Development and evaluation of lessons and psychometric tools for peer-led nutrition education interventions in childhood and adolescence
Open Access
- Author:
- Nelson, Sarah Ann
- Graduate Program:
- Nutrition
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- May 02, 2013
- Committee Members:
- Sharon M Nickols Richardson, Dissertation Advisor/Co-Advisor
Sharon M Nickols Richardson, Committee Chair/Co-Chair
Penny Margaret Kris Etherton, Committee Member
Katarzyna Kordas, Committee Member
Melissa Jean Bopp, Committee Member
Marilyn Ann Corbin, Special Member - Keywords:
- peer education
childhood obesity
behavior change
nutrition education
lesson development
instrument testing - Abstract:
- The prevalence of childhood obesity in the United States (U.S.) is clinically and financially concerning. Most prevention strategies utilize socioecological models to design interventions that contextualize obesity-related risk behaviors. Behavior change models, such as the Social Cognitive Theory (SCT), are often used to characterize the pathways by which changes occur within these socioecological frameworks. SCT proposes that individual- and environmental-level variables within different socioecological contexts mediate changes in actual behaviors. Peer-led nutrition education is one novel prevention strategy utilized to modify behaviors through increases in individual-level mediators, such as social support and social norms related to living a healthy lifestyle. Limited studies have used peer-based intervention strategies to reduce risky eating behaviors in adolescence. Peer-led culinary nutrition education serves as one innovative avenue for teaching youth how to apply nutrition education to experiment with foods. There has been a demand to resurrect culinary nutrition education programs for school-aged children, because lack of culinary skills has been associated with poorer dietary habits. Future research needs to test the effectiveness of peer-led approaches to culinary nutrition education on behavior change among children and adolescents. This research project was conducted to develop and evaluate the feasibility of designing three culinary nutrition education lessons that effectively impact SCT mediators of behavior change among adolescents. This project also sought to validate a SCT tool for adolescents and parents that may be used to assess changes in SCT mediators among adolescents and their parents in future peer-led nutrition education lessons aimed at implementing the Dietary Guidelines for Americans, 2010. The validated lessons and psychometric tools will be used in a future peer-led nutrition education program to understand if novel peer-led programs can modify obesity-related risk behaviors in adolescence. In the first part of this research project, culinary nutrition education lessons were pilot tested in two studies. In the first pilot study, early adolescent youth (ages 11-14 years) were recruited to participate in a 2-hour Family Menu Planning lesson. In the second pilot study, youth were recruited to participate in two, 2-hour mechanical and perceptual culinary skills lessons, Culinary Skills and Culinary Skills In Action. In both pilot studies, participants were asked to participate in each 2-hour lesson, followed by a 1-hour focus group. Content validity analyses were conducted to assess internal validity prior to pilot testing. Process evaluation tools were used to measure feasibility of conducting the lessons in an after-school setting. Focus groups captured data for assessments of formative outcomes and self-reported behavior change mediators. Eight adolescent females participated in the pilot testing of all three lessons. Participants were all Caucasian and either enrolled in the sixth or seventh grades. Content validity analyses revealed that all three lessons were valid for achieving key lesson objectives. Process analyses from the pilot studies indicated that it was feasible to deliver each lesson to early adolescent children in an after-school setting. Observers from the research team rated that students were highly engaged in all three lessons and that most learning objective tasks were executed “well” by the instructor. All tasks rated as “not completed well” by observers in the Culinary Skills and Culinary Skills In Action lessons were related to time constraints. Formative data from focus groups revealed that students were highly satisfied with all three lessons. Most participants would have been more satisfied, if the lessons would have had more visual learning aids, hands-on activities and opportunities for participants to teach their peers. All three lessons impacted self-reported heightened self-efficacy, social support and outcome expectations related to both family menu planning and mechanical and perceptual culinary concepts. In summary, results from the first part of this research project suggest that it is feasible to deliver culinary skills lessons that effectively impact mediators of behavior change in early adolescent youth. These results warrant the use of these lessons in a future peer-led culinary nutrition education program for adolescents. The second part of this research involved validating the effectiveness of SCT tools for assessing changes in SCT mediators among adolescents and their parents. Early adolescent children, between the ages of 11-14 years, and their parents were recruited to participate in a pilot study for instrument testing. Parents-child dyads were asked to complete SCT questionnaires at two time points within one week. Time 1 responses were used to assess the internal consistency of scales for each SCT mediator on the parent and adolescent questionnaires. Scales with Cronbach’s α values ≥0.70 were considered internally consistent. For all scales with Cronbach’s α >0.70, item-total analyses were used to remove individual items from scales, if item deletion resulted in higher α values. Test-retest reliability analyses between Time 1 and Time 2 were conducted for each SCT mediator with Spearman correlations. A total of 42 parent-child dyads completed SCT questionnaires at Time 1, and 36 pairs completed questionnaires at Time 2. Youth had a mean±SD age of 12.3±0.6 years and were enrolled in the seventh grade. A majority of participants were female (n=31, 73.8%) and Caucasian (n=32, 76.2%). The mean±SD age of parents was 48.3±5.1. Parents were mostly female (n=30, 71.4%) and Caucasian (n=29, 69.0%), had either a 4-year college degree (n=21, 50.0%) or master’s degree (n=12, 28.6%) and possessed mid-high household incomes (n=32, 76.2%). Cronbach’s α coefficient for most scales on both the adolescent and parent SCT questionnaires were ≥0.70, suggesting internal consistency of questionnaires. Self-regulation related to Balancing calories to manage weight had low-to-moderate internal consistency for both the parent and adolescent SCT questionnaires. Item-deletion analysis revealed that dropping items related to more restrictive weight management behaviors increased the internal consistency of both questionnaires. Test-retest reliability analysis revealed that both instruments possessed high internal reliability between study time points. Time 1 and time 2 responses were highly correlated, with correlation coefficients ranging from 0.40 to 0.97 for both questionnaires. Results from the second part of this research suggest that the SCT tools may be useful for assessing changes in SCT mediators among adolescents and their parents who participate in a future peer-led culinary nutrition education program, aimed at promoting the Dietary Guidelines for Americans, 2010. In summary, it is feasible to deliver culinary nutrition education lessons that effectively impact SCT mediators among early adolescent youth. Furthermore, the SCT instruments may be useful for assessing changes in SCT mediators over time in future nutrition education programs. Future use of these lessons in a peer-led format may provide a developmentally relevant strategy for teaching youth the basic skills they need to select, handle and prepare food in the current food environment. Childhood obesity prevention relies on these innovative education efforts to address the multiple influences that promote risky obesity-related behaviors.