Nutrition education, behavioral theories, and the scientific method: another viewpoint

Implementation and Evaluation of a School-Based Educational Program Targeting Healthy Diet and Exercise (DIEX) for Greek High School Students

The present study examined the effectiveness of a school-based health education program promoting healthy diet and exercise, named DIEX, implemented on adolescents. The program is based on the Theory of Planned Behavior (TPB) and is supported by life skills training. The recipients of the program were high school students (n = 367; 168 boys and 199 girls) from 14 schools in Greece who attended 10 1 h sessions implemented by their schoolteachers. Data were collected before and after the program implementation through online questionnaires for: a. attitude, intention, subjective norms, and PBC toward healthy eating; b. knowledge about healthy eating; c. exercise behavior and attitude toward the DIEX program; and d. satisfaction with the DIEX program (only post-program). The results showed that there were significant differences among the pre- and post-measures of students' knowledge and behavior about healthy diet, as well as attitudes and satisfaction toward the program's application. The results show that the DIEX program may have improved nutrition behavior variables. Conclusively, a theory-based behavioral intervention with skills training may result in positive behavioral changes for young students during health education in school settings with the assistance of new technologies.

Trends in the Number of Behavioural Theory-Based Healthy Eating Interventions Inclusive of Dietitians/Nutritionists in 2000-2020

Nutrition interventions developed using behaviour theory may be more effective than those without theoretical underpinnings. This study aimed to document the number of theory-based healthy eating interventions, the involvement of dietitians/nutritionists and the behaviour theories employed from 2000 to 2020. We conducted a review of publications related to healthy eating interventions that used behaviour change theories. Interventional studies published in English between 2000 and 2020 were retrieved from searching Medline, Cinahl, Embase, Psycinfo and Cochrane Central. Citation, country of origin, presence or absence of dietitian/nutritionist authors, participants, dietary behaviours, outcomes, theories and any behaviour change techniques (BCTs) stated were extracted. The publication trends on a yearly basis were recorded. A total of 266 articles were included. The number of theory-based interventions increased over the two decades. The number of studies conducted by dietitians/nutritionists increased, but since 2012, increases have been driven by other researchers. Social cognitive theory was the most used behaviour theory. Dietitians/nutritionists contributed to growth in publication of theory-based healthy eating interventions, but the proportion of researchers from other professions engaged in this field increased markedly. The reasons for this growth in publications from other professions is unknown but conjectured to result from greater prominence of dietary behaviours within the context of an obesity epidemic.

The Mediator and/or Moderator Role of Complexity of Knowledge about Healthy Eating and Self-Regulated Behavior on the Relation between Family's Income and Children's Obesity

Childhood obesity rates have been increasing over the years and is considered one of the most serious public health problems of the century. Low socioeconomic status has been associated with a higher body mass index. However, the pathways underlying this complex relationship are poorly understood. This study aimed to evaluate the possible mediation and/or moderation effects of complexity of knowledge about healthy eating, and self-regulation processes towards healthy eating, in the association between family's income and weight of elementary school age children. The results showed that complexity of knowledge does not mediate the relationship between socioeconomic status and weight. Still, whenever the levels of complexity of knowledge and self-regulation are high, there is a moderation effect of complexity of knowledge on the relationship between family's income and weight, conditioned by self-regulation scores. These promising findings support the idea that knowledge about healthy eating in isolation could be insufficient for practicing a healthy diet and underline the relevance of combining transmission of knowledge with training in specific competences (e.g., self-regulation strategies). Considering that complexity of knowledge about healthy eating and self-regulation strategies are interrelated and can be both improved, future preventive interventions could consider incorporating both in their design to mitigate childhood obesity.

