Theory based Nutrition Education Program

Theory based Nutrition Education Program

Theorybased Nutrition Education Program

Theorybased Nutrition Education Program

  1. Analyze Food and Health Behaviors, Assets, and Needs to State Program Behavioral Goals

Changesin lifestyles in the modern society have resulted into an increasednumber of obese individuals in the modern society. The healthcomplication associated with obesity has evolved into some of themost important health concerns in the modern health care systems.However, the increased cases of obesity among children and adolescentare a greater concern. It is estimated that the number of obesechildren in the world has increased four folds in the last threedecades. In the United States, the number of obese children betweenthe age of 6 and 11 has increased from 7 percent to 18 percent in thelast three decades. Additionally, the number of obese adolescents hasincreased from five percent to 21 percent over the same period oftime. It is estimated that a third of children in the United Statesare obese or overweight (McBride, 2010). Although obesity is moreprevalent in the low income families, childhood obesity is a problemin all societies, affecting children from both genders, all racialand ethnic groups. There are many reasons why childhood obesity isattracting a lot of attention in the health care system. Mostimportantly is the impact of obesity on the social, emotional andphysical development of the child as well as the projected challengesin future of the health care system. Majority of obese children andadolescent will be obese in adulthood. Due to the health challengesassociated with obesity, increased childhood obesity translates intoincreased demand for health care services in the future (McBride,2010).

Theimpacts of childhood obesity of the health of individuals, duringchildhood and later in life are well documented. Childhood obesityincreases the risk of obesity in later stages of life. This exposesthe child to long term risks associated with obesity. Obesity hasbeen identified as one of the leading causes of preventable deaths inthe world. There are life threatening conditions that are associatedwith childhood obesity which includes effects of obesity includeincreased risk chronic diseases such as cardiovascular diseases,diabetes and bone and joints problems. Childhood obesity is alsoassociated with psychological problems such as low self esteem andsocial stigma. However, it is important to note that while adults areresponsible for there health and wellness, children have no totalcontrol over the factors that contributes to obesity and other healthrelated issues. The actions or inaction of the parents, guardians,teachers, the society and the government can impact on childhoodobesity (Bessesen, 2008).

Thereis no doubt that there are several factors that predisposes childrenand adolescent to obesity. This includes genetic factors, medicalconditions, nutrition and inadequate physical activity. Although allthe factors are very essential in establishing a solution andmitigation measures against childhood obesity, the focus of thisprogram is the role of eating habits in dealing with childhoodobesity. In both children and adult, the choice of food or the foodavailable has huge health implications. Overindulgence in unhealthyfoods such as junk food and highly processed food is the mostimportant causes of obesity in children and adult. However, due tothe significance of physical activity in children, it is important tocombine both nutritional and physical exercise behavioral changegoals in dealing with childhood obesity. Scientific studies havesupported the common knowledge that health diet is beneficial to anindividual in many ways. Increased consumption of fruits andvegetables, less salt and sugars as well as fat is the ultimatesolution to obesity in children and adults. Despite this popularknowledge, majority of school going children and adolescentoverindulge in unhealthy foods. Since they taste better and are moreattractive, children and adolescence prefer foods rich in artificialsweetness and fats as opposed to healthy fruits and vegetables. Inaddition to taste, fast food stores mainly target children andadolescence which is major contributor to increased incidences ofchildhood obesity (Han &amp Lawlor, 2010).

Aneffective program that is aimed at dealing with obesity in childrenand adolescent should recognize the critical factors, health diet andphysical exercise that can be modified to achieve the intendedoutcome. The program will focus in increasing the intake of a healthdiet by ensuring that the children take at least two servings offruits and vegetables in every day. This will reduce the amount ofunhealthy food consumed by the children. In addition to promoting ahealthy diet, the program will also aim to promoting physicalactivity among children and adolescent.

  1. Identify Personal and Environmental Mediators of Change

Obesityaffects individuals of all ages and across the society. However, thisprogram targets school going children and adolescent between the ageof nine years and 15 years. The choice of the intended audience isbased on the challenges facing the groups and the opportunitiesavailable for the project. The target group is increasingly becomingindependent and is experiencing numerous changes in their lives.Although they are children, they have had significant cognitivedevelopment. They are beginning to understand that their actions haveconsequences, and therefore can decide which food is healthy orunhealthy. The program is appropriate for this group because they areable to make choices and regulate their behaviors to achieve a setgoal.

