Dairy intake-related attitudes, subjective norms and perceived behavioural control of South African nutrition professionals

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1 Dairy intake-related attitudes, subjective norms and perceived behavioural control of South African nutrition professionals Friede Wenhold Zelda White Department Human Nutrition, University of Pretoria

2 Dairy intake-related attitudes, subjective norms and perceived behavioural control of South African nutrition professionals

3 Introduction Intakes of dairy-related nutrients of South Africans are low (NFCS, 1999; NFCS 2005; Shisana et al, 2013) SA Food-based dietary guideline Have milk, maas or yoghurt every day (Vorster et al, 2013) Nutrition professionals influence dietary behaviour their own disposition related to dairy: unknown

4 Aim To describe (in relation to dairy in general and in respect of selected dairy products) o Behaviour: USUAL INTAKE o Behavioural beliefs & outcome evaluations: ATTITUDES o Normative beliefs and motivation to comply: SUBJECTIVE NORMS o Barriers and facilitators: PERCEIVED BEHAVIOURAL CONTROL of SA nutrition professionals within Theory of Planned Behaviour (TPB)

5 Conceptual / theoretical framework: THEORY OF PLANNED BEHAVIOUR (Ajzen, 1991) Nutrition professionals Adult clients / Patients Own ATTITUDES SUBJECTIVE NORMS (significant others) PERCEIVED BEHAVIOURAL CONTROL intake INTENTIONS INTAKE (= Behaviour)

6 Have 2-3 servings of milk, maas, yoghurt or cheese daily BEHAVIOURAL BELIEFS X OUTCOME EVALUATIONS ATTITUDES INTENTIONS BEHAVIOUR NORMATIVE BELIEFS X MOTIVATION TO COMPLY SUBJECTIVE NORMS CONTROL BELIEFS X PERCEIVED POWER PERCEIVED BEHAVIOURAL CONTROL

7 Methods Design o Cross-sectional survey Population o SA Nutrition professionals registered with ADSA / NSSA in 2015 Instrument development o TPB principles (item generation: elicitation: previous studies, expert group discussion); scales Likert 7- point) o Dairy in general & specific products: milk, maas, yoghurt & cheese

8 Methods Data collection o Online (Qualtrics) testing o Paper-based (2 CPD events in Gauteng) Data analysis (Stata release 14 ; 2015) o Descriptive statistics according to TPB o Cronbach s alpha o Pearson s correlations o Instrumental-variables regression analysis

9 Description of sample: Response rate: Results Total number of responses: 306 Usable responses: 282 Response rate: 15%

10 Results Description of sample: Mean age: 36.4±10.5y; 90% dietitians; 42% from Gauteng 140 Number of respondents >50 y >41-50 y >30-40 y 30 y 0 Provinces AGE GROUP AND PROVINCE OF RESIDENCE OF RESPONDENTS

11 Description of sample: Results PRIMARY WORK ENVIRONMENT (N=282) n % Public sector: Clinical Public sector: Non-clinical Private sector: Non-clinical Private sector: Clinical (hospital-based) Private practice Academic / research institution Private practice Total

12 Results ATTITUDES SUBJECTIVE NORMS (significant others) PERCEIVED BAHEVIOURAL CONTROL intake INTENTIONS INTAKE (= Behaviour)

13 Results General dairy intake % Respondents Never Once per month 2-3 times per month Once per week 2-3 times per week 4-6 times per week 0.0 Every day "How often is your daily dairy intake 2-3 servings or more?"

14 Results Intake of selected dairy products: MILK n % Consumption as such? Yes No Portion size? S (±125 ml) M (±250 ml) L (±500 ml) Consumption with other foods? No Companion foods (> 1 could be chosen) Yes Coffee /Tea 242 Cereal / Porridge 219 Shakes / Drinks 104 Other 198

15 Results Intake of selected dairy products: MAAS n % Consumption as such? Yes No Portion size? S (±125 ml) M (±250 ml) L (±500 ml) Consumption with other foods? No Companion foods (> 1 could be chosen) Yes Cereal 31 Other 93

16 Results Intake of selected dairy products: YOGHURT n % Consumption as such? Yes No Portion size? S (± ml) M (±250 ml) L (±250 ml) Consumption with other foods? No Companion foods (> 1 could be chosen) Yes Cereal 143 Shakes / Smoothies 73 Other 104

17 Results Intake of selected dairy products: CHEESE n % Consumption as such? Yes No Portion size? S (± 30g) M (± 80g) L (± 120g) Consumption with other foods? No NA Yes

