Effectiveness of a nutrition education programme to increase grain intake of university nursing students: a randomised controlled trial

D.Nurs.Background: A balanced diet is the golden standard for dietary recommendation. It is observed that people tend to replace carbohydrate intake by protein and fat intake. The current diet trend is associated with chronic health problems such as non-communicable diseases. Nurses, health care professionals, also demonstrate unhealthy dietary behaviour. The need for education is identified.Aims: This study aimed at evaluating effectiveness of a nutrition education programme promoting grain intake amongst university nursing students. Study objectives were comparing grain intake, nutrition self-efficacy and body weight between intervention and control groups across time at baseline (T0), one-week (T1), one-month (T2), three-month (T3) and six-month (T4) after intervention.Methods: An integrative review was conducted to explore effective components of nutrition education promoting dietary behaviour change amongst young adults. Amongst the nine included studies, key components identified were face-to-face teaching strategies, e/m Health approach for communication, intention-implementation strategy and use of incentives. An evidence-based intervention programme was developed based on the review. A two-arm randomised controlled trial was conducted in a local university for testing the effectiveness of the programme effectiveness. Inclusion criteria included: full-time university nursing students who were proficient in English language and Chinese language; aged from 17 to 23 years old and owned a smart phone with camera. Exclusion criteria included: EAT-26 score above 20, had chronic diseases and had special diets. Participants were randomly allocated in nutrition education intervention group or wait list control group. Intervention was a two-hour nutrition education delivered by a nutritionist. Participants in control group received the same intervention after completion of data collection. Demographic data, physical activity frequency, diet restraint extent, body shape concern and self-esteem level were measured as participant characteristics. For data collection, participants were required to submit image-assisted food record, measure body weight and complete a nutrition self-efficacy questionnaire at all the time points. Data analysis was performed by using SPSS 22.0 and intention-to-treat principle was applied. Intervention effectiveness was examined by using Generalised Estimating Equations models.Results: 128 students were randomised into two groups. 14.8% of them has dropped out. There was no statistically significant difference in proportion of drop out between intervention and control group. Between-group differences across all the time points were significant in grain intake and nutrition self-efficacy but body weight otherwise.Conclusions: The nutrition education programme was effective in promoting grain intake and enhancing NSE of university nursing students without bringing about statistically significant change in body weight, it is recommended that nutrition education should be recommended to university nursing students. Similar programme should be done on other populations such as general university students or secondary school students for health education and health promotion.背景：飲食金字塔乃建議進食標準。據觀察，人們傾向以蛋白質及脂肪涉取以取代五穀。不健康飲食與長期病患有關。護士作為健康服務專業人士，亦未能表現出健康飲食，因此需要接受營養教育。目的：研究目的為評核營養教育於提升大學護士學生五穀類涉取之成效。研究目標為比較治療組及對照組在不同時段的五穀類涉取、營養自我勝任感及體重。比較時段為治療前，治療後一星期，一個月，三個月及六個月。方法：一個綜合性綜述找出了營養教育內，有效改變年青成年人飲食行為之要點。在九個隨機對照研究中，找出的要點包括：(1) 面授教育方式、(2) 通訊科技作溝通方法、(3) 使用預備策略及(4) 使用鼓勵策略。研究項目基於綜合性綜逑結果進行了規劃。本研究在本土一所大學進行了隨機對照實驗。對象均需為 (1) 全職大學護士學生、 (2) 明白中、英文、 (3) 年齡介乎十七至二十三歲及 (4) 擁有有拍照功能之智能電話。對象若 (1) 於EAT-26 檢測分數高於二十分、(2) 有長期病患史及 (3)進食特別餐，會被排除在研究外。合資格對象均被隨機分配到治療組或對照組。治療組會接受一個由營養師講解之兩小時營養教育。對照組會於所有跟進資料收集完畢後接受同樣治療。人口統計資料，恆常運動密度，飲食控制程度，體重關顧度及自信程度資料會被收集。研究項目資料，如五穀涉取量，營養自我勝任感及體重會於不同時段被收集。資料分析以意向分析 (intention-to-treat) 原則、廣義估計方程 (GEE) 及SPSS軟件完成。研究結果：一百二十八人被隨機分配到治療組或對照組。百分之十四點八在研究中途退出。兩組之退出比率，在統計學上沒有明顯差異。結果顯示，兩組在五穀涉取量及營養自我勝任感方面，治療組有較高提升。體重在兩組之比較則沒有明顯差異。結論：該項營養教育課能有效地提升大學護士生之五穀涉取量及營養自我勝任感，並能維持體重。基於現行護士及護士學生之不健康飲食行為，故此營養教育課應應用於護士教育課程上。再者，同類課程應授與一般大學生或中學生作健康教育及推廣。Tong, Ying Ting.Thesis D.Nurs. Chinese University of Hong Kong 2020.Includes bibliographical references (leaves 115-138).Abstracts also in Chinese.Title from PDF title page (viewed on April 1, 2022)