The US population over the age of 65 years is growing rapidly, with elderly women outnumbering men by 50 percent. Studies show that aging is often accompanied by reduced energy intake, inadequate nutrition, and the loss of lean body mass with a subsequent increase in body fat, as well as the tendency towards inactivity. An increased level of physical activity elevates energy needs, which can lead to increased energy and nutrient intake, and has been shown to aid in the maintenance of lean body mass and the reduction of body fat. Positive health outcomes for seniors depends partly on a clearer understanding of the interrelationships between physical activity, diet, and body composition. The purpose of this study was to determine whether higher overall levels of physical activity among elderly women, were related to higher energy intake, nutrient adequacy, and less body fat, and to what extent age affected these associations. Sixty-three elderly women (aged 65-98 years) volunteers completed a three part study spanning 14 weeks. Mean level of physical activity (MLPA) and mean nutrient intakes were estimated using nine self-reported days of records, three predetermined days from each of three recording periods. MLPA was determined from self-reported hours spent in five physical activity categories (resting, very light, light, moderate, and heavy), multiplied by corresponding weighted factors of intensity (1.0, 1.5, 2.5, 5.0, 7.0, respectively). Nutrient analyses for seven vitamins (vitamin A, vitamin C, thiamin, riboflavin, niacin, vitamin B6, vitamin B12) and three minerals (calcium, iron, and zinc) were done using the Food Processor II computer software. A mean adequacy ratio (MAR) was calculated for each subject as the average percent of the RDA for intakes of all 10 nutrients. Body composition assessment included triplicate measures of: height and weight from which body mass index (BMI) was determined; waist-to-hip ratio (WHR); and an estimation of percent body fat (PBF) from the sum of four skinfolds (triceps, biceps, subscapular, suprailiac). It was determined that MLPA was not directly related to energy intake, nutrient adequacy, or the three body composition parameters. However, the correlation coefficients between MLPA and energy intake, mean adequacy ratio, and percent RDA for 8 of the 10 nutrients were positive, and the correlation coefficients between MLPA and all three body fatness measures were negative, as was expected. The small coefficient of variability of MLPA limited its discriminating power in determining associations with energy intake, nutrient adequacy, and body composition. Backward stepwise regression models were conducted to distinguish potential confounding effects of age, education, and MLPA on the variables kcal/day, kcal/kg/day, MAR, BMI, WHR, and PBF. Age was found to account for the largest portion of the variations, and was greater than the contribution of MLPA for all of these variables, except in the case of kcal/kg/day. When the subjects were divided into young-old (65-74 yr) and old-old (75-98 yr) subgroups, the younger compared to the older women were found to be more active as measured by MLPA (p=.02), explained by their engaging in more light activities of daily living (p=.04). The young-old compared to the old-old women consumed more kcalories/day (p=.01), and had a higher MAR score (p=.00). The nutrient densities of the two groups' diets were not significantly different. The younger women had slightly lower BMI, WHR, and PBF values. This study revealed age, rather than MLPA, was a better predictor of some parameters of diet adequacy and body fatness among this sample of elderly women. In addition, consistently higher levels of physical activity and greater dietary adequacy and was found among the younger compared to the older portions of this sample of senior women, suggesting that nutrition intervention programs for the elderly should encourage daily activeness as a strategy to maintain or improve dietary adequacy with advancing age. / Graduation date: 1993