18 BEHAVIOURAL BELIEFS Results X OUTCOME EVALUATIONS ATTITUDES SUBJECTIVE NORMS (significant others) intake INTENTIONS INTAKE (= Behaviour) PERCEIVED BEHAVIOURAL CONTROL

19 Results Behavioural beliefs: For me 2-3 servings of milk is associated with Environmental concerns Good taste 7 6 Nutritional quality Milk 5 Diabetes 4 3 Bone health 2 Cancer 1 0 Weight management Physical activity Cardiovascular health Familiarity Growth (e.g. infancy ) Adverse reactions

20 Results Behavioural beliefs: For me 2-3 servings of maas is associated with Environmental concerns Good taste Nutritional quality Milk Maas Diabetes 4 3 Bone health 2 Cancer 1 0 Weight management Physical activity Cardiovascular health Familiarity Growth (e.g. infancy ) Adverse reactions

21 Results Behavioural beliefs: For me 2-3 servings of yoghurt is associated with Diabetes Environmental concerns Good taste Nutritional quality Bone health Milk Maas Yoghurt Cancer Weight management Physical activity Cardiovascular health Familiarity Growth (e.g. infancy ) Adverse reactions

22 Results Behavioural beliefs: For me 2-3 servings of cheese is associated with Diabetes Environmental concerns Good taste Nutritional quality Bone health Milk Maas Yoghurt Cheese Cancer Weight management Physical activity Cardiovascular health Familiarity Growth (e.g. infancy ) Adverse reactions

23 Results NORMATIVE BELIEFS X MOTIVATION TO COMPLY ATTITUDES SUBJECTIVE NORMS (significant others) intake INTENTIONS INTAKE (= Behaviour) PERCEIVED BEHAVIOURAL CONTROL

24 Results Normative beliefs & Motivation to comply

25 Results CONTROL BELIEFS ATTITUDES SUBJECTIVE NORMS (significant others) intake INTENTIONS INTAKE (= Behaviour) X PERCEIVED POWER PERCEIVED BEHAVIOURAL CONTROL

26 Results Perceived behavioural control: Nutrition professionals (=own) & adult clients

27 Results THEORY OF PLANNED BEHAVIOUR ATTITUDES R2 = Nutrition professionals Own SUBJECTIVE NORMS (significant others) intake INTENTIONS INTAKE (= Behaviour) PERCEIVED BEHAVIOURAL CONTROL Internally consistent scales: Cronbach s alpha: Behavioural beliefs: 0.72 Outcome evaluation: 0.42 Normative beliefs: 0.73 Motivation to comply: 0.79 Control beliefs: 0.86 Perceived power: 0.81 r = 0.7 (P < 0.001) Beta = 0.728

28 Conclusions & Recommendations GENERAL PREMISE Tap on nutrition professionals leadership roles as nutrition educators, advocates and agents for behaviour change for nutritional health of South Africans Assumption: Effectiveness of above role related to own dietary behaviour and disposition Always: Emphasis on whole diet (all FBDG s), i.e. balance, variety, moderation Behaviour change: Function of multiple interventions - over time

29 Conclusions & Recommendations BEHAVIOUR (DAIRY INTAKE)-RELATED Maintain / strengthen current high intakes of yoghurt and cheese (emphasis: reduced fat) Modify current intake patterns of milk by encouraging as such consumption, particularly among children (establish life-long habits) Introduce maas (e.g. comprehensive maas drive with nutrition facts [ new dairy regulations], tasting, recipes/ideas for use: familiarity & skills-based approach)

30 Conclusions & Recommendations ATTITUDE-RELATED Strengthen existing positive attitudes (e.g. nutritional value and bone health) Enlighten / empower regarding controversial / complex matters and strength of evidence (e.g. link to cancer, diabetes and environmental matters)

31 Conclusions & Recommendations SUBJECTIVE NORMS-RELATED Use scientific evidence as significant other / communication channel Work through universities (i.e. professional training)

32 Conclusions & Recommendations PERCEIVED BEHAVIOURAL CONTROL-RELATED Development of tools that nutrition professionals can use to increase their clients ability to include dairy in their diets (cost, perishability & access)

33 Dissemination of information Full Report (Feb 2016) Stakeholder presentations (May & June 2016) Manuscript: Submitted SAJCN (June 2016) Scientific poster UP: Research day (Aug 2016) IDF: Netherlands (Oct 2016) Advertorial SAJCN (Sept 2016)

34 We gratefully acknowledge: Consumer Education Project of Milk SA (Funding) Technical Advisory Committee of CEP ADSA & NSSA and their participating members Statistical advisors, P Becker & U MacIntyre Graphic designer, Nicky (Studio Nica)

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