|Year : 2013 | Volume
| Issue : 1 | Page : 24-28
Informal group intervention technique to promote a healthy dietary habit in adults
Annamalai Manickavasagan1, Govardhana Rao Dubasi2, Mohammad Shafiur Rahman3, M Mohamed Essa3
1 Department of Soils, Water and Agricultural Engineering College of Agricultural and Marine Sciences, Sultan Qaboos University, Oman
2 Central Food Technological Research Institute, Resource Centre, Hyderabad, India
3 Department of Food Science and Nutrition, Sultan Qaboos University, Muscat, Oman
|Date of Submission||14-Mar-2012|
|Date of Acceptance||23-Mar-2012|
|Date of Web Publication||6-Feb-2013|
College of Agricultural and Marine Sciences, Sultan Qaboos University, Al-Khoud 34, PIN 123
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Healthy dietary habit is one of the important factors in the maintenance of good health. A study was conducted to determine the effect of informal discussion to motivate adults toward healthy eating. Materials and Methods: Healthy dietary habits were discussed informally with the help of "Dietary Guidelines for Indians" published by National Institute of Nutrition, to an individual group in Tamil Nadu at least for 3 hours (n = 42 in 3 groups). After 1 year of these informal discussions, without in-between follow-ups, a telephone interview (informal) was conducted to the participants individually (n = 31) to determine the changes in their eating behavior. Results and Discussion: About 68% of the participants interviewed reduced the quantity of rice intake as a result of informal discussion, and 42% of the participants shared their learning with other people. The changes in eating behavior were significantly higher in females than in males. Participants living in urban areas made more changes in eating behaviors than in rural areas. Similarly more changes in dietary habits were observed among participants with postgraduate qualifications than with higher secondary qualification. Conclusion: This informal intervention approach has great potential to change the eating behavior toward healthy diet in India and other developing countries. However different strategies may be required for the people with different educational and economical background.
Keywords: Brown rice, group intervention, informal discussion, traditional eating, white rice
|How to cite this article:|
Manickavasagan A, Dubasi GR, Rahman MS, Essa M M. Informal group intervention technique to promote a healthy dietary habit in adults. Int J Nutr Pharmacol Neurol Dis 2013;3:24-8
|How to cite this URL:|
Manickavasagan A, Dubasi GR, Rahman MS, Essa M M. Informal group intervention technique to promote a healthy dietary habit in adults. Int J Nutr Pharmacol Neurol Dis [serial online] 2013 [cited 2021 Mar 3];3:24-8. Available from: https://www.ijnpnd.com/text.asp?2013/3/1/24/106976
| Introduction|| |
Healthy diets and adequate physical activity are the major factors in the promotion and maintenance of good health. Coronary heart disease, some types of cancer, stroke, hypertension, obesity, and non-insulin-dependent diabetes mellitus are the major diseases in which diet plays a role. , All over the world, the number of people affected by these diseases is increasing. For example, it has been estimated that the number of diabetic patients in India will be increased by more than 150% by 2030 from 2000 (from 31 million to 79 million).  In India, decreased intake of coarse cereals, pulses, fruits, and vegetables, and increased intake of meat products and salts coupled with declining levels of physical activity have resulted in escalating levels of obesity, atherogenic dyslipidemia, subclinical inflammation, the metabolic syndrome, type 2 diabetes, and coronary heart diseases in the last 30 years. ,
In south India, white rice consumption is generally very high. People living in many parts of this region consume white rice for breakfast, lunch, and supper in different forms. They try to change their traditional eating behavior only after diagnosed by any disease. Health agencies have been established around the world to promote healthy diets based on scientific evidence. They make recommendations through websites, pamphlets, compact disks, and other similar campaigning modes. Alternatively, face-to-face personal and group counseling in different settings and telephonic counseling (personal and group) approaches have been widely used to promote healthy diet or provide treatment for diseases. However, the ability of counseling, and campaigning through different approaches, to change dietary pattern and improve health is unclear.  Achieving a positive dietary change is a complex and formidable endeavor, and the nutrition message should be communicated in a scientifically precise, practical, and motivating manner.  The objective of this study was to determine the effectiveness of informal discussions about healthy diet on the changes in traditional eating behavior for adults living in Tamil Nadu.
