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The effectiveness of nutrition
education programme for primary
school children
ARTICLE in MALAYSIAN JOURNAL OF NUTRITION MARCH 2007
Source: PubMed
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Mal J Nutr 13(1): 45-54, 2007
The Effectiveness of Nutrition Education Programme for
Primary School Children
Ruzita AT1, Wan Azdie MAB2 & Ismail MN1
1 Department of Nutrition and Dietetic, Faculty of Allied Health Sciences, Universiti Kebangsaan
Malaysia, 50300 Kuala Lumpur;
2 Department of Nutrition Sciences, Kulliyyah of Allied Health Sciences, International Islamic
University Malaysia, Jalan Istana, Bandar Indera Mahkota, 25200 Kuantan, Pahang
ABSTRACT
This study was conducted to determine changes in nutrition knowledge,
attitude and practice of 8-year-old school children after receiving a nutrition
education package. A total of 418 school children from urban and rural areas
participated in this study. The intervention group consisted of 237 children
while 181 children who did not receive the nutrition education package acted
as controls. The nutrition education programme that was conducted for 3
weeks comprised of a video viewing session and a comic reading session
followed by exercise questions as reinforcement for each session, and also
classroom activities. Knowledge, attitude and practice questionnaires were
distributed to the children before (pre-intervention) and after (post-
intervention) receiving the nutrition education programme. A follow-up visit
was conducted six months after the programme had elapsed. The results
obtained indicated that the nutrition knowledge score increased significantly
in the intervention group from 48.313.2 at pre-test to 54.616.2 in post-test
and 55.014.3 in follow-up test (p<0.05). The nutrition attitude score also
increased significantly from 68.715.5 at pre-intervention to 72.615.0 and
74.715.8 during post-test and follow-up test respectively (p<0.05). However,
the nutrition practice score had no significant improvement in both groups
throughout the study period. There were no significant changes in the control
group in knowledge, attitude and practice scores at pre, post and follow-up
tests. In conclusion, this study showed that a good nutrition education
programme had a positive impact whereby better nutrition knowledge,
attitude and healthy eating habits in children were seen. It is hoped that the
improvements would be sustained throughout their lives.
____________________
Correspondence author: Ruzita Abd. Talib, Email: [email protected]
46 Ruzita AT, Wan Azdie MAB & Ismail MN
INTRODUCTION In Malaysia, the Ministry of
Education in collaboration with the
Children are facing rapid develop- Ministry of Health has put into action pro-
ment mentally and physically thus grammes to promote and improve health
good nutrition is very important in this and nutritional status among school chil-
phase of life to ensure they grow normally dren (Sahari, 1992). Examples of such
and healthily. Eating habits in children are programmes are the School Health Pro-
generally developed since young and gramme, School Health Education Pro-
usually will continue into adulthood gramme, School Supplementary Feeding
(Kelder et al., 1994; Krebs-Smith et al., 1996; Programme and School Milk Programme.
Auld et al., 1998). Therefore, nutrition edu- The Ministry of Education also has incor-
cation should be conveyed to children porated several topics related to nutrition
from an early age. and health into the science, and physical
The rapid change in socio-economic and health education syllabus. The aim is
status among Malaysians has resulted in to help students to improve their knowl-
changes in lifestyle, including eating edge, promote positive attitudes towards
habits and food intake and consumerism. good health and nutrition and also to prac-
Changes in eating habits and leading tice a healthy lifestyle (Ministry of
sedentary or inactive lifestyles are known Education Malaysia, 1998).
to be some of the factors contributing In this study the nutrition teaching
towards increasing prevalence of chronic media were produced in the form of a
diseases such as diabetes, cardiovascular video and comic. The idea was to provide
diseases and hypertension in the popula- an alternative choice of teaching media in
tions (Ismail et al., 2002). nutrition education at schools instead of
The school has been identified as a using the usual textbook. The main objec-
suitable place to implement nutrition edu- tive of this study is to determine the
cation programmes because it has a effectiveness of a nutrition education pro-
systematic environment (Kolbe, 1993; gramme implemented among primary
Auld et al., 1998). Contento, Manning & school children. It is hoped that this
Shannon (1992) cited that nutrition educa- programme will benefit the students and
tion in schools could improve childrens could help to improve their knowledge
eating habits. This is because school is a besides encouraging them to practice good
place where almost all children and ado- eating habits in their daily lives.