The percentage of the American population who are 65 years old or older is rapidly increasing, especially the proportion of women. It is becoming crucial to encourage lifestyle behaviors that will enable senior women to remain in optimal health. Following the 1990 Dietary Guidelines' recommendations to limit fat intake and consume adequate amounts of dietary fiber has been shown to positively impact longevity and health status in the elderly by decreasing risk factors for chronic diseases. An expected outcome of engaging in regular exercise is a reduction in body fat, which is also associated with a lowered incidence of several chronic illnesses. However, the literature clearly indicates that nutritional quality of the diet and involvement in regular exercise decrease with increasing age. There is evidence that, with the adoption of one health enhancing behavior, there is a greater tendency to engage in other health promoting behaviors, but little data exist on the healthseeking behaviors of older adults. The purpose of this study was to ascertain if there were identifiable differences between self-defined exercising and self-defined non-exercising elderly women with respect to their nutrient intake, food sources of dietary fat and fiber, dietary change behavior, and body composition parameters, considering their age and education and income levels. The objective was to determine whether those women who had consciously undertaken a regular exercise program would also have higher micronutrient intakes, make lower fat and higher fiber food choices, report having made more dietary changes in the direction of the 1990 Dietary Guidelines, and have leaner body compositions than those who had not undertaken such a program. Thirty-three elderly women self-reported exercisers (mean age 74.1 years) and 30 self-reported non-exercisers (mean age 71.3 years) were enrolled in a 14 week study. Exercisers were defined as those who reported having engaged in a regular program of planned exercise a minimum of 15 minutes per session, 2 times per week, for at least the last year, and non-exercisers were those who had not. They kept three, 7-day food records at 5 week intervals. Nutrient intake was estimated from 9 days of food records, 3 predetermined days from each recording period, using the Food Processor n software. Dietary intakes were analyzed for energy, macronutrients, dietary fiber, and selected micronutrients. Food sources of dietary fat and fiber were determined using a food categorization adapted from Popkin and coworkers (1989). Information concerning dietary change behavior, obtained from questionnaire responses, was compared between groups using chisquare tests. Body composition, assessed through repeat measurements during each dietary recording period, included determination of percent body fat through skinfolds, waist-to-hip-ratio and body mass index. Average 9-day nutrient intakes and anthropometric measures were compared between groups using t-tests or Mann- Whitney U tests. Both elderly women exercisers and non-exercisers had similar energy, macronutrient, and dietary fiber intakes based on 9-day means. Their total fat intakes, expressed in grams and as percentages of energy, were not significantly different. Both groups consumed a lower percentage of their daily kcalories as total fat (32%) compared with national surveys of women over 65 (36%). Exercisers consumed more total vitamin A (p=.03) and carotene (p=.00) than the non-exercising women. A great proportion of both groups did not meet 75 % of the Recommended Dietary Allowances for calcium and zinc. A larger proportion of the exercisers than the non-exercisers reported using lower fat cheese (p=.02) and green and yellow vegetables (p=.03), which partially explained their higher total vitamin A and carotene intakes. Exercisers obtained less of their total fat intake from lower fat milk (p=.02) and more of their fat intake from lower fat lunch meats (p=.04) than the non-exercisers. The categories of legumes (p=.02) and lower fiber vegetables (p=.05) supplied greater amounts of dietary fiber for the exercisers compared with the non-exercisers. When asked about dietary changes made over the past decade, a greater percentage of the exercisers than non-exercisers reported having decreased red meat intake (p=.05) and increased consumption of cereals (p=.05) and legumes (p=.00). Actual intake data showed that the legume food category contributed more dietary fiber to the diets of the exercisers than the non-exercisers (p=.02). No differences were found in body fat measures between the exercisers and non-exercisers. The lack of observed differences between