The Study in Change of Nutrition Knowledge, Attitude, and Behavior of College Students as Affected by Different Method of Nutrition Education

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1 The Study in Change of Nutrition Knowledge, Attitude, and Behavior of College Students as Affected by Different Method of Nutrition Education Dr. Huang, C.Y., Dept. of Hotel Mgt., National Kaohsiung University of Hospitality and Tourism, Taiwan Dr. Liu, Y.L., Corresponding Author, Dept. of Hospitality Management, I-Shou University, Taiwan Dr. Tsou, H.F., Dept. of Hospitality Management, National Taitung College, Taiwan ABSTRACT College students of Food and Beverage Management related disciplines in southern Taiwan were surveyed in order to investigate the influencing factors of students nutritional knowledge, behaviors and attitudes. Eight hundred and fifty questionnaires were given with 723 returned and of which 584 were valid. Results showed that the overall percentage of correct answers on nutritional knowledge, attitudes and behaviors were 77.5%, 77.6% and 67.5%, respectively, which indicated that nutritional behaviors possessed by college students were on fair ground. The location of institutes and residences, grade, age, academic system, food and beverage related working experiences had no significant effects. Students on metropolitan areas scored higher on nutritional attitudes and behaviors (P<0.001). Students who had taken related courses had better nutritional knowledge, attitudes and behaviors. Female students and professional certificate holders also had higher scores on nutritional knowledge and attitudes. Major sources of nutritional information were mass communication media (50.6%), followed by newspapers and magazines (21.0%), radio and TV (15.2%), while the Internet also received 14.4%. But the influences from schools (24.2%) and families (8.9%) education were decreased. There were positive correlation between nutritional knowledge and attitudes, so as attitudes and behaviors, similar positive relationship between knowledge and behaviors were also identified (p<0.01). Keywords: nutritional education intervention, nutritional knowledge, nutritional attitude, nutritional behavior INTRODUCTION The concept of balance diet has been promoted by health administration for past several years. In order to obtain enough nutrients, it is necessary to select various types of foods and adequate quantity from the six major food categories daily. It is important not only to obtain the basic nutrition and energy, but also follow the concept of balance diet. Furthermore, the Department of Health has endorsed the concept of healthy diet and enforces notions of five vegetables and fruits a day and three less, two more rules to alter people s eating habits and improve health. As the changing with work patterns, the workloads and pressure also increasing, thus, the population of dinging-out also increasing as well, therefore, promoting the hospitality industry to invest more on research and development on lunch-boxes, microwavable food, fast-food, and preference beverages, which have gradually changed eating habits of general public, as a result, creating harmful 80 The Journal of Human Resource and Adult Learning, Vol.9, Num. 2, December 2013 issue

2 effects to public health due to high calories, high fat, high sugar, and low fiber diets. In 2006, there were seven diseases which related to the inappropriate eating habit which were included in the ten leading causes of death in Taiwan; they were malignant, heart disease, cerebral vascular disease, diabetes, chronic hepatic disease, cirrhosis, and hypertension. The hospitality industry must be acknowledged that it should take the responsibility concerning public health. It is no longer solely focuses on the sanitation and safety, variety recipes, but also the up-taking of dietary fiber and cutting fat. However, due to traditional believes, promoting healthy diet has encounter some obstacles, such as lacking of professional training in hospitality industry, which creates difficulties in designing a menu which is nutritious while still maintaining its flavor. Therefore, therefore, for the purpose of promoting public health, it is very important to include nutritional education in the general courses in higher education in order to improve public health. Main purpose of this study was to determine the effect of intervention of nutritional education and various teaching methods on students nutritional knowledge, attitudes, and behaviors which before and after taking such course. According to the results, there is also having several suggestions for the content of courses. LITERATURE REVIEW A study conducted by Lin (2000) indicated that nutritional education can be correctly and completely incorporated into school-lunch program under the guidance and with cooperation from experts with nutrition professions. The acceptance of menu items was also improved. Lin et al. (2001) conducted a research concerning fat intake reduction nutrition education program. The results indicated that the nutrition education program which named Journey of Dietary Fat Reduction, could successfully enhance adults dietary fat reduction with the assistance of nutrition knowledge, attitude, and self-efficacy, thereafter, improve dietary behavior. Huang and Horng (2002) conducted a nutrition education related research concerning eighty aborigines form Tsou tribe in Tefuye of Ali Mountain. Results indicated that after nutritional education the treatment group exhibited significant improvement in the dietary behaviors, but the control group showed improvement only in the use of alcohol. Therefore, the nutritional education had beneficial on the dietary behavior modification of aborigines from Tsou tribe in Tefuye of Ali-Mountain. Results of a study conducted by Lee et al. (1998) showed that obesity children's knowledge, attitude, and behavior toward nutrition in the experimental group were slightly higher and more positive than those in the control group. Conclusively, this weight reduction program was slightly effective for obesity children, but no significant difference in two groups, however, the intervention of obesity reduction must be achieved by a long-term cooperation among school, children and parents. Barton (2000) discovered a significant difference in the carbohydrate content of the lunch boxes which was observed post-intervention. It was concluded that all parents recognized the importance of healthy eating habit for their children but somehow felt that the largest barrier to changing children's eating habits were the child's likes and dislikes. The study highlights the need for more nutrition education both inside and outside the school. Sandra Danielzik, et.al.(2007) also concluded that school-based health promotion has sustainable effects on nutritional knowledge and remission of overweight being most pronounced in girls. The effect of intervention was most pronounced using TSF and WC as criteria of overweight. Liu (1999) conducted a study comparing the effects of Social Learning Strategy and traditional The Journal of Human Resource and Adult Learning, Vol. 9, Num. 2, December 2013 issue 81

