Evaluation of a food label nutrition intervention for women with type 2 diabetes mellitus.

OBJECTIVE: To evaluate an educational intervention about the food label designed specifically for women with type 2 diabetes mellitus. DESIGN: A pretest-posttest control group design. Participants received random group assignment. SUBJECTS/SETTING: Forty-three women aged 40 to 60 years with type 2 diabetes living in a rural community in Pennsylvania participated. Forty participants (93%) completed the program. INTERVENTION: Nine weekly group sessions were developed on the basis of findings from previous research among this sample. Principles from Ausubel's learning theory were also incorporated into program design and evaluation. MAIN OUTCOME MEASURES: The effectiveness of the food label education program on participants' knowledge was determined using a multiple-choice test designed to measure declarative and procedural knowledge. A skills inventory assessed participants' perceived confidence in using the food label. The validity and reliability of the instruments had been established previously. STATISTICAL ANALYSES: Analysis of variance was performed to compare groups. Paired t tests compared pretest and posttest results. RESULTS: The experimental group showed a greater gain than the control group in total knowledge (P < .001), declarative knowledge (P < .001), and procedural knowledge (P < .01) at posttest. Posttest data showed a significant increase (P < .01) in experimental participants' perceived confidence in using the food label. CONCLUSIONS: Women with diabetes need more education about the food label. This intervention is an effective outpatient education program. Participant knowledge and perceived confidence in using the food label improved significantly as a result of the intervention. Future research should assess retention of knowledge gained and the impact of the intervention on metabolic measures of diabetes management and control.

One-year follow-up of nutrition education for hypercholesterolemic children.

OBJECTIVES: This study evaluated retention of the effect of a home-based, practitioner-initiated nutrition education model. METHODS: Children with elevated low-density lipoprotein (LDL) cholesterol levels were randomly assigned to one of two nutrition interventions or to an at-risk control group. Intervention effects were evaluated 3, 6, and 12 months postbaseline. RESULTS: The parent-child autotutorial group demonstrated significant increases in knowledge and, along with the counseling group, decreases in total and saturated fat intake. Also, the autotutorial and counseling groups retained a majority of their initial LDL cholesterol decrease. CONCLUSIONS: Knowledge of heart-healthful eating and dietary fat intake as well as dietary change can be affected and retained via home-based, practitioner-initiated nutrition interventions with hypercholesterolemic children, although some form of ongoing intervention may be necessary to produce lasting decreases in LDL cholesterol levels.

Knowledge and misconceptions about the food label among women with non-insulin-dependent diabetes mellitus.

Women on restricted diets are reportedly among the most frequent readers of nutrition information on food labels. However, the specific label information that women with non-insulin-dependent diabetes mellitus (NIDDM) comprehend and use has not been determined. The purpose of this study was to explore the attitude toward, use, and knowledge of information on the food label among rural women with NIDDM age 40 to 60 years. Focus groups and in-depth interviews were conducted. Participants reported that they referred to the nutrition information on the label when grocery shopping and preferred the newly revised format. Yet, comprehension of the terms and percentages on the label was poor (eg, the majority of participants could not explain the difference between total carbohydrate and sugars). Misconceptions also were noted about nutrients listed on the label and the percent daily value. Further education is needed to help people with NIDDM understand and apply the nutrition information on food labels to meet their individual needs.

Food shopping and label use behavior among high school-aged adolescents.

Ninety adolescents (41 males and 49 females) stratified by shopping experience (44 shoppers and 46 nonshoppers) were given a list of 20 foods to select in a supermarket. An interview was conducted to determine reason(s) given for each food selection, use of nutrition information, and other variables. Reasons most often reported for selecting foods were personal preference/taste, custom/habit, and price/cost. Participants were five times more likely to use front label/nutrition claims than nutrient labels. Fat free/low fat, lite/light, and cholesterol free/low cholesterol were the most commonly used claims whereas total fat and calories were the most commonly used nutrient label constituents. Females were more likely than males to use front label/nutrition claims (F (1,82) = 4.78, p < .01). There were no significant differences between males' and females' use of nutrient labels. Education that emphasizes food-shopping and label-reading skills is needed by adolescents.

Reduction of elevated LDL-cholesterol levels of 4- to 10-year-old children through home-based dietary education.