the two groups reinforces what other researchers have found, that a large number of factors influence body composition, of which exercise is only one. More research is needed to distinguish the interactions of age, energy intake, and physical activity on the body fatness of elderly women, as well as the most accurate instruments for assessing body composition for this age group. Exercise participation among elderly women in this study appeared to be associated with several positive dietary behaviors. Elderly women exercisers compared to non-exercisers made food choices leading to higher total vitamin A and carotene intakes, and also reported making more changes in food consumption behaviors in the direction of current dietary recommendations. These observed outcomes provide support for designing health-promotion programs for elderly women which include both nutrition education and exercise components. / Graduation date: 1993

Submitted in fulfillment of the requirements for the Degree Magister Technologiae: Consumer Science Food and Nutrition, Durban University of Technology, 2014. / Introduction: Dietary diversity is an indicator of access and measurement of household food security as it relates to income, location and seasonality. Dietary diversity is measured by physically counting the number of individual foods as well as food groups consumed over a given reference period. When dietary diversity is accurately measured, nutrient adequacy will be easily predicted. In order to measure dietary diversity accurately, it is important to determine household food security. Insufficient food and resources often result in food insecurity which leads to little or no dietary diversity. Poor populations suffer most from achieving dietary diversity because they consume a standard diet based on starchy staple food with limited fruits and vegetables resulting in multiple nutrient deficiencies. Rural communities rely on seasonal food variety in order to obtain fruits and vegetables needed by the body to limit nutrient deficiencies. Some seasons are more productive than others. Rural communities also use various coping strategies to deal with food insecurity in all four seasons. High levels of unemployment as well as a lack of nutrition education results in most rural households unable to cater for dietary diversity. Aim: The aim of the study is to determine the effect of seasonal food variety, dietary diversity and nutrient adequacy on the nutritional status of women in rural areas. Method: A hundred women in this community were weighed and measured and BMI determined and classified according to the WHO cut-off points for BMI. Waist circumference was measured in order to determine the waist-to-height ratio indication risk of metabolic syndrome. Twenty four hour recall questionnaires were used to determine actual intake compared to dietary reference intake (DRIs). Food Frequency Questionnaires for a period of seven days were completed captured and analysed using the SPSS version for descriptive statistics in order to determine food diversity. Coping strategies were determined by Focus Group interviews with community members in order to identify the various strategies used in time of food shortages. The severity of these strategies was determined by the community. Seasonal food consumption patterns and dietary intake behaviour were assessed over the four seasons. The highest frequency score (7) x severity weight (1-4) x10 strategies = maximum score of 140. Thus the higher the score the more food insecure the community is. Results: Food production from crops differs in different seasons. Food insecurity is high in summer and autumn due to a low number of food items harvested from crops. The community cope less in summer and autumn due to less crops available. The community is more food insecure in spring and winter due to the high number of food items harvested from crops. The community cope better in winter and spring due to the high level of available crops. Anthropometric measurements indicated that 41.2% of women between 31 and 50 and 49% of women between 51 and 70 years of age had a BMI of 30 and above. About 44% of total women are obese and 29% are pre obese. Only 26% had a normal weight. The 24 hour recall analysis indicates that the high level of obesity is due to the fact that a high number of participants consume large amount of carbohydrates every day. Conclusion: Overall results in this study indicated that this rural community is food insecure, on a higher level during summer and autumn, which leads to the consumption of undiversified diets. The women are malnourished and obese with a risk of metabolic syndrome. The information obtained in this study can be used to formulate strategies to develop interventions that can be used to access sufficient food in rural area in order to improve food insecurity, dietary diversity and, therefore, nutrient adequacy.

