© 2006 thomson-wadsworth chapter 15 designing community nutrition interventions

© 2006 Thomson-Wadsworth

Chapter 15

Designing Community Nutrition Interventions


Learning Objectives

• Describe five factors to consider when designing a community nutrition intervention.

• Describe three levels of intervention.

• Discuss five theories and models of consumer health behavior.


Introduction

• There are two important aspects of designing interventions:– You must have information about

your target population and why they do what they do in terms of behavior.

– You need an arsenal of tools for influencing behavior.


Choose an Intervention Strategy

• The first step in designing an intervention is to review the program’s goals and objectives, which specify the program outcomes.

• Next you need to design a rough outline of what the intervention might look like.



• The intervention strategy is the approach for achieving the program’s goals and objectives.

• It addresses the question of how the program will be implemented to meet the target population’s nutritional needs.



• The intervention strategy can be directed towards:– Individuals– Communities– Systems

• The intervention strategy can also encompass one or more levels of intervention:– Level I– Level II– Level III



• Level I: building awareness– These focus on increasing awareness of a

problem.– They are helpful for changing attitudes and

beliefs and increasing knowledge of risk factors but they seldom result in actual behavior changes.

– Examples include health fairs, screenings, Internet web sites, and newsletters.



• Level II: changing lifestyles– These are designed to help individuals make

lifestyle changes.– They can be successful when they call for

small changes over time and when they use a combination of education and behavior modification.

– Level II interventions reach individuals through one-on-one counseling and small group meetings.



• Level II (continued)– They involve a program of assessing current

behaviors, setting goals for behavior change, developing skills needed to change behavior, providing support for change, and evaluating progress.

– Examples include fitness programs in schools and health promotion programs for city employees.



• Level III: creating supporting environments for change– These work toward creating environments

that support the behavior changes made by individuals.

– They include worksite health promotion and cafeteria programs.

– Supportive environments can be created through policies that support gleaning, point-of-purchase labeling, and tax incentives for companies with health promotion programs.


Study the Target Population

• When designing an intervention, study the target population’s eating patterns and their beliefs, values, and attitudes about foods and health.

• Conduct library research, review existing programs that deal with the target population, network with colleagues who work with the group, and post queries about the target population on Internet listservs.



• The target population’s food-related behavior is important.

• Many factors influence food intake and nutritional status...



• Food Supply and Food Availability– Food choices are influenced by the

types and amounts of foods available in the food supply.

– Food availability is affected by the food distribution system, types of imported foods, facilities for food processing and production, and the regulatory environment.



• Income and Food Prices– Two economic factors that affect food

consumption.– Households with higher incomes have

more money to spend on food and choose whatever foods they want, regardless of price.



• Sociocultural Factors– Food choices are strongly influenced by social

groups, and primary social groups include families, friends, and work groups with the family exerting the most influence.

– Culture influences food behaviors and even dictates how foods are stored, processed, consumed, disposed of, and even which foods are considered edible.

– Religious beliefs affect food choices, and some religions specify the foods that may be eaten and how they should be prepared.



• Food Preferences, Cognitions, and Attitudes– Preferences for certain tastes and

foods appear to develop quite early in humans.

– Food choices are affected by our cognitions, or what we think.

– Attitudes are believed to influence behavior indirectly.



• Health Beliefs and Practices– Beliefs about foods, diet, and health

influence food choices.– Example: traditional Chinese beliefs

of yin and yang


Draw from Current Research on Consumer Behavior

• Many theories have been proposed to explain the decision-making process as it relates to health.

• Theories are sometimes presented in the form of models - simple images of the decision-making process.


Draw from Current Research on Consumer Behavior

• Theories include:– Stages of Change Model– Health Belief Model– Theory of Planned Behavior– Social Cognitive Theory– Diffusion of Innovation Model


The Stages of Change Model

• Founded on 3 assumptions:– Behavior change involves a series of

different steps or stages.– There are common stages and processes of

change across a variety of health behaviors:– Tailoring an intervention to the stage of

change in which people are at the moment is more effective than not considering the stage people are in.



• Common stages:– Precontemplation - the individual is either

unaware of or not interested in making a change.

– Contemplation - the person is thinking about making a change, usually within the next six months.

– Preparation - the person actively decides to change and plans a change, usually within one month.



• Common stages (continued):– Action - the individual is trying to make the

desired change and has been working at making the change for less than six months.

– Maintenance - the individual sustains the change for six months or longer and the changed behavior has become a part of his or her daily routine.



• The model resembles a spiral, with people moving around the spiral until they eventually achieve maintenance and termination.

• People in the contemplation stage are seeking information...

• ...whereas people in the maintenance stage are likely to be looking for information and searching for ways to strengthen the behavior.



• The Application—Individual – The Smithfield Fitness Club (members

in various stages)

• The Application—Communities – City of Scottsville (in

precontemplation stage)


The Health Belief Model

• Developed to explain why people failed to participate in programs designed to detect or prevent disease.

• The model has three components:– The perception of a threat to health.– The expectation of certain outcomes related

to a behavior. – Self-efficacy - the belief that one can make

a behavior change.


The Health Belief Model

• Other variables, such as education, income, sex, age, and ethnic background influence health behaviors in this model, but they are believed to act indirectly.

• The Application – American Cancer Society’s public

awareness campaign


The Theory of Planned Behavior

• a.k.a. the Theory of Reasoned Action• A fundamental model for explaining

virtually any health behavior over which the individual has control.