Althoughsome of the selected participants have exhibited behaviors thatenables them to attain the intended goals in the program, they arenot involved in any behavioral change practices aimed promotinghealthy eating habits. However, it is important to note that theparticipant comes from diverse family and social backgrounds. Thismeans that they have varying exposure to information that is relatedto the program. Therefore, there are some family based as well asschool based environmental factors that will have a direct impact onthe policy. A good example is school based programs and policies thatare aimed at promoting health eating habits and increased awarenessof the negative healthy effects of obesity are available.

Thefeeling and thoughts that are likely to be motivational mediators arediverse. Majority of the participants are aware of the perceivedrisks and benefits accrued from eating healthy or unhealthy diets.Although some of them are not aware of some of the potential barrierssuch as cost and availability of healthy food, they are aware ofundesirable taste of healthy foods as opposed to unhealthy option andhow they impact on healthy choices. Generally, at their age, theparticipant is aware of the benefits and risks associated with foodchoices and whether they are able to control what they eat. Mostimportantly, the children are aware of their peers perceptions andpreferences on healthy diet. Other mediators include knowledge onwhat constitutes a healthy diet, food preparation skills, criticalthinking in relation to food choices, self efficacy, specific goalsetting, self assessment skills and positive reinforcement.

Theenvironment and the possible modifications that can be done will havea huge influence on the achievement of the goal. The decision makershave a huge influence on environmental influences. Changes such ascreating awarenessamong parents, teachers, school administrators and other responsibleadults on the critical aspects of the program are necessary.Additionally, changes in the social environment such as advocatingfor changes in social norms and values that have a negative impact onhealth eating habits is necessary. Other changes in the environmentinclude modification of food environment to increase accessibilityand availability of healthy food and modification of the built foodenvironment such as streets and parts. However, changes andmodification of the environment to support the program will not bepossible without supportive organizational policies as well acommunity and national level policy activities. For example, in theschool environment, a school food policy that would support theprogram may include subsidizing healthy foods such as fruits in theschool canteens. In the community and national level, supportingpolicy activities may include initiatives that increase the supply offruits and vegetables in the food market. The information theparticipants are able to access in their immediate environment canalso have an important motivating factor. Although the program maynot be able to modify all the available information, displayingmessages on the benefits and risks of the different kind of eatinglifestyles will have a huge contribution in the implementation of theprogram.

Thereare important characteristics of the targeted group that can mediatethe intended behavioral changes in the program. The level ofeducational of both the participants and their parents and guardianswill have an influence on the outcomes of the program. Majority ofchildren involved in the program are in middle school while theirparents have high school or its equivalent level of education. Theparticipant age is characterized by rapid physical and cognitivedevelopment. However, they have significantly developed cognitiveskills that can enable them made decisions and set their own goals.Additionally, they have relatively good numerical and literacyskills. Due to their age, interactive learning is more appropriate toensure that the program is interesting to the participants. It isalso essential to take care of the social and emotional needs of thechildren. For example, family and community support as well aspsychiatric support when necessary will be essential in theimplementation of the program. Some of the necessary resources in theimplementation of the program include two lessons per week for sixweeks incorporated within the school learning activities, the normalclassroom, standard classroom equipment and administrative staff fromthe involved schools.

  1. Integrating Theory, Research, and Practice

Thefigure (figure 3.1) below represents the theoretical model that willbe used in the program in order to achieve the set objectives.

Fig 3.1

Personal risks expectations

Benefits expectations

Social outcome expectations

Self evaluation expectations


Self efficacy

Skills: nutritional knowledge and skills

Cognitive self regulation process

Goal intention


Overall good


Theprogram aims at modification of behaviors among the participants andcreation of health eating habits goals. This is by providing theparticipant with the necessary information that will enable them tomake informed decisions. The philosophy adopted in this program isthat young people have the ability to take responsibility for theirhealth. Young people between the age of nine and fifteen years havethe ability to set goals and adopt lifestyles that enables them tomeet these goals. However, they need awareness, tools as well as thepush to adopt health living standards. Through support programs,these children can adopt healthy options and manage or preventchildhood obesity. Therefore, the main philosophy in the program isbased education the children on the risks of unhealthy eating habitsand promoting health choices. This enables them to take charge oftheir health.

