Efficacy, Intent to Teach, and Implementation of Nutrition Education Increases After Training for Health Educators

Evaluating an integrated nutrition and mathematics curriculum: primary school teachers' and students' experiences

OBJECTIVE

To present the process evaluation of a curricular Cross-curricular Unit on Portion Size (CUPS) program that integrates nutrition and mathematics, describing teacher and student perspectives on the intervention.

DESIGN

Semi-structured interviews and focus groups were conducted following the implementation of the CUPS program during a pilot randomised controlled trial designed to evaluate efficacy for improved portion size estimation. Lessons involved experiential learning using food models and mathematics cubes and focussed on portion size, food groups, volume and capacity. Data were collected immediately post-intervention and analysed using an inductive thematic approach.

SETTING

Primary schools in Newcastle, Australia.

PARTICIPANTS

Year 3 and/or 4 teachers (n 3) and their students (n 15).

RESULTS

Teachers believed the programme supported the learning of nutrition concepts, with the majority of students enjoying the lessons, cubes and food models. Teachers indicated most students were engaged and became more aware of healthy eating and serve size recommendation. Although teachers enjoyed and valued the lessons, they suggested that the integration of volume and capacity should be further improved in order to address the time barrier for teaching nutrition.

CONCLUSION

The process evaluation reports on challenges and successes of implementing an integrative nutrition programme. This teaching approach could be useful and successful when aligned with teacher' and student' needs. Based on participant feedback, lessons could be refined to enhance integration of mathematics content and to support student learning.

Family Child Care Providers' Nutrition Practices and Policies: Happy Healthy Homes

OBJECTIVE

Determine the impact of family child care home providers' nutrition knowledge, confidence, and perceived barriers on program nutrition best practices and written nutrition policies.

METHODS

Cross-sectional analysis of self-reported surveys of 49 female providers in Oklahoma City analyzed with Spearman correlation, multivariate linear and logistic regression (α < 0.05).

RESULTS

Confidence and barriers were significantly correlated (r_s(47) = -0.4, P = 0.004). Independent variables explained 36% of practices (r² = 0.357). Nutrition knowledge (standard β = 0.442, P = 0.001) and confidence (standard β = 0.358, P = 0.008) were significantly associated with practices; barriers were not. No significant association between independent variables and written policies resulted.

CONCLUSIONS AND IMPLICATIONS

Provider nutrition knowledge and confidence appear to be suitable targets to improve nutrition practices. Further research can evaluate possible influences on the presence and quality of family child care home written nutrition policies and specific nutrition policy topics associated with healthier nutrition practices.

Nutrition across the curriculum: a scoping review exploring the integration of nutrition education within primary schools

Primary schools contribute to promoting healthy eating behaviour and preventing overweight and obesity by providing nutrition education. Research highlights the importance of improving teachers' programme implementation to enhance intervention effectiveness. An integrative approach has been suggested to reduce time barriers that teachers currently experience in teaching nutrition. This scoping review explores use and effectiveness of integrative teaching in primary-school-based nutrition education programmes. Six databases were searched for primary-school-based interventions on nutrition education. Papers reporting on integration of nutrition topics within core curriculum were included. Abstracts and full texts of potentially relevant articles were screened to determine eligibility. Next, data were extracted and tabulated. Findings were collated and summarised to describe intervention characteristics, subject integration and effectiveness of the included programmes. Data describing integration of nutrition into the primary school curriculum were extracted from 39 eligible papers. Nutrition education programmes often involve lessons about food groups and are frequently embedded within the mathematics, science or literacy syllabus. Although articles report on the integration of nutrition, the use of this approach was not commonly described in detail. Only seven papers discussed student outcomes related to the integration of nutrition education within core subjects. The ability to draw strong conclusions about school-based nutrition intervention effectiveness is limited by the current lack of programme description and methodological issues. Hence, more research is warranted to inform evidence on effectiveness of integrative nutrition education for both teacher and student outcomes. Future studies that include greater detail regarding the integrative approach are needed.

