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Mal J Nutr 26(2): 189-201, 2020 School-based nutrition education to improve children and their mothers’ knowledge on food and nutrition in rural areas of the Philippines * Idelia G. Glorioso , Milflor S. Gonzales & Andrea Marie P. Malit Food and Nutrition Research Institute, Department of Science and Technology ABSTRACT Introduction: Nutrition education among school children and their mothers is an opportunity to promote lifelong healthy eating behaviours to improve their nutrition and well-being. The present study determined the effectiveness of nutrition education modules in improving children and their mothers’ knowledge on food and nutrition. Likewise, changes in attitude and behaviour among children were also determined. Methods: Five nutrition education modules were developed with key messages on healthy plate, fruits and vegetables, protein sources, nutrient- dense sources of energy, and water and healthy beverages. Grades 2 and 3 students received 60 hours of nutrition education with a duration of 25 minutes per session. Students were divided into two groups: (1) nutrition education alone (n=83) and (2) nutrition education with feeding (n=83). Simultaneously, a total of nine one- hour nutrition education sessions were conducted among mothers, following the same five modules taught to the students. Mothers were also grouped according to their child’s group. Results: Student participants in both groups exhibited improvements in mean scores on knowledge, attitude, and behaviour (KAB) from baseline to end line. Based on results of mothers’ classes, mean post-test scores of participants were significantly higher than mean pre-test scores in both groups. Group 1 had a higher increase in score from 67.2±32.8 at pre-test to 71.8±33.7 in post-test. Conclusion: The developed nutrition education modules were effective in teaching children proper nutrition. Incorporation of these modules into the K to 12 curriculum will emphasise importance of proper nutrition in early childhood. Moreover, mothers’ classes can be an effective way to bridge the gap between school and community nutrition interventions. Keywords: School-based nutrition education, nutrition knowledge scores, mothers’ nutrition classes INTRODUCTION Survey of the Department of Science Stunting and underweight among and Technology-Food and Nutrition Filipino school children of 6-10 years Research Institute (DOST-FNRI) (FNRI- old are still public health problems of DOST, 2015). Overweight and obesity high severity with prevalences of 31.1% are also growing problems for this age and 31.2%, respectively, as reported in group with a prevalence of 8.6%. the 2015 Updating National Nutrition Nutrition plays a vital role in ensuring __________________________ *Corresponding author: Idelia G. Glorioso Supervising Science Research Specialist, Food and Nutrition Research Institute Department of Science and Technology, DOST Compound, Bicutan, Taguig City Tel: (63) 8837-20-71 local 2287; Fax: (63) 8837-29-34; E-mail: maideliag@yahoo.com doi: https://doi.org/10.31246/mjn-2020-0004 190 Glorioso IG, Gonzales MS & Malit AMP full potential physiological and cognitive al., 2012). Another systematic review growths among children. Eating habits, which identified effective behavioural which also develops early in life, can models and behavioural change also affect health and nutritional status strategies showed a similar outcome and of children. Thus, teaching nutrition suggested that interventions should also at an early age can be an opportunity be focused on developing children’s and to promote lifelong healthy eating parents’ perceived competence at making habits and other behaviours to improve dietary and physical changes (Nixon, nutrition and well-being of school 2012). Evidence suggests that school- children. based nutrition education is effective Schools are the most effective and in improving nutrition knowledge and efficient venue to reach out to young attitudes of school children. Nutrition children, school staffs, families and education in the classroom is intended community members via nutrition to convey nutrition information and education. In addition, children and change unhealthy attitudes to motivate adolescents spend the most time in students in establishing healthy eating schools (Aldinger & Jones, 1998; Perez- practices and to teach positive skills. Rodrigo et al., 2001). Several studies In the Philippines, schools recently examined the effects of school-based transitioned to a new curriculum with a nutrition and health education in 13-year basic education called the K to improving nutrition and health-related 12 Programme. The K to 12 Programme knowledge, attitude and behaviour (KAB) covers Kindergarten and 12 years of of children related to healthy eating, basic education (six years of primary diet, physical activity, and increased education, four years of Junior High consumption of fruits and vegetables School, and two years of Senior High (Wall et al., 2012; Watts, 2012; Evans School [SHS]). In this curriculum, et al., 2016). Other studies looked into nutrition is taught in the first quarter the duration, length and frequency of each school year among Grades 1-4 of nutrition education interventions students as part of their Health subject. in relation to increasing fruits and For Grade 1, nutrition topics focus vegetables consumption, increasing on healthful and less healthful foods, physical activity, promoting healthy consequences of eating less and good eating and reducing overweight and eating habits. Nutrition topics for Grade obesity among school children (Morgan 2 include healthy foods and the body, et al., 2010; Prelip et al., 2012; Rosario and guides in eating a balanced diet et al., 2012; Moss et al., 2013). Based on such as the food pyramid and healthy a systematic review across 7218 studies plate. For Grade 3, good nutrition and about the effectiveness of school-based health, and Nutritional Guidelines for interventions among children and Filipinos (NGF) are topics included in adolescents aged 6–18 years old, most the curriculum guide. Reading food school-based interventions (82.0%) labels and food safety principles are have the potential to improve dietary topics discussed in Grade 4 (Department and physical activity behaviours and to of Education, 2016). Given that the prevent unhealthy body weights in low- curriculum is particularly new, learning and middle-income countries. To reach materials can still be enhanced so that full potential, process evaluations that students acquire in-depth knowledge, document programme implementation skills, and attitudes, particularly on should be conducted (Verstraeten et nutrition. Developing a good nutrition School-based nutrition education to improve children and mothers’ knowledge 191 education module is important to create MATERIALS AND METHODS an effective nutrition education (Anwar