Dietary fat reduction strategies used by a group of adults aged 50 years and older.

OBJECTIVE: To investigate the fat-reduction strategies used by a group of older adults who successfully made and maintained positive dietary changes for 5 years or longer. DESIGN: Participants completed 2 copies of a self-administered food frequency questionaire: The first copy assessed diet before they began making changes and the second copy assessed diet after initiation of healthful dietary changes. Positive food changes were identified from the food frequency questionnaires. During in-person interviews, participants placed food changes onto a time line according to the nearest estimated date of initiation of the change. SUBJECTS: Participants were 65 free-living older adults (aged >50 years) who had maintained substantial changes to decrease fat intake in their diet for at least 5 years. Statistical analyses performed Quantitative and qualitative data were used to identify the fat-reduction strategies and to confirm and validate the fat-reduction strategy model. Confirmatory factor analysis was performed to confirm the new model. The Kuder-Richardson-20 reliability coefficient (kr) was used to determine internal consistency of the scales developed for the study. RESULTS: The majority of participants decreased their fat intake gradually, at different time points in their lives, and over a long period of time (5 to 43 years). Mean percent energy intake from fat decreased from 44.3 +/- 5.9% before dietary improvement to 25.9 +/- 7.1% at the time of the study. The final model consisted of 5 fat-reduction strategies with 63 food changes. The strategies were: increase summer fruits (4 items; kr=0.66), increase vegetables and grains (14 items; kr=0.79), decrease recreational foods (14 items; kr=0.76), decrease cooking fat (20 items; kr=0.86), and use fat-modified foods (11 items; kr=0.80). APPLICATIONS/CONCLUSIONS: Dietetics professionals should base their advice on the dietary strategies used by consumers rather than hypothetical premises such as food or nutrient groupings. Nutrition education interventions will have better chances for success if they are based on a set of customized programs that guide appropriate consumer segments through a series of small, comfortable, and sustainable dietary changes over a prolonged period of time.

Client satisfaction with the nutrition education component of the California WIC program.

Past evaluation research has documented improved nutritional outcomes resulting from participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). However, these evaluations have not examined the program from the clients' perspective, nor have they examined the independent effect of the nutrition education component. The purpose of this study was to quantitatively and qualitatively examine client satisfaction with the nutrition education component of the California WIC program. The methodology consisted of two phases. During phase I of the study (the quantitative component), participants completed Client Satisfaction Surveys immediately following attendance of one nutrition class. During phase II (the qualitative component), four focus groups were conducted. All subjects were participants in the California WIC program. Client Satisfaction Surveys were completed by 2138 participants, and the focus groups included 29 participants. Results from both phases of the study indicated that client satisfaction with the nutrition education component of the California WIC program was high. Between 80% and 95% of participants responded positively to five satisfaction questions, and focus group participants unanimously agreed that the nutrition education was an essential component of the program. Hispanic participants were more likely than non-Hispanic Caucasians, Asians, or African Americans to respond positively to three of the five satisfaction questions. For two of the questions, the frequency of positive responses increased as age increased and decreased as education level increased. A small segment of clients reported some dissatisfaction by responding negatively to one or more of the satisfaction questions (4% to 20% of respondents). Some suggestions for improvement were made by survey respondents. Identification of some WIC participants who are not completely satisfied with the nutrition education that they have received, paired with differences in satisfaction across demographic variables, suggests the need for a personalized approach to WIC nutrition education.

Text and graphics: manipulating nutrition brochures to maximize recall.

This study examined how altering text and graphics of a nutrition brochure could affect the ability to remember the content of the message. Two theoretical models were used to guide alterations: dual-coding theory and the communications model. Three brochure formats were tested: the original brochure containing abstract text and abstract graphics, a modified brochure with relatively concrete text and abstract graphics, and a relatively concrete text brochure with concrete graphics. Participants (N = 239 women) were divided into four age groups: 20-30, 40-50, 60-70 and over 70 years. Women were randomly assigned into each of the three experimental brochure formats or a control group. Participants completed recalled materials from the assigned brochures (the no treatment control group did not include a brochure) at two different sessions, 30 days apart. Data were content analyzed and results were compared using analysis of covariance to test differences by age and brochure types. Younger women (20-30 and 40-50 years) recalled more information than women over 60 years. More concrete nutrition education print materials enhanced recall of information presented immediately after reading the material; however, this effect was transient and lasted less than 30 days after a one-time reading. The implications of these data for communicating nutrition messages with print materials are discussed.

How to make nutrition education more meaningful through facilitated group discussions.