OBJECTIVE: To assess the effects of a home-based, parent-child autotutorial (PCAT) dietary education program on the dietary knowledge, lipid consumption, and plasma low density lipoprotein-cholesterol (LDL-C) of 4- to 10-year-old children with elevated plasma LDL-C. METHODS: "At-risk" children (screening total cholesterol, (TC), exceeded 4.55 mmol/L and average LDL-C from two fasting samples was between 2.77 and 4.24 mmol/L for boys or 2.90 and 4.24 mmol/L for girls) were randomized to the PCAT program (N = 88), for dietary counseling with a registered dietitian (N = 86), or to an at-risk control group (N = 87). Dietary knowledge, diet, and LDL-C of these groups were assessed at baseline and after the educational period (3-month follow-up). The knowledge and diet of a not-at-risk (TC below 4.22 and 4.34 mmol/L for boys and girls, respectively) control group (N = 81) was also assessed and compared with that of the at-risk control group. RESULTS: At the 3-month follow-up, the PCAT children's knowledge scores had increased three times more than those of the counseling and at-risk control groups (P < .001). Mean grams of total and saturated fat consumed by PCAT and counseling groups declined while that of the at-risk control group increased slightly; these differences were significant (P < .05). The mean LDL-C decline of the PCAT group was significantly different (P < .05) from the decline of the at-risk control group (0.26 vs 0.09 mmol/L), and approached significance (P = .07) when compared with that of the counseling group (0.26 vs 0.11 mmol/L). The at-risk control group's knowledge and diet did not differ from that of the not-at-risk group. CONCLUSION: The PCAT program offers a mechanism for providing effective dietary education to children with elevated cholesterol and to their families.

Qualitative research: what do we know about teaching good nutritional habits?

Drawing from a number of qualitative studies, a set of basic principles is presented for development of sound, effective nutrition education material. First, research is needed each and every time a new intervention or materials development project is initiated. This research should include formative, process, and outcome testing. Second, reality checks are needed. Programs and materials need to be tested in the settings and for the purpose for which they are intended. Third, messages need to be tailored to the audience. Certain concepts, such as the Dietary Guidelines, may be more or less universal, but the actual educational process and materials need to be tailored to specific target groups. Generic messages do not work. Sound scientific methodology is readily available as well as empirical principles to guide in the development and testing of nutrition education programs and materials, but each new intervention must be tested because there is always a creative element involved. Research will be ineffective, however, unless the right questions are asked and the right people (usually requiring a multidisciplinary team) are used to find the answer.

Role of food and nutrition in the health perceptions of young children.

Sixty healthy children, 4 to 7 years of age, were interviewed to evaluate their health perceptions in general and to determine the degree to which they included food and eating behavior in their perceptions. Individual interviews with children incorporated both closed-ended and open-ended questions. Concept maps were used to analyze interview transcripts. The pretest/posttest experimental design randomly assigned children to experimental and control groups. Children in the experimental group completed a 4-week, home-based, nutrition education program to determine the feasibility of changing children's health perceptions with an educational intervention. Pretest and posttest health perception scores were compared by analysis of covariance. Results indicated that children perceived nutrition as a meaningful concept in relation to their health perceptions at pretest, but that after program participation, children significantly increased their perception that health and nutrition were related concepts. Our findings indicate that young children are cognitively ready to learn more about food, nutrition, and health than previously thought, but closed-ended questions may not be sensitive enough to evaluate their learning at this age.

Use of focus groups in evaluating nutrition education materials.

Focus groups were used to study public reaction to the nutrition education material, Dietary Guidelines for Americans, US Department of Agriculture bulletin HG232. Respondents were asked to comment specifically on the content and format of bulletin HG232 and to compare it with several other commonly used nutrition education print materials. The focus group discussions were recorded on videotape and the information was analyzed by two independent reviews of the tapes. The focus groups produced good information on perceived usability of a variety of nutrition education print materials and made specific suggestions for improving HG232. Although there are limitations to using focus groups as a data collection technique (data are not quantitative, making data analysis difficult; responses are influenced by group dynamics; and some suggestions made by the group are not appropriate), the richness and innovativeness of the data collected make focus groups a worthwhile evaluation method for nutritionists.

Comparison of family interaction patterns related to food and nutrition.

The study examined family interaction patterns related to food and nutrition and parents' attitudes toward the importance of nutrition and compared interaction patterns and attitudes of parents participating in a nutrition education program (self-selected) to a cross-sectional sample of parents. It also assessed differences according to educational level, income, and mother's employment status. Income and education levels were higher for the self-selected sample. Parents from the self-selected sample had higher attitude scores and interaction behavior scores than those in the cross-sectional sample. Ninety-five percent of mothers and 83% of fathers with young children in the cross-sectional sample ate the evening meal together. Parents who participated in a nutrition education program reported discussing topics related to food and nutrition with their families more frequently than did parents in the cross-sectional sample. For both fathers and mothers, attitude and interaction scores differed with education level. Mothers who were employed part-time showed the most positive attitudes toward nutrition and the highest family interaction scores. Possible explanations for and implications of these findings are discussed.