March/April 2002
Educating Nutrition Consumers—A Growing Need
Nutrition information abounds in today's world _ every form of media and every method of information dispersal is used to spread nutrition facts, and the less-than-factual, to every consumer. As nutrition educators, we know our clients, students, program participants and patients are bombarded with nutrition messages from all directions _ from fast food chains to the United States Surgeon General, and from every point in between. How can we help nutrition consumers _ the audiences we reach _ obtain credible, accurate, science-based nutrition information? The answer: nutrition education.
This issue of Nutrition Spotlight offers educators and their audiences tools to build the nutrition knowledge needed for health. We know consumers get most of their nutrition information from television, magazines and newspapers. While much of the information is sound, and the original source is credible, there is often a headline here or a eye-catching twist there that misleads and confuses the public. Occasionally, blatant nutrition misinformation is spread, and nutrition educators must quickly respond with the real story.
Dietitian Diane Quagliani, MBA, RD, LD, serves as a media spokesperson for the American Dietetic Association and offers this advice for combatting nutrition misinformation. (1)
What to Consider When Choosing Materials for Nutrition Education
With all the nutrition educational materials that are available, it can be a challenge to know which is the best for your particular needs. Connie Betterley, Iowa State University Extension, and Brenda Dobson, Iowa Department of Public Health, have prepared a helpful guide for evaluating nutrition education materials.
First, develop a base-line understanding of your audience. Information such as age range, gender, income level, race and ethnicity, educational level and family structure can be helpful. You may find after your assessment that you have a homogenous audience, or it may be quite diverse, requiring a variety of materials to meet specific needs. Identify your objectives. This will help you know what you want your audience to come away with. Often, people are at different stages of nutrition awareness and skill. Knowledge of this is very helpful, but where do you get this information? Advisory committees or other professionals who have worked with this audience will have valuable insight that you may tap. Information derived from focus groups can be very helpful, if time is not an issue. Determine method of delivery. Focus groups are especially useful in identifying how the target audience prefers to receive information.
Betterley and Dobson offer review forms which provide the educator a method for evaluating written nutrition education materials. Initially, it is important to record source information, for easy reference at a later date. Other things to consider are: is the reading level appropriate, are the key concepts organized, is it easily understandable, and is it positive and respectful toward the learner? It is of utmost importance that material content is accurate, appropriate, addresses the needs of the audience and teaches recommended food behaviors. Also, note if design and quality characteristics capture and hold the attention of the learner. For example, is the flow of words easy to follow, is the font size appropriate for the audience, do the illustrations relate to the information presented and does any color used enhance the information conveyed?
When you have tentatively decided on your materials, pre-test a sample of the target audience. There are several ways, depending on time and money constraints, to do this through self-administered questionnaires, individual interviews or focus groups. This is an important step, even if the sample is small. Ask questions such as: are these materials understandable? credible? useful? attractive?
Finally, with any nutrition education material, it is important to point out how it can be useful to the learner. To maximize the effect, encourage the learner to write down his or her goals for behavior change.
The review forms mentioned above can obtained at pubdist@exnet.iastate.edu or 515-294-5247.
Looking for websites to help with your nutrition education programs?
Check these sites:
www.5aday.gov Information on the National 5 A Day Program
www.eatright.org The American Dietetics Association's site for consumers and professionals—food and nutrition topics; nutrition fact sheets
www.foodallergy.org Food Allergy and Anaphy laxis Network (FAAN)
www.cnpp.usda.gov USDA Center for Nutrition Policy and Promotion- Find the source of USDA's Food Guide Pyramid and Dietary Guidelines
www.nfsmi.org The NFSMI Resource Guide provides descriptions of training and nutrition education materials for child care.
www.nal.usda.gov/wicworks/index.html Information on
breastfeeding promotion and support, childhood obesity, children with special
needs, folic acid, food safety, infant nutrition, and more
About 800 K-State students a year experience the course taught by Sharon Morcos for the past decade: HN 132, Basic Nutrition. Morcos displays a passion for both her subject and her students. "I love teaching my students how to reduce their own risk for chronic diseases, such as type 2 diabetes, osteoporosis, cancer, hypertension and cardiovascular disease."