Themain perspective of the nutritional program is to promotethe consumption of healthy diets by children and adolescents. Although it is clear that given a chance, majority of children andadolescent will choose highly processes and sweetened food, they candevelop preference for healthy food choices. This is by encouragingthem to consume less processed foods, less junk food and consume morehealth foods including vegetables and fruits though provision ofinformation on the benefits and risks associated with the foodchoices. However, the program recognizes that this can only be donebased on the available resources. Therefore, increasing theavailability and affordability of healthy food is also an importantconcern.

Theprogram will mainly consist of three components. The first componentwill be the classroom component which will aim at influencingbehavioral change among school going children and adolescent. Thesecond component of the program will involve the parental andguardian program which will target adults directly responsibly forthe children, which includes parent000s, guardians, teachers andschool administrators. The third component of the program willinvolve an environmental program that aims at modifying the immediateenvironment to provide healthy eating option and healthy dietinformation to the children and adolescent.

Thereare specific objectives of the program that cut across all the threecomponents of the program. These objectives include motivationalobjectives, action objectives, and environmental and policy supportobjectives. The motivational objectives are educational objectivesthat are aimed at educating the participant on health risk, healthybenefits and social outcomes associated with particular eatinghabits. The objective increase awareness among the participants andmotivates behavioral changes. The active objectives includeobjectives that are aimed at facilitating the ability of theparticipant to adopt good eating habits. They include behavioralcapabilities such as nutritional and food skills. Environment andpolicy support objectivesthat are aimed at modifying the environment, for example, increasedavailability and affordability of health foods. This increases theopportunities of the participants to adopt behavioral changes

  1. Design Nutrition Education

Thegeneral education objectives will include:

  1. Physical outcome expectation (risks): Identify the health risks associated with unhealthy diet.

  2. Physical outcome expectation (benefits): Identify the health benefits associated with a healthy diet.

  3. Social outcome expectation: Identify the social implications of a healthy diet.

  4. Self evaluation outcome expectation: evaluate themselves on the ability to adopt the recommended diet.

  5. Barriers: Identify the barriers to adopting healthy eating habits and methods of avoiding the barriers.

  6. Self efficacy: Have the intention of adopting a behavior change.

Thematrix below (figure 4.1) represents the overall design that linksmediators, objectives and the specific learning activities in theprogram.


Mediator (from Step 3)

Specific educational objectives*

Learning domain/level*

Theory-based strategy** and educational activities, experiences, and/or content


Physical outcome expectations (personal risks)

List of specific health risks such as obesity and diseases associated with bad diet.


Exhibits such as obese children, videos and statistics on the effects of bad eating habits.


Physical outcome expectation (benefits)

Specific benefits associated with good diet, for example body strength and low risk of diseases.


Introduce a role model (probably a sporting personality) to explain the importance of eating healthy food.


Social outcome expectations

Specific positive social outcomes of a good diet, for example, peer acceptance.


Use of peer educators


Self evaluation outcome expectation

Specific methods of self evaluation.


Use of monitoring techniques and related skills.



Understanding why there barriers to good diet such as dislikes and tastes.


Use of interactive seasons to identify unique barriers.


Self efficacy

Increasing confidence and control over one’s eating habits.


Group practical work.

Engaging nutritional experts in demonstrations.


*C = cognitive domain A = affective domain P = psychomotor domain.

Theabove (figure 4.1) matrix can be translated into the followingeducation plan. The plan includes the materials and a procedure ofhow a simple education plan can be implemented. The nutritionaleducation materials that can be used in the learning process areincluded as an attachment.


