Tailored nutrition education: is it really effective?

Perceptions of Tailored Dietary Advice to Improve the Nutrient Adequacy of the Diet in French Pregnant Women

Tailored dietary counseling could be specifically efficient during pregnancy, a period accompanied by a rise in nutrition awareness, but little is known about the expectations of pregnant women in this regard. We studied these expectations regarding tailored dietary advice in French women during their pregnancy, as well as their motivations and the perceived barriers and enablers. In French pregnant women, we evaluated the perceptions of tailored dietary advice provided by stepwise dietary counseling based on three types of dietary changes, consisting of: (1) a modification of the amounts consumed, (2) substitutions within the food subgroups, and (3) substitutions between food subgroups. A sequential explanatory mixed-method approach was designed. Using qualitative data from a focus group study (n = 40), we intended to explore in depth the women’s expectations regarding dietary advice and adherence to a tailored approach. These were combined with quantitative and qualitative data from a 6-week online longitudinal study (n = 115), using questionnaires designed to assess the modifications of dietary habits during pregnancy and to evaluate each type of dietary change. Both studies confirmed that most women in our samples did indeed intend to institute changes regarding healthier dietary practices during pregnancy. The principal motivation behind changes to their habits was to ensure the health and well-being of both their babies and themselves. The proposal of dietary advice that is tailored to both the current diet and the specific needs of pregnant women, but that is also positive and credible, was perceived as enabling implementing healthier dietary practices during pregnancy. Regarding the implementation of the dietary changes proposed, the enablers and barriers identified differed between modifications of the amounts consumed and substitutions. The women displayed interest in all types of dietary changes. This gave relevance to combining different types of changes in order to propose dietary counseling during pregnancy. Tailored dietary counseling was identified by French pregnant women in our samples as enabling them to adopt a healthier diet. However, perceived barriers might limit the implementation of dietary changes, especially when they involved marked modifications to their usual diet.

Retail Nutrition Programs and Outcomes: An Evidence Analysis Center Scoping Review

As nutrition-related diseases contribute to rising health care costs, food retail settings are providing a unique opportunity for registered dietitian nutritionists (RDNs) to address the nutritional needs of consumers. Food as Medicine interventions play a role in preventing and/or managing many chronic conditions that drive health care costs. The objective of this scoping review was to identify and characterize literature examining Food as Medicine interventions within food retail settings and across consumer demographics. An electronic literature search of 8 databases identified 11,404 relevant articles. Results from the searches were screened against inclusion criteria, and intervention effectiveness was assessed for the following outcomes: improvement in health outcomes and cost-effectiveness. One-hundred and eighty-six papers and 25 systematic reviews met inclusion criteria. Five categories surfaced as single interventions: prescription programs, incentive programs, medically tailored nutrition, path-to-purchase marketing, and personalized nutrition education. Multiple combinations of intervention categories, reporting of health outcomes (nutritional quality of shopping purchases, eating habits, biometric measures), and cost-effectiveness (store sales, health care dollar savings) also emerged. The intervention categories that produced both improved health outcomes and cost-effectiveness included a combination of incentive programs, personalized nutrition education, and path-to-purchase marketing. Food as Medicine interventions in the food retail setting can aid consumers in navigating health through diet and nutrition by encompassing the following strategic focus areas: promotion of health and well-being, managing chronic disease, and improving food security. Food retailers should consider the target population and desired focus areas and should engage registered dietitian nutritionists when developing Food as Medicine interventions.

The mix of good nutritional attitude and poor nutritional knowledge is associated with adequate intake of vitamin A and iron from wild fruits and vegetables among rural households in Acholi subregion of Northern Uganda

Nutritional knowledge and attitude of a population greatly affect intake of essential micronutrients. Much of the understanding on the impact of nutritional knowledge and attitude on nutrient intake has been derived from studies conducted among affluent societies using commercial food products. However, information on the link between status of nutritional knowledge and attitude on intake of essential nutrients from wild fruits and vegetables among rural communities is largely lacking. This study examined the status of nutritional knowledge and attitude associated with intake of vitamin A and iron from wild fruits and vegetables among rural households in Acholi subregion of northern Uganda. A cross-sectional study design making use of individual household questionnaire and proximate dietary recall of a calendar year consumption period involving 248 randomly selected rural households was applied. Results showed that households had good nutritional attitude but poor nutritional knowledge. Status of knowledge was dependent on nutrition training (p = 0.028; coefficient, β = 0.710) and age of the respondent (p = 0.044; β = -0.023), whereas status of attitude was predicted by age of the respondent (p = 0.014; β = 0.048). Consumption of wild fruits and vegetables contributed adequately to the dietary vitamin A and iron requirements of the households. The results have demonstrated that intake of vitamin A and iron from wild fruits and vegetables among rural households is associated with good nutritional attitude but poor nutritional knowledge. A concerted effort is necessary to improve household nutritional knowledge for better utilization of wild fruits and vegetables.

