Search PubMed⌕ Search

Biomedical subjects

C Achterberg

Publications and source records attributed to C Achterberg.

18 recordsLinked to original sources
PubMed2001

Dietary fat reduction strategies used by a group of adults aged 50 years and older.

OBJECTIVE: To investigate the fat-reduction strategies used by a group of older adults who successfully made and maintained positive dietary changes for 5 years or longer. DESIGN: Participants completed 2 copies of a self-administered food frequency questionaire: The first copy assessed diet before they began making changes and the second copy assessed diet after initiation of healthful dietary changes. Positive food changes were identified from the food frequency questionnaires. During in-person interviews, participants placed food changes onto a time line according to the nearest estimated date of initiation of the change. SUBJECTS: Participants were 65 free-living older adults (aged >50 years) who had maintained substantial changes to decrease fat intake in their diet for at least 5 years. Statistical analyses performed Quantitative and qualitative data were used to identify the fat-reduction strategies and to confirm and validate the fat-reduction strategy model. Confirmatory factor analysis was performed to confirm the new model. The Kuder-Richardson-20 reliability coefficient (kr) was used to determine internal consistency of the scales developed for the study. RESULTS: The majority of participants decreased their fat intake gradually, at different time points in their lives, and over a long period of time (5 to 43 years). Mean percent energy intake from fat decreased from 44.3 +/- 5.9% before dietary improvement to 25.9 +/- 7.1% at the time of the study. The final model consisted of 5 fat-reduction strategies with 63 food changes. The strategies were: increase summer fruits (4 items; kr=0.66), increase vegetables and grains (14 items; kr=0.79), decrease recreational foods (14 items; kr=0.76), decrease cooking fat (20 items; kr=0.86), and use fat-modified foods (11 items; kr=0.80). APPLICATIONS/CONCLUSIONS: Dietetics professionals should base their advice on the dietary strategies used by consumers rather than hypothetical premises such as food or nutrient groupings. Nutrition education interventions will have better chances for success if they are based on a set of customized programs that guide appropriate consumer segments through a series of small, comfortable, and sustainable dietary changes over a prolonged period of time.

Aged↗
PubMed2001

Food insecurity is positively related to overweight in women.

Although individuals with poor food security might be expected to have reduced food intake, and thus reduced body fat and less likelihood of being overweight, these associations have not been adequately studied. The purpose of the current study was to examine the relationship between food insecurity and overweight as measured by body mass index (BMI) using data from the nationally representative 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII). Overweight was defined as BMI >27.3 kg/m(2) for women and 27.8 kg/m(2) for men. Food insecurity was related to overweight status for women (n = 4509, P < 0.0001), but not for men (n = 4970, P = 0.44). Excluding the 11 severely insecure women, the prevalence of overweight among women increased as food insecurity increased, from 34% for those who were food secure (n = 3447), to 41% for those who were mildly food insecure (n = 966) and to 52% for those who were moderately food insecure (n = 86). Food insecurity remained a significant predictor of overweight status, after adjustment for potentially confounding demographic and lifestyle variables (P < 0.01). In a logistic regression analysis, mildly insecure women were 30% more likely to be overweight than those who were food secure [odds ratio (OR) 1.3, P = 0.005]. Thus, food insecurity had an unexpected and paradoxical association with overweight status among women with a higher prevalence of overweight among the food insecure, and a resulting potential for increased incidence of obesity-related chronic diseases. Given that the rates of both overweight and food insecurity are on the rise, this research area warrants further investigation.

Adult↗
PubMed2000

Responses of older adults to theory-based nutrition newsletters.