  1. A short film to introduce the topic

  2. Importance of good nutrition

  3. Engaging the participant to assess the nature of their diet.

  4. Basic nutritional skills

  5. Simple recipes

  6. Mentors


  1. Basic utensils

  2. Basic food stuffs (mainly fruits and vegetables) for demonstrations.

  3. Handouts

  4. Basic classroom materials.


  1. Introduce the learning session with a relevant educational film.

  2. Explore the importance of good eating habits and the risks of bad diet.

  3. Involve the participants in a discussion about their current diet.

  4. Demonstrate basic nutritional skills to the participants.

  5. Engage the participants and mentors in practical learning activities.

  6. Conclude with a reflection season.

  1. Implement Nutrition Education

Theimplementation nutrition program will take one and half months,although assessment of the impact will continue there after. Theprinciple means of delivering the program would be face to facesetting. It is important to note that the participants are childrenand adolescents within a school environment. The traditionalclassroom will facilitate the face to face setting for the programwhere the nutritional educator will be assigned normal classes by theschool administrators. There are several advantages that areassociated with the face to face setting. Since the audience in theprogram is children, the learning process will be more effectivesince it is possible to incorporate interactive learning, modelingand personalization of the learning process. Although it is highlydepended on the nutritional educator, it is more appropriate for theparticular audience. However, the internet can also play a criticalrole in the program, especially when soliciting social support fromthe community, parents and guardians. By involving the immediatecommunity online through the various online social media platforms,the will be higher educational, mediated and health outcomes(Contento, 2010).

  1. Evaluate Nutrition Education

Duringimplementation and at the tail end of the program, it is essential toevaluate the effectiveness of the program relative to the setobjectives. The evaluation will involve both formative and summativeevaluation. The figure (figure 6.1) represents the conceptualframework that will be used in the program.


Thereare different indicators of achievement that can be used to evaluatethe various mediator outcomes based on the educational objectives.Some of the most important indicators of achievement includeimprovement in the tools measuring perceived physical outcomesexpectations, both perceived benefits and risks. Other indicatorsincludes improved and decline in perceived barriers and overcomingbarriers scores respectively, improvement in descriptive normsscores, improvement in self monitoring scores and improved selfefficacy scores. Objectivequestionnaires such as multiple choice or true/false questions willbe the principles measures that will be used to evaluate theindividual changes as a result of the program.

Thebehavior outcome and health outcomes that will be used to evaluatethe three level of change targeted by the program is mainly the childwill register a decreased consumption of meals that are considered tobe unhealthy and an increased consumption of healthy diet. Thesurveys should indicate a significant reduction in the intake ofunhealthy snacks such as processed and sweetened foods. The surveyshould also show an increase in consumption of vegetables and fruitsby the child. These outcomes should be evident in the short term andlong term. In both short term and long term, the child should show ageneral improvement in the mediated outcomes. In the long run, thesurveys should indicate an improvement in the health outcome whichwill be indicated by a reduction in the prevalence of obesity amongthe participants. A survey on the BMI of the student based on theself reported data should indicate an improvement compared to thebaseline survey.

Thereare many stakeholders who are involved in the program. This includesthe participants, parents and guardians, teachers and schooladministers and the community in general. It is very critical tocommunicate the finding and evaluation report with the stakeholdersand the community. Both formal and informal methods of communicationcan be used to share the findings. Some of the formal methods ofcommunication that can be used include meetings, conferences andnewsletters. Formal communications are very necessary because theycan be documented for future reference, enhances the message andavoid misinterpretation of information. On the other hand, informalcommunication such as hallway conversation and lunch hourconversation among other can also be used to share some of thefindings of the program. The informal communication channels createinterest in the findings and attract the attention of thestakeholders to the formal communication.

  1. Nutrition Educators as Change Agents

Althoughthey are not in the main stream medical profession, nutritioneducators play a critical role in the health care system. This isbecause majority of health care issues affecting the society arelinked to diet. Therefore, they play a critical role in initiationbehavioral change and adoption of healthy eating habits. According toContento (2010), nutritional education is critical in translatingscientific finding into information that can be communicated with thegeneral public. This is the basic role of a nutritional educationprofessional. They are tasked with establishing the nutritional needsof individuals or groups of individuals with specific characteristicsand proposing the most appropriate diet. Additionally, they providenutritional education interventions by planning and implementingeducational programs that promote health eating habits. Inprinciples, nutritional education professional provide information tothe public on how to eat healthy food (Contento, 2010).


BessesenD. H. (2008). &quotUpdate on obesity&quot. J.Clin. Endocrinol. Metab.93 (6): 2027–34.

Contento,I. (2010). Nutrition Education: Linking Research, Theory, andPractice, Jones &amp Bartlett Learning, ISBN 0763775088.

HanJ. &amp Lawlor D. (2010). &quotChildhood obesity&quot. Lancet375 (9727): 1737–1748.

McBride,D. (2010). “Childhood obesity”. PracticeNurse,39(11), 40-45