| BackgroundWith the social and economic development and the improvement of people’s living standards, nutrition and diet-related diseases have affected more human health. The nutritional status of childhood has important effect on intellectual and physical development, as well as the nutritional and health status in future. The studies found that physical quality of young students in China was worse than foreign teenagers, and the incidences of obesity, hypertension and other chronic diseases are gradually improving. At present, although the nutritional attitude of primary and secondary students is well, lack of nutritional knowledge, having no breakfast, having fried foods and sugary drinks frequently and inadequate intake of nutrients are widespread. And the adolescence is an important stage in forming the eating habits and lifestyle, so taking the appropriate methods to improve the nutritional knowledge and behavior is essential. Obesity is hazard on pupils’health, and there have no related nutritional studies in Shijingshan District as far, so a nutritional intervention study is necessary. In order to explore dietary intervention model for pupils in Shijingshan District, we carried a KAP intervention study in pupils of 6 classes of Grade 4 in 2 schools as well as their parents from Sep.2015 to Dec.2015, try to learn the situations of nutritional knowledge, attitude and behavior before and after the intervention respectively, as well as the effect of intervention.Knowledge-Attitude-Practice (KAP) model is commonly used in dietary survey. "Knowledge" is knowledge and learning, "attitude" is the right faith and a positive attitude, "practice" is action. The theory believes knowledge is basis, attitude is the driving force, behavior change is the goal. Only mastering a certain knowledge of nutrition and having positive nutritional attitude, can people develop healthy nutritional habits. According the KAP investigation, we can know the status of nutritional knowledge, attitude and behavior in teenagers, then to take timely and appropriate means to improve adolescent dietary knowledge, promote their positive nutrition attitude and correct unhealthy nutritional behaviors.Objective1. To know the status of nutritional knowledge, attitude and behavior before and after the intervention respectively of pupils and their parents.2. To evaluate the effect of nutritional intervention on pupils’ nutritional knowledge, attitude and behavior.3. To provide suggestions on improvement of pupils’ diet and nutrition.MethodThe study is an intervention study, using the method of two-stage cluster random sampling to take sample, collected students in 2 schools of Grade 4 and their parents as research subjects. The subjects were required to have reading and writing ability, can independently complete a questionnaire, have no diabetes and other special dietary requirements, have no mental illness, and no intellectual and language disabilities. They were also not involved in other related nutritional intervention programs. Students and their parents were randomly divided into intervention and control groups after the informed consent.Before the intervention, students and parents were required to complete the questionnaire. Then the intervention group were given the "nutrition class", "Happy nutrition learning", "parent-child interaction" and health knowledge propaganda.. The control group did not take any interventions.3 months later, all the subjects needed to complete the questionnaire again.EpiData3.1 was used to establish a database, double entry questionnaire and do consistency test, using SPSS22.0 statistical software for data analysis.Results1. The general situationA total of 380 matched questionnaires were collected. There were 190 students, the intervention and control groups was 90 and 100 people,190 parents had the same grouping. In this study, the average age of students was 9.6 ± 0.5, with 105 boys (55.3%) and 85 girls (44.7%). There were no differences on gender, age and BMI between two groups(P>0.05). The average age of parents was 38.0 ± 5.4, with 62 males (32.6%) and 128 females (67.4%). There were no differences on gender, age, education level and income between two groups, either(P>0.05).2. BaselineNo differences were found on nutritional knowledge, attitude and behavior between intervention group and control group in baseline survey, no matter in students and parents (P>0.05).The main ways in pupils to acquire knowledge of nutrition were "parents teaching," "television, radio, newspapers, internet and other media", "health education classes", the rates were 59.5%,48.9%,40.5%. For parents, the most important of the three ways to get the nutritional knowledge were "television, radio, newspapers, internet and other media"(80.5%), "family and friends"(38.4%) and "health education classes"(30.5%).3. Intervention3.1 Nutritional knowledge3.1.1 Nutritional knowledge in studentsIn the intervention group, the correct response rates of "balanced diet pagoda", "the amount of salt intake", "food with the highest heat", "food with the highest fat", "beverage choice", "interchangeable between fruits and vegetables", "Western-style fast food harm the health" and "beneficial food" after intervention were higher than the rates in baseline (P<0.05). After the intervention, the correct