Self evaluation questionnaires to determine the degree of change in eating behaviour of parents who have attended healthy eating education groups.

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Instructions

Aim – To identify through the use of self-evaluation questionnaires, the degree of change in eating behaviour of parents who have attended healthy eating education groups. The parents have children aged between 0-5 years of age and live in the London Borough of Tower Hamlets.

Research question

Whether parents (with children aged 0-5) living in the borough of Tower Hamlets have improved their dietary intake ( as assessed by using self evaluation questionnaires against population based health eating guidelines ) as a result of attending healthy eating sessions.

I will be focusing at the following points only, in my research :

1) Demographics

2)Consumption of fresh fruits

3)Consumption of fresh  vegetables

4)Fibre intake

5)Consumption of sugar or sugary foods

Expected Outcomes are

1.Reduction in sugar intake

2.Increase in the consumption of fresh fruits

3.Increase in the consumption of fresh vegetables

4.Increase in fibre intake

5. Positive changes in eating behaviour after intervention

My research supervisor gave me the following instructions. Please follow them.

1) Use SPSS to analyse data

2) nicely present data on tables. Don’t make charts. We could use some histograms but the priority should be presenting data (frequency tables) on tables.

3)Use only percent from the frequency table.

4) For the result section, pre-post data that can be matched , present them on the table and use the McNemar’s Test to look at the significance (P value). Pre-post data that can’t be matched, present the data nicely on the table and interpret it.

5)Use plenty of other related studies and critically analyse your result looking at current healthy eating guidelines. If there are any new guidelines, reseach it. For example, a current guidance on free sugars.

6)Data has lots of limitations, explore them. For instance- it’s not validated and varified; we are just making assumptions on what people tell us through filling up their pre and post questionnaires.

[I went to Barts NHS London hospital where I entered the completed data set pre and post quesionnaires.  I entered questionnaires data from three years, 2014, 2013 and 2012 analysed them on spss).

SAMPLE ANSWER

Self evaluation questionnaires

Abstract

There is a marked decline in nutritional knowledge as a prerequisite for healthy eating habits and lifestyle. Unhealthy lifestyle and behaviours have been attributed to the high incidents of nutrition-related diseases such as cancer and diabetes. As a result, several agencies have embarked on behaviour change interventions that focus on dietary habits and lifestyle. One such program is the Cook For Life session by Bartis hospital. This study sought to identify the degree of change in eating behaviour of parents who have attended the healthy eating sessions. The study involved 137 parents living in the London Borough of Tower Hamlets. Data from the Barts NHS London Hospital, which consisted of completed pre and post educational session questionnaires from three years, 2012, 2013, and 2014, was used. The self-admitted questionnaires against population-based eating guidelines by respondents who had attended a healthy eating educational programme were then analysed using the SPSS. The findings were then analysed and interpreted using frequency distribution tables and the respective percentages. In the past, most of the interventions aimed at promoting healthy eating habits have been school-based. The Cook For Life intervention program employed a totally different approach for reaching out to families, one that involved the parents as a starting point and an avenue to bring about the desired change for the whole family. This study has the potential to guide future research on the role and effectiveness of intervention programs on behaviour change in eating healthily.

Keywords: healthy eating habits, self-evaluation questionnaires, cook for life, behaviour change.

To Identify Through the Use of Self-Evaluation Questionnaires, the Degree of Change in Eating Behaviour of Parents Who Have Attended Healthy Eating

Introduction

Families often have poor eating and dietary habits, making them vulnerable to the many risks presented by nutritional inadequacies. As a result, intervention programmes such as training and healthy living campaigns have a fundamental role in reversing these trends (Ruxton & Derbyshire, 2014, p. 33). Most importantly, parents should be educated and trained on consumption of fresh fruits, fresh vegetables, and fibre. One such initiative is one undertaken by Bartis NHS London hospital whose data was used as a source of secondary data for this study. Parents, as well as their children, require sufficient nutrients and energy to sustain the normal metabolic and physical functioning, and more importantly to support growth and development (Schuster et al., 2013, p. 80). For instance, children grow rapidly in their first year of their life, and this forms a stage in which they acquired substantial physical and mental skills, before settling into more steady growth (Winham et al., 2014, p. 99). Consequently, adolescents and young adults also require proper nutritional balance to cater for their body needs as they transform into adults with new emotional, mental, and physical capabilities (Park et al., 2013, p. 655). As such, nutrition inadequacies during these very early stages can have very negative impacts on short and long-term health and wellbeing.