Facilitated group discussions provide an alternative method to lecture and one-on-one approaches for conducting educational interventions at clinic sites. They are an interactive form of education wherein learners generate the specific topics to be addressed and share their knowledge and experience with other group members through discussion. In brief, the educator becomes a facilitator who, rather than lecturing, encourages clients to discuss freely among themselves their own approach to the nutrition problems posed during the session. As a facilitator, the nutritionist strives to create a comfortable atmosphere for discussion, encourages participation, and interjects only to correct misinformation and manage group dynamics. Facilitated group discussions allow nutrition practitioners to deliver meaningful nutrition education in a manner that helps empower their clients to improve their dietary habits; at the same time such discussions meet the increased public administrative demands for efficiency. Possible benefits to clients include more confidence, better communication skills, improved thinking skills, and increased motivation and commitment to improving nutrition behavior. We recommend that nutrition educators try facilitated group discussions in their clinics.

Body weight, body composition, and energy intake changes in breastfeeding mothers.

Body weight, body composition, and energy intake changes are described for 13 breastfeeding mothers followed for 18-24 months after delivery. Body weight was assessed at 1-6, 9, 12, 18, 24 months postpartum and 1 month after infant weaning, and energy intake was assessed at 2-6, 9, 12, 18, 24 months postpartum and 1 month after infant weaning. Compared to prepregnancy weight, participants were an average of 4.0 +/- 6.6 kg heavier 18 months postpartum (p < 0.05). The mean rate of weight loss from 1 month postpartum until termination of lactation was 0.32 +/- 0.27 kg/month. Eight of the 12 women gained weight after weaning their infant. Percent body fat assessed by underwater weighing declined from 34.6 +/- 2.8% at 1 month postpartum to 31.4 +/- 4.8% at 1 month after infant weaning (p < 0.05). Further research is needed to study the factors which affect weight loss postpartum, and how weight gain after weaning can be prevented.

Review of self-efficacy and locus of control for nutrition- and health-related behavior.

This article reviews several cognitive predictors of health- and diet-related behaviors commonly used in theories and models of nutrition and health behavior change. Constructs such as self-efficacy, self-esteem, outcome expectancies, health value, and locus of control are examined. Self-efficacy has repeatedly been a good predictor of health behavior, sometimes explaining more than 50% of variability. Research on locus of control and other predictive factors has been less conclusive. The take-home message is threefold: (a) task specificity of self-efficacy and domain specificity of locus of control are crucial for unraveling their effects on behavior; (b) careful segmentation of different population groups under study may explain the inconsistencies in previous research; and (c) especially when studying dietary behavior, these predictors of behavior change should not be used alone or in place of one another but should be used simultaneously to explain complex food and diet-related behaviors. We recommend that nutritionists systematically integrate available theories and models and explore new areas for studying human behavior, such as sociology and anthropology, to form a more powerful, comprehensive model for behavior change.

Use of qualitative and quantitative methods to define behavioral fat-reduction strategies and their relationship to dietary fat reduction in the Patterns of Dietary Change Study.

OBJECTIVE: The purposes of this study were to identify specific food choice behaviors used to decrease dietary fat intake in a community-dwelling population; assess how people categorize changes to diet; determine whether logical grouping of food intake changes revealed one or more common patterns or strategies used by these participants to decrease fat; and determine which strategies were responsible for the greatest decrease in dietary fat intake in the study population. DESIGN: Survey analysis and in-depth interviews were used to quantitatively and qualitatively define dietary change patterns retrospectively in a population who, according to self-report, had decreased their fat intake. Specific food changes made to decrease fat intake, interview statements, and participants' reduction of percentage energy from fat were examined. SETTING: Interviews were conducted from June 1993 through April 1994. SUBJECTS: Included in the study were 145 persons aged 30 to 55 years who reported that they had been decreasing their dietary fat intake for 5 years or more, maintained a healthful diet for at least 5 months, and resided in the United States while changing their diets. STATISTICAL ANALYSES PERFORMED: Confirmatory factor analysis, reliability analysis, and linear regression analysis were performed. RESULTS: Nine fat-reduction strategies were identified. Decrease fat flavorings, decrease "recreational foods," decrease cooking fat, replace meat, change breakfast, and use fat-modified foods accounted for significant reduction in fat intake. CONCLUSIONS: People use a variety of dietary changes to reduce their fat intake. These changes can be categorized into strategies according to the way people change their diets. Knowledge of these strategies and their importance in dietary fat reduction can improve and help nutritionists prioritize the messages they convey.