response rates in interventional groups of "balanced diet pagoda", "the amount of salt intake", "food with the highest heat", "interchangeable between fruits and vegetables", "Western-style fast food harm the health" and "beneficial food" were higher than control groups (P<0.05). The average score of the intervention group after intervention increased 25.6 points, the control group increased 4.9 points, the difference was statistically significant (P<0.05).3.1.2 Nutritional knowledge in parentsIn the intervention group, the correct response rates of "balanced diet pagoda", "cereal position in dietary pagoda", "the main kind of healthy foods", "proportion of energy intake of three meals", "the amount of water intake of adults", "the amount of salt intake", "the amount of oil intake", "the normal BMI of adults", "the salt control cooking" after intervention were higher than the rates in baseline (P<0.05). After the intervention, the correct response rates in interventional groups of "cereal dietary pagoda position", "proportion of energy intake of three meals", "the amount of water intake of adults", "the amount of salt intake", "the amount of oil intake", "the normal BM1 of adults", "the salt control cooking" were higher than control groupt (P<0.05). The average score of the intervention group after intervention increased 22.8 points, the control group increased 5.9 points, the difference was statistically significant (P<0.05).3.2 Nutritional attitude3.2.1 Nutritional attitude in studentsIn the intervention group, the correct response rates of "wants to make eating more in line with nutritional requirements", "willing to accept public nutrition knowledge training", "willing to learn public nutrition knowledge", "willing to disseminate dietary knowledge to others" after intervention were higher than the rates in baseline (P<0.05). After the intervention, the correct response rates in interventional groups of "want to make the diet more in line with nutritional requirements", "willing to accept public nutrition knowledge training", "willing to learn public nutrition knowledge" and "willing to disseminate dietary knowledge to others" were higher than control groupt (P<0.05). The average score of the intervention group after intervention increased 5.9 points, the control group increased 1.0 points, the difference was statistically significant (P<0.05).3.2.2 Nutritional attitude in parentsIn the intervention group, the correct response rates of "interested in food nutrition knowledge", "wanted to make the diet more in line with nutritional requirements" and "willing to learn public nutrition knowledge" after intervention were higher than the rates in baseline (P<0.05). The average score of the intervention group after intervention increased 6.3 points, the control group increased 2.8 points, the difference was no statistically significant (P>0.05).3.3 Dietary behavior3.3.1 Dietary behavior in studentsIn the intervention group, the rates of "eat breakfast daily", "select water when thirsty", "check food nutrition label when buying" after intervention were higher than the rates in baseline (P<0.05); the rates in interventional groups of "eating Western-style fast food 1 and more times per month", "eating fried foods more than twice per week", "often drinking sugary drinks " were lower than control groupt (P<0.05). The average score of the intervention group after intervention increased 2.2 points, the control group increased 0.2 points, the difference was statistically significant (P<0.05).3.3.2 Dietary behavior in parentsIn the intervention group, the rate of "eating in restaurants three times a week or more" after intervention was lower than the rate in baseline(P<0.05). The average score of the intervention group after intervention increased 0.8 points, the control group increased 0.4 points, the difference was no statistically significant (.P>0.05).3.4 The relation between the students and parents on the scores of nutrition knowledge, attitude and behaviorBefore the intervention, students’and parents’nutrition behavior scores were positively correlated. After the intervention, students’nutrition knowledge score and nutritional behavior score were positively related with parents’scores (P<0.05).Conclusion1. Interventions in this study were led by the school, including the "nutrition class", "happy nutrition learning" and "parent-child interaction". Parents and students were accepted interventions. The results were well after the intervention.2. The main way to get the nutritional knowledge of pupils including parents, schools and the media, parents’ nutritional knowledge and nutritional behavior situations were related with students’ knowledge and behavior.3. Pupils have positive nutritional attitude, but the knowledge is not comprehensive, some healthy dietary behavior such as frequently eating coarse grains and drinking milk every day haven’t develop.4. Dietary intervention is a long-term work, short-term interventions’effectiveness is limited. Using healthy nutrition knowledge and positive attitude to promote healthy eating habits and changing unhealthy eating behaviors need long time. Pupils are lack of self-control but with the good plasticity, so parents and teachers supervision is required in the process. |
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