While there is sufficient evidence on the ill impacts of the nutritional deficiencies in developing countries, where food insecurity is a major concern, there are just a few studies on the effects of poor diet and initiatives taken to address the situations in the developed world (Sperry et al., 2014, p. 218). One such study was done by the National Diet and Nutrition Survey (NDNS) of 19 to 64-year-olds in the UK over a period of 10 years and published in 2012. Each of the age groups failed to meet dietary targets especially for sugars and fibre. Intake of fruit and vegetables were particularly very low in adults at only two portions per day (Ostbye et al., 2012, p. 186).

On the basis of evidence from such findings concerning dietary intakes, it is necessary to develop health promotion initiatives for target groups. Godsey (2013, p. 430) postulates that such programs should include advice on reduction of the consumption of sugar, saturated fat, salt, and alcohol. Families should be advised and trained to instead develop new dietary habits such as intake of fibre-rich foods, important micronutrients, as well as fruits and vegetables (Tatlow-Golden et al., 2013, p. 164). Papaioannou et al. (2013, p. 645) note that an analysis of studies on the most successful dietary interventions undertaken across the world shows the most common interventions to be educational sessions, distribution of brochures and newsletters, and teacher training programs. A fruit and vegetable sense session conducted in Australia targeted at parents resulted in significant improvements in children intake of fruits and vegetables increasing servings by about 0.62 (Bean et al., 2014, p. 315).

This study sought to identify the degree of change in eating behaviour of parents who have attended healthy eating education groups. The analysed data focused on evaluating the health changes achieved by parents who were involved in a healthy eating session that was aimed at improving their dietary intake. The healthy eating sessions focused on educating the participants on reducing the sugar intakes, and increase in the consumption of fresh fruits, consumption of fresh vegetables, and fibre intake as well as the overall changes in the eating behaviour of the families of the participating parents after intervention. The use of secondary data from the hospital was found effective due to the nature of the information required for this study. The hospital provided credible data concerning dietary intervention that would not have been found elsewhere, and that was relevant for the purpose of the study (Chahal et al., 2014, p. 190). It also saved time and provided a cost efficient source of the required data.  Data acquired from the hospital offered an opportunity to compare the impact of the three different years of intervention as a basis for understanding how effective and successful such initiatives are in addressing the dietary problem.

Methods

The study involved 137 parents with children aged between 0-5 years of age and living in the London Borough of Tower Hamlets. Data from the Barts NHS London Hospital was used for the analysis. The data consisted of completed pre and post educational session questionnaires from three years, 2012, 2013, and 2014. The questionnaires, which were self-admitted against population-based eating guidelines by respondents who had attended a healthy eating educational programme, were then analysed using the SPSS to acquire a statistical outcome. The findings were then analysed and interpreted using frequency distribution tables and the respective percentages.

Analysis

Descriptive statistics (frequencies and mean) were used for the analysis of the findings. Analyses are organized in demographics, sugar intakes, fruits and vegetables intakes, and fibre intakes. Respondents consisted of 137 parents who had participated in a Cook For Life program in 2011, 2012, and 2013. They comprised of adults of origins ranging from Bangladeshi, Chinese, Indian, Pakistan, other Asian backgrounds, Caribbean, Somalis, other Africans, other Blacks, British, and other White background.

Demographics

Table 1: Ethnicity population representations of the study

Ethnicity		Percent
	Bangladeshi	28.5
	Chinese	5.1
	Indian	8.0
	Pakistani	1.5
	Other Asian background	13.1
	Caribbean	.7
	Somali	7.3
	Other African	3.6
	Other black	.7
	British	13.9
	Other white background	14.6
	White and Black Caribbean	.7
	Not known	2.2
	Total	100.0

The study population was representative in terms of racial characteristics as indicated in the table 1 above with respondents comprising of Europeans, African Americans, Africans, Asians, and Caribbean.