Ecuador, a country of multi-ethnic culture, has very acute health problems, especially in rural areas where two out of every three poverty-stricken Ecuadorians live. 77% of the population under 18 years of age is under the poverty level. The greater part of the indigenous population inhabits the rural areas of the Andes and the Amazon. 76% of children in the rural Andes are poor. Little Afro-Ecuadorian boys and girls also face severe disadvantages where, in the rural areas, poverty climbs above 70% of the population under 18 years of age. Academic desertion is another factor that affects especially the young women, who have to assume agricultural and communitary jobs due to the adult men's migration to the cities. In areas of indigenous population, chronic malnutrition in those who are under five years of age ascends to 65.3% while the national average reaches 49.4%. Another at-risk group is expecting mothers. Of every 1,000 births, 70 will die before living one year, and for every 100,000 births, 198 mothers die. The Province of Imbabura is rich in alimentary production and has hot, cold, and temperate climates which in turn contribute to a diversity of cultivated products. Nevertheless, the polarization of wealth and the existence of classes with low income levels lessen the possibility of acquiring good nutrition. To this is added the individual nutritional customs and beliefs of each culture that do not allow adequate nourishment in communities which are principally indigenous, Mestizo, and Black. Indigenous, Mestizo, and Black communities have very small parcels of land (minifundios or "small farms") which they cultivate with few resources and tools. This destines the majority for living conditions of extreme poverty. The majority of Mestizos are unemployed or semi-employed, have limited health services, and lack a basic sanitary infrastructure. Another minority group is the Blacks, the majority of whom cultivate fruit and legumes, who also have limited health services and a barely acceptable sanitary infrastructure. In addition, all of these people are victims of racism and federal neglect, and claim the highest rates in general, infant, and maternal mortality in the country. This reality makes difficult the development of adequate training activities which bring about the improvement of the nutritional state of the designated at-risk groups: nursing babies, children under five years of age, and pregnant women. Facing this lacerative situation, and thanks to the support of the EZRA TAFT BENSON Institute (Agriculture and Food Institute. Brigham Young University), we designed this study to determine the understanding, attitudes, and practices in nutritional traditions and beliefs of mothers of nursing babies, children under five years old, and expecting mothers. These three groups were analyzed within the three ethnic groups in the communities of Chota, La Gangotena, and Chilcapamba-communities selected randomly and because of their ethnic populations. In the mothers of the three ethnic groups, we found similar beliefs regarding certain foods. But, there are also discrepancies regarding other recommended and prohibited foods. Diets have a lack of indispensable foods such as vitamins and minerals. Even though these goods are produced in the communities, they are not administered due to stronger ancestral traditions and beliefs. This study provides profound knowledge of their nutritional traditions and beliefs, and with the results, an appropriate intervening proposition may be formulated. The proposition will permit the bettering of alimentary and nutritional conditions in nursing babies, children under five years, and pregnant women by ethnic groups. The Universidad Ténica del Norte has complied in this manner with the social commitment assigned by the State for improving the quality of life of Ecuadorians in general and of the groups studied in particular.