OBJECTIVE: To evaluate the effect of a theory-based newsletter on knowledge, attitude, and behavior change in older adults. DESIGN: Pretest-posttest, random assignment, and treatment-control design with 2 treatment groups: 1 that received newsletters only and 1 that received newsletters with follow-up telephone interviews. Control group completed pretest-posttest surveys only. SUBJECTS/SETTING: Four hundred eighty men and women, aged 60 to 74 years, were recruited to participate in a home-based educational intervention using a patient list generated from a rural tertiary care hospital database, Geisinger Medical Center in Danville, Pa. INTERVENTION: Five nutrition newsletters designed using the nutrition communication model and adult learning theory principles were mailed biweekly. Telephone interviews followed each of the 5 newsletters 10 to 14 days after distribution. OUTCOME MEASURES: Nutrition knowledge and interest, food behavior related to dietary fat, and stages of change for dietary fat and fiber. STATISTICAL ANALYSES PERFORMED: Analysis of covariance was used to determine group differences in posttest outcome measures using pretest as covariate. RESULTS: In addition to achieving higher scores than the control group, the treatment groups were significantly different from each other in correct and perceived nutrition knowledge at posttest. Those in the treatment group receiving telephone calls scored higher (mean change = 19.0% for correct and 20.3% for perceived) than those who received the newsletters only (mean change = 12.5% for correct and 14.3% for perceived; P < .05). Treatment groups also rated their interest in nutrition higher than the control group did; there was no between-treatment difference. Treatment groups performed significantly better than the control group for dietary fiber stage of change (P < .05). Those receiving only newsletters scored significantly better than the control for the "avoid fat" food behavior (P < .05). APPLICATIONS/CONCLUSIONS: This study provides an example of the incorporation of a theoretical model in development and evaluation of newsletters. Home-delivered nutrition newsletters based on this model can communicate health and nutrition information to older adults. Consumers today have more opportunities than ever before to access nutrition information quickly and inexpensively. Newsletters can help dietetics professionals filter and limit what consumers must process, saving clients time and improving the accuracy of information obtained. Dietetics professionals in both clinical and community practice are uniquely positioned to provide highly focused and understandable information to consumers via a newsletter format.

Aged↗
PubMed1999

How to make nutrition education more meaningful through facilitated group discussions.

Facilitated group discussions provide an alternative method to lecture and one-on-one approaches for conducting educational interventions at clinic sites. They are an interactive form of education wherein learners generate the specific topics to be addressed and share their knowledge and experience with other group members through discussion. In brief, the educator becomes a facilitator who, rather than lecturing, encourages clients to discuss freely among themselves their own approach to the nutrition problems posed during the session. As a facilitator, the nutritionist strives to create a comfortable atmosphere for discussion, encourages participation, and interjects only to correct misinformation and manage group dynamics. Facilitated group discussions allow nutrition practitioners to deliver meaningful nutrition education in a manner that helps empower their clients to improve their dietary habits; at the same time such discussions meet the increased public administrative demands for efficiency. Possible benefits to clients include more confidence, better communication skills, improved thinking skills, and increased motivation and commitment to improving nutrition behavior. We recommend that nutrition educators try facilitated group discussions in their clinics.

Group Processes↗
PubMed1999

Outcomes of a cardiovascular nutrition counseling program in African-Americans with elevated blood pressure or cholesterol level.

OBJECTIVE: To evaluate a cardiovascular nutrition education package designed for African-American adults with a wide range of literacy skills. DESIGN: Comparison of a self-help group and a full-instruction group; each group received nutrition counseling and clinical monitoring every 4 months. SUBJECTS: Three hundred thirty African-American adults, aged 40 to 70 years, with elevated cholesterol level or high blood pressure were randomly assigned to the self-help or full-instruction group; 255 completed the 12-month follow-up. INTERVENTIONS: Counseling to reduce intake of dietary fat, cholesterol, and sodium was based on Cardiovascular Dietary Education System (CARDES) materials, which included food-picture cards, a nutrition guide (self-help and full-instruction group), a video and audiotape series, and 4 classes (full-instruction group only). MAIN OUTCOME MEASURES: Changes in lipid levels and blood pressure after 12 months. STATISTICAL ANALYSES PERFORMED: Primary analyses consisted of repeated-measures analysis of variance to examine effects of time and randomization group on outcomes. RESULTS: Total cholesterol and low-density lipoprotein cholesterol level decreased by 7% to 8% in the self-help and full-instruction groups of men and women (P < .01). The ratio of total cholesterol to high-density lipoprotein cholesterol (HDL-C) decreased in both groups of women and in the men in the full-instruction group (P < .01). In full-instruction and self-help participants with elevated blood pressure at baseline, systolic blood pressure decreased by 7 to 11 mm Hg and diastolic blood pressure decreased by 4 to 7 mm Hg (P < .01). Outcomes did not differ by literacy scores but were positively related to the reported initial frequency of using CARDES materials. APPLICATIONS/CONCLUSIONS: These results suggest that periodic nutrition counseling based on CARDES materials used for home study can enhance management of lipid levels and blood pressure in African-American outpatients.