Development of nutrition education et al., 2018). modules Most of the local nutrition Workshop interventions by the government are A workshop was conducted among focused only on children as programme teams of DOST-FNRI nutritionist- participants. However, in reality, mothers dietitians and teachers from Daang Hari and caregivers play an important role in Elementary School, Bicutan, Taguig City, achieving proper nutrition for children. Philippines to develop comprehensive Extending nutrition interventions to nutrition education modules that are mothers will have a positive impact on in line with the K to 12 curriculum. health and nutrition. Improved nutrition Five nutrition education modules were knowledge of mothers can be applied developed based on the pre-determined in their households, thus preventing key messages of the researchers. malnutrition among children (Sukandar et al., 2015). Pre-testing of nutrition education modules In August 2017, the DOST-FNRI These nutrition education modules undertook a comprehensive one-year were pre-tested to determine their school-based programme on food attractiveness, comprehensibility, and nutrition, which includes feeding acceptability, and self-involvement of the underweight school children and modules for Grades 2 and 3 students, nutrition education among targeted and to assess if the materials given to the school children and their mothers. The teachers were sufficient for the conduct programme, Forging Public-Industry- of nutrition education classes. Pre- Society alliance: A Program United for testing activities were done in elementary Healthier Kids (PISO for Healthy Kids), schools of both urban and rural areas. consisted of four components, namely, These elementary schools had similar Project 1 – Translation of Pinggang Pinoy characteristics with the study schools, for Children into Adequate Meals, Project but were not study participants. 2 – Translation of Pinggang Pinoy for The study employed random Children into Adequate Meals - Recipe pre-testing. Pre-tested lessons were Development, Project 3 – Nutrition representative of five modules. Out of Education, and Project 4 – Evaluation the 29 lessons in each module, nine Research. lessons were randomly selected for Project 3 of the programme - Nutrition pre-testing. These pre-testing lessons Education aimed to develop nutrition were also representative of the different education modules for use by Grades 2 learning activities included in the and 3 teachers of four selected public modules like word search, true or false, elementary schools, and to conduct and matching type. Nutrition education nutrition education campaigns among lessons that were to be pre-tested Grades 2 and 3 students of selected were given to the teachers in advance public schools and their mothers or for familiarisation. Collaterals for the caregivers. Therefore, the present study lessons like worksheets, posters, flash determined the effectiveness of these cards, big books, and puzzles were developed nutrition education modules also given in advance to the teachers. in improving children and their mothers’ Teachers demonstrated the lessons in knowledge on food and nutrition. the modules and conducted individual Likewise, changes in behaviours among or group activities for the evaluation of children were also determined. 192 Glorioso IG, Gonzales MS & Malit AMP the lessons. After the demonstration, nutrition concepts in every module to the researchers conducted key ensure that the teachers understood the informant interviews using a validated content of the modules. After discussions questionnaire developed by the on the technical content of the modules, researchers following the metrics of a teaching demonstration of the nine attractiveness, comprehensibility, sessions in each module was done. acceptability and self-involvement. The teacher-participants were grouped and asked to demonstrate the nine Study design and participants topics in each module. The facilitators The study used a quasi-experimental and nutritionists gave comments and design. The study participants were from suggestions for further improvement the PISO for Healthy Kids programme in discussing the nutrition concepts. who received nutrition education. A A follow-up meeting was conducted total of 1,788 Grades 2 and 3 students among Grades 2 and 3 teachers after from four schools in Laguna, Philippines completing each module. This was done were included in the nutrition education to get feedback from the teachers on the sessions from August 2017 to March use of these modules. 2018. Among these students, 166 were Copies of the nutrition education considered eligible study participants modules were given to the teachers, based on criteria for age (7-9 years old) which served as their guide in teaching and nutritional status (underweight). students. The teachers followed the The criteria for age were based on the modules provided by the project and age grouping of the Philippine Dietary used the collaterals for each module. Reference Intakes (PDRI). The eligible The teachers taught the modules participants were the ones assessed in their individual creative ways by based on changes in their KAB. Students adding more photos and drawings, and were distributed into two groups: (1) supplementing the modules with audio- nutrition education alone (n=83) and (2) visual presentations and videos. nutrition education with feeding (n=83). The students were exposed to Simultaneously, nutrition education nutrition education topics through sessions were conducted among mothers a 25-minute session totalling to 144 of these selected students, following sessions (about 60 hours). There was the same five modules taught to the a dedicated time slot for the 25-minute students. The groupings of the mothers nutrition education session, and was were based on their child’s grouping. conducted during school days (Monday to Friday). The nutrition sessions were The intervention not incorporated in the Health and Implementation of nutrition education Science subject because in the existing component curriculum, nutrition concepts are only A training entitled “Teaching Nutrition discussed in the first quarter of each for Healthier Kids” was conducted to school year. The four schools conducted capacitate the teachers for the ensuing different number of hours of nutrition conduct of nutrition education in education sessions, ranging from 57.50 selected schools in Bay and Calauan, hours to 60.42 because of varying school Laguna, Philippines. A total of 51 Grades activities and class suspensions due to 2 and 3 teachers from Calauan and Bay typhoons and holidays (Table 1). Two Central Elementary Schools attended nutritionist-researchers were assigned the training on July 24-25, 2017. A to ensure that the nutrition education nutritionist emphasised important sessions were conducted during school
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