| Materials and Methods|| |
Three groups of people (gathered for different families and formal occasions) in Tamil Nadu, India were randomly selected for this study (n = 42). The details of the participants in this study are given in [Table 1]. It was informed to the participants in advance that this discussion is on healthy food. The participants in group 1 were living in rural areas, and groups 2 and 3 were living in urban areas. This informal discussion in groups 2 and 3 took place at one of the participant's residence. Whereas in group 1, the discussion was organized in a public school (South Street Hindu Nadar Higher Secondary School, Muhavur, Virudhunagar district) after a formal event by alumni of that School. In all groups, the informal explanation was given by the first author for about 3 h after the formal events during July to September 2008.
"Dietary Guidelines for Indians" published by the National Institute of Nutrition, India and "Healthy Food Pyramid" suggested by Willet  were shown and used as main reference during discussion. The discussion was conducted in the regional language (Tamil). The calorie concept and effect of major and minor nutrients were discussed in a simple manner. The glycemic index concept in carbohydrate, effect of saturated, unsaturated, and trans types of fat, and the importance of protein were discussed.  The fat profiles of the locally consumed oil were explained. The need for the higher consumption of fruits and vegetables (7-10 servings per day) were mentioned. The necessity for the higher intake of calcium was stressed and suggested to take three cups of skim milk or equivalent dairy products every day. However about 50% of the time during discussion was spent for the calorie and carbohydrate concept as refined carbohydrate consumption is higher in this region. It was suggested to reduce the quantity of white rice intake and replace with whole grains such as brown rice and whole wheat products. The benefits of having whole grains were also explained in a simple manner with the help of glycemic index concept.
After discussion in each group, nothing was mentioned about the follow-up or interview. In December 2009 (approximately after 1 year of the informal discussions), a telephone call was made to 31 members individually to study their changes in eating behavior. Since 11 members who participated in the study changed their residence and phone numbers, it was not possible to get the feedback from them. [Table 2] shows the number of participants interviewed after 1 year of the informal discussion. Changes in the dietary habits of seven components of healthy diet (1. calorie concept; 2. reduction in rice quantity intake; 3. switch from white to brown rice; 4. reduction in saturated and transfat intake; 5. skim milk consumption; 6. increase in protein intake; and 7. increase in fruits and vegetables intake) were collected during the interview.
|Table 2: Number of participants during interview conducted 1 year after informal discussion|
Click here to view
The effect of different types of participants on the positive dietary changes was studied statistically using Statistical Analysis System software (SAS, version 8.02, SAS Institute, Inc., Cary, NC). The effect of gender (male and female), education level (high school, undergraduate and postgraduate, and residing region (rural and urban) on the dietary changes in different components were studied by analysis of variance (ANOVA) using two factorial design models (7 components ×2 gender, 7 components ×3 education levels, and 7 components ×2 residing regions) with general linear model (GLM) procedure. The participants were divided into two groups based on the residing regions (rural and urban). Group 1 was considered as rural and groups 2 and 3 together were considered as urban. In all analyses, the differences within the levels under each variable were tested at 95% confidence interval (type I error, α = 0.05) using the least significant difference (LSD) method of comparison of means.
| Results and Discussion|| |
The summary of responses for changes in eating behavior after 1 year of informal discussion is given in [Table 3]. Out of 31 participants interviewed, 21 (68%) reduced the intake of quantity of rice. For supper, instead of rice or rice-based products, they moved to Indian flat bread (chappathi, made from whole wheat flour). This shift increased the consumption of protein (20 positive responses). One person reduced the quantity of rice in supper and started taking fruits and vegetables to fill the gap. Reduction in intake of rice was higher in groups 2 and 3 (9 out of 10) than in group 1 (11 out of 20). Even though there is a good reduction in the intake of rice quantity, only one person (out of 31) had switched from white rice to brown rice.