• Behavior is determined directly by a person’s intention to perform the behavior.– Intentions - the instructions people give to

themselves to behave in certain ways.



• In forming intentions, people consider the outcome of their behavior and the opinion of significant others before committing themselves to a particular action.– In other words, intentions are influenced by

attitudes and subjective norms, or perceived social pressure to perform or not perform a behavior.



• Attitudes are determined by:– The individual’s belief that a certain

behavior will have a given outcome.– An evaluation of the actual outcome of the

behavior.– A perception of his or her ability to control

the behavior.

• The Application – Fairlawn Weight Management Center’s “Get

Fit Now” program


Social Cognitive Theory

• Explains behavior in terms of a model in which behavior, personal factors such as cognitions, and the environment interact constantly, such that a change in one area has implications for the others.



• The environment includes: – The social real (family, friends,

peers, coworkers) – The physical real (the workplace,

layout of a kitchen, etc.)



• Strength of this model = it focuses on certain target behaviors rather than on knowledge and attitudes.

• The Application – Peer counseling course to reduce pica

among WIC participants


Eat Healthy: Your Kids Are Watching

• Michigan Nutrition Support Network – A public–private partnership to improve the

nutritional health of Michigan’s low-income families.

• “Eat Healthy, Your Kids Are Watching” – Focus group–tested message designed to

prompt awareness in parents that they are role models for their children.



• Goals and Objectives– Primary goal - improve the nutritional health

of Kent County’s low-income families through collaborative efforts among partners.

– Objectives:• Develop and implement “awareness-building”

activities promoting healthful eating to the target audience and to the public in general

• Construct a public–private partnership with businesses and agencies to assist with specific programs for the campaign.



• Methodology– Potential partners were located– Awareness-building activities:

• 30-second cable spots• Campaign newsletters in English and Spanish• Signs on and in transit buses• Logo and slogan program with grocery stores and

school districts• Toll-free telephone number with messages in

English and Spanish



• Methodology (continued)– Partnership programming:

• Information on grocery store tours• Cooking demonstrations• WIC module for nutrition education

– Partner kit included an events schedule, lesson plans, activity sheets, and recipes



• Results– Reached an estimated 49,000

residents, including close to 7,000 low-income households

– Random sample of 800 adults in households with children surveyed

– Campaign awareness was 52%



• Results (continued)– 67% in low-income households– 2/3 indicated that they understood

and agreed with the message when they heard it

– 20% indicated that they would adopt the message



• Lessons Learned– An enthusiastic collaboration among

businesses, community agencies, and community leaders was the key to the success of this venture.

– Partnerships forged between public and private organizations can grow strong as a result of working together on such campaigns.


The Diffusion of Innovation Model

• Developed to explain how a product or idea becomes accepted by a majority of consumers.



• It consists of four stages:– Knowledge - the individual is aware

of the innovation and has acquired some information about it.

– Persuasion - the person forms an attitude either in favor of or against the innovation.



• Four stages (continued):– Decision - the individual performs

activities that lead to either adopting or rejecting the innovation.

– Confirmation - the individual looks for reinforcement for his or her decision and may change if exposed to counter-reinforcing messages.



• Consumers are classified according to how readily they adopt new ideas or products:– Innovators - adopt the innovation quite

readily and perceive themselves as popular and financially privileged.

– Early adopters - the next to adopt; include opinion leaders, are integrated into the community and are well respected by their families and peers.



• Consumer classifications (continued):– Early majority - tend to be cautious.– Late majority - skeptical; usually adopt an

innovation only through peer pressure.– Laggards - the last to adopt; tend to come

from small families, to be single and older, and to be traditional.

• The Application – Seeking early adopters for the “Heart-

Healthy Living” program


Put It All Together: Case Study 1

• Defining levels of intervention for target groups

• Formative evaluation and literature review

• Influence of theories of consumer behavior on health promotion activities


Use Entrepreneurship to Steer in a New Direction

• One of the major challenges for community nutritionists is to think of new ways of delivering health messages and services to vulnerable populations.

• We need a better understanding of the community factors that influence change and the reasons why consumers resist change.


Use Entrepreneurship to Steer in a New Direction

• When you plan community interventions:– Think of new ways to reach your

target audience.– Plan strategies for finding out why

your clients are resisting a behavior change.

– Apply your creativity to influencing people to achieve behavior change.


Being an Effective Speaker

• Things to Do Before Your Presentation– First, tell your audience what you are

going to tell them...– then tell them what you have to tell

them...– and finally, tell them what you told

them!



• Before Your Presentation (continued)– Prepare your visual aids so that they

present your ideas effectively.• Clear purpose• Readily understood• Simple format• Free of nonessential information• Graphical format• Visible• Legible• Integrated with verbal text



• Before Your Presentation (cont.)– Rehearse your presentation several

times.– Use mental imaging to boost your

self-confidence. •Mental imaging - a technique to

develop and strengthen a positive mental picture of the performance.



• Things to Do During Your Presentation– Smile– Use eye contact– Use gestures– Control the pace– Use pauses– Vary the volume and pitch



• Remember that the purpose of your presentation is to share information with your audience.

• You will want to develop your own style.

© 2006 thomson-wadsworth chapter 15 designing community nutrition interventions

Documents

intervention strategy

thomsonwadsworth slide

levels of intervention

thomsonwadsworth study

thomsonwadsworth chapter

thomsonwadsworth introduction

health promotion programs

programs goals