Morcos enjoys providing research-based information to her students, enabling them to make intelligent decisions as consumers and developing their critical thinking skills. She describes herself as "a crusader" against tobacco and immoderate use of alcohol, and emphasizes the importance of physical activity for good health.
She stresses variety and moderation, and shares her belief that food is meant to be enjoyed.
Enrollment in the course has grown. One-third of her students take the class as an elective. She provides opportunities for experiential and active learning; engages students in service learning projects; and uses multiple media in her presentations, such as audio, compressed video and animation. She also incorporates a multitude of disciplines, including anatomy and physiology as well as music, film, poetry and art. Morcos likes the challenge presented by the diversity of students who take her course and the wide differences in their academic preparation and age. Her oldest student so far was a delightful 61-year old, but, she admits, "90% of them are the traditional 18 to 22 year olds."
Morcos holds her pre-exam review sessions via cable television five times each semester. This has allowed some local residents to become familiar with her lecture material, and they stop her occasionally in her daily errands around town to clarify a nutrition fact. "Some of them just recognize my `Texas twang'," she explains.
Morcos graduated in nutrition from Texas Tech University before completing a dietetic internship at the University of Alabama in Birmingham. She earned an M.S. degree in Institution Management from K-State. She was a clinical dietitian in a research hospital and a hospital foodservice dietitian, but nutrition has always been her first love. She joined the K-State faculty 18 years ago.
Morcos is putting the content of her course into a multimedia CD-ROM format, which is a time-intensive endeavor. This course will soon be offered to distance students for credit through K-State's Division of Continuing Education, although some modules will also be available for Family and Consumer Sciences professional development credits.
According to Morcos, one benefit of teaching such a large class is working with graduate teaching assistants, as well as undergraduate student assistants who are nutrition majors. "Mentoring young people who show promise—giving them opportunities and providing them with feedback, watching them develop professionally—is very satisfying," she stated.
While Morcos has no children of her own, she and her husband, a K-State professor of electrical engineering, feel they have "adopted" many of their students over the years.
In her leisure time, Morcos is active in her church and enjoys singing classical sacred music in Latin.
Theory-based Nutrition Education 101
Sometimes a nutrition message really "speaks" to you. Maybe the graphics,
phrasing, voice, or timing help you understand the idea. Another reason may be
that the nutrition education is theory-based. A theory is a set of ideas,
definitions, and concepts that help explain or predict events or situations. In
a sense, a theory is like a road map for a trip.
Imagine that you get in and start up your car. You can get on a road and drive in any direction for as long as you have gas. You may end up at a welcome location or you could find yourself at a dead end. A road map will park you in the spot you choose. Although you can look at the roadmap during the trip, the best time to consult it is before you move down the highway. Nutrition education "trips" that are pre-planned with a theoretical base have a greater chance of leading to a successful location. Just as there are different types and styles of maps, several theories can be used to plan nutrition education projects. Specific theories may work better for some projects than others, i.e., looking at more than one map (or theory) is sometimes the only way you can truly arrive at your destination.
Here are three theories commonly used in nutrition education.
-behavior and environment influence each other,
-training how to do related tasks (e.g. cooking) is important,
-expectations of behaviors and the value placed on outcomes affect acceptance of change,
-modeling, learning from others' experiences influences willingness to adopt behaviors,
-self-efficacy or task specific self-confidence will influence what people choose to do and how long they will persist.
Sometimes maps show one trail functioning as two roads; a state and county road for example. Likewise some theory concepts serve as a building block for more than one theory. Self-efficacy is a good example of this because it is also an important part of the Stages of Change and Health Beliefs Model. For more information about theory in nutrition education go to http://oc.nci.nih.gov/services/Theory_at_glance/HOME.html.
Dietary assessment tools provide a quick measure of a person's diet quality. Consumers can analyze their dietary status and maintain a record so improvements in their diet can be observed. In the past, professionals that were interested in analyzing the nutrient content of foods had to look up food in tables and transfer the data to a sheet of paper and physically add up the amount of each nutrient. This was tedious and sometimes inaccurate. Today with the help of computer programs and on-line data, this task is much easier.
