Typescript. / Digitized by Kansas Correctional Industries

Digitized by Kansas Correctional Industries

Over the last few decades, a shift in the American diet towards more ready-to-eat, ready-to-heat foods and fewer fruits and vegetables has occurred. Simultaneously, there has also been a rise in chronic diet-related diseases disproportionately affecting underserved and minority populations. Highly processed foods are cheap and abundant, they tend to be nutritionally poor, and are disproportionately marketed to minority youth. Despite an increased public focus on health and many health promotion initiatives, health disparities continue to widen. Michael Pollan and many others criticize the nutrition and food industries for focusing health messages on composite nutrients and bioactive components in foods (for example eat less fat or eat more fiber) rather than on dietary patterns (eat fewer highly processed, eat more whole foods). Pollan’s book, In Defense of Food (IDOF), was made into a documentary film, highlighting these important messages and generating solutions for what to eat to be healthy. This study is a development project that describes the systematic development and evaluation of the In Defense of Food nutrition education curriculum as the companion guide to the documentary film. It was designed for a middle-school aged audience in an afterschool setting to encourage an increased intake of fruits and vegetables and a decreased intake of highly processed foods. In the formative stages, a project development assessment was conducted to inform the development of the curriculum for its target audience and setting. Often health promotion programs focus on ensuring the valid development of content. This study examined delivery and logistical considerations specific and important to the afterschool context. Delivery, refers to how the content is executed. Findings suggest that a curriculum with youth in an afterschool setting should include non-didactic instruction, the sharing of teacher perspectives to elicit student perspectives, address different learning needs, and help students learn through an incremental process. Logistics included the time, space, and financial constraints of the afterschool settings. Findings indicate that teachers generally only have 1-2 hours of preparation time, a lack of fixed classroom space, and small financial budgets for accompanying lesson resources and materials. Next, the study developed the content of the IDOF curriculum using a systematic stepwise behaviorally-focused and theory-based process, the Nutrition Education DESIGN procedure. The DESIGN procedure was applied to try and enhance motivation and facilitate the achievement of the actionable behavioral outcomes of the curriculum: an increased intake of fruits and vegetables and a decreased intake of highly processed foods. The behavior-change theories applied were the Social Cognitive Theory and The Self Determination Theory. The resulting curriculum consisted of 10 sessions, 2 hours each, based on IDOF’s basic message of “Eat Food; Not Too Much, and Mostly Plants.” The curriculum was activity-based, used clips from the documentary film in each session with accompanying discussions, incorporating opportunities to taste and prepare foods, and to think critically about food marketing. The curriculum was piloted in 3 classes in 2 afterschool programs in New York City with a total of 32 youth. Professional development training was provided to the three teachers facilitating the curriculum before the start of the program and on-going as needed throughout. A mixed methods process evaluation was conducted to examine aspects of the curriculum that were more and less likely to be delivered and variations in how they were received by students. Trained research staff conducted in-class observations in nine of the 10 lessons measuring components of program delivery (fidelity, percentage completion, teacher attitude/motivation, classroom management) and program reception (student engagement). Trained staff administered student satisfaction surveys at the end of each lesson. Descriptive statistics and intra-class correlations were calculated. Observation field notes were codified using inductive content analysis. A high proportion of the curriculum was completed across all three classrooms, however the majority of fidelity deviations occurred for those involving worksheets, performance activities, and homework assignments. Social modeling in support of behaviors and greater teacher motivation to engage with the materials was seen in high performing lessons whereas modeling that undermined the curricular messages and low motivation were observed in low performing lessons. This study revealed that for this context, activities that require students to work alone at their desks on worksheets, that require them to perform in front of their peers and return materials to subsequent lessons should be minimized. Additionally professional development to increase teacher buy-in may be important to improve delivery of the curriculum. Lastly, a mixed methods outcome evaluation was conducted using pre-posttest surveys measuring the targeted dietary intake of the target behaviors and psychosocial determinants (n=32), one-on-one assessments of knowledge using a quantitative rubric and accompanying notes (n=22), and semi-structured in-depth interviews (n=12). A statistically significant increase in intake of fruits and vegetables from pre to posttest, and trends towards decreases in highly processed foods were seen. Significant changes in the psychosocial determinants: self-efficacy and positive outcomes expectations were also seen; all other changes were not significant but generally in the desired direction. One-on-one knowledge assessments demonstrated that short actionable rules were easily recalled and understood. Findings also suggest that youth adopted self-regulation skills and elicited support from their family members to help them increase their intake of fruits and vegetables. However social and environmental barriers were described as difficult to overcome for highly processed foods. Decreasing the health disparity gap starts with ensuring that nutrition education programs are developed to be responsive to the specific needs of the target audience and setting. While Pollan’s messages have been successful in raising awareness about the American diet for the general public, this study showed that they can also be integrated into educational materials that, when systematically designed and well implemented, can increase the likelihood of actionable outcomes. It also demonstrates the types of considerations that are imperative for effective delivery and implementation in out-of-school time settings.

