Volume 9, Issue 3 (Summer 2020)
Arch Hyg Sci 2020, 9(3): 168-178 |
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Saidi F, Ahmadi Z, Gharlipour Z, Isadkhah F S, Arabshahi A. Relationship of Awareness, Perceived Benefits, and Perceived Barriers with Nutritional Behavior of Elementary School Students in Kashan. Arch Hyg Sci 2020; 9 (3) :168-178
URL: http://jhygiene.muq.ac.ir/article-1-443-en.html
URL: http://jhygiene.muq.ac.ir/article-1-443-en.html
Fariba Saidi1 
, Zohre Ahmadi2 , Zabihollah Gharlipour3 , Fateme sadat Isadkhah4 , Amin Arabshahi * 4
, Zohre Ahmadi2 , Zabihollah Gharlipour3 , Fateme sadat Isadkhah4 , Amin Arabshahi * 4
1- a BSc in Food and Beverage, Deputy of Food and Drug Administration, Kashan University of Medical Sciences, Kashan, Iran
2- b Student Research Committee, Department of Health Education and Health Promotion, School of Health, Qom University of Medical Sciences, Qom, Iran
3- Public Health Department, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
4- d Student Research Committee, Department of Health Education and Health Promotion, School of Health, Qom University of Medical Sciences, Qom, Iran
2- b Student Research Committee, Department of Health Education and Health Promotion, School of Health, Qom University of Medical Sciences, Qom, Iran
3- Public Health Department, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
4- d Student Research Committee, Department of Health Education and Health Promotion, School of Health, Qom University of Medical Sciences, Qom, Iran
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higher, compared to boys (Table 4).
The results of the regression model showed that an increase in awareness (P=0.04) and the perceived benefits (P=0.018) scores was significantly associated with an increase in students' nutritional behavior. However, perceived barriers displayed no effect on students' nutritional behavior (Table 5).
In the current study, the mean score of students' nutritional awareness was relatively good. In line with our study results, the mean score of awareness was relatively good in the study performed by Khakpour et al. (1). Nevertheless, inconsistent with the results of the present study, in their research, O'Brien et al. and Parameter et al. indicated that students did not have sufficient nutritional awareness (17,18). Studies on the nutritional status of students in Iran are indicative of the low level of awareness and nutritional performance in this age group, and most researchers have emphasized that further studies should be conducted in this filed (19-22).
It seems that food and nutrition information in science books, as well as the sensitivity of school health educators to students' nutritional knowledge, has led to a relatively favorable nutritional awareness in students included in the present study. In the present study, the mean score of students' nutritional behavior was at a desirable level. In a study carried out by Ostad Rahimi et al. (23), despite the favorable level of awareness and nutritional knowledge, most subjects had unbalanced eating behaviors. In a study conducted by Talatappeh et al. (3), the level of awareness and performance was reported to be at a moderate level, while in our study, awareness and performance were at good levels.
These discrepancies can be ascribed to differences in the research setting, sample, and time. Sometimes such factors as friends' tastes or lack of access to healthy food or good packaging affect students' eating behaviors. It seems that students' desirable nutritional behavior is related to their high level of awareness. Awareness can be a determining factor in nutritional behaviors. Furthermore, in the present study, the mean score of the perceived barriers and the perceived benefits were relatively favorable.
It can be said that school health educators and students' parents have greatly increased children's knowledge about the beneficial effects of eating breakfast on school performance and using fruit, milk, and yogurt to keep your bones and muscles strong and healthy. Moreover, they discouraged students from eating unhealthy and available foods, such as chips and cheese puffs, and skipping breakfast. The present study showed that nutritional behavior has a significant relationship with awareness.
The results of studies conducted by Alizadeh (24), Yoon (25), Wardle (11), Huang (26) Koci (27) showed that increased awareness has a significant relationship with student's nutritional behavior. In this regard, students with higher nutritional awareness demonstrated better nutritional behavior. The results of the present study revealed that behavior has a significant relationship with nutritional awareness. These results are in line with the results of the study performed by Alizadeh (24). Good performance has not been reported in numerous studies despite high awareness (28,29).
Contrary to the findings of the current study, the results of studies carried out by Rasouli
(30) and Niknami (31) noted that increased nutritional awareness does not necessarily bring about a change in behavior. Nutritional knowledge is not the only factor that can affect people's nutritional behavior. In other words, unhealthy nutrition is a multifactorial problem which can be affected by other factors. It seems that in the present study, the nutritional awareness of students, which was at a relatively good level, resulted in a favorable level of students' nutritional behavior.