Table 2: Respondents treated for co-morbidities

Conditions	Yes	No
Treated for any heart conditions	0%	100%
Treated for stroke	0.7 %	99.3%
Treated for high-blood pressure	2.2%	97.8%
Treated for diabetes	4.4%	95.6%
Treated for high-blood cholesterol	1.5%	98.5%
Treated for bone and muscle problems	10.2 %	89.8%
Treated for asthma or other respiratory diseases	3.6 %	96.4%
Treated for overweight	6.6%	92.7%

Table 3: General health at present

		Percent
	Good for my age	29.9
	Average for my age	42.3
	Very good for my age	22.6
	Poor for my age	2.9
	Very poor for my age	2.2
	Total	100.0

Table 4: Do you know how to improve your/your family eating habit?

Percent
Pre		Post
Yes	No	Yes	No
52.6	47.4	99.3	0.7

McNemar Test for table 4

	Value	df	p-value
McNemar-Browker Test	Not given	Not given	0.000 (binominal distribution used)

Health statistics reveals that a cross-section of the respondents has been treated for nutritional related diseases such as diabetes, muscle and bone problems, and high-cholesterol problems. Diabetes, respiratory diseases, and high-blood pressure forms the largest proportions of the diseases treated in table 2. Most of the respondents feel that their current health is only average 42.3% compared with only 22.6% who believe that their health is very good for their age. The impact of the session is also evident on the great change demonstrated by the responses of the parents concerning whether they know how to improve the family’s eating habits pre at 52.6% and after 99.3% the programme.

Sugar

Tables for Sugar

Table 5: Use of sugar in cooking pre and post course

Description	Percent
	Pre	Post
Too little sugar	20.4	1.5
About the right amount of sugar	57.7	15.3
Too much sugar	13.1	81.0
Don’t know about sugar	8.8	2.2

McNemar Test of Table 5

	value	df	P value
McNemar-Bowker	89.645	5	0.000

Table 6: Do you measure sugar before you add them? Pre and post

Description	Percent
	Pre	Post
Yes	24.8	73
No	75.2	27

McNemar Test of Table 6

	value	df	P value
McNemar-Bowker	not given	Not given	0.000

Table 7 (a): Teaspoons of sugar in tea/coffee pre-course before attending the course

Number of teaspoons	(n=137)
	Percent
3	2.2
4	0.7
5 or more	2.2
none	38.0
1	36.5
2	20.4

Table 7 (b): Teaspoons of sugar in tea/coffee post course after attending the course

Number of teaspoons	(n=137)
	Percent
none	40.9
1	53.3
2	5.8

Table 8 (a): Parents intake of confectionary, cakes and biscuits before attending course

	Confectionary (n=137)	Cakes and biscuits (n=137)
Frequency	Percent	Percent
>once per day	7.3	10.9
Daily	8.8	17.5
5-6 times a week	5.1	8
3-4 times a week	13.1	13.9
1-2 times a week	29.2	32.8
Once per month	16.8	8.8
< once per month	4.4	2.2
Rarely or never	15.3	5.8

Table 8 (b): Parent’s intake of confectionary, cakes and biscuits after attending course

	Confectionary (n=137)	Cakes and biscuits (n=137)
Frequency	Percent	Percent
More often	0.7	1.5
About the same	13.9	10.9
Less often	78.1	83.9
Don’t know	7.3	3.6

Table 9 (a): Child’s intake of confectionary, cakes and biscuits before attending course

	Confectionary (n=137)	Cakes and biscuits (n=137)
Frequency	Percent	Percent
>once per day	2.9	2.9
Daily	8.0	19.0
5-6 times a week	3.6	5.1
3-4 times a week	13.9	14.6
1-2 times a week	27.7	36.5
Once per month	10.2	4.4
< once per month	2.9	1.5
Rarely or never	30.7	16.1