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Most dietitians assume they know how to teach and educate because they are content experts. Most also assume that the process of teaching is equated with techniques, skills, and methods. Teaching techniques and skills are important; however, they do not represent the entire educational process. Educational beliefs are paramount and shape what dietitians say, do, and how they interact with their clients. Currently, only limited conceptual frameworks on teaching and education exist within dietetics. In this study, the five Educational Perspectives and general model of teaching developed by Pratt (1998) were used as conceptual frameworks to examine the educational beliefs of dietitians. An equally important goal was to reveal professional interests, roles and responsibilities, educational backgrounds and experiences, teaching influences, and international education and work experience - topics which have not been investigated on a large scale but which provide information on the interests and characteristics of dietitians. The study was also designed to determine if relationships existed between personal, professional and social-cultural characteristics and the five Educational Perspectives. To meet the research goals, a quantitative mail-out survey named the Educational Perspectives of Registered Dietitians was sent to 483 dietitians throughout British Columbia. Two hundred and forty or just over half of the total sample frame returned surveys and were analyzed using SPSS. Data from closed-ended questions were analyzed using frequency tabulations and other univariate statistical procedures to summarize demographic, work, and professional characteristics. Then correlational analyses tested for relationships between the educational perspectives and personal, professional and social-cultural characteristics. Open-ended questions were initially alphabetized using SPSS and were then thematically analyzed by the researcher. Results of the survey revealed that the vast majority of respondents were female, most were in their early thirties to late forties, over half had children, and the large majority were native speakers of English. A relatively small number of respondents had obtained Bachelor degrees outside of dietetics. Less than one-quarter of respondents had obtained or were in the process of obtaining graduate degrees, but a slightly greater number of respondents had either obtained or were in the process of obtaining certificates or diplomas. Most degrees were science or nutrition oriented and most certificates reflected either management or clinical specialties. Less than one-quarter of these dietitians had received some schooling outside of Canada in coursework that was taught mainly in English; a relatively small number of respondents had worked as dietitians outside of Canada. A small number of respondents had previous careers prior to dietetics. Respondents had practiced dietetics for an average of about fourteen years; and less than half worked full-time. Dietitians interact with many different types of people but the majority work in traditional health care settings. Over half of respondents are responsible for nutrition counseling and teaching. The majority of dietitians valued the relationship of nutrition to health, helping others and working with health care team. At the outset of their careers, most respondents were initially interested in nutrition counseling and behavior change, health promotion, nutritional sciences and teaching; but over time respondents became more interested in research, management and food production, cultural food habits and entrepreneurial activities. The number of their professional interests increased by about a third over time and the increase was statistically significant. Other people - particularly colleagues, influenced the majority of dietitians' teaching practices. In terms of their Educational Perspectives, dietitians were most dominant in Nurturing, followed closely by Apprenticeship, Transmission, then to a smaller degree Developmental and to a very small degree, Social Reform. Forty-eight dietitians were dominant in two Educational Perspectives; Nurturing and Apprenticeship or Apprenticeship and Transmission. When dietitians' Educational Perspective scores were compared to groups of 414 other professionals, dietitians were less Nurturing and Developmental oriented, were more Transmission oriented, and slightly less Social Reform. Except for Apprenticeship, the small differences in scores were statistically significant. Although the difference in Apprenticeship Perspective scores between the two groups was not significant, they represented the highest scores for both groups. There were thirty-five significant correlations between personal and professional variables and the five Educational Perspectives. Three significant correlations characterized dietitians high on Transmission: attending school in a country outside of Canada, valuing management opportunities within dietetics, and feeling that university coursework had influenced their teaching practices. Two significant correlations characterized dietitians high on Apprenticeship: possessing graduate degrees and feeling that university coursework had influenced their teaching practices. Eight significant correlations characterized dietitians high on Developmental: practicing dietetics over a longer period of time, expressing an initial interest in teaching within dietetics and in managing people and resources, interacting with community groups, marketing, being involved with public and media relations, and interacting with community groups and the public. Another eight significant correlations characterized dietitians high on Nurturing: expressing an initial interest in teaching, interacting with community groups, being involved with public and media relations, and feeling that workshops and seminars, authors, colleagues, teachers of education, and authors on educational topics had influenced their teaching practices. Fourteen significant correlations characterized dietitians high on Social Reform: speaking