Teachers' self-efficacy beliefs in teaching food and nutrition subjects in Australian secondary schools

Purpose

Teachers play important roles in school food and nutrition education. This study aims to explore Australian teachers' self-efficacy beliefs (i.e. belief in their own capabilities to perform specific teaching tasks) in teaching secondary school food and nutrition-related subjects.

Design/methodology/approach

Teachers' overall self-efficacy beliefs in teaching these subjects (overall-SEB) and self-efficacy beliefs in teaching different food and nutrition-related topics (topics-SEB) were explored using a survey among 183 teachers in 2017. Principal components analysis derived three overall-SEB components: “Motivation and accommodation of individual differences”, “Classroom management” and “Communication and clarification” and three topics-SEB components: “Food system”, “Food and nutrition information” and “Food preparation”.

Findings

Overall, higher percentages of teachers were confident or very confident in the majority of items that loaded on “Classroom management” and “Communication and clarification” compared to “Motivation and accommodation of individual differences”. Moreover, higher percentages of teachers were confident or very confident about items that loaded on “Food and nutrition information” and “Food preparation” compared” to “Food system”. The overall-SEB and topics-SEB were higher among more experienced teachers. There were moderate positive correlations between overall-SEB and topics-SEB components.

Originality/value

The exploration of broader aspects of self-efficacy beliefs related to teaching secondary school food and nutrition-related subjects makes this study unique. The findings highlight that these teachers had high self-efficacy beliefs in teaching food and nutrition education, but there are gaps in tailoring the teaching process to meet the diverse needs of students and teaching broader food-related topics.

Nutrition Curriculum Training and Implementation Improves Teachers' Self-Efficacy, Knowledge, and Outcome Expectations

OBJECTIVE

To examine the effects of training and implementation of Forecasting Your Future: Nutrition Matters on teachers' self-efficacy to teach nutrition and teachers' nutrition knowledge and explore outcome expectations for students.

METHODS

A mixed-methods study, with Indiana Family and Consumer Sciences high school teachers randomized to control and intervention, was conducted using baseline surveys, implementation of new or usual curriculum, follow-up survey(s), and semistructured interviews. Self-efficacy and knowledge were analyzed by hierarchical linear modeling. Interviews were thematically analyzed using a 5-phase process to identify outcome expectations.

RESULTS

Intervention teachers (n = 17) had greater increases in nutrition knowledge (P = 0.028) and self-efficacy (P = 0.010) compared with controls (n = 18). Interviews revealed that teachers sought to affect students' long-term health by providing knowledge and skills to make healthy choices.

CONCLUSIONS AND IMPLICATIONS

This training with updated curricula and implementation improved theoretical determinants of effective nutrition instruction. Teachers expected student learning will contribute to future eating behaviors.

Integrating nutrition into the mathematics curriculum in Australian primary schools: protocol for a randomised controlled trial

Background

Nutrition education programs in schools have been effective in improving children’s knowledge and behaviours related to food and nutrition. However, teachers find it challenging to implement such programs due to overcrowded curricula. Integrating nutrition with core subjects such as mathematics could potentially address time constraints and improve the learning of both. The primary aim of this randomized controlled trial (RCT) is to evaluate the impact of a cross-curricular nutrition and mathematics program on primary school students’ portion size estimation skills. Secondary aims include impact on their nutrition knowledge, attitudes towards mathematics and evaluating the quality of the lessons.

Methods

Twelve Year 3–4 classes from Catholic schools in New South Wales, Australia will be randomised to intervention (n = 6) or control (n = 6) groups. Teachers in the intervention group will receive a professional development workshop and resources to teach 4–5 lessons on portion size and measurements across 1–4 weeks. Outcome measures include portion size estimation skills, nutrition knowledge and attitudes towards mathematics, with data collected during three school visits (pre-intervention, immediately post-intervention, 4 weeks post-intervention). Additionally, teaching quality will be assessed in both intervention and control groups and process evaluation undertaken using teacher interviews and student focus groups.