Adult↗
PubMed1999

Text and graphics: manipulating nutrition brochures to maximize recall.

This study examined how altering text and graphics of a nutrition brochure could affect the ability to remember the content of the message. Two theoretical models were used to guide alterations: dual-coding theory and the communications model. Three brochure formats were tested: the original brochure containing abstract text and abstract graphics, a modified brochure with relatively concrete text and abstract graphics, and a relatively concrete text brochure with concrete graphics. Participants (N = 239 women) were divided into four age groups: 20-30, 40-50, 60-70 and over 70 years. Women were randomly assigned into each of the three experimental brochure formats or a control group. Participants completed recalled materials from the assigned brochures (the no treatment control group did not include a brochure) at two different sessions, 30 days apart. Data were content analyzed and results were compared using analysis of covariance to test differences by age and brochure types. Younger women (20-30 and 40-50 years) recalled more information than women over 60 years. More concrete nutrition education print materials enhanced recall of information presented immediately after reading the material; however, this effect was transient and lasted less than 30 days after a one-time reading. The implications of these data for communicating nutrition messages with print materials are discussed.

Adult↗
PubMed1997

Review of self-efficacy and locus of control for nutrition- and health-related behavior.

This article reviews several cognitive predictors of health- and diet-related behaviors commonly used in theories and models of nutrition and health behavior change. Constructs such as self-efficacy, self-esteem, outcome expectancies, health value, and locus of control are examined. Self-efficacy has repeatedly been a good predictor of health behavior, sometimes explaining more than 50% of variability. Research on locus of control and other predictive factors has been less conclusive. The take-home message is threefold: (a) task specificity of self-efficacy and domain specificity of locus of control are crucial for unraveling their effects on behavior; (b) careful segmentation of different population groups under study may explain the inconsistencies in previous research; and (c) especially when studying dietary behavior, these predictors of behavior change should not be used alone or in place of one another but should be used simultaneously to explain complex food and diet-related behaviors. We recommend that nutritionists systematically integrate available theories and models and explore new areas for studying human behavior, such as sociology and anthropology, to form a more powerful, comprehensive model for behavior change.

Feeding Behavior↗
PubMed1997

Food purchase decision-making typologies of women with non-insulin-dependent diabetes mellitus.

Food selection is a key factor in the nutritional management of diabetes mellitus. Since up to 80% of food purchase decisions are made at the supermarket, the purpose of this study was to identify the criteria which influence point-of-purchase decision-making in women with NIDDM aged 40-60 years. A qualitative approach with individual interviews and in-store observations was used. Analysis of the interviews identified four decision-making typologies based on the extent nutrition, price and family needs were emphasized. The four typologies included (1) the Overloaded Shopper, (2) the Budget Shopper, (3) the Nutrition Savvy Shopper, and (4) the Out-of-Touch Shopper. Cluster analysis confirmed the typologies for 71% of the sample. Educators should classify shoppers according to a typology to determine their clients' personal needs and interests. Then, educators can tailor the educational or counseling message to meet those specific needs.

Adult↗
PubMed1996

Use of qualitative and quantitative methods to define behavioral fat-reduction strategies and their relationship to dietary fat reduction in the Patterns of Dietary Change Study.

