Nutrition EducationDESIGN Procedure

Pamela Koch, EdD, RDProgram in Nutrition

Teachers College Columbia University

With Isobel Contento, PhD, Emily Abrams PhD, & Ana Islas EdD

Social /Environmental Determinants:

Social/ culturalenvironment:•Social relations•Cultural practices•Social structures•Public policy

Informational environment

Economicenvironment•Resources•Price•Time

• Food availability• Built environment

•Advertising•Media

Biologically determined behavioral

predispositions:•Taste/pleasure •Sweet, sour, salt, bitter•Hunger/satiety mechanisms•Sensory specific satiety

Experience with Food: Associative conditioning

Physiological conditioning:•Familiarity: learned safety •Conditioned food preferences•Conditioned satiety

Social conditioning:

Person-Related Determinants

•Motivations & values•Personal meanings•Knowledge & skills

FOOD CHOICE AND DIET-RELATED BEHAVIORS

•Social norms•Cultural norms•Social affective

context•Parenting practices

•Perceptions•Attitudes•Beliefs

Inter-person factors

Family & social networks

Intra-person factors

Physical/ builtenvironment

.

Social /Environmental Determinants:

Social/ culturalenvironment:•Social relations•Cultural practices•Social structures•Public policy

Informational environment

Economicenvironment•Resources•Price•Time

• Food availability• Built environment

•Advertising•Media

Biologically determined behavioral

predispositions:•Taste/pleasure •Sweet, sour, salt, bitter•Hunger/satiety mechanisms•Sensory specific satiety

Experience with Food: Associative conditioning

Physiological conditioning:•Familiarity: learned safety •Conditioned food preferences•Conditioned satiety

Social conditioning:

Person-Related Determinants

•Motivations & values•Personal meanings•Knowledge & skills

FOOD CHOICE AND DIET-RELATED BEHAVIORS

•Social norms•Cultural norms•Social affective

context•Parenting practices

•Perceptions•Attitudes•Beliefs

Inter-person factors

Family & social networks

Intra-person factors

Physical/ builtenvironment

Nutrition Education

.

Social /Environmental Determinants:

Social/ culturalenvironment:•Social relations•Cultural practices•Social structures•Public policy

Informational environment

Economicenvironment•Resources•Price•Time

• Food availability• Built environment

•Advertising•Media

Biologically determined behavioral

predispositions:•Taste/pleasure •Sweet, sour, salt, bitter•Hunger/satiety mechanisms•Sensory specific satiety

Experience with Food: Associative conditioning

Physiological conditioning:•Familiarity: learned safety •Conditioned food preferences•Conditioned satiety

Social conditioning:

Person-Related Determinants

•Motivations & values•Personal meanings•Knowledge & skills

FOOD CHOICE AND DIET-RELATED BEHAVIORS

•Social norms•Cultural norms•Social affective

context•Parenting practices

•Perceptions•Attitudes•Beliefs

Inter-person factors

Family & social networks

Intra-person factors

Physical/ builtenvironment

Nutrition Education

.

DEFINING NUTRITION EDUCATION

Is “Nutrition Education” The Wrong Term?

DEFINING NUTRITION EDUCATION

Nutrition education is any combination of educational strategies, accompanied by environmental supports, designed to facilitate voluntary adoption of food choices and other food and nutrition-related behaviors conducive to health and well-being (of individuals, community, planet)

DEFINING NUTRITION EDUCATION

Promoting environmental supports for actionWhen and where to take action

Enhancing motivation to act

Why-to take action

Facilitating ability to act

How-to take action

Selecting the behavior change or action

* Alternative names: Behavior Change Communication (BCC); Food and Nutrition Communication and Education (FNCE);Nutrition Education and Promotion (NEP).

DESIGN Procedure Overview

The DESIGN Procedure creates behavioral, theory-based nutrition education lessons tailored to the target audience.

DESIGN Procedure Overview

Decide behavior change goals of the program based on:• analyzing issues of concern for audience• identifying and prioritizing behaviors

contributing to issues of concern

DESIGN Procedure Overview

Explore determinants of behavior change or action based on a variety of data sources

DESIGN Procedure Overview

Select theory/ create appropriate model based on determinants• Clarify educational philosophy• Articulate perspectives on content

DESIGN Procedure Overview

Identify general objectives for key determinants of behavior change or action

DESIGN Procedure Overview

Generate educational / program plans based on:• strategies to address determinants of

change• sequencing for implementation

DESIGN Procedure Overview

Nail down evaluation plan:• specify outcomes• create indicator(s) and tool(s) to measure

outcomePlan process evaluation• create tool(s) to measure how

implementation went

DESIGN Procedure Overview

Nail down evaluation plan:

Outcomes /objectives

Indicators for outcomes

Tools for indicators

Mediators

Behaviors

Environmental factors

Health

Food, Health & Choices

An innovative intervention for 5th grade students that involved classroom nutrition curriculum and wellness activities

Food, Health & Choices

Step 1: Decide issue & behavior

• Decide health issue: - Childhood obesity

• Decide audience: - Beginning independence

• Decide on goal behaviors: - Choose more and choose less behaviors (Based on literature & survey)

Food, Health & Choices

Step 1: Decide behavior

Choose more: Choose less: • Fruits & vegetables • Sweetened drinks• Physical activity • Processed packaged snacks

• Fast food• Recreational screentime

Food, Health & Choices

Step 1: Decide behavior

Choose more: Choose less: • Fruits & vegetables • Sweetened drinks• Physical activity • Processed packaged snacks

• Fast food• Recreational screentime

Food, Health & Choices

Step 2: Explore audience motivators

Student comment Mediator

• Good at sport • Outcome expectations: physical • See friends eat • Outcome expectations: social• Feeling good about self choosing healthy

• Outcome expectations: self-evaluative

• Not confident knowing healthier snacks

• Self-efficacy

Food, Health & Choices

Step 2: Explore audience knowledge & skills

Student comment Mediator

• Did not know sugar in drinks • Factual knowledge• Do not use food labels • Food skills • Do not select salad bar • Behavioral skills • Never set action goals for healthier eating or PA

• Self-regulation skills

Food, Health & Choices

Step 3: Select theory, philosophy & components

• Select theory: - Social cognitive and self-determination theories

• Select philosophy: - System-blame, not person-blame approach

• Select program components: - Classroom curriculum & wellness - Family support

Food, Health & Choices

Step 3: Select theory, philosophy & Components

Food, Health & Choices

Step 4: Indicate general objectives

Mediators Objectives

• Outcome expectations • Explain why energy balance is important

• Outcome expectations • Describe health benefits of F&V /PA/ healthy snacks

• Social norms • Explain how food ads influence us

• Perceived/ actual barriers

• Describe how environment makes it hard to do FHC behaviors

Food, Health & Choices

Step 4: Indicate general objectives

Mediators Objectives

• Factual knowledge • State how much F, V, sugar, fat is recommended

• Skills • Identify ‘right size’ for foods

• Action goal-setting skills • Create a personal action plan

• Self-regulation skills • Monitor progress towards goals

• Autonomous motivation • State personal desire/ policy to eat healthier and be more active

Food, Health & Choices

Step 5: Generate educational plans

• Teacher lesson plans

• Student worksheets • Supplemental pages for teachers • Case study skit that students would read in class • Goal setting and self-monitoring sheets

Food, Health & Choices

Overview Curriculum Units

Unit 1: Success through science: energy balance Unit 2: ‘Choose more’ behaviors Unit 3: ‘Choose less’ behaviors Unit 4: Summarizing & sharing: ‘Just right’ eating/ PAUnit 5: Sustaining ‘just right’ balance Unit 6: Change agents

Food, Health & Choices

Step 5: Generate educational plans

Teacher Educational Plans • Create activities to address determinants

of change

• Sequence activities for implementation

Food, Health & Choices

Step 5: Generate educational plans

Food, Health & Choices

Step 6: Nail down evaluation plan

Outcomes / objectives

Indicators for outcomes Tools for indicators

Determinants/ mediators

Mediators for each of the 6 behaviors

87-item survey

Behaviors Frequency & portion size, duration intensity of PA

49-item survey

Health BMI Height, weight

Food, Health & Choices

Step 6: Nail down evaluation plan

Food, Health & Choices

Step 6: Nail down evaluation plan

Food, Health & Choices

Step 6: Nail down evaluation plan

Heights &Weights

Nutrition Education DESIGN Procedure

Nutrition Education DESIGN Procedure

Nutrition Education DESIGN Procedure

Conclusions

• Provides a systematic way to design nutrition

education sessions and environmental supports

• Behavior focused, based on strong assessment

• Uses theory as a tool or framework for designing

the intervention

• Can be brief or comprehensive depending on need

Nutrition Education DESIGN Procedure

Conclusions

• Provides a systematic way to design nutrition education sessions and environmental supports

• Behavior focused; strong needs assessment

• Uses theory as a tool for designing the intervention

• Can be brief or comprehensive depending on need