Post-natal care is a care given to the mother and the newborn during post-natal period. This period is crucial to save the lives of the mother and the newborn. Despite its importance, the utilisation of this service is very low in Ethiopia. This study was conducted to establish the views and experiences of women and health care workers on post-natal care services and determine the factors influencing its utilisation with the ultimate purpose of developing guidelines to improve uptake and quality of the services in South West Shoa Zone of Oromia Region, Ethiopia. The objectives of the study were to explore and describe the women’s views and experiences on utilisation of post-natal care service. Furthermore, the study sought to explore and describe health care workers views and experiences on provision of the services and to assess the factors facilitating or hindering to the utilisation of it. Ultimately, the study had intended to develop guidelines that would contribute towards improving the uptake and quality of the post-natal care services. The study used a qualitative descriptive and explorative research design to address the research questions. Qualitative data were collected from 19 women who gave birth in the past six months and from 24 health care workers providing post-natal care services (health care workers and health extension workers) and coordinating the overall maternal, neonatal and child health services in the study area (Zone and district health officials; primary health care units heads). The study used in-depth interview guides to collect data from the aforementioned study participants. Inductive thematic analysis was performed on the verbatim transcriptions using the Atlas ti version 8 qualitative data analysis software. Overall, the emerged themes from the analysis are categorised into women’s views and experiences on utilisation of PNC services, views and experiences of health care workers on PNC and factors facilitating and hindering the utilisation of PNC services. The study identified wide range of socio-cultural, knowledge and attitude related, physical, health facility related and health care workers related factors affecting the utilisation of post-natal care services. Consequently, after a systemic review of literature and stakeholders consultation the researcher used the findings of the study to develop guidelines to improve the uptake and quality of post-natal care services. The developed guidelines were also validated by maternal, neonatal and child health service providers and program leaders and the researcher strongly recommend the use of the developed guidelines that would improve the uptake and quality of post-natal care services. / Health Studies / Ph. D. (Public Health)

Pau King-man. / Thesis submitted in: October 2001. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 173-181). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / Abstract (Chinese version) --- p.iii / Table of Contents --- p.iv / List of Figures --- p.xii / List of Tables --- p.xiii / List of Abbreviations --- p.xxiv / Chapter CHAPTER ONE: --- INTRODUCTION / Chapter 1.1 --- Women's Overweight and Obesity Prevalence and Trends --- p.1 / Chapter 1.2 --- Etiology of Overweight and Obesity --- p.2 / Chapter 1.3 --- Health Consequences of Obesity in Women --- p.4 / Chapter 1.4 --- Dietary and Physical Activity Recommendations for Good Health for Adults --- p.6 / Chapter 1.5 --- Health Behavior Change Theories --- p.8 / Chapter 1.6 --- Weight Control/Loss Interventions for Women --- p.10 / Chapter 1.7 --- Weight Loss Risks --- p.11 / Chapter 1.8 --- Health Promotion Programs for Women --- p.12 / Chapter 1.9 --- General Situation and Population Trends Among Hong Kong Middle- aged Women --- p.15 / Chapter 1.10 --- Nutrition-related Morbidity and Mortality Among Hong Kong Women --- p.16 / Chapter 1.11 --- Diet Composition of Hong Kong Middle-aged Women --- p.20 / Chapter 1.12 --- Physical Activity Patterns of Hong Kong Middle-aged Women --- p.21 / Chapter 1.13 --- Education and Health in Hong Kong Middle-aged Women --- p.23 / Chapter 1.14 --- Attitudes Toward and Beliefs About Diet and Health of Hong Kong Middle-aged Women --- p.24 / Chapter 1.15 --- Common Weight Loss Methods