Table 9 (b): Child’s intake of confectionary, cakes, and biscuits after attending course

	Confectionary (n=137)	Cakes and biscuits (n=137)
Frequency	Percent	Percent
More often	0	2.2
About the same	15.3	13.1
Less often	77.4	79.6
Don’t know	7.3	5.1

The impact of the change in eating habit is again evident from the statistics about the sugar intake levels before and after the programme. One of the aims of the study was to reduce sugar intake. The drop in sugar intake levels and change in eating habit in the use of sugar by measuring before use are significant as represented by the P-value of 0.00. The results also reveal that parents were able to significantly adjust the amount of sugar added into tea/coffee with a shift of those who used one teaspoon before the study rising from 36.5% to 53.3% and those who used two reducing from 20.4% to 5.8%. Consequently, the use of confectionary cakes, and biscuits on very regular basis for both parents and children improved greatly.

Fruits and Vegetables

Table 10: McNemar Test – Parents portions of fresh fruits a day before and after attending cook for life course

	Value	df	p-value
McNemar-Browker Test	60.492	14	0.000

Table 11: McNemar Test – Parents portions of dried fruits a day before and after attending cook for life course

	Value	df	p-value
McNemar-Browker Test	23.905	12	0.021

Table 12:  McNemar Test – Parents portions of vegetables a day before and after attending cook for life course

	Value	df	p-value
McNemar-Browker Test	34.128	14	0.002

Table 13:  McNemar Test – Parents portions of fruit juice a day before and after attending cook for life course

	Value	df	p-value
McNemar-Browker Test	15.043	13	0.305

Table 14: McNemar Test – Child portions of fresh fruits a day before and after attending cook for life course

	Value	df	p-value
McNemar-Browker Test	41.010	13	0.000

Table 15:  McNemar Test – Childs portions of dried fruits a day before and after attending cook for life course

	Value	df	p-value
McNemar-Browker Test	14.814	12	0.252

Table 16: McNemar Test – Childs portions of vegetables a day before and after attending cook for life course

	Value	df	p-value
McNemar-Browker Test	29.870	13	0.005

Table 17:  McNemar Test – Childs portions of fruit juice a day before and after attending cook for life course

	Value	df	p-value	n
McNemar-Browker Test	12.986	15	0.603	137

Another main aim guiding the study was to analyse the degree of increase of the intake of fruits and vegetables for parents and their children after attending cook for life programme and compare that with statistics of habits before the session. The findings showed that the session had a great impact in the proportions of fruits and vegetables. The change in the parent’s portions of fresh fruits and vegetables intake a day is valid as indicated by a P-value of 0.000 and that of 0.002 respectively). For children, the change in the proportions of fresh fruits and vegetables intake a day is also significant (P-value of 0.000 and 0.005). However, there impact seems not to be significant in the uptake of fruit juice a day for both children and parents (P-value of 0.603 and 0.305 respectively).

Fibre

Table 18 (a): Parents’ intake of fibre containing foods before attending Cook For Life

	Wholemeal Bread (n=137)	Brown Rice (n=137)	Wholewheat Pasta (n=137)
Frequency	Percent	Percent	Percent
>once per day	5.8	0.7	0
Daily	42.3	8.0	1.5
5-6 times a week	5.8	0	1.5
3-4 times a week	13.1	0.7	4.4
1-2 times a week	10.2	9.5	27.7
Once per month	2.2	8.0	11.7
< once per month	2.2	5.8	6.6
Rarely or never	18.2	67.2	46.7

 

Table 18 (b): Parents’ intake of fibre containing foods after attending Cook For Life

	Wholemeal Bread (n=137)	Brown rice (n=137)	Wholewheat Pasta (n=137)
Frequency	Percent	Percent	Percent
More often	46.0	32.1	31.4
About the same	38.0	33.6	37.2
Less often	8.0	16.1	14.6
Don’t know	8.0	18.2	16.8

 

Table 19 (a) : Child intake of fibre containing foods before attending Cook For Life