Discussion

This RCT uses an innovative approach to improve both nutrition and mathematics related learning outcomes among primary school children. It has the potential to impact teaching practices regarding integration of nutrition into curricula and enhance the implementation of nutrition education interventions.

Trial registration

Australian and New Zealand Clinical Trials Register ACTRN12619001071112 31/07/2019.

Improving knowledge, self-efficacy and collective efficacy regarding the Brazilian dietary guidelines in primary health care professionals: a community controlled trial

Background

Capacity-building of health professionals regarding to nutrition is a strategy for qualifying public health work to promote healthy diets in primary health care (PHC) services.

Objective

To evaluate the effect of an intervention based on Brazilian Dietary Guidelines (BDG) on the knowledge, self-efficacy (SE) and collective efficacy (CE) of interprofessional teams working in PHC.

Methods

It refers to a pre-post intervention study involving 24 health professionals divided into a control group (CG) and intervention (IG). The IG received a 16-h educational workshop on the BDG, guided by a validated protocol. Knowledge, SE and CE for using the BDG were assessed via a self-administered scale, ranging from 0 to 16 and 0 to 36 points, respectively; the scale was previously validated, completed before and after 2 months of the intervention. The effects of the intervention were estimated by paired t-test for intragroup comparisons over time.

Results

The mean difference in the knowledge and SE scores of the IG pre- and post-intervention was 2.0 (CI 0.49–3.51) and 6.75 (CI 4.05–9.45) points, respectively. These results means the IG participants obtained 59 and 52.8% more points in knowledge and in SE in relation to CG, with significative difference (p = 0.007 and p <  0.00, respectively). There was no significant variation in the CE scores in both groups.

Conclusions

Considering the results presented and due to the originality of the study in question, the educational workshop was effective in increasing the knowledge and SE of professionals working in PHC in using the Dietary Guidelines in their work routines. These findings can assist other research in developing nutrition interventions with interprofessional teams.

Implementation of a Food-Based Science Curriculum Improves Fourth-Grade Educators' Self-efficacy for Teaching Nutrition

BACKGROUND

Teacher self-efficacy can positively impact student dietary behaviors; however, limited curricular resources and professional development can serve as barriers to the provision of nutrition education in the classroom. The purpose of this study was to assess the impact of a food-based, integrative science curriculum on 4th grade teachers' self-efficacy toward teaching nutrition.

METHODS

Researchers used a quasi-experimental design to implement the FoodMASTER Intermediate (FMI) curriculum in 19 4th-grade classrooms across Ohio and North Carolina. The Nutrition Teaching Self-Efficacy Scale was used to assess baseline and post-test teacher self-efficacy using a 4-point Likert-scale (1=not confident at all; 4=very confident). ANCOVA and Wilcoxon-Signed Rank Test were used for statistical analysis.

RESULTS

Teachers in the intervention group displayed significantly higher post-efficacy expectation scores (mean=3.52; sd=0.41) than comparison group teachers (mean=2.86; sd=0.55). Overall, the intervention group showed significant improvement in self-efficacy on 15 of the 18 items.

DISCUSSION

The results suggest providing training and integrative resources to teachers can significantly improve self-efficacy toward teaching nutrition. Future research should focus on determining the amount of training needed to improve the quality of teacher-delivered nutrition education.

TRANSLATION TO HEALTH EDUCATION PRACTICE

Health educators can use the findings to inform the development of teacher trainings in nutrition and health.

Exploring nutrition education resources and barriers, and nutrition knowledge in teachers in California

OBJECTIVE

To determine barriers to nutrition education, nutrition education resources used, and the relationship between nutrition knowledge and whether public school teachers in California teach nutrition in the classroom.

