative to the CG. The effects of school-based nutrition education and physical activity intervention on children with obesity are diverse, including not only the improvement of metabolic health but also mental health promotion.

FP5 Lessons Learned From the Healthy Schools Healthy Students Project: Strategies to Improve Future Team Nutrition Interventions

Objective To determine the success and challenges encountered when implementing the Healthy Schools, Healthy Students (HSHS) intervention. Description HSHS was a multi-component nutrition intervention targeting 4th grade students focused on improving nutrition knowledge, MyPlate awareness, and fruit and vegetable attitudes and preferences. The project included classroom-based nutrition education, cafeteria coaching with older students, and taste tests with 606 students in 10 schools. Evaluation As part of a larger mixed methods evaluation, we conducted in-depth interviews with project stakeholders and nutrition educators, along with focus groups of cafeteria coaches. We also visited schools to conduct fidelity checks. These data collections sought to determine what worked, what did not work, and what recommendations participants would have for future interventions. While all participants described the project as successful and did not state major implementation challenges, they described ways the intervention could have been improved. Project stakeholders stated that more communication and technical assistance, particularly before the project, would have been helpful. Nutrition educators stated that the lessons had too much content for the allotted time and that some activities (i.e. sing-along songs) were not age appropriate. Cafeteria coaches requested more training and technical assistance. Nutrition lessons were generally implemented as planned, but often did not include all activities, as discussed in the interviews. All schools implemented at least one of the strategies required for the cafeteria coaching component, but differences made comparisons between schools difficult. Conclusions and Implications The process evaluation of the HSHS intervention provides future Team Nutrition grantees and others working to improve school-based interventions with important factors to consider when planning and implementing school-based nutrition education interventions.

The Short- and Long-term Effectiveness of the WhyDairy? School-based Nutrition Education Intervention: A Randomized Controlled Trial

Background:Despite the known health benefits of dairy products, their daily consumption continues to decline in many populations, particularly in pre-adolescents and adolescents.Objective:The primary objective of the cluster randomized controlled trial was to assess whether a school-based intervention enhanced with a web-based component, known as WhyDairy? was more effective than a standardized dairy education program at changing: (i) knowledge of dairy products, (ii) intentions to consume dairy products, and (iii) dietary intake of dairy products.Methods:Grade 7 students (n=175) in 10 Southwestern Ontario schools were randomized by the school, into intervention or control. Intervention schools received the WhyDairy? intervention with a website component while control schools received a DFO education program. Intervention schools were further randomized to receive follow-up contact, through monthly emails, or no follow-up contact. A questionnaire, consisting of three surveys (knowledge, FFQ, and intention), was delivered at baseline, post-intervention, and follow-up.Results:All groups significantly increased their knowledge post-intervention but only intervention schools with follow-up email contact maintained this positive change in knowledge. No groups saw significant changes in dietary behaviour. The email campaign was successful in reaching parents but did not result in high engagement or changes in student outcomes.Conclusion:The results of this study demonstrate the effectiveness of a school-based intervention enhanced with a web-based component in changing student knowledge regarding dairy products and the engagement of the website during the intervention period. Future work should consider longer durations to see changes in dietary behaviour and more targeted approaches during follow-up periods.

Characterization of Website use Associated with the WhyDairy? School-based Nutrition Education Intervention

Background: Despite the known health benefits of dairy products, their daily consumption continues to decline, particularly in pre-adolescents and adolescents. It is therefore of interest to develop effective strategies to increase dairy intake and education in this population. Objective: The objective of this study was to evaluate the use of the web-based component of a school-based dairy nutrition intervention called WhyDairy?. Through analysis of popular website content, traversal paths and timing of website access, we aimed to investigate how students used this website and to identify areas of improvement for future research. Method: Grade 7 students (n=115) in 10 Southwestern Ontario schools received the WhyDairy? intervention, which included three classroom visits and a website that could be voluntarily accessed. Website use data was collected using Google Analytics. The intervention delivered to control schools did not have a website component and is therefore not described in this report. Results: The website was voluntarily accessed by 33.6% of students participating in the intervention. Almost 70% of website visits occurred within two days following a classroom visit. Popular content included games and interactive pages. While there was moderate engagement with the website during the intervention period, there was poor engagement during the follow-up period. Conclusion: The utilization of the WhyDairy? website represents students’ interest in independently furthering their knowledge and student engagement with a web-based component of a dairy nutrition intervention. Future work should investigate students’ motivations for accessing the website and how to encourage prolonged website use.