3 learning strategy on the efficiency of intervention of nutritional education on elementary school students. Results indicated that Social Learning-oriented teaching techniques had significant effect on improving student s dietary self-efficacy vegetable and fruit consumption and decreasing frequency of sugar-contained soft drinks intake immediately after the intervention. After eight weeks, the effect lasted for eight weeks on dietary self-efficacy, vegetable and fruit consumption. It is suggested that the courses arrangement should focus on the practicing of social learning teaching techniques. Classroom lecturing is not the only method for teaching, but also the cooperation from environment change and school policies. Peng and Kuo (1994) also pointed out that it is necessary for school to provide nutrition relating courses for students who have not in contact with this discipline. Mass communication media should also report adequate information concerning health diet in order to improve students nutritional knowledge, attitudes, and behaviors. RESEARCH METHODS The purpose of this study was to discover the different teaching methods on students toward their nutritional knowledge, attitudes, and behaviors, which including comparison between before and after taking nutrition courses. Sample population was students of five-year-institute who took the general nutrition course. Tests were given at the beginning of and after semester has finished. The course includes 32 hours lecturing. Course content includes: six-main-food categories, five-main-nutrition categories, function, metabolism, deficiency, food resources, daily dietary guideline, and dietary index, the concept of healthy eating, calories, weight control and dietary psychiatric. One hundred and forty questionnaires were issued with 133 returned and 133 valid. According to the purposes of this study, two hypotheses were established. Nutritional knowledge was evaluated using true and false questions. One point was given to correct answers while incorrect or unanswered questions received no point. Nutritional attitudes and behaviors were measured using Likert s Scale. Scores from one to five were assigned for each item selected from totally disagree to totally agree. Higher scores indicated more correct nutritional attitudes. Same scoring system was also employed for measuring nutritional behaviors. Contents of the questionnaire were divided into four parts. First part contain twenty questions related to nutritional knowledge which included basic knowledge, functions of nutrients, characteristics o nutrients, deficiency syndromes, and diet guides. There were 18 questions included in nutritional attitudes, which were divided into five categories include diet habit, food selection, food sanitation, nutritional values, and healthy diet. The third part contained thirty-one questions which included low sodium diet, greasy food selection, vegetable and fruit selection, general food selection, and dining habits. SPSS for Windows Version 10.0 was utilized for statistical analysis. Descriptive statistics, independent sample T-test, ANOVA, paired sample T-test, and Chi-square were employed for data analysis. RESULTS AND DISCUSSIONS Results showed that there was significant effect on nutritional knowledge by the intervention of nutritional education (P<0.001). However, there were no significant differences between pre- and post-semester test scores on nutritional attitudes under the intervention of nutritional education (Table 1). There was also no significant difference between the pre- and post- scores for nutritional behaviors under 82 The Journal of Human Resource and Adult Learning, Vol.9, Num. 2, December 2013 issue

4 the intervention of nutritional education. (Table 2). This result might be caused by far too much class materials which equip students mind but not enough opportunities for them to practice. Students received only lecturing scored higher on nutritional knowledge while students received more demonstration other than lecturing had higher scores on nutritional attitudes. This result indicated that students received only lecturing tend to memorize more class materials, therefore, scoring higher for knowledge, however, students received focused on practicing balanced diet and healthy food, who tended to demonstrate more correct attitudes than lecturing group. However, behaviors of both groups were not altered by the intervention of nutritional education Gender, residence locations, dining allowance, and perception of body type had no significant effects on the pre- and post-test scores by the intervention of nutritional education. Students grades (first year, second year, etc.) and faculty s professional background posed significant effect on the nutritional knowledge (P<0.001) and attitudes (P<0.05), but no significant effect on the nutritional behaviors. The intervention of nutritional education had less significant effects on higher grade students. Table 1: Differences between Pre- and Post test Scores of Nutritional Knowledge, Attitudes, and Behaviors Item Pre Post Paired-variables Mean S.D. Mean S.D. Mean S.D. t value Knowledge *** Attitudes Behaviors *p<0.05 **p<0.01 ***p<0.001 The relationship between nutritional knowledge, attitudes, and behaviors as affected by intervention of nutritional education was shown on Table 3. Positive relationship was found between nutritional knowledge and nutritional attitudes (p<0.05), and the attitudes and behaviors (p<0.01), but there was no relationship between nutritional knowledge and behaviors. This result applied to students received only lecturing. Positive relationship (P<0.05) was identified between attitudes and behaviors on group of students received demonstrations. Table 2: Differences between Pre- and Post-test Scores on Nutritional Knowledge, Attitudes, and Behaviors as Affected by Different Methods of Intervention of Nutritional Education. Item Lecturing Demonstration Mean S.D. Mean S.D. t value Knowledge Pre Attitudes Behaviors Knowledge ** Post Attitudes * Behaviors *p<0.05 **p<0.01 ***p<0.001 The Journal of Human Resource and Adult Learning, Vol. 9, Num. 2, December 2013 issue 83