Older adults are an extremely diverse group. Elders differ more from one another than other age groups do. This category includes people whose calendar-years span 30 years or more, and who have had a lifetime to accumulate changes due to disease status; physical and cognitive abilities; ethnicity, culture and social class; literacy and formal education levels; financial resources; social support; life experiences; emotional health; and lifestyle factors.
As a group, older adults are disproportionately female. Many have limited financial and social support resources. They are healthier and less disabled by chronic conditions than previous generations were. Approximately 95% of adults over age 65 years live independently. Many rely on home and community-based services to do so, with about 20% being homebound.
People older than age 85 are growing the fastest of any population sub-group. However, chronological age is not functional age. Aging individuals vary, and may experience no, gradual, or sudden losses in their abilities. Additionally, the number and kind of affected bodily systems differ among older people. The deficits require adjustments of elders, their social supports and nutrition educators.
As educators, we offer older adults the least amount of nutrition education. Ironically, this group often has the highest motivation of all age groups. Most are receptive to education. They tend to engage in informal learning throughout their lifetimes and many are deeply involved in self-directed learning projects. Another characteristic of older adult learners is that they serve as resources for one another. Educators do well to tap into and draw out older adults' wisdom in teaching and learning interactions. They have much to teach as well as to learn.
Educators often assume that major barriers for older adults are lack of knowledge and misinformation. However, older adults may possess a great deal of information and just not put it into practice. It is appropriate to address their educational needs and support efforts to change their behavior toward recommendations. Older adults can and do adopt and maintain substantial behavioral changes.
Effective educational programs for older adults include communication and educational strategies for enhancing awareness and motivation; behavioral change strategies; environmental interventions; and community activation and organization.
Collaborative goal setting is key. Educators need to act as facilitators and work with elders to problem solve, as well as create opportunities for individuals to reflect on the choices they make and the goals they hope to achieve. Understand and emphasize behavior from their point of view. Focus messages in lively, entertaining ways that are also personal and meaningful to the audience. Then deliver messages through multiple and reinforcing media. Continually refine the message.
Offer a repertoire of strategies, letting the clients choose what they find useful. Incorporate the learner's life experiences and expertise to enhance motivation. Use problem-oriented learning, not just learning information about a subject. Focus on relevant, concrete and familiar informational topics. Give your older learners opportunities to build rapport, increase positive affect and develop self-efficacy. Use self-directed learning to enhance autonomy. Encourage active participation to promote behavior change.
As an educator, keep a spirit of open exchange between you and your older learners. The "best" approach will not always be the best, without adaptations. Individualize education based on the older adult group's specific needs and interests.
Perhaps you have experienced it - you have a client or patient who needs information, and you have just the handout to help. It covers the topic your teaching, it is attractive and brief - what else could it need? Here's a point for you to consider - is it understandable to your audience?
The definition of literacy reinforces the need for easy to read nutrition education materials. The National Adult Literacy Survey, or NALS, defines literacy as "using printed and written information to function in society, to achieve one's goals, and to develop one's knowledge and potential." We cannot assist our customers, clients or homemakers if we do not have nutrition education pieces written at or below their level of literacy.
NALS determined that 21% of American adults read at a 0 to 5th grade level, and 27% more at a 6th to 8th grade level. This equals 90 million people that read at a basic level. At particular risk are certain subgroups of the American population - for example, 76% of persons over age 65 read at the 8th grade level or below. Sixty-six percent of persons living in poverty read at basic levels. Certain ethnic minority populations are also at risk of having low literacy skills. For many nutrition educators, persons from these at-risk groups comprise a large part, if not all, of their client base. How can we be certain our written tools are reaching our audiences?
Experts in the literacy field urge us to write in plain language. That means to pay attention to these basic rules:
Sue Stableford of the Maine Health Literacy Center offers these guidelines for developing health education pieces in plain language:
Creativity is a must. Just because materials CAN be read doesn't promise the WILL be read. Here are some suggestions to make your piece engaging:
Above all, don't be afraid to rework and rewrite your pieces. Simplicity may take some extra effort, but it is worth it!
Questions or concerns about this publication? Contact Shelly Burklund, 207 Justin Hall, Manhattan, KS 66506, Phone: (785) 532-1670, FAX: (785) 532-1678