School-Based Nutrition Education Intervention Using Social Cognitive Theory for Overweight and Obese Iranian Adolescent Girls: A Cluster Randomized Controlled Trial.

Background Nowadays childhood obesity has become one the most challenging issue which is considered as a principle public health problem all around the world. This study was conducted with the aim of evaluating the impact of a 7-month school-based nutrition education intervention using social cognitive theory (SCT) to prevent obesity among overweight and obese adolescent girls. Method In this cluster randomized community trial after choosing schools, a total of 172 overweight and obese girl students participated in the study (87 in the intervention and 85 in the control group). A 7-month intervention based on SCT for students, their parents, and teachers was conducted. At baseline and end of the study, body mass index (BMI), waist circumstances (WCs), dietary intake, and psychological questionnaires regarding the SCT constructs were obtained. Results After 7 months, the mean of BMI and WCs reduced in the intervention group from 29.47 (4.05) to 28.5 (4.35) and from 89.65 (8.15) to 86.54 (9.76), respectively, but in comparison to the control group, they were not statistically significant ( p values .127 and .504, respectively). In the intervention group, nutritional behaviors and most of the psychological variables (self-efficacy, social support, intention, and situation) were improved in favor of the study and they were significant in comparison to the control group ( p < .05). Conclusion Although school-based nutrition education intervention using SCT did not change significantly BMI and WCs among the targeted population in this study, dietary habits as well as psychological factors improved significantly in the intervention group. This trial was registered in Iranian Registry of Clinical Trials, www.irct.ir (IRCT2013103115211N1).

School-Based Nutrition Education Intervention Improves Nutrition Knowledge and Lipid Profile among Overweight/Obese Children

Many children in Ghana do not meet the dietary and physical activity recommendations for their health due to several reasons including limited nutrition education intervention (NEI) programmes. NEI provides children with information on knowledge, attitudes and practices (KAPs) required to ensure proper dietary intake and physical activity. In this intervention study, we recruited eighty (80) overweight and obese students aged 11-15 years from two schools in the Ga-East municipality of Ghana. Anthropometric, biochemical, dietary and physical activity information were collected on the two groups before and after three months of NEI. Between group comparisons (test and control); before and after interventions were performed using student t-tests. It was shown that NEI improved nutrition knowledge (mean change = 5.13, p&lt;0.01), attitude (mean change = 2.75, p&lt;0.01) but not practice (mean change = -1.42, p&lt;0.05) in overweight and obese children. Although anthropometric indicators did not improve with NEI, serum lipid profile of participants improved as indicated by the following mean changes: TC [-1.22, 95%CI (-1.90 -0.55)] mg/dL, HDL-c [-0.19, 95% CI (-0.38, 0.00)] mg/dL, LDL-c [-0.90, 95%CI (-1.52, -0.28)] mg/dL and TG [(-0.66, 95%CI (-1.23, -0.09)] mg/dL. Our findings show that NEI undertaken within a relatively short period of time could have positive effects on lipid profile, knowledge and attitudes of school children, and in turn, promote the fight against childhood obesity, and improve the health and wellbeing of children.

A Nutrition Education Intervention Trial for Adolescent Girls in Isfahan: Study Design and Protocol

BackgroundNutrition behaviors of adolescent girls is of serious health concerns. Although nutrition education interventions in Iran have met with some success, most of them could not promote nutrition behavioral changes. The aim of our study is to determine a school-based nutrition education intervention to improve adolescents’ nutrition behaviors and behavioral mediators based on the social cognitive theory (SCT).Materials and MethodsThis study is a single-blind randomized controlled trial. Eligible participants will be all student girls in grade 6 and 7, their parents and teachers in Isfahan governmental schools. This multi com‌ponent school-based intervention include adolescents’ nutrition education package, parents’ nutrition massages, participatory homework, parents and teachers nutrition education package, supportive group, and collaboration with decision makers. Changing in nutrition behaviors including breakfast, fruit and vegetable, snack and fast food consumption will be examined, as primary outcome. Secondary outcome will be behavioral mediators such as knowledge, self-efficacy, intention, situation, self-regulation, social support, outcome expectations and expectancies, in adolescent girls. The outcomes will be assessed at baseline, and after 3 and 6-month follow-up.DiscussionThis study evaluates a school-based, guided SCT intervention, designed to improve healthy dietary behaviors, nutrition knowledge of adolescent girls. Few behavioral interventions have targeted this high-risk population in Iran. The intervention seems to be promising and has the potential to bridge the gap of the limited program outcomes of nutrition education in Iranian adolescents.