Background Childhood obesity is a major public health concern and families play an important role. Improving strategies to reach parents and directing tailored nutrition education to them is needed. Purpose To investigate the challenges and facilitators to promoting a healthy environment at home and to identify communication preferences to inform intervention strategies for effectively reaching low-income urban minority families. Procedure Semi-structured focus group interviews were conducted with four groups involving 16 low-income urban parents (94% female; 88% Hispanic/Latino, 12% African American) of elementary school children. Interviews were transcribed and analyzed applying Social Cognitive Theory and using in-vivo coding. Main Findings The most common barriers to parents providing healthy foods to their children were accommodating child preferences and familial opposition. Parents showed intentionality to engage in healthy behaviors, and often shared procedural knowledge for reaching health goals. The analyses of desired communication channels yielded major preferences: tailored information, information provided through multiple mediums, appropriate duration/frequency of messages, and presented from a voice of authority. Conclusion and Implication While parents expressed desires to be healthy, the home food environment presented substantial challenges. Multi-media supports such as workshops, flyers, and text messaging may be useful to facilitate the sharing of information to minimize the tensions between intentionality and reaching desired goals to be healthy. Some parents thought that information received through text messaging could be easily shared and would act as a voice of authority to support child behavior change.
Background. Highly processed foods are inexpensive and abundant in our food supply, nutritionally poor, and disproportionately marketed to minority youth. This study is part of a curriculum development project to develop, implement, and evaluate the In Defense of Food (IDOF) curriculum designed to increase intake of whole/minimally processed foods and decrease intake of highly processed foods in youth. Aims. This pilot outcome evaluation was undertaken to assess initial effectiveness and to provide an in-depth understanding of changes in behavioral outcomes and psychosocial mediators. Methods. We used an explanatory mixed method approach, including a single-arm pretest–posttest of intervention effect, followed by a food rules assessment and in-depth interviews to describe participant responses to the intervention in more detail. The study was conducted in three afterschool classrooms in urban low-income neighborhoods with 32 multiethnic middle-school youth, receiving 10 weekly 2-hour sessions. Results. Two weeks postintervention, there was a large positive significant increase in whole/minimally processed food intake ( p < .01; d = 0.59) and a small decrease in consumption of highly-processed foods ( p = ns; d = 0.06), compared with baseline. Significant increases in psychosocial mediators: Self-efficacy and positive outcomes expectations were seen; others were not significant but changed in the desired direction. Qualitative assessments suggest that the intervention promoted skill building, but environmental barriers made these difficult to use. Discussion. The IDOF curriculum may be most effective for promoting consumption of fruits and vegetables, rather than decreasing intake of highly processed foods. In addition, in this young age-group, short actionable food rules may support self-regulation and behavior change. Conclusion. Among adolescent students in low-income urban neighborhoods, the IDOF afterschool curriculum may help promote self-efficacy and positive outcome expectancies and increase fruit and vegetable intake. Focusing on food processing and using “Food Rules” may be promising to elicit behavior change in youth; however, greater supports are needed to overcome social and environmental barriers.
Objective: This study describes the use of the Nutrition Education DESIGN Procedure for developing the In Defence of Food Curriculum, a health education curriculum serving as the companion guide to the In Defence of Food documentary film based on the book with the same title. Design: The DESIGN Procedure is a systematic stepwise framework that produces behaviourally focused, theory-driven health education programmes and evaluation plans. Methods: DESIGN begins with an audience assessment and literature review that guides the selection of desired behaviours and psycho-social theory. For the In Defence of Food Curriculum, the desired behaviour changes were increased intake of whole/minimally processed plant-based foods and decreased intake of highly processed foods. A theoretical framework combining social cognitive and social determination theories guided programme development and evaluation plans. Education theory guided translating this framework into a ready-to-deliver curriculum. DESIGN aims to ensure alignment of theory determinants/mediators, behaviour change strategies, objectives, instructional activities and evaluation measures for systematically addressing desired behaviour changes. Over the course of 10 lessons, young people participate in interactive activities that explore the benefits of healthy eating, while appreciating how the ubiquity of heavily marketed and highly processed foods make healthy eating challenging. The evaluation plan guides measurement of target behaviours and the theory-based determinants/mediators. Results: This case study describes the development of the In Defence of Food curriculum using the DESIGN Procedure and demonstrates how a comprehensive and structured method for health education curriculum development and evaluation planning can be applied. Conclusion: The DESIGN Procedure has relevance for researchers, practitioners and programme planners.
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