"RIP KFC": Public Perceptions of a Fast-Food Restaurant Closure

This paper used netnography and thematic analysis of the comments made in online news articles to understand better the public response to the closure of the only KFC restaurant in Yellowknife, Northwest Territories, Canada, in 2015. While the popular media often cover fast-food restaurant closures, past academic research has not examined the public response to these closures. To begin to fill this gap, we examined the comments sections of five online news articles from the Canadian news outlet, CBC.ca, and reactions shared on Facebook. 239 commenters made 308 publicly available online comments addressing the closure. Key themes in commenter perceptions included pro-closure reactions, which were based on the perceived public health benefits of reduced fast-food consumption, and anti-closure reactions to such factors as the loss of a local landmark and a source of positive memories. The unfavorable reactions appeared to pose a significant barrier to public acceptance of the KFC closure. This paper argues that it is important to examine public perceptions of fast-food closures to understand better what these restaurants mean to individuals and communities. This information, in turn, can be used to promote healthier restaurant-eating in ways that will complement efforts to encourage healthier food choices.

Promoting healthy eating in primary health care from the perspective of health professionals: a qualitative comparative study in the context of South America

BACKGROUND

Educational interventions designed to promote healthy eating are essential in primary health care. Nevertheless, given the nutrition controversies about what is healthy, the contradictions created by the media, and the situation of users with complex needs, the prioritization of the themes to be addressed in the services has scarcely been described in the planning process. This study aimed to identify the process of implementing the themes discussed by health professionals in nutrition education groups in two primary health care models.

METHODS

Our study followed a qualitative comparative approach. It included the systematic observation of nutrition education group meetings to identify the key messages addressed and semi-structured interviews with health professionals in São Paulo, Brazil, and in Bogotá, Colombia. We used thematic networks to classify the messages and the collective subject discourse technique to organize the information obtained from interviews. We observed 28 nutrition education groups in São Paulo, and 13 in Bogotá, and conducted 27 interviews with nutritionists in each city.

RESULTS

The messages identified were grouped into four global themes: feeding habits, life cycle, disease, and "being a multiplier". The process of implementing the themes, understood as identification, selection, consultation, and application of themes, is intermediated by social representations of the health professionals about service requirements, training and professional performance, and the relationship with users. Two notions shape these representations: Control, although the time and the physical space dedicated to health services are restricted to the disease in São Paulo, in Bogotá only limited health promotion is provided; and specificity, which is portrayed as therapeutic support within a more educational model in São Paulo and as health promotion training courses within a prescriptive model in Bogotá.

CONCLUSIONS

Understanding the process of implementing the themes discussed in nutrition education groups can reveal mechanisms that support the approach to themes on healthy eating, including communicative and educational adaptations of health professionals. This study contributes to the discussion about educational models in health care and their effects on the qualifications of health professionals within the service, especially those included in the context of low- and middle-income settings.

Barriers to Eating Traditional Foods Vary by Age Group in Ecuador With Biodiversity Loss as a Key Issue

OBJECTIVE

To document the perceptions of indigenous peoples for the sustainable management of natural resources against malnutrition.

DESIGN

Initially 4 and then 12 interviews were conducted with 4 different age groups.

SETTING

Eight rural villages in Guasaganda, central Ecuador, were studied in 2011-2012.

PARTICIPANTS

A total of 75 people (22 children, 18 adolescents, 20 adults, and 15 elders).

MAIN OUTCOME MEASURES

Benefits, severity, susceptibility, barriers, cues to action, and self-efficacy of eating traditional foods.

ANALYSIS

Qualitative content analysis was completed using NVivo software. Initial analysis was inductive, followed by a content analysis directed by the Health Belief Model. Coding was completed independently by 2 researchers and kappa statistics (κ ≥ 0.65) were used to evaluate agreement.

RESULTS

Healthy perceptions toward traditional foods existed and differed by age. Local young people ate traditional foods for their health benefits and good taste; adults cultivated traditional foods that had an economic benefit. Traditional knowledge used for consumption and cultivation of traditional foods was present but needs to be disseminated.

CONCLUSIONS AND IMPLICATIONS

Nutrition education in schools is needed that supports traditional knowledge in younger groups and prevents dietary changes toward unhealthy eating. Increased production of traditional food is needed to address current economic realities.

The adaptive nature of implementation practice: case study of a school-based nutrition education intervention

OBJECTIVE

To describe how and why nutritionists implement and strategize particular program operations across school contexts.

DESIGN

Instrumental case study with empirical propositions from Actor-Network Theory (ANT). Data derived from interviews with interventionists and observations of their practices.

SETTING

Seven primary schools from disadvantaged Montreal neighborhoods.