Because nutritional awareness can be a predictor of healthy eating behavior. The results of the present study showed that behavior has a significant relationship with perceived benefits, while there was no significant relationship between behavior and perceived barriers. These results are consistent with the results of the study by Alizadeh in terms of the relationship between behavior and perceived benefits. At the same time, these results are contrary to the results of the mentioned study regarding the relationship between behavior and perceived barriers.
In the study by Alizadeh, a significant relationship was observed between nutritional behavior and perceived barriers (24). Examining this result, it can be concluded that students who are aware of the benefits of eating breakfast and healthy foods such as milk, yogurt, bread, cheese, and walnuts do so in practice. On the other hand, they may be aware of the dangers of eating unhealthy foods, such as chips and cheese puffs, and skipping breakfast; nonetheless, they do not observe it in practice. It seems that chips and cheese puffs with delicious flavors are appealing to students and this interest has discouraged them from healthy eating.
In accordance with the results of a study conducted by Peyman et al., in the present study, no significant relationship was detected between mother's education and nutritional awareness (32). Furthermore, gender was found to be directly and significantly associated with awareness, behavior, perceived barriers, and perceived benefits. Consistent with the results of our study, in a study performed by Isazadeh et al. (33), the difference between gender and the nutritional behavior score was statistically significant.
In line with the results of our study, Sharifnia et al. (34) found no significant relationship between parental occupations and health awareness. In accordance with the results of the present study, Khazaie et al. (35) observed a significant relationship between father's job and perceived benefits. Similar to the results of our study, Peyman et al. (32) state that there is no significant difference between mother's education and nutritional awareness. The mentioned study also found that perceived awareness and benefits were associated with father's education, and perceived benefits were associated with mother's education and father's employment.
However, mother's education and occupation displayed no significant relationship with perceived awareness and barriers. In a study performed by Vafaee-Najar et al. (36), there was no significant relationship between students' awareness score with mother's education and occupation. Nonetheless, consistent with our study results, a significant relationship was observed between father's education and students' awareness score. It can be attributed to the fact that educated fathers, who are also employees, pay more attention to the nutritional status of their children due to their higher awareness of the harmful effects of poor nutrition and unhealthy eating.
Nutritional awareness in the father of the family can raise the nutritional awareness of children. In the present study, a significant relationship was observed between the economic status of the family and the nutritional behavior of students. This result can be ascribed to the fact that economically well-off families pay more attention to breakfast and eating healthy foods, such as milk and yogurt, which are essential for the mental well-being and growth of bones, compared to low-income families. Low-income families may not be able to provide their children with healthy foods such as milk and walnuts at high prices.
Every study has some limitations which should be addressed in the paper. One of the limitations of the current study is the self-report nature of the questionnaire, which is often relied upon in most behavioral studies. Moreover, the present research was performed only on students. Nevertheless, families, especially mothers, play a peculiar role in shaping students' eating habits. Therefore, it is required to conduct further studies with the cooperation of students and their mothers.
The executive limitations of this program include the non-cooperation of school officials and the allocation of incentives to school officials who have had good cooperation in this regard. The strengths of the current study entailed a sufficiently large sample size and multi-stage sampling.
The results of the present study pointed to a significant relationship between nutritional awareness and nutritional behavior. In other words, increased nutritional awareness can improve students' eating behavior. Students perform a critical role in the future of the country and a large part of nutritional habits are formed in childhood and adolescence, and these habits form food preferences in the coming years. Therefore, it is recommended that students and their parents receive educational training regarding healthy eating patterns, the use of breakfast and snacks, and prohibition of malnutrition-providing foods based on behavior change models that promote nutritional behaviors in other educational levels and others regions of the country, especially the deprived areas.
Acknowledgements
The current article was extracted from a research project approved by the Research Vice-Chancellor of Kashan University of Medical Sciences (IR.KAUMS.REC.1395.28). The authors' deepest appreciation goes to all students, school authorities, Kashan Department of Education, and all those who sincerely helped us in different stages of this research project.
Funding
The current study was financially supported by a grant from Kashan University of Medical Sciences.
Conflict of Interest
The authors declare that they have no conflict of interest regarding the publication of the current article.
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Background
Nutrition plays a vital and direct role in health promotion and maintenance since nutrition is essential for all the vital functions of the body. According to available documents, unhealthy eating habits are currently observed in children and adolescents in our society. Apart from threatening the health of this group, these behaviors will put the society at risk for non-communicable disease epidemic in the next two decades (1). Evidence suggests that malnutrition in the early years of life is responsible for the dismal growth of children, short stature, and mental retardation. Moreover, it leads to recurrent respiratory infections, resistance to treatment, and reduced physical activity (2).