METHODS

A total of 102 teachers in California participated in a Web-based survey about nutrition education barriers, resources used to plan nutrition lessons, and factors that would encourage inclusion of nutrition. A validated questionnaire was used to assess nutrition knowledge. Analyses included ordinary least-squares regression.

RESULTS

Common barriers were lack of instructional time and unrelated subject. Teachers were unaware of many nutrition education resources. Nutrition knowledge was not associated with nutrition lessons but was positively associated with teaching high school (β = 5.13; P < .05) and female gender (β = 6.78; P < .05), and negatively associated with identifying as Hispanic or Latino (β = -15.50; P < .001).

CONCLUSIONS AND IMPLICATIONS

Barriers of time and lack of unrelated subject matter are difficult to address but lack of awareness of resources indicates that promotion of existing resources may encourage teachers to provide nutrition education. Larger studies are needed to determine whether this holds true in a broader sample.

Factors facilitating and constraining the delivery of effective teacher training to promote health and well-being in schools: a survey of current practice and systematic review

Background

Schools are an important setting for health promotion and teachers have an integral role to play in promoting children and young people’s health and well-being. Adequate initial teacher training (ITT) and continuing professional development in health is therefore important.

Objectives

To conduct a survey of initial teacher training providers in England and a systematic review of effectiveness to assess how health and well-being is covered on courses, and to identify barriers and facilitators to effective training.

Methods

Methods included an online questionnaire survey with a sample of 220 ITT course managers in England; interviews with a purposive sample of 19 of the course managers responding to the questionnaire; and a two-stage systematic review comprising a descriptive map of the characteristics of international research studies of health teacher training and a detailed synthesis of a subset of studies specifically on pre-service training. Databases (including MEDLINE, EMBASE, The Campbell Library and PsycINFO) were searched from the period of database inception up to May 2011.

Results

The overall response rate for the survey was 34%. The majority (89%) of respondents agreed that it was either important or very important to cover health within the ITT curriculum. The most commonly covered topics on courses wereEvery Child Matters(100%), child protection (100%), emotional health (99%) and antibullying (97%). Fewer course managers reported covering healthy eating (63%), sex and relationships (62%), drugs (56%), alcohol (41%) and smoking (34%). Many interviewees expressed a holistic view of education and believed that health was important in the ITT curriculum. However, there was variability in how health was addressed across and within institutions. Trainee teachers' experience of addressing child health on school placement was also variable. Facilitators to covering health included interests and backgrounds of ITT staff; staff health-related professional experience; availability of health expertise from external agencies; supportive government policy frameworks; and interprofessional and interdepartmental working. The main barriers were limited curriculum time; health being perceived to be a lower priority than other aspects of training; health no longer a high government priority in education; and lack of funding. A total of 170 studies met the eligibility criteria for the descriptive map. The majority covered teacher training in relation to sexual and reproductive health, drugs and alcohol or mental and emotional health. A total of 21 publications (20 studies) were prioritised for the synthesis. All were evaluations of health training for pre-service teachers, and just under half were from the UK. Twelve studies reported outcomes (impact of training on teachers, but not pupils), many of which were single cohort before-and-after studies. Sixteen studies reported processes. Following training there were some increases in trainee teachers' factual knowledge of health and a general increase in their confidence to address health issues. In general, training was acceptable and well received by trainees. Evidence suggested that effective training should include practical experience and skills and be personally relevant and take into account individual needs. Barriers to health training identified from the studies included lack of time, balancing breadth and depth, and variation in training provision.

Conclusions

Among those surveyed there appears to be general support for health and well-being in ITT. However, further research on the longer-term impact of ITT around health and well-being is needed, particularly in the early career period. The main limitation of this research was the low response rate (34%) to the survey.

Study registration

PROSPERO number CRD42012001977.

Funding

The National Institute for Health Research Public Health Research programme.