PARTICIPANTS

Six nutritionists implementing the nutrition intervention in grades 4 and 5. From 133 nutrition workshops held in 2005/06, 31 workshops were observed with audio-recordings.

INTERVENTION(S)

Little Cooks--Parental Networks aims to promote healthy eating behaviors through engagement in food preparation and promotion of nutrition knowledge.

PHENOMENON OF INTEREST

The program-context interface where interventionists' practices form interactively within a given social context.

ANALYSIS

Coding inspired by ANT. Interview analysis involved construction of collective implementation strategies. Observations and audio-recordings were used to qualify and quantify nutritionists' practices against variations in implementation.

RESULTS

Nutritionists privileged intervention strategies according to particularities of the setting. Some such variation was accounted for by school-level social conditions, individual preferences and nutritionists' past experiences.

CONCLUSIONS AND IMPLICATIONS

Implementation practices are strategic and aim to engage educational actors to achieve intervention goals. These results challenge implementation frameworks centered on purely technical considerations that exclude the social and interpretive nature of practice.

Avaliação do conhecimento nutricional de atletas profissionais de atletismo e triathlon

A alimentação adequada é a chave para a melhora do desempenho esportivo. Com isso, um conhecimento nutricional satisfatório torna-se importante para as práticas alimentares saudáveis e, consequentemente, mais eficazes para o rendimento. O objetivo deste estudo foi avaliar o conhecimento nutricional de atletas profissionais de atletismo e triathlon. Foram avaliados 50 atletas com idade média de 32,4 ± 11,1 anos, sendo 37 (74%) do sexo masculino. Os atletas preencheram um questionário que continha informações sobre treinamento, consultas nutricionais e a escala de conhecimento nutricional validada. Para associar o conhecimento nutricional com as variáveis de escolaridade e consulta com nutricionista, foi utilizado o teste do Qui-quadrado, e para correlacionar as variáveis ordinais foram utilizadas a correlação de Pearson. Os atletas treinavam a 9,4 + oito anos, 82% possuíam nível superior incompleto ou completo e 70% já haviam consultado um profissional nutricionista. A média de pontos da escala foi de 9,6 ± 2,2 pontos, que corresponde à classificação de "moderado conhecimento nutricional", e não foi verificada diferença estatisticamente significativa entre o conhecimento nutricional e o sexo (p = 0,067). Ter frequentado ou não um curso superior não modificou o conhecimento nutricional destes atletas (p = 0,352), assim como consultar ou não o nutricionista (p = 0,362). Porém, quanto maior a escolaridade, maior foi o número de atletas que relataram o acompanhamento com o nutricionista. Estes resultados apontam para a necessidade de educação continuada em nutrição para atletas profissionais, bem como a necessidade de outros estudos avaliando o conhecimento nutricional neste público.

Psychometric properties of the healthful eating belief scales for persons at risk of diabetes

OBJECTIVE

To examine the validity and reliability of Theory of Planned Behavior (TPB) scales for healthful eating for persons at risk for diabetes.

DESIGN

Cross-sectional, using a self-administered questionnaire.

SETTING

Community in the Midwest.

PARTICIPANTS

106 adults who self-identified based on one or more American Diabetes Association diabetes risks.

VARIABLES MEASURED

Behavioral, normative, and control beliefs; and attitude, subjective norm, perceived behavioral control, and intention to eat a healthful diet.

ANALYSIS

Construct validity was assessed with factor analyses and measurement and structural models using structural equation modeling. Reliability of the scales was assessed with Cronbach alpha and a 2-month test-retest.

RESULTS

Factor analysis loadings were greater than .37. Cronbach alphas for the behavioral, normative, and control belief scales were .80, .91, and .84, respectively. The measurement model revealed that the measures were significant estimates for the TPB constructs, and they fit well as indirect measures of attitude, subjective norm, and perceived behavioral control in predicting intention to eat a healthful diet. Test-retest revealed 2-month stability of the scales.

CONCLUSIONS AND IMPLICATIONS

Scales for measuring TPB behavioral, normative, and control beliefs were valid and reliable for use with adults at risk for diabetes. Further examination with minority persons is warranted.