languages other than English (initially fluent and currently speaking languages other than English, and currently speaking more than one language), practicing dietetics over a longer period of time, expressing an initial interest in cultural food habits, managing people and food production, expressing a current interest in managing people, interacting with the general public, community groups, being involved with public and media relations, feeling that activities or other people influenced teaching practices, and being less responsible for nutrition counseling and one-to-one interactions with patients. Although they were offered the opportunity for feedback, less than one-half of respondents requested that an Educational Perspectives Inventory Profile sheet be mailed back to them. Respondents who requested a profile sheet were generally no different from the other respondents who did not request feedback. There were no significant correlations between respondents who requested an educational profile and the five Educational Perspectives. However, in terms of their work-related characteristics, people requesting feedback had been attracted by a wider range of potential features of the profession. It was surprising to discover the degree of importance that dietitians attributed to measurable behavioral change. Generally, dietitians attributed lack of change as a result of deficiencies in clients (lack of compliance, interest, or motivation) rather than other factors such as dietitians' approaches or attitudes about learning and education or challenges associated with the learning contexts. Another surprise was the extent that dietetic colleagues influence each other's teaching practices. There are several recommendations from this study: dietitians need to constantly re-examine undergraduate and internship educational competencies to encourage future dietitians to critically analyze their roles as educators; formation of an Adult Education Practice Group; member forums on educational and teaching issues; development of online education discussion groups; and continuing education activities on the roles of dietitians as educators and teachers. The five Educational Perspectives and general model of teaching were used as theoretical tools to help reveal assumptions about dietitians and their learners, content, context, and beliefs about knowledge and learning. Additionally, information about personal and professional characteristics of dietitians was obtained which can be used to create a database and monitor trends and interests. Dietitians are health professionals who work in different settings, interact with different clientele, and who accumulate a unique body of knowledge based on their education, training, and experience. Although differences exist among individual dietitians, there is one unifying thread. Dietitians are teachers and educators.

Most dietitians assume they know how to teach and educate because they are content experts. Most also assume that the process of teaching is equated with techniques, skills, and methods. Teaching techniques and skills are important; however, they do not represent the entire educational process. Educational beliefs are paramount and shape what dietitians say, do, and how they interact with their clients. Currently, only limited conceptual frameworks on teaching and education exist within dietetics. In this study, the five Educational Perspectives and general model of teaching developed by Pratt (1998) were used as conceptual frameworks to examine the educational beliefs of dietitians. An equally important goal was to reveal professional interests, roles and responsibilities, educational backgrounds and experiences, teaching influences, and international education and work experience - topics which have not been investigated on a large scale but which provide information on the interests and characteristics of dietitians. The study was also designed to determine if relationships existed between personal, professional and social-cultural characteristics and the five Educational Perspectives. To meet the research goals, a quantitative mail-out survey named the Educational Perspectives of Registered Dietitians was sent to 483 dietitians throughout British Columbia. Two hundred and forty or just over half of the total sample frame returned surveys and were analyzed using SPSS. Data from closed-ended questions were analyzed using frequency tabulations and other univariate statistical procedures to summarize demographic, work, and professional characteristics. Then correlational analyses tested for relationships between the educational perspectives and personal, professional and social-cultural characteristics. Open-ended questions were initially alphabetized using SPSS and were then thematically analyzed by the researcher. Results of the survey revealed that the vast majority of respondents were female, most were in their early thirties to late forties, over half had children, and the large majority were native speakers of English. A relatively small number of respondents had obtained Bachelor degrees outside of dietetics. Less than one-quarter of respondents had obtained or were in the process of obtaining graduate degrees, but a slightly greater number of respondents had either obtained or were in the process of obtaining certificates or diplomas. Most degrees were science or nutrition oriented and most certificates reflected either management or clinical specialties. Less than one-quarter of these dietitians had received some schooling outside of Canada in coursework that was taught mainly in English; a relatively small number of respondents had worked as dietitians outside of Canada. A small number of respondents had previous careers prior to dietetics. Respondents had practiced dietetics for an average of about fourteen years; and less than half worked full-time. Dietitians interact with many different types of people but the majority work in traditional health care settings. Over half of respondents are responsible for nutrition counseling and teaching. The majority of dietitians valued the relationship of nutrition