Adult behavioral patterns and eating habits are rooted in childhood and adolescence. Therefore, following a varied and balanced diet during childhood will help prevent chronic and incurable diseases in the future (3). Children are at risk for such adverse effects as iron deficiency anemia, obesity, indigestion, and tooth decay in the short term, and chronic and dangerous cardiovascular disease, cancer, heart attacks and strokes, or diabetes in the long term. (4). People urgently need nutrients for their growth in the age range of 7-15. On the other hand, undernourished students are less able to concentrate and learn and have a marked academic decline (5).
According to UNICEF statistics, 11%, 5%, and 15% of Iranian children have moderate to severe underweight, moderate to severe emaciation, and moderate to severe short stature, respectively (6). According to the United States Department of Health & Human Services, 61% of American teens use snacks that are high in fat and carbohydrates and low in fiber. It can cause such problems as obesity, hyperlipidemia, and the spread of chronic disease (7, 8). One of the causes of nutritional deficiencies in children and adolescents is unawareness of the importance of consuming a wide variety of foods and wrong diets, such as eating a variety of ready-to-eat meals, sweets, and chocolate.
Consumption of these kinds of foods reduce the physical and mental efficiency of children and adolescents. Moreover, its adverse effects would be demonstrated in various forms, such as diabetes, hypertension, cardiovascular disease, and hyperlipidemia in the coming years. Therefore, it is necessary to adhere to proper nutrition and have a healthy diet that includes a balanced amount of different foods from each food group (9). A study conducted by Shim et al. (10) demonstrated that increased nutrition knowledge improves eating habits. According to a study performed by Wardle et al. (11), nutritional awareness improved the quality of diet and healthy eating behaviors.
Since most eating habits are formed in childhood and adolescence, it is important to devote assiduous attention to nutritional awareness, attitudes, and eating behaviors (12). If health promotion programs are designed based on people's knowledge, attitudes, and behaviors, they can be successful in terms of healthy eating. Proper nutritional behavior regarding healthy eating principles requires awareness in this area. Although knowledge is not the same as behavior, it can be considered a determining factor in nutritional behaviors.
Correction of nutritional behaviors in childhood and adolescence, which are associated with developmental stages, can bring many benefits. These benefits include proper design and implementation of a national school food program in order to solve nutritional problems and ensure health in this age group. These programs increase undernourished students’ concentration during the learning process and improve their performance by the elimination of short-term starvation (13).
Pender's health promotion model (HPM) is one of the widely used models to change unhealthy behaviors and promote health. This model is a preventive model that regards behavior as a function of one's knowledge and attitude (14). The present study is part of the Health Belief Model, which is based on disease prevention and potential adverse effects. It is the first model specifically developed to correct behaviors related to health promotion. One of the applications of this model is the promotion of healthy eating behavior (15).
Considering the critical importance of nutrition in primary school students, the present study aimed to determine the relationship of awareness, perceived benefits, and perceived barriers with the nutritional behavior of elementary school students in Kashan.
This descriptive-analytic cross-sectional study was conducted in 2017. The statistical population included the fourth-grade students in Kashan. The sample size was calculated at 300 students (192 boys and 108 girls) using the formula of estimating the sample size for mean comparison based on the study performed by Alizadeh et al. (16). Study subjects were selected by multi-stage sampling, and the list of primary schools in Kashan was initially obtained from the Department of Education. Thereafter, the list was classified according to the type of school (governmental-non-profit) and gender of students.
Subsequently, a public boys school, a public girls school, a non-profit boys school, and a non-profit girls school were randomly selected from each category. Thereafter, one class was selected from each school, and participants were randomly selected. In the case of classes with a large number of students, 20 students were randomly selected.
The inclusion criteria were as follows: 1. the fourth-grade elementary student, 2. willingness to participate in the study, 3. attending school during research. On the other hand, the exclusion criteria entailed: 1. Unwillingness to participate, 2. discontinued participation in the research program, 3. disease, and 4. absence from the class on data collection day. The data collection tool was the standard questionnaire for measuring awareness, perception, and behavior. The questionnaire consisted of demographic questions, awareness questions (n=17), behavior questions (n=13), perceived barriers (n=6), and perceived interests (n=5).