5 L D Table 3: Relationship Matrix for post-test scores between nutritional knowledge, attitudes, and behaviors. Knowledge Knowledge Knowledge Knowledge 1.00 Attitudes 0.22* 1.00 Behaviors ** 1.00 Knowledge Attitudes Behaviors * 1.00 *p<0.05 **p<0.01 ***p<0.001, L=lecturing, D=demonstration The major source for nutrition related information was classroom (28.3%), followed by family education (16.6%), newspapers and magazines (15.1%), broadcasting media such as television programs or radio (13.6%), the Internet (12.4%), classmates and friends (9.0%). Medical professions received least percentage (0.5%). The combination of classroom and family education was 44.9%, which is similar to the combination of both mass communication media. This result indicated that education played an equally important role as mass communication media in educating students. CONCLUSIONS Most five-years-colleges do not provided school-lunch programs. Students of these colleges have no other choices but dining-out, therefore, their food selection and dining habits are greatly influenced by surrounding environment. They are eager to try new products and constantly searching for new places for dining. On the other hand, their dining habits are easily affected by various food services providers. However, by introducing nutritional education into general education courses, their nutritional knowledge was apparently improved (p<0.001). Although attitudes and behaviors were not affected by the intervention of nutritional education, however, they were not affected by the environment as mentioned previously. This indicates that nutritional education still pose positive effect on their attitudes and behaviors. Various previous studies (Lin et al., 2001; Liu, 1999; Huang and Horng, 2002) explained that nutritional education would change the attitudes and behaviors, but these changing were not caused only by lecturing, but also demonstrations and practices. It is suggested that educational institutes should continue searching for faculty members with professional training and background in order to design more suitable and useful courses for the purpose of educating hospitality students with positive nutritional knowledge, attitudes, and behaviors. REFERENCES Barton R. (2000). The effect of nutrition intervention, using the Balance of Good Health Model, on the composition of the packed lunches of year-old schoolchildren. Journal of Human Nutrition and Dietetics 13 (5), pp Chang, C.C., and Hu S.P. (2006). The effect of an environmental nutritional intervention on knowledge and practice of college dormitory students. Nutritional Sciences Journal 31(2), pp Danielzik S., Pust S., and Müller M.J. (2007). School-based interventions to prevent overweight and obesity in prepubertal children: process and 4-years outcome evaluation of the Kiel Obesity Prevention Study (KOPS). Acta Paediatrica 96 (454), pp Health and National Health Insurance Annual Statistics Information Service, Huang, S.Y., and Horng, J.S. (2002). The effect of nutrition education intervention on the dietary behavior of Tsou Tribe in Tefuye of Ali-Mountain. Fu Jen Journal of Human Ecology 7:1/8:1, pp The Journal of Human Resource and Adult Learning, Vol.9, Num. 2, December 2013 issue

6 Lee, H.I., Kuo, H.W., Lee, M.C., and Hung, L.C. (1998). The intervention program of body weight reduction on knowledge attitude and behavior toward nutrition among elementary school children. Nutritional Sciences Journal 23(3), pp Lin, R.D., Lai, S.P., Cheng, P.L., and Tang, F.C. (2005). Effect of nutrition education intervention on the physical fitness of exercise-induced weight loss children. Nutritional Sciences Journal 30(4), pp Lin, W. and Wang, H.C. (1998). Effects of the school lunch nutrition program on elementary fourth grade students. Nutritional Sciences Journal 23(1), pp Lin, W., Liu, G.Y., Hsu, K.P., Huang, C.Y., and Kao, L.L. (2000). A pilot study of school lunch modification and nutrition education intervention in elementary school. Nutritional Sciences Journal 25(3), pp Lin, W., Liu, G.Y., Chen, S.H., and Liu, Y.C. (2001). Evaluation of an adult fat intake reduction nutrition education program--journey of dietary fat reduction. Nutritional Sciences Journal 26(3), pp Liu G. Y. (1999). The effects of nutrition education program on elementary students: social learning strategies versus traditional teaching strategies. Journal of Health Education 12, pp Pong, T. and Kuo, H. W. (1994). Investigation of knowledge and attitude of junior college students on the basic and fast food nutrition in central Taiwan. Journal of the Chinese Nutrition Society 19(3), pp The Journal of Human Resource and Adult Learning, Vol. 9, Num. 2, December 2013 issue 85