Impact of a multicomponent community-based nutrition education program (Camp HECT) on the nutrition knowledge, nutrition attitudes, dietary practices, and dietary diversity among elementary school students in Taiwan
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Aim. Childhood malnutrition, including both under- and over- nutrition, remains the biggest health concern among school-aged children, particularly for the recent dramatic increase of childhood obesity worldwide and in Taiwan. Poor dietary behavior is the major contributing factor for childhood obesity in Taiwan. To address childhood obesity issues effectively, the emerging research has recommended to implement multicomponent nutrition education programs (NEPs) for school-aged children, particularly during summer months where children have significantly gained weight due to poor dietary behaviors and environment changes. Nonetheless, there are limited research and efforts for conducting NEPs to improve unhealthy dietary behaviors among school-aged children during summer months in Taiwan. Hence, the purpose of this study was to develop Camp Healthy Eating for Children in Taiwan (Camp HECT), a theory-informed and multicomponent community-based NEP, and to determine its impacts on children’s nutrition knowledge, nutrition attitude, dietary practices (KAP), and dietary diversity toward healthy eating. Methods. The study was a mixed methods design including both qualitative and quantitative methods. Qualitative research was carried out as a focus group before conducting Camp HECT; thus, elementary school students and their parents (N=21) participated in three focus groups to determine the needs and preferred content and communications for NEPs among school-aged children in Taiwan. For quantitative research, a cluster-randomized controlled trial (cRCT), with pre-, post-, and follow-up measurements, was performed. After eight community churches (clusters) recruited 151 elementary school students, the eight clusters were randomized to two groups, namely a control and experimental group, to determine the effectiveness and impacts of Camp HECT on nutrition KAP and dietary diversity of school-aged children. The experimental group had 4 clusters (N=81) and the control group had 4 clusters (N=70). Children in the control group received paper-based nutrition information that was unrelated to the experimental groups. Children in the experimental group received a face-to-face nutrition summer camp that involved both nutrition classes and cooking activities of 45-50 minutes daily for six consecutive days. A celebration event with parents was held during the last class of the intervention. Outcome measurements included the change scores in KAP, and dietary diversity in pre-, post-, and follow-up measurements with self-administered KAP and dietary diversity questionnaires for all participants. Course feedback was evaluated by a self-administered questionnaire at the celebration event. Data analyses included descriptive and inferential statistics from the qualitative data (transcription analysis) and quantitative data (SPSS and R software). Results. For qualitative data, all participants expressed that there was a need to conduct NEPs for school-aged children, and the top three preferred topics were healthy cooking, MyPlate, and healthy drinks. For quantitative data, a significant improvement (p<0.001) was found in the change scores for the overall and all subgroup scores of nutrition knowledge, dietary practices, and dietary diversity between the control and experimental groups after the intervention. For overall scores of nutrition attitude, there was an insignificant improvement (p=0.025) between the experimental and control groups after the intervention; however, the nutrition attitude subgroups of F&V, and dairy & calcium were significantly improved (p<0.001) in the experimental groups. For course feedback, the majority of students and parents expressed that Camp HECT was helpful for them to eat and prepare healthier food and increase their knowledge toward healthy eating. Conclusion & Recommendations. The results of this study indicate that there is a need to conduct NEPs for school-aged children during summer months. Further, this study suggests that a multicomponent community-based NEP during summer months can be effective in improving children’s nutrition knowledge, nutrition attitudes, dietary practices, and dietary diversity toward healthy eating; and may ultimately help to address the poor dietary behaviors which are the major risk contributing factors of childhood obesity in Taiwan. For future research, it is recommended to conduct multicomponent NEPs for a longer-period and include physical activities. Camp HECT serves as the first multicomponent community-based NEP aiming to improve poor dietary behaviors among school-aged children with parents’ involvement during summer months in Taiwan. This study will inform policy makers regarding the importance and the needs of conducting community-based multicomponent NEPs for school-aged children during summer months to improve school-aged children’s poor dietary behaviors, and ultimately to prevent the risk of developing childhood obesity.Embargo status: Restricted until 06/2172. To request the author grant access, click on the PDF link to the left.