Regarding scoring, in the section of awareness questions, each correct answer was assigned a score of 2, incorrect responses were scored 0, and don’t know answers were assigned a score of 1, yielding a range of 0-34. In the behavior questions section, the most desirable state was assigned a score of 3 while the worst state was scored 0. For perceived benefits, a score of 2 was assigned to " I agree", 1 to " No idea", and "I disagree" was scored 0. In the perceived barriers section, "I agree" was scored 0, "no idea" was assigned a score of 1, and "I disagree" was rated as 2.
Cronbach Alpha Coefficient of 0.80 confirmed the reliability of this questionnaire (16). Validity of the questionnaire was approved in the study conducted by Alizadeh et al. (6) in which 10 copies of the questionnaire were provided to 10 health and nutrition education specialists, and the formal and content validity was confirmed.The data were analyzed in SPSS software (version 20), and the students' mean scores of awareness, behavior, perceived benefits, and perceived barriers were initially calculated. Measures of Central Tendency and dispersion were used for data presentation, and the data were finally analyzed using multivariate linear regression tests, independent t-test, and one-way analysis of variance.
It is noteworthy that the present study was approved by the Ethics Committee of Kashan University of Medical Sciences with the code IR.KAUMS.REC.1395.28. Ethical considerations were also observed by explaining the objectives of the study to patients, voluntary nature of participation, and obtaining informed consent.
Based on the results of the study, 108 (36%) of students were female and 192 (64%) were male. Regarding economic status, 71 (23.7%), 96 (32%), 43 (14.3%), and 90 (30%) of cases were very good, good, average, and poor, respectively. In terms of parents' education, 123 (41%), and 132 (44%) of fathers and mothers had an academic education, respectively. Considering parents profession, 92 (30.7%), and 45 (15%) of fathers and mothers were employees, respectively. (Table 1).
The mean scores of students 'nutritional awareness and nutritional behavior were obtained at 28.66±3.77 and 28.99±3.99 (Table 2).
The ANOVA test revealed that none of the variables of awareness (P=0.0575), performance (P=0.193), perceived barriers (P=0.401), and perceived benefits (P=0.466) was associated with mother's occupation. According to the results, there is no relationship between mother's education and awareness (P=0.379), and
Table 1) Demographic characteristics of participants
perceived barriers (P=0.641). Nonetheless, perceived benefits (P=0.004) and nutritional behavior (P=0.046) are associated with mother's education. In this regard, the mean score of nutritional behavior and perceived benefits in students with illiterate mothers was lower, compared to other students (Table 3).
As illustrated in Table 3, the ANOVA test found a relationship between the perceived benefits (P=0.001) and father's occupation. In this connection, the children whose fathers were laborers had less perceived benefits; nonetheless, father's occupation showed no significant relationship with perceived barriers, awareness, and behavior (P<0.05). Moreover, father's education was found to be significantly correlated with awareness (P=0.014), perceived benefits (P=0.017), and nutritional behavior (P<0.001). In this regard, students with illiterate fathers had less nutritional awareness, nutritional behavior, and perceived benefits. In addition, there was no significant relationship between perceived barriers (P=0.054) with father's education.
As displayed in Table 4, the ANOVA test showed that awareness (P = 0.052), perceived barriers (P=0.989), and perceived benefits (P=0.137) are not significantly associated with economic status. Nevertheless, a significant relationship was observed between nutritional behavior and economic situation, and the mean nutritional behavior is higher in people who are in a very good economic situation. The independent t-test demonstrated that gender had a significant relationship with students' awareness (P=0.003), nutritional behavior (P=0.010), perceived benefits (P<0.001), and perceived barriers (P<0.001). Furthermore, the mean score of girls in all four variables was
Nutrition plays a vital and direct role in health promotion and maintenance since nutrition is essential for all the vital functions of the body. According to available documents, unhealthy eating habits are currently observed in children and adolescents in our society. Apart from threatening the health of this group, these behaviors will put the society at risk for non-communicable disease epidemic in the next two decades (1). Evidence suggests that malnutrition in the early years of life is responsible for the dismal growth of children, short stature, and mental retardation. Moreover, it leads to recurrent respiratory infections, resistance to treatment, and reduced physical activity (2).
Adult behavioral patterns and eating habits are rooted in childhood and adolescence. Therefore, following a varied and balanced diet during childhood will help prevent chronic and incurable diseases in the future (3). Children are at risk for such adverse effects as iron deficiency anemia, obesity, indigestion, and tooth decay in the short term, and chronic and dangerous cardiovascular disease, cancer, heart attacks and strokes, or diabetes in the long term. (4). People urgently need nutrients for their growth in the age range of 7-15. On the other hand, undernourished students are less able to concentrate and learn and have a marked academic decline (5).
