The Use of a Higher Education Intervention to Modify the Level of Nutrition Knowledge, Degree of Weight Bias and General Obesity Awareness Among Pre-Service Professionals

Abstract

Youth obesity is a global issue, affecting more than 5 million children. Known to affect the mental, social and physical health of those who suffer it, preventing and treating youth obesity retains ongoing importance in the field of obesity research. Key individuals who are responsible for treating and preventing youth obesity include professionals such as educators and health workers. These professionals have ongoing interaction with obese youth and are involved in their health and nutrition education, impacting upon their health status. In order to conduct health and nutrition education effectively, an adequate and accurate knowledge of nutrition principles is required. Likewise, a common barrier to effective nutrition education is possession of negative weight based attitudes towards overweight and obese individuals. As crucial factors for effective practice in these professions, it is best to address nutrition knowledge and weight bias during the formative years health-related professions spend in higher education. Programs and interventions aimed at improving these factors have had mixed success when conducted in the higher education setting or offered as professional development for allied health professionals and educators. No known intervention has sought to ameliorate nutrition knowledge and weight bias concurrently in the higher education setting and it is this gap in the literature which the study sought to address. The overall methodology of this project was modelled on action research. Over the span of the project, numerous smaller studies were conducted. The first was a background, formative study which sought to investigate nutrition and health knowledge of pre-service health educators. Following on from this, an intervention was designed and following studies reported the implementation, key results and modifications to the intervention itself. The project was longitudinal in nature, with each study informing the design and implementation of the next. Quantitative instruments were used for the majority of data collections and were made to be consistent through each phase of research, allowing longitudinal analyses to be conducted. In the latter stages of the project, qualitative data was collected to supplement the study. Based on an action research model, an intervention program was developed and tested over three phases. The 12-week intervention aimed to increase the level of nutrition knowledge, decrease the degree of weight bias, and improve obesity awareness of those undertaking the program. The intervention was embedded into the content of a general level nutrition elective subject offered to University students studying either health education, allied health or non-health-related degrees. Being an action model, cycles of the intervention were conducted and examined to refine the intervention. Three theoretical frameworks were selected to assist the modification of attitudes and knowledge. The Constructivist Learning Theory was selected to promote active learning (Fosnot, 1996), with a successful history of use in school-based nutrition knowledge interventions (Fahlman, McCaughtry, Martin, & Shen, 2011). Nutrition knowledge and attitudinal change content and activities were also underpinned by the Social Cognitive Theory (Bandura, 1986b) and the Theory of Planned Behaviour (Fishbein & Azjen, 1975) which have a history of use in interventions geared towards achieving behavioural change and challenging socially accepted beliefs (Conner & Sparks, 2005; Mankarious & Kothe, 2015). Pedagogical content to increase nutrition knowledge addressed general principles of nutrition knowledge, which included familiarity with national dietary guidelines and factors affecting food choice and dietary behaviours. Content to reduce weight bias was framed upon the Health At Every Size and Fitness not Fatness theories which are holistic in their approach to health and wellbeing. Results show nutrition knowledge can be significantly improved through an intervention. Antifat attitudes decreased significantly as desired, yet fat stereotyping attitudes were seen to be slightly worse at the conclusion of the intervention. The degree of weight bias displayed also changed over the course of the intervention; increases to weight bias are a known side effect after exposure to stigma reduction material, and are unintentional. Awareness of obesity and an understanding of the aetiology of the disease increased significantly. Understanding of the roles of schools in treating and preventing youth obesity, and barriers that may prevent educators from being involved in the prevention or treatment of obesity also increased significantly over the course of the intervention. The design and implementation of the program was moderately successful. Implications of these results from this study are wide. Adaptation of the study methodology is possible for similar groups of pre-service educators and allied health professionals whose employment involves health education and nutrition counselling. If successfully adapted and implemented, professional practice could be improved to be free of bias and the influence of inaccurate knowledge. Future research in the field would benefit from using a control group and an experimental research design, so the influence of the intervention on attitudes and knowledge could be further determined.