	Wholemeal Bread (n=137)	Brown Rice (n=137)	Wholewheat Pasta (n=137)
Frequency	Percent	Percent	Percent
>once per day	6.6	2.2	1.5
Daily	30.7	4.4	0.7
5-6 times a week	8.8	0.7	4.4
3-4 times a week	16.1	4.4	9.5
1-2 times a week	9.5	6.6	20.4
Once per month	0.7	9.5	8.8
< once per month	2.2	4.4	6.6
Rarely or never	25.5	67.9	48.2

 

Table 19 (b): Child intake of fibre containing foods after attending Cook for Life

	Wholemeal Bread (n=137)	Brown rice (n=137)	Wholewheat Pasta (n=137)
Frequency	Percent	Percent	Percent
More often	33.6	24.8	28.5
About the same	36.5	32.8	38.0
Less often	18.2	21.2	16.1
Don’t know	11.7	21.2	17.5

 

This study also sought to identify the impact of the dietary education after the sessions in increasing the intake of fibre containing foods as compared with the same before the programme. The findings demonstrate a contrasting trend from that of the other two categories; consumption of vegetables and fruits, and sugar intakes where significant change in behaviour was reported. In this case, the change in behaviour was considerately on the minimal. The number of parents who consumed about the same amount of whitemeal bread, brown rice, wholewheat pasta after the intervention remained substantially high with a percentage of 38%, 33.6%, 37.2% respectively. The same scenario was reported with the case of the children. The number of children who consumed about the same amount of whitemeal bread, brown rice, and wholewheat pasta remained high as demonstrated by the high percentages of 36.5%, 32.8%, and 38% respectively.

Discussion

The main findings of the study showed a decrease in the amount of sugar consumption, increase in fruit and vegetable consumption, and little increase in fibre intake. Indeed, the drop in sugar intake levels and change in eating habit in the use of sugar exhibited a notable change. Again, parents were able to significantly adjust the amount of sugar added into tea/coffee while the use of confectionary cakes, and biscuits on very regular basis for both parents and children improved greatly. The findings also showed that the session had a great impact in the proportions of fruits and vegetables consumption among the parents and children. The change in the parent’s portions of fresh and dried fruits and fresh fruit juice intake a day was found to have increased significantly. Although, the change in the proportions of fresh fruits and vegetables intake a day for children had a positive outcome there was little impact on the intake of fruit juice. Concerning fibre intake, there was little change in habit in consumption of about the same amount of whitemeal bread, brown rice, wholewheat pasta after the intervention among the parents and children.

About 70 percent of adults have been found to engage in unhealthy behaviours including poor diet, smoking, and lack of exercise leading to obesity and overweight (Mazzeo et al., 2013, p. 176). The situation is worse for those in the lower socioeconomic groups contributing to the huge gap in the younger onset morbidity in the society (Frankel et al., 2014, p. 170). Behaviour influencing health interventions to address such issues include eating healthily, regular exercise, attending screening appointments, and harm avoidance (Johnson et al., 2013, p. 567). The eating healthily intervention program, Cook For Life, was found to be successful in changing habits concerning the levels of sugar consumption among the parents who participated in the study. The intervention was also effective in increasing the consumption of fruits and vegetables although there was little change recorded in fibre intake among the participants. More importantly, respondents overwhelmingly reported being better placed now to take care of their family’s dietary needs than before the intervention. This implies the effectiveness of such a program.

Theoretical Background of Behaviour Change Interventions

Notably, Belansky (2013, p. 201) contends that understanding the factors that influence the way people behave would be a good starting point for such change initiatives. There are three major cognitive theories seeking to explain behaviour, including; the health belief model, the social cognitive theory, and the theory of reasoned action and planned behaviour (Lochrie et al., 2013, p. 165). Succinctly, the theory of reasoned action posits that an action is dependent on a person’s acting intention. The theory emphasizes that a person’s intention is determined by their attitude to behaviour and subjective norms (Peters et al., 2014, p. 131). This theory adds the idea of self-efficacy, the individual’s perceived control over skills, resources, and opportunities at their disposal to perform the behaviour.