Among Hong Kong Middle-aged Women --- p.25 / Chapter 1.16 --- Sources of Health Information Among Hong Kong Middle-aged Women --- p.25 / Chapter 1.17 --- Summary --- p.26 / Chapter 1.18 --- Study Purpose and Objectives --- p.26 / Chapter CHAPTER TWO: --- METHODOLOGY / Chapter 2.1 --- Recruitment of Participants --- p.29 / Chapter 2.2 --- Focus Groups --- p.29 / Chapter 2.3 --- Survey Instrument --- p.30 / Chapter 2.3.1 --- Questionnaire --- p.30 / Chapter 2.3.2 --- Three-day Dietary Record --- p.35 / Chapter 2.3.3 --- Anthropometric and Cholesterol Measurements --- p.35 / Chapter 2.4 --- Intervention --- p.37 / Chapter 2.5 --- Evaluation --- p.39 / Chapter 2.5.1 --- Process Evaluation --- p.39 / Chapter 2.5.2 --- Outcome Evaluation --- p.40 / Chapter 2.6 --- Data Management --- p.40 / Chapter 2.7 --- Statistics --- p.40 / Chapter 2.8 --- Data Analysis --- p.41 / Chapter 2.8.1 --- Physical Activity Patterns --- p.41 / Chapter 2.8.2 --- Dietary Patterns --- p.44 / Chapter 2.8.3 --- Nutrition Knowledge Score --- p.45 / Chapter 2.8.4 --- Physical Activity Knowledge Score --- p.46 / Chapter 2.8.5 --- Blood Total Cholesterol --- p.46 / Chapter 2.8.6 --- Body Mass Index --- p.47 / Chapter 2.8.7 --- Percent Body Fat --- p.47 / Chapter 2.9 --- Ethics --- p.47 / Chapter CHAPTER THREE: --- RESULTS / Chapter 3.1 --- Focus Group Results --- p.43 / Chapter 3.1.1 --- General Description of Participants --- p.48 / Chapter 3.1.2 --- Perceived Values and Views on 'Health' --- p.50 / Chapter 3.1.3 --- Perceived Values and Views on 'Healthy Lifestyle' --- p.51 / Chapter 3.1.4 --- Perceived Values and Views on 'Healthy Eating' --- p.52 / Chapter 3.1.5 --- Perceived Values and Views on 'Physical Activity' --- p.53 / Chapter 3.1.6 --- The Factors Motivating the Women to Adopt a Healthy Lifestyle --- p.53 / Chapter 3.1.7 --- Sources of Information About Healthy Eating and Physical Activity --- p.55 / Chapter 3.1.8 --- Suggestions for the Type and Content of Activities in a Health Promotion Program --- p.55 / Chapter 3.2 --- Participation Rate in the Study --- p.56 / Chapter 3.3 --- Pretest --- p.57 / Chapter 3.3.1 --- General Participant Sociodemographic Description --- p.57 / Chapter 3.3.2 --- Anthropometry --- p.59 / Chapter 3.3.3 --- Health Conditions Reported --- p.60 / Chapter 3.3.4 --- Meal Patterns --- p.61 / Chapter 3.3.5 --- Nutrient Supplements Practices --- p.62 / Chapter 3.3.6 --- Cooking Practices --- p.63 / Chapter 3.3.7 --- Food Removal Behavior --- p.65 / Chapter 3.3.8 --- Food Label Reading --- p.65 / Chapter 3.3.9 --- Dietary Intake --- p.66 / Chapter a. --- From the Three-day Dietary Records --- p.66 / Chapter b. --- From the Food Frequency Questionnaire --- p.68 / Chapter 3.3.10 --- Nutrition Knowledge --- p.69 / Chapter 3.3.11 --- Physical Activity Habits --- p.72 / Chapter 3.3.12 --- Physical Activity Knowledge --- p.73 / Chapter 3.3.13 --- Intention and Confidence in Changing Behavior --- p.76 / Chapter 3.3.14 --- Perceived Difficulties in Changing Behavior --- p.77 / Chapter 3.3.15 --- Perceived Methods Facilitating Behavior Change --- p.79 / Chapter 3.3.16 --- Health Information Desired --- p.80 / Chapter 3.3.17 --- Areas of Health the Women Would Like to Improve --- p.81 / Chapter 3.3.18 --- Summary Profile of the Women at Pretest --- p.82 / Chapter 3.4 --- Outcome Evaluation --- p.85 / Chapter 3.5 --- Posttest --- p.85 / Chapter 3.5.1 --- General Participant Sociodemographic Description --- p.85 / Chapter 3.5.2 --- Anthropometry --- p.86 / Chapter 3.5.3 --- Health Conditions Reported --- p.87 / Chapter 3.5.4 --- Meal Patterns --- p.88 / Chapter 3.5.5 --- Nutrient Supplements Practices --- p.89 / Chapter 3.5.6 --- Cooking Practices --- p.90 / Chapter 3.5.7 --- Food Removal Behavior --- p.91 / Chapter 3.5.8 --- Food Label Reading --- p.91 / Chapter 3.5.9 --- Dietary Intake --- p.93 / Chapter a. --- From the Three-day Dietary Records --- p.93 / Chapter b. --- From the Food Frequency Questionnaire --- p.94 / Chapter 3.5.10 --- Nutrition Knowledge --- p.95 / Chapter 3.5.11 --- Physical Activity Habits --- p.98 / Chapter 3.5.12 --- Physical Activity Knowledge --- p.99 / Chapter 3.5.13 --- Analysis the Changes by Education Level --- p.102 / Chapter 3.5.14 --- Analysis the Changes by Age Group --- p.104 / Chapter 3.5.15 --- Intention and Confidence in Changing Behavior --- p.105 / Chapter 3.5.16 --- Perceived