|Table 3: Summary of responses received during telephone interview conducted 1 year after informal discussion|
Click here to view
Around 42% of the people started taking higher amounts of fruits and vegetables as per the recommendations. Skim milk was not commercially available in many places of Tamil Nadu. However, a few people mentioned that they started removing the floating top cream layer before drinking the milk. Only two participants were cautious about saturated and transfat contents, and reduced their intake. Many participants expressed their intention to gain more knowledge on the good and bad oil. Nonavailability of oil profile information and inconsistencies in nutrition labels were other reasons for the challenges to follow this oil concept. Around 42% of the people were excited about this new knowledge, and discussed with other people. Friends, family members, and colleagues were the important people they shared their learning experience on the adaption of healthy diet.
The gender of the participants had significant effect on the positive responses in following the suggestions. The changes in eating habits were more significant in females than in males. Similarly the educational level of the participants had a significant effect on the changes in eating behavior. High school graduates had the lowest changes, and the postgraduates had the highest changes in dietary behavior. Changes in the discussion pattern and contents according to different educational level of people might be more effective in changing their habits. The participants living in urban areas made higher changes than their counter parts in rural areas.
Factors responsible for changing and not changing to healthy dietary behavior
Many people expressed their happiness and satisfaction for the learning about healthy diet, whereas others mentioned that although they were interested to change, some factors were inhibitive for them to do that. The common reasons mentioned by the participants during interview for their response to informal discussion are given in [Table 4].
|Table 4: Reasons mentioned by the participants during interview for changing and not changing to healthy diet|
Click here to view
The reasons mentioned by the participants for not changing to brown rice were nonavailability and hardness to chew. It has been always a challenge to make the people to eat whole grain products. The common barriers for the consumption of whole grain products are taste, appearance, cost, texture, consumer knowledge of health benefits and ability to identify whole grain products at the point of purchase. ,,,
Cooking for the whole family was another important issue for not changing by some participants. This may be solved by educating all the family members about healthy food and asking them to take team efforts. Otherwise, they have to accept others preferences and find a way to support them. In a study on perception of whole grain foods,  it was mentioned that in some houses in the USA, the family members were open and ready to eat different types of foods according to their preference. For example, one parent responded "It is not uncommon, for us to have 4 different breads in the house and there is only 3 of us."
The ideas suggested by Burgess-Champoux et al.  to increase the intake of whole grain products in school menu could be very well adopted for adults in the family: a. gradual adaptation to whole grain products b. samples of variety of whole grain based new products before replacing any current menu c. education about whole grain products and continuous exposure about these products.
The benefits of group intervention over personal discussion have been mentioned by several researchers. Befort et al.  conducted a comparative study (group versus individual) for telephone based obesity treatment for rural women in Kansas. In the group approach, they used the conference call method. It was determined that the weight loss was greater in the group than in the individual condition. It was also stated that group treatment was a cost-effective treatment than individual treatment. In another study, face-to-face group treatment was more beneficial than face-to-face individual treatment in obese women.  Group treatment provides opportunities for interpersonal learning, imparting information to others, developing optimism and hope for change. , In our study also the group intervention was found to be effective which was evident from the fact that even after discussion, there were lots of exchanges going on among the participants in all groups. However, the optimum size of the groups should be determined.
The informal meetings provide an opportunity to communicate the message emotionally to heart. During our discussion, examples of the families suffered because of the early death of head of the family, and sufferings of the people with diseases were emotionally mentioned. Emotions act as a driving force for the people to take decisions, and think on their own. 
The informal discussion approach made significant changes in healthy dietary habits. However, introducing several concepts at one time may not be effective to make a complete shift from traditional eating behavior. One or two concepts at a time, and three to four gatherings for each group might be beneficial to make successful changes. In-between follow-ups will be useful to make sure that the participants have started changing the behavior, and continuing the change. As the educational level has a significant effect on learning abilities, different protocols are required for various groups of people. The optimum size of the group for effective communication must be studied by further research.