OBJECTIVE: The purposes of this study were to identify specific food choice behaviors used to decrease dietary fat intake in a community-dwelling population; assess how people categorize changes to diet; determine whether logical grouping of food intake changes revealed one or more common patterns or strategies used by these participants to decrease fat; and determine which strategies were responsible for the greatest decrease in dietary fat intake in the study population. DESIGN: Survey analysis and in-depth interviews were used to quantitatively and qualitatively define dietary change patterns retrospectively in a population who, according to self-report, had decreased their fat intake. Specific food changes made to decrease fat intake, interview statements, and participants' reduction of percentage energy from fat were examined. SETTING: Interviews were conducted from June 1993 through April 1994. SUBJECTS: Included in the study were 145 persons aged 30 to 55 years who reported that they had been decreasing their dietary fat intake for 5 years or more, maintained a healthful diet for at least 5 months, and resided in the United States while changing their diets. STATISTICAL ANALYSES PERFORMED: Confirmatory factor analysis, reliability analysis, and linear regression analysis were performed. RESULTS: Nine fat-reduction strategies were identified. Decrease fat flavorings, decrease "recreational foods," decrease cooking fat, replace meat, change breakfast, and use fat-modified foods accounted for significant reduction in fat intake. CONCLUSIONS: People use a variety of dietary changes to reduce their fat intake. These changes can be categorized into strategies according to the way people change their diets. Knowledge of these strategies and their importance in dietary fat reduction can improve and help nutritionists prioritize the messages they convey.

Adult↗
PubMed1994

How to put the Food Guide Pyramid into practice.

The Food Guide Pyramid represents changes and challenges for nutrition educators. Nutrition educators will have to change the focus, content, and teaching expectations for lessons. Use of the Pyramid will also require changes in the way the concepts of good nutrition are related to different audiences. In contrast to previous food guides, which represented a foundation diet, the Food Guide Pyramid represents the total diet, addressing overnutrition as well as undernutrition. The Food Guide Pyramid is a graphic representation of the Dietary Guidelines for Americans, and illustrates the key concepts of variety, moderation, and proportionality. For practitioners, one challenge is to find ways to effectively use the Food Guide Pyramid to teach clients how to put the Dietary Guidelines into action. Another challenge involves designing materials that adapt the messages of the Food Guide Pyramid to a variety of audiences. Teaching materials and instructions should emphasize the key concepts of the Food Guide Pyramid and should be clear, consistent, motivational, and culturally sensitive. Few educational materials are available to help practitioners with these challenges. In this article we outline the key changes that the Food Guide Pyramid embodies, and provide ideas and suggestions for using the Pyramid in a practice setting.

Diet↗
PubMed1991

A dietary education program for hypercholesterolemic children and their parents.

A parent-child autotutorial dietary education program for 4- to 10-year-old, hypercholesterolemic children and their families was developed and pilot tested. The 10-lesson program, designed for weekly use at home, uses a "talking-book" approach (audiotapes with accompanying picture booklet) for the child. Parents are provided with information on ways to make recommended dietary changes, along with hands-on activities to do with the children. To help match the instructional approach to the wide developmental range within the children's age span, materials are divided into three program levels that use different story characters and concept presentations. During program development, evaluation by two children (and their parents) for each of the program levels guided the design and refinement of the lessons. A pilot test among 22 hypercholesterolemic children (whose treatment was limited to diet modification) revealed that children within the 4- to 10-year age range liked the "talking-book" approach and identified positively with the story characters. Parents indicated that their materials were clear and helpful. Between the baseline and 3-month follow-up visits, the children exhibited a significant increase in knowledge of heart healthy foods, a decrease in total fat consumption that approached significance, and a significant decrease in plasma low-density-lipoprotein cholesterol values.

Adult↗
PubMed1991

Gender differences in adults' knowledge about fat and cholesterol.

Cognitive learning theories suggest that an individual's prior knowledge is a major factor for determining what can be learned. The objectives of this study were to compare the organization of knowledge about fat and cholesterol in adult, middle-class men and women and changes in that knowledge after reading an educational bulletin. Forty men and 48 women participated in two semistructured interviews to assess their knowledge; half received a US Department of Agriculture bulletin on fat and cholesterol at the end of the first interview. Concept maps (two-dimensional representations of an individual's cognitive knowledge structure) were made from the interview transcripts to assess knowledge organization. Both genders had limited knowledge, scoring less than 25% of the maximum possible score at interview 1. Overall, known and not known concepts were similar in men and women; however, women had slightly more integrated knowledge and more misconceptions than men. Both groups receiving the bulletin made significant gains in knowledge at interview 2, but knowledge gains were twice as great in men as in women. Our findings indicate that practitioners need not create separate materials about fat and cholesterol for middle-class men and women.