Difficulties in Changing Behavior --- p.107 / Chapter 3.5.17 --- Perceived Methods Facilitating Behavior Change --- p.109 / Chapter 3.5.18 --- Health Information Desired --- p.110 / Chapter 3.5.19 --- Areas of Health the Women Would Like to Improve --- p.111 / Chapter 3.5.20 --- Summary Profile of the Women at Posttest --- p.112 / Chapter 3.6 --- Participants' Evaluation of the Intervention Program --- p.113 / Chapter 3.7 --- Follow-up --- p.118 / Chapter 3.7.1 --- General Participant Sociodemographic Description --- p.118 / Chapter 3.7.2 --- Anthropometry --- p.118 / Chapter 3.7.3 --- Health Conditions Reported --- p.121 / Chapter 3.7.4 --- Meal Patterns --- p.121 / Chapter 3.7.5 --- Nutrient Supplements Practices --- p.122 / Chapter 3.7.6 --- Cooking Practices --- p.123 / Chapter 3.7.7 --- Food Removal Behavior --- p.125 / Chapter 3.7.8 --- Food Label Reading --- p.126 / Chapter 3.7.9 --- Dietary Intake --- p.127 / Chapter a. --- From the Three-day Dietary Records --- p.127 / Chapter b. --- From the Food Frequency Questionnaire --- p.129 / Chapter 3.7.10 --- Nutrition Knowledge --- p.131 / Chapter 3.7.11 --- Physical Activity Habits --- p.135 / Chapter 3.7.12 --- Physical Activity Knowledge --- p.136 / Chapter 3.7.13 --- Intention and Confidence in Changing Behavior --- p.140 / Chapter 3.7.14 --- Analysis the Changes by Education Level --- p.142 / Chapter 3.7.15 --- Analysis the Changes by Age Group --- p.143 / Chapter 3.7.16 --- Perceived Difficulties in Changing Behavior --- p.144 / Chapter 3.7.17 --- Perceived Methods Facilitating Behavior Change --- p.145 / Chapter 3.7.18 --- Health Information Desired --- p.148 / Chapter 3.7.19 --- Areas of Health the Women Would Like to Improve --- p.149 / Chapter 3.7.20 --- Summary Profile of the Women at Follow-up --- p.150 / Chapter CHAPTER FOUR: --- DISCUSSION / Chapter 4.1 --- Implications of Findings --- p.154 / Chapter 4.1.1 --- Current Situations in Diet and Physical Activity of Hong Kong Middle-aged Women --- p.154 / Chapter 4.1.2 --- Overall Effects of the Program --- p.161 / Chapter a. --- Changes in Knowledge --- p.161 / Chapter b. --- Changes in Awareness and Intention --- p.163 / Chapter c. --- Changes in Behavior --- p.164 / Chapter d. --- Changes in Anthropometery --- p.166 / Chapter 4.2 --- Strengths and Limitations of the Study --- p.167 / Chapter 4.3 --- Implications and Recommendations for Meeting the Challenges of Improving Hong Kong Middle-aged Women's Nutrition and Physical Activity Habits --- p.169 / Chapter 4.4 --- Suggestions for Future Research --- p.170 / Chapter CHAPTER FIVE: --- CONCLUSIONS --- p.172 / References --- p.173 / Appendices / Chapter A --- Consent form (Chinese version) --- p.182 / Chapter B --- Consent form (English version) --- p.183 / Chapter C --- Questionnaire (Chinese version) --- p.184 / Chapter D --- Questionnaire (English version) --- p.196 / Chapter E --- Photos for food amount quantities and household measures (Chinese version) --- p.210 / Chapter F --- Photos for food amount quantities and household measures (English version) --- p.213 / Chapter G --- Sample of dietary record (Chinese version) --- p.216 / Chapter H --- Sample of dietary record (English version) --- p.217 / Chapter I --- Three-day dietary record (Chinese version) --- p.218 / Chapter J --- Three-day dietary record (English version) --- p.221 / Chapter K --- Pamphlets for health talks (Chinese version) --- p.224 / Chapter L --- Pamphlets for health talks (English version) --- p.236 / Chapter M --- Pamphlets for physical activity demonstration (Chinese version) --- p.248 / Chapter N --- Pamphlets for physical activity demonstration (English version) --- p.253 / Chapter O --- Process evaluation questionnaire (Chinese version) --- p.258 / Chapter P --- Process evaluation questionnaire (English version) --- p.260 / Chapter Q --- Overall evaluation questionnaire (Chinese version) --- p.262 / Chapter R --- Overall evaluation questionnaire (English version) --- p.263 / Chapter S --- Focus group questionnaire (Chinese version) --- p.264 / Chapter T --- Focus group questionnaire (English version) --- p.265 / Chapter U --- Focus group question guides (Chinese version) --- p.266 / Chapter V --- Focus group question guides (English version) --- p.268 / Chapter W --- The food consumption patterns of women in the Education and Control Groups --- p.270