lescents can be reached and are gathered
among their peers, besides having all the MATERIALS AND METHOD
teaching facilities and expertise (Auld et
al., 1998; Willeford, Splett & Reicks, 2000). Study design
Inculcation of activities and exercises in
the school that express the relationship This study was organised in 2
between the children and food could bring phases. During the first phase, the teach-
about positive results that lead to the ing materials (video and comic) of the
building of a healthy lifestyle (Moberg & intervention programme were developed
Piper 1990) among the children. Matheson and tested, and the knowledge, attitude
& Spranger (2001) suggested that educa- and practice (KAP) questionnaire was
tors should incorporate attractive and validated. In the second phase, an inter-
amusing activities in nutrition education vention was implemented for 2 consecu-
programmes in order to create an enjoy- tive weeks at the intervention schools. The
able learning environment. control schools did not receive any
intervention programme.
Effectiveness of nutrition education programme for primary school children 47
Study population Evaluation of the programme
A total of 418 Malay children, 204 Before the study started, children
boys and 214 girls aged 8 years old were and their parents were asked to complete a
recruited for this study. The children were demographic questionnaire. A question-
divided into two groups, an intervention naire comprising questions on nutrition
group (n=237) and control group (n=181). knowledge, attitudes and practices (KAP)
The study was conducted in four schools was administered to each child before they
(2 urban and 2 rural areas). In each urban received the nutrition education pro-
and rural area, one school served as the gramme and right after the programme
intervention school while the other one was completed. Follow-up test was done
acted as control. The locations were using the same questionnaire six months
Daerah Ulu Langat in Selangor and after the programme elapsed. Changes in
Wilayah Persekutuan Kuala Lumpur. the KAP scores were used as the main
The study protocol was approved by parameter to determine the effectiveness
the Research Ethical Committee of of the nutrition education programme.
University Kebangsaan Malaysia. The offi- The results were also compared between
cial consent was obtained from the rural and urban areas. All data were
Ministry of Education for the school selec- analysed using SPSS programme version
tion and the study activities in the selected 11.05. The results were presented as mean
schools. Written informed consent was and standard deviation. General Linear
obtained from the parents, and verbal con- Model as well as t-tests was used in data
sent was obtained from the children for interpretation.
the intervention activities and for all meas-
urement procedures.
RESULTS
Intervention component
Changes in nutrition knowledge, attitude
A video and comic entitled Food and practice before and after the
Pyramid were prepared specifically for programme
this study and pre-tested before they were
used as teaching materials in the class- Changes in nutrition knowledge score
room. Teaching sessions took place during
the period of Physical and Health Figure 1 shows the changes in nutri-
Education at school. The video viewing tion knowledge score during the study
session was done during the first week. period in both intervention and con-
During the second week, the children were trol groups. At pre-intervention, the nutri-
given a comic and were asked to read it tion knowledge in both intervention
together with their teacher in the class- (48.313.2%) and control (49.912.7%)
room. Each activity was followed by exer- groups did not differ significantly
cise questions as enforcement. Group (p>0.05). The nutrition knowledge of the
work also became part of the nutrition intervention group increased significantly
education programme in the third week, at post intervention (54.616.2%) and
where children working in a group of 4 or follow-up visit (55.014.4%) as compared
5 were asked to complete a food pyramid to the pre-intervention data. However, the
on a sheet of triangular cardboard. Only changes in nutrition knowledge of the con-
children from the intervention group trol group were not significant (Wilks
received the nutrition education pro- Lambda=0.937, F=13.9, p=0.00) during the
gramme. study period.
52 Ruzita AT, Wan Azdie MAB & Ismail MN
chronic diseases throughout their lives. that in his study, the implementation of a
This is because some of the physiological teaching curriculum called The Great Grow
processes that lead to certain chronic Along has shown significant changes in
diseases are associated with unhealthy nutrition knowledge and attitude in
eating habits during childhood. Unhealthy schoolchildren. As a consequence, 75% of
eating habits in children usually continue the children have changed or are planning
until adulthood (Kelder et al., 1994). Subse- to change their food choices. On the other
quently, it is very important to educate hand, as mentioned earlier, a study done
children and instil them with healthy eat- by Ruzita et al. (2000) using a video pack-
ing habits during early childhood because age and incorporated with activities such
eating habits are difficult to change in as singing and exercise programmes have
adulthood after they have been practised improved nutrition knowledge among
for a long period of time. overweight and obese schoolchildren.