As Eumark-Sztainer et al. (2010, p. 273) note, the social cognitive theory holds that behaviour is founded on environmental factors, personal factors, self-efficacy, and the attributes of the given behaviour itself. As such, successful behaviour change would require an individual to believe in their ability to perform the behaviour, should feel the projected positive outcome outweigh the negative (Swanson et al., 2013, p. 149). According to Cohen et al. (2014, p. 51) self-belief in successfully undertaking behaviour is necessary for determining a successful behaviour change. In the light of this standpoint, the parents in the study felt the need to change the way they handled their nutritional needs. They believed in the cause of the undertaking and the benefits of the outcome following behaviour change.

The health belief model proposes that beliefs are the basic cues to action and includes self-efficacy (Prelip et al., 2012, p. 310). The theory holds that the four major beliefs are concerned with the perceived sickness severity, an individual’s perceived susceptibility to it, as well as what they believes are the likely benefits and barriers to taking action. The likely cues for action could be media campaigns, life-changing events, sticky notes, or habitual cues. On the basis of this concept, it can be argued that that the educational session acted as one of the cues for action. The parents shared the belief that the dietary issue required their effort to address to avoid some likely negative impacts.

Basic Principles to the Success of the Intervention

Seeking to understand the perspective of individuals is the basic starting point in delivering and supporting behaviour change interventions. Some of the important factors influencing people’s behaviour are, respecting the messenger, individual’s weighing of the interventions and the disincentives of a behaviour or change, norms and behaviours surrounding an individual, individual effort and determination, importance, subconscious, emotional associations, ego, and commitments (Van Grieken et al., 2014, p. 1).

More importantly, behaviour change intervention should focus on generic competencies that cover: helping people to develop accurate knowledge about the short and long-term health consequences of their own behaviours on themselves and others. They should work with what is relevant to the individual and be capable of enhancing people’s self-efficacy (Loeb et al., 2012, p. 22). The programmes should raise awareness of the positive behaviour and role models in the individual’s social group and support moral and personal commitment to change (Garcia et al., 2014, p. 1013). Additionally, the initiatives should assist people to make changes while identifying realistic goals as well as developing supportive plans in specific contexts over time (Jaballas et al., 2011, p. 301). People carrying out the intervention programmes must not be coercive, patronizing, or coercive when trying to influence behaviour change among the participants (Morgan et al., 2014, p. 94). Instead, it would be more effective to adopt strategies that are used more regularly in motivational and coaching interviewing such as listening to understand, building rapport, building self-efficacy and supporting change, and assessing readiness of participants to change.

The results in this study concurred with the findings of an earlier study involving 3059 young women of ages 17 to 21 attending a virus trial of a population-based human papilloma virus in Finland. The study which focused on developing and evaluating the effectiveness of an individualized lifestyle counselling approach in improving dietary behaviour, preventing weight gain, and physical activity established positive correlation between nutritional intervention and behaviour change. The proportion of the girls physically inactive decreased from 34% to 23% following the initiative (Janicke et al., 2013, p. 191). The study also confirmed the argument that the success of lifestyle programs and interventions in helping people to achieve dietary change depended on the intensity of the intervention. In addition, it was also identified that self-reported behaviour is affected by the measurement process itself in that repeated assessment on health behaviours may have some motivating factor for participants to increase the intensity of behaviour change interventions (McGowan et al., 2013, p. 769). The findings in the two studies form a strong basis for future intervention through self-evaluation questionnaires to nutritional behaviour change.

In a study where four focus groups were conducted in 2012 at worksites during the lunch break showed positive correlation between the eating habits and practices of children and the role of parents in the same. A total of 21 randomly picked parents of primary school children were chosen (15 mothers and 6 fathers) (Morin et al., 2013, p. 46). These results concurred with the rationale of the Cook For Life campaign to use parents as a starting point for addressing nutritional inadequacies in families. Parents cited rules and regulations as some of the factors contributing to healthy dietary habits to their children. They reported that some of the rules involved limiting the consumption of soft drinks (Talvia et al., 2011, p. 2065). Some stated applying strict rules about when and how much their child is allowed to consume a soft drink. Other argued that it is important that parents the role of good models for their children eating behaviour by not consuming soft drinks, eating fruits, and drinking water at dinner (Turner et al., 2013, n.p). These findings demonstrate the important role that parent’s influence has on their children. By targeting the parents, then the whole family is likely to benefit from the intervention.