to health, helping others and working with health care team. At the outset of their careers, most respondents were initially interested in nutrition counseling and behavior change, health promotion, nutritional sciences and teaching; but over time respondents became more interested in research, management and food production, cultural food habits and entrepreneurial activities. The number of their professional interests increased by about a third over time and the increase was statistically significant. Other people - particularly colleagues, influenced the majority of dietitians' teaching practices. In terms of their Educational Perspectives, dietitians were most dominant in Nurturing, followed closely by Apprenticeship, Transmission, then to a smaller degree Developmental and to a very small degree, Social Reform. Forty-eight dietitians were dominant in two Educational Perspectives; Nurturing and Apprenticeship or Apprenticeship and Transmission. When dietitians' Educational Perspective scores were compared to groups of 414 other professionals, dietitians were less Nurturing and Developmental oriented, were more Transmission oriented, and slightly less Social Reform. Except for Apprenticeship, the small differences in scores were statistically significant. Although the difference in Apprenticeship Perspective scores between the two groups was not significant, they represented the highest scores for both groups. There were thirty-five significant correlations between personal and professional variables and the five Educational Perspectives. Three significant correlations characterized dietitians high on Transmission: attending school in a country outside of Canada, valuing management opportunities within dietetics, and feeling that university coursework had influenced their teaching practices. Two significant correlations characterized dietitians high on Apprenticeship: possessing graduate degrees and feeling that university coursework had influenced their teaching practices. Eight significant correlations characterized dietitians high on Developmental: practicing dietetics over a longer period of time, expressing an initial interest in teaching within dietetics and in managing people and resources, interacting with community groups, marketing, being involved with public and media relations, and interacting with community groups and the public. Another eight significant correlations characterized dietitians high on Nurturing: expressing an initial interest in teaching, interacting with community groups, being involved with public and media relations, and feeling that workshops and seminars, authors, colleagues, teachers of education, and authors on educational topics had influenced their teaching practices. Fourteen significant correlations characterized dietitians high on Social Reform: speaking languages other than English (initially fluent and currently speaking languages other than English, and currently speaking more than one language), practicing dietetics over a longer period of time, expressing an initial interest in cultural food habits, managing people and food production, expressing a current interest in managing people, interacting with the general public, community groups, being involved with public and media relations, feeling that activities or other people influenced teaching practices, and being less responsible for nutrition counseling and one-to-one interactions with patients. Although they were offered the opportunity for feedback, less than one-half of respondents requested that an Educational Perspectives Inventory Profile sheet be mailed back to them. Respondents who requested a profile sheet were generally no different from the other respondents who did not request feedback. There were no significant correlations between respondents who requested an educational profile and the five Educational Perspectives. However, in terms of their work-related characteristics, people requesting feedback had been attracted by a wider range of potential features of the profession. It was surprising to discover the degree of importance that dietitians attributed to measurable behavioral change. Generally, dietitians attributed lack of change as a result of deficiencies in clients (lack of compliance, interest, or motivation) rather than other factors such as dietitians' approaches or attitudes about learning and education or challenges associated with the learning contexts. Another surprise was the extent that dietetic colleagues influence each other's teaching practices. There are several recommendations from this study: dietitians need to constantly re-examine undergraduate and internship educational competencies to encourage future dietitians to critically analyze their roles as educators; formation of an Adult Education Practice Group; member forums on educational and teaching issues; development of online education discussion groups; and continuing education activities on the roles of dietitians as educators and teachers. The five Educational Perspectives and general model of teaching were used as theoretical tools to help reveal assumptions about dietitians and their learners, content, context, and beliefs about knowledge and learning. Additionally, information about personal and professional characteristics of dietitians was obtained which can be used to create a database and monitor trends and interests. Dietitians are health professionals who work in different settings, interact with different clientele, and who accumulate a unique body of knowledge based on their education, training, and experience. Although differences exist among individual dietitians, there is one unifying thread. Dietitians are teachers and educators. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

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The present study investigated the basic question: Will preschool, kindergarten, and first grade students have a greater increase in knowledge of selected nutritional concepts as a result of viewing a puppet story than a similar composite will have when the same material is presented via dramatic storytelling?

M. S.