Adult↗
PubMed1988

Factors that influence learner readiness.

Dietitians and nutrition educators can better decide what and how to teach if they first determine what the client or student is ready to learn. This article describes four major factors that influence learner readiness in short one-to-one interactions. The factors include information processing capacity, affective state, prior learning and experience, and the learner's "way of knowing" or philosophy of learning. Important aspects of the factors can be revealed quickly with 2 to 3 minutes of respectful, interested questioning to determine whether the learner is in a negative mood or oppressed affective state and to determine his or her experiential or knowledge background and approach or reaction to learning new material. The most common mistake educators make is "information overload." The human capacity to process information is limited. Instruction should be made to fit the learner's capacity (i.e., a maximum of seven +/- two concepts should be addressed in a 15-minute period). When nutritionists adjust their teaching style to better fit individual variations, they will maximize their impact as educators.

Attitude↗
PubMedDate not supplied

Ecologic study of children's use of a computer nutrition education program.

The purpose of this research was to describe the context created by students as they worked in groups on a nutrition computer-assisted instruction (CAI) program. Students worked on the program in groups of three. Observational methods were used to collect data from students in two sixth-grade classrooms that were part of an experimental program designed to restructure the educational process. Thirty-two students, from 12 groups, were observed as they completed the program. The groups were assigned by the teachers according to standard principles of cooperative learning. Students completed "Ship to Shore," a program designed specifically for this research. The program required three to five 50-minute classroom periods to complete. The objectives of the program were to change children's knowledge structure of basic nutrition concepts and to increase children's critical thinking skills related to nutrition concepts. We collected observational data focused on three domains: (1) student-computer interaction, (2) student-student interaction, and (3) students' thinking and learning skills. Grounded theory methods were used to analyze the data. Specifically, the constant-comparative method was used to develop open coding categories, defined by properties and described by dimensions. The open coding categories were in turn used in axial coding to differentiate students' learning styles. Five styles of student interaction were defined. These included (1) dominant directors (n = 6; 19%), (2) passive actors (n = 5; 16%), (3) action-oriented students (n = 7; 22%), (4) content-oriented students (n = 8; 25%), and (5) problem solvers (n = 5; 16%). The "student style" groups were somewhat gender specific. The dominant directors and passive actors were girls and the action-oriented and content-oriented students were boys. The problem solvers group was mixed gender. Children's responses to computer-based nutrition education are highly variable. Based on the results of this research, nutrition educators may recommend that nutrition CAI programs be implemented in mixed gender groups.

Adolescent↗
PubMedDate not supplied

Client satisfaction with the nutrition education component of the California WIC program.

Past evaluation research has documented improved nutritional outcomes resulting from participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). However, these evaluations have not examined the program from the clients' perspective, nor have they examined the independent effect of the nutrition education component. The purpose of this study was to quantitatively and qualitatively examine client satisfaction with the nutrition education component of the California WIC program. The methodology consisted of two phases. During phase I of the study (the quantitative component), participants completed Client Satisfaction Surveys immediately following attendance of one nutrition class. During phase II (the qualitative component), four focus groups were conducted. All subjects were participants in the California WIC program. Client Satisfaction Surveys were completed by 2138 participants, and the focus groups included 29 participants. Results from both phases of the study indicated that client satisfaction with the nutrition education component of the California WIC program was high. Between 80% and 95% of participants responded positively to five satisfaction questions, and focus group participants unanimously agreed that the nutrition education was an essential component of the program. Hispanic participants were more likely than non-Hispanic Caucasians, Asians, or African Americans to respond positively to three of the five satisfaction questions. For two of the questions, the frequency of positive responses increased as age increased and decreased as education level increased. A small segment of clients reported some dissatisfaction by responding negatively to one or more of the satisfaction questions (4% to 20% of respondents). Some suggestions for improvement were made by survey respondents. Identification of some WIC participants who are not completely satisfied with the nutrition education that they have received, paired with differences in satisfaction across demographic variables, suggests the need for a personalized approach to WIC nutrition education.

Adolescent↗