A recent report by Scientific Advisory Committee on Nutrition recommends the dietary reference value for total carbohydrates at a population average be maintained at about 50% of dietary energy. it also recommends that the dietary reference value for free sugars be set at a population average of approximately 5% of the dietary energy for all age-groups from 2 years upwards. Following the reductions in the intake of free sugars, then that energy should be replaced with starches found in cellular structures sugar-containing foods such as milk and milk products. In addition, the consumption of soft drinks should be minimized for both parents and adults (Draft Carbohydrates and Health Report, 2014).

Another study that had similar results is one of a pilot nutrition intervention on knowledge, attitudes, and behaviour change of female combat soldiers in Israeli army in 2013. The results of the intervention strongly indicate meaningful improvements in daily food consumption. Before the intervention programme, the subjects had very limited knowledge of the basic nutrition and few tools for making informed choices in their mess hall. The intervention was also found to improve attitude and knowledge significantly towards healthy eating (Wright et al., 2013, p. 730). However, in the Cook For Life intervention it was noted that the percentage of the parents and children who took about the same amount of whitemeal bread, brown rice, wholewheat pasta after the intervention remained substantially high. Some of the reasons to explain this little change could be the preference issues where most people see the white rice and the white bread as more appealing than brown rice and white bread. Another explanation could be that whitemeal bread, brown rice, wholewheat pasta are quite expensive and cooking becomes very time consuming. Although, most interventions are effective in increasing knowledge, the true challenge lies with impacting the decision-making process as well as changing eating behaviours.

A study evaluating the impacts of an intervention carried on 5-year olds to investigate child health behaviours by youth health care professionals found no significant outcomes on behaviour change. The study involved counselling for 637 parents of overweight children on lifestyle according to the invention protocol and follow-up questionnaires for a two-year follow-up (Ohly, et al., 2013, p. 9). The results reflected the findings of this study concerning the behaviour change in fruit juice intake where no significant change was reported for both parents and children. One of the likely explanations for this outcome can be based on the health belief model where barriers to achieving the behaviour change greatly affect the outcome. Some of the barriers could be that fresh fruit juice is not readily available or could be expensive. It could that parents are preferring to use fruits instead.

Study Limitations

The rather small sample size of 137 participants used for the study is not so representative, and it would not qualify for generalization of the entire population. The study was limited in capacity due to failure to evaluate other factors that might be crucial in determining behaviour change such as economic status and literacy levels. In addition, the study might have been limited by the subjective nature of self-reported dietary intake assessment as used in the study. The validity of the study is, therefore, questionable since there was no clinical validity biomarker used making it prone to underestimates resulting from bias and imprecision of the actual change.

Conclusion

The findings of this and other studies have demonstrated the effectiveness of intervention programs such as Cook For Life in bringing about a great impact in terms of behaviour change among parents and children. However, the success of such interventions is dependent on a number of rationales on behaviour change. Educational sessions have the capacity to address nutritional deficiencies in families through behaviour change (Robertson, 2012, p. 230). The Cook For Life intervention was able to achieve the intended outcomes of reducing sugar consumption, increasing intake of fruits and vegetables, and fibre intake. Similar programs should be guided by the identified basics such as listening to understand, building rapport, building self-efficacy and supporting change, and assessing readiness of participants to change behaviour.

ACKNOWLEDGEMENTS

First and foremost, I would like to thank God for His goodness and faithfulness, divine strength, provision, and ever-present help all through my studies and also for the idea of this study.  Secondly, I would like to acknowledge several people for whom their support, encouragement, help and assistance made this work possible: my parents, instructor, as well as my lecturer (enter names).

References

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