Whetting disadvantaged adults' appetite for nutrition education

OBJECTIVE

To identify the features of a nutrition education programme for disadvantaged adults deemed most attractive and useful by participants.

DESIGN

A two-year, multi-method, qualitative evaluation of pre and post data collected from programme participants. Data were imported into NVivo10 for coding to facilitate a thematic analysis.

SETTING

Western Australia. Participants Individuals attending the Western Australian FOODcents nutrition education programme that is designed to provide knowledge and skills needed to consume a healthy diet on a budget. Focus groups were conducted several weeks after course completion (five groups, forty-seven participants), observations were conducted during FOODcents sessions (thirty-one observation episodes, 237 participants), and open-ended questions were asked in pre-post hard-copy surveys administered in sessions (n 927) and an online survey administered on average six weeks after course completion (n 114).

RESULTS

The course attributes that were found to be especially important to participants were: (i) user-friendly, practical information that could be immediately translated to their daily lives; (ii) experiential learning that involved direct contact with food products; and (iii) opportunities for social interaction. These aspects of nutrition education were described as being highly influential in the decision to participate in the course, the application of the information in their subsequent food purchase and preparation activities, and their word-of-mouth communications with others about the course.

CONCLUSIONS

Incorporating aspects of most importance to participants into nutrition education programme delivery and promotion may increase joining rates, enjoyment, satisfaction with course content and, ultimately, the uptake of recommended behaviours.

The personal shopper--a pilot randomized trial of grocery store-based dietary advice

The objective of this study was to test the feasibility and preliminary efficacy of a store-based dietary education intervention against traditional clinic-based advice. Patients with obesity (n = 55, mean [standard deviation, SD] age 44.3[9.2] years, 64% women, 87% non-Hispanic Black) were randomized to receive dietary counselling either in a grocery store or a clinic. Change between groups (analysis of covariance) was assessed for outcomes including: dietary quality (Healthy Eating Index--2005 [0-100 points]), and nutritional knowledge (0-65-point knowledge scale). Both groups reported improved diet quality at the end of the study. Grocery participants had greater increases in knowledge (mean [SD] change = 5.7 [6.1] points) than clinic participants (mean [SD] change = 3.2 [4.0] points) (P = 0.04). Participants enjoyed the store-based sessions. Grocery store-based visits offer a promising approach for dietary counselling.

Nutrition interventions at point-of-sale to encourage healthier food purchasing: a systematic review

BACKGROUND

Point-of-sale is a potentially important opportunity to promote healthy eating through nutrition education and environment modification. The aim of this review was to describe and review the evidence of effectiveness of various types of interventions that have been used at point-of-sale to encourage purchase and/or eating of healthier food and to improve health outcomes, and the extent to which effectiveness was related to intensity, duration and intervention setting.

METHODS

Records from searches in databases were screened and assessed against inclusion criteria. Included studies had risk of bias assessed. Intervention effectiveness was assessed for two outcomes: i) purchase and/or intake of healthier food options and/or nutrient intake; and ii) mediating factors that might effect the primary outcome.

RESULTS

The search identified 5635 references. Thirty-two papers met the inclusion criteria. Twelve studies had low risk of bias and were classified as strong, nine were moderate and 11 were weak. Six intervention types and a range of different outcome measures were described in these papers: i) nutrition education and promotion alone through supermarkets/stores; ii) nutrition education plus enhanced availability of healthy food; iii) monetary incentive alone; iv) nutrition education plus monetary incentives; v) nutrition intervention through vending machines; and vi) nutrition intervention through shopping online. The evidence of this review indicates that monetary incentives offered to customers for a short-term look promising in increasing purchase of healthier food options when the intervention is applied by itself in stores or supermarkets. There was a lack of good quality studies addressing all other types of relevant point-of-sale interventions examining change in purchase and/or intake of healthier food options. There were few studies that examined mediating factors that might mediate the effect on the primary outcomes of relevant interventions.

CONCLUSIONS

A range of intervention types have been used at point-of-sale to encourage healthy purchasing and/or intake of healthier food options and to improve health outcomes. There is a need for more well designed studies on the effectiveness of a range of point-of-sale interventions to encourage healthier eating and improve health outcomes, and of the mediating factors that might impact these interventions.