This report is based on the self-reported data during telephone interview time, it may not be a strict indicator on the actual level of changes; however it can be used as a broader indicator on the effect of informal discussion in changes to healthy diet.
| Acknowledgment|| |
This study was partially supported by the Dean's Seed Grant, College of Agricultural and Marine Sciences, Sultan Qaboos University.
| References|| |
|1.||Pignone MP, Ammerman A, Fernandez L, Orleans CT, Pender N, Woolf S, et al. Counseling to promote a healthy diet in adults: A summary of the evidence for the U.S. preventive services task force. Am J Prev Med 2003;24:75-92. |
|2.||Ammerman A, Pignone M, Fernandez L. Counseling to promote a healthy diet. Systematic evidence review no. 18. Rockville, MD: Agency for Health care Research and Quality; 2003. (Prepared by the RTI-University of North Carolina Evidence-based Practice Center under contract No. 290-97-011). Available from: http://www.ahrq.gov/clinic/serfiles.htm. [Last accessed on 2010 Apr 30]. |
|3.||WHO. Diabetes Program: Facts and Figures-Eastern Mediterranean Region. Available from: http://www.who.int/diabetes/facts/world_figures/en/index2.html: [Last accessed on 2010 July 01]. |
|4.||Misra A, Singhal N, Sivakumar B, Bhagat N, Jaiswal A, Khurana L. Nutrition transition in India: Secular trends in dietary intake and their relationship to diet-related non-communicable diseases. J Diabetes 2011:3:278-292 |
|5.||Asif M. The role of fruits, vegetables, and spices in diabetes. Int J Nutr Pharmacol Neurol Dis 2011a;1:27-35. |
|6.||Fitzggibbon M, Gans KM, Evans WD, Viswanath K, Johnson-Taylor WL, Krebs-Smith SM, et al. Communicating healthy eating: Lessons learned and future directions. J Nutr Educ Behav 2007;39:63-71. |
|7.||Willett WC, Skerrett PJ. Eat, drink, and be healthy. The Harvard Medical School Guide to Healthy Eating. New Yoyk, NY: Free Press, Simon and Schuster Inc.; 2005. |
|8.||Asif M. Process advantages and product benefits of interesterification in oils and fats. Int J Nutr Pharmacol Neurol Dis 2011b;2:134-8. |
|9.||Adams J, Griffiths P, Reicks M. The consumer and whole grains. In: Whole Grains in Health and Disease. In: Marquart L, Slavin J, Fulcher G, editors. St. Paul, Minn: American Association of Cereal Chemist; 2002. |
|10.||Kantor L, Variyam J, Allshouse J, Putnam J, Biing-Hwan L. Choose a variety of grains daily, especially whole grains: A challenge for consumers. J Nutr 2001;131:473S-86S. |
|11.||Chase K, Reicks M, Smith C, Henry H, Reimer K. Factors influencing purchase pf bread and cereals by low-income Aftrican American women and implications for whole grain education. J Am Diet Assoc 2003;103:501-4. |
|12.||Burgess-Champoux T, Marquart L, Vickers Z, Reicks M. Perceptions of children, parents and teachers regarding whole-grain foods, and implications for a school-based intervention. J Nutr Educ Behav 2006;38:230-7. |
|13.||Befort CA, Donnelly JE, Sullivan DK, Ellerbeck EF, Perri MG. Group versus individual phone-based obesity treatment for rural women. Eat Behav 2010;11:11-7. |
|14.||Renjilian DA, Perri MG, Nezu AM, Mckelvey WF, Shermer RL, Anton S D. Individual versus group therapy for obesity: Effects of matching participants to their treatment preferences. J Consult Clin Psychol 2001;69:717-21. |
|15.||Yalom ID. The theory and practice of group psychotherapy. New York: Basic Books; 1995. |
|16.||Colchamiro R, Chiringhelli K, Hause J. Touching hearts, touching minds: Using emotion-based messaging to promote healthful behavior in the Massachusetts WIC program. J Nutr Educ Behav 2010;42:S59-65. |
[Table 1], [Table 2], [Table 3], [Table 4]