The nutrition education programme These examples show that a well-planned
conducted in this study enhanced the nutrition education programme can be an
nutrition knowledge, attitude and prac- excellent medium to teach children on
tices of the target group. However, the nutrition and healthy lifestyle topics.
nutrition knowledge and attitude scores Although much research on nutrition
were more apparent compared to the education has not acquired a strong corre-
nutrition practices. This study also found lation between nutrition knowledge and
that there was a significant difference in practices, some researchers reported that
overall KAP score between the interven- nutrition knowledge can at least change
tion and control groups. However, the the eating habits (Worsley, 2002). For
increment of nutrition practice was signif- example, Wardle, Parmenter & Waller
icant among children in urban areas as (2000) reported that nutrition knowledge
compared to rural areas. This result was has a significant correlation with healthy
because children in urban areas were more eating habits such as fruits and vegetables
exposed to nutrition information and they intake. He also discovered that individuals
already had self motivation, thus found it with knowledge are 25 times more likely
easier to accept and understand the infor- to include fruits and vegetables in their
mation delivered in the programme. diet compared to those with less or no
Earlier studies involving nutrition knowledge on nutrition. However, Ruzita
education also reported that nutrition edu- et al. (2000) pointed out that an increase in
cation programmes could improve nutri- the understanding and knowledge con-
tion knowledge and attitude significantly, cerning nutritional concepts does not
as well as improving the eating habits or necessarily bring positive changes in
practices among the children (Contento, making healthy food choices. This is
Balch & Bronner, 1995; Contento, Manning because people need extra periods of time
& Shannon, 1992). Perez-Rodrigo & to change their food choices and eating
Aracenta (1997) suggested that effective habits.
nutrition education should focus on the In the present study, even though the
initiative to increase nutrition knowledge, average score for nutrition knowledge had
as well as to establish positive dietary increased, there are not many changes in
habits and practices. A study by Ruzita et the practice score. The short intervention
al. (2000) in Kuala Lumpur showed that period may be one of the factors that con-
nutrition knowledge among overweight tribute to the few changes observed in
schoolchildren can be improved by means their eating habits or practices. Besides,
of nutrition education programmes. childrens eating habits are always influ-
Willeford, Splett & Reicks (2000) reported enced by other factors especially food
Effectiveness of nutrition education programme for primary school children 53
availability at home, family socioeconomic Centers for Disease Control and
status as well as mothers who prepare Prevention (CDC) (1996). Guidelines
food for the family (Crockett & Sims 1995). for School Health Programs to
On the other hand, programmes that focus Promote Lifelong Healthy Eating.
on changing certain habits such as fat Morbidity and Mortality Weekly Report
intake and fruits and vegetables intake, 45(RR-9).
together with suitable evaluation and
implementation methods, could offer Contento IR, Balch GI & Bronner YL
positive impact towards nutrition prac- (1995). The effectiveness of nutrition
tices. In addition, the type of question- education and implications for nutri-
naires administered as well as statistic tion education policy, programs, and
tests used play an important part in research: a review of research. J Nutr
obtaining good correlation between indi- Edu 27: 279-418.
vidual nutrition knowledge and their
practices (Wardle, Parmenter & Waller, Contento IR, Manning AD & Shannon B
2000). (1992). Research perspective on
school-based nutrition education. J
Nutr Edu (24): 247-260.
CONCLUSION
This study has shown that a well Crockett SJ & Sims LS (1995).
planned nutrition education programme Environmental influences on chil-
could improve nutrition knowledge and drens eating. J Nutr Edu 27(5): 235-
promote positive changes in attitudes and 249.
practices towards good nutrition. In addi-
tion, the usage of educational media such Ismail MN, Chee SS, Nawawi H, Yusoff K,
as comics and videos in this programme Lim TO & James WPT (2002).
may attract childrens attention to learn Obesity in Malaysia. Obesity Review
and understand better nutrition. This pro- 3:203-208.
gramme could be a nationwide model for
nutrition education and promotion pro- Kelder SH, Perry CL, Klepp K & Lytle LL
grammes in the school setting in Malaysia. (1994). Longitudinal tracking of ado-
By implementing the programme in lescent smoking, physical activity,
schools, it will give a positive impact by and food choice behaviors. Am J Publ
inculcating good nutrition knowledge, Hlth 84: 1121-1126.
attitude and healthy eating habits in
Malaysian children, and that hopefully Kolbe LJ (1993). An essential strategy to
will persist throughout their lives improve health and education of
Americans. Preventive Medicine 22:
544-560.
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