According to UNICEF statistics, 11%, 5%, and 15% of Iranian children have moderate to severe underweight, moderate to severe emaciation, and moderate to severe short stature, respectively (6). According to the United States Department of Health & Human Services, 61% of American teens use snacks that are high in fat and carbohydrates and low in fiber. It can cause such problems as obesity, hyperlipidemia, and the spread of chronic disease (7, 8). One of the causes of nutritional deficiencies in children and adolescents is unawareness of the importance of consuming a wide variety of foods and wrong diets, such as eating a variety of ready-to-eat meals, sweets, and chocolate.
Consumption of these kinds of foods reduce the physical and mental efficiency of children and adolescents. Moreover, its adverse effects would be demonstrated in various forms, such as diabetes, hypertension, cardiovascular disease, and hyperlipidemia in the coming years. Therefore, it is necessary to adhere to proper nutrition and have a healthy diet that includes a balanced amount of different foods from each food group (9). A study conducted by Shim et al. (10) demonstrated that increased nutrition knowledge improves eating habits. According to a study performed by Wardle et al. (11), nutritional awareness improved the quality of diet and healthy eating behaviors.
Since most eating habits are formed in childhood and adolescence, it is important to devote assiduous attention to nutritional awareness, attitudes, and eating behaviors (12). If health promotion programs are designed based on people's knowledge, attitudes, and behaviors, they can be successful in terms of healthy eating. Proper nutritional behavior regarding healthy eating principles requires awareness in this area. Although knowledge is not the same as behavior, it can be considered a determining factor in nutritional behaviors.
Correction of nutritional behaviors in childhood and adolescence, which are associated with developmental stages, can bring many benefits. These benefits include proper design and implementation of a national school food program in order to solve nutritional problems and ensure health in this age group. These programs increase undernourished students’ concentration during the learning process and improve their performance by the elimination of short-term starvation (13).
Pender's health promotion model (HPM) is one of the widely used models to change unhealthy behaviors and promote health. This model is a preventive model that regards behavior as a function of one's knowledge and attitude (14). The present study is part of the Health Belief Model, which is based on disease prevention and potential adverse effects. It is the first model specifically developed to correct behaviors related to health promotion. One of the applications of this model is the promotion of healthy eating behavior (15).
Considering the critical importance of nutrition in primary school students, the present study aimed to determine the relationship of awareness, perceived benefits, and perceived barriers with the nutritional behavior of elementary school students in Kashan.
|
Materials & Methods
|
This descriptive-analytic cross-sectional study was conducted in 2017. The statistical population included the fourth-grade students in Kashan. The sample size was calculated at 300 students (192 boys and 108 girls) using the formula of estimating the sample size for mean comparison based on the study performed by Alizadeh et al. (16). Study subjects were selected by multi-stage sampling, and the list of primary schools in Kashan was initially obtained from the Department of Education. Thereafter, the list was classified according to the type of school (governmental-non-profit) and gender of students.
Subsequently, a public boys school, a public girls school, a non-profit boys school, and a non-profit girls school were randomly selected from each category. Thereafter, one class was selected from each school, and participants were randomly selected. In the case of classes with a large number of students, 20 students were randomly selected.
The inclusion criteria were as follows: 1. the fourth-grade elementary student, 2. willingness to participate in the study, 3. attending school during research. On the other hand, the exclusion criteria entailed: 1. Unwillingness to participate, 2. discontinued participation in the research program, 3. disease, and 4. absence from the class on data collection day. The data collection tool was the standard questionnaire for measuring awareness, perception, and behavior. The questionnaire consisted of demographic questions, awareness questions (n=17), behavior questions (n=13), perceived barriers (n=6), and perceived interests (n=5).
Regarding scoring, in the section of awareness questions, each correct answer was assigned a score of 2, incorrect responses were scored 0, and don’t know answers were assigned a score of 1, yielding a range of 0-34. In the behavior questions section, the most desirable state was assigned a score of 3 while the worst state was scored 0. For perceived benefits, a score of 2 was assigned to " I agree", 1 to " No idea", and "I disagree" was scored 0. In the perceived barriers section, "I agree" was scored 0, "no idea" was assigned a score of 1, and "I disagree" was rated as 2.
Cronbach Alpha Coefficient of 0.80 confirmed the reliability of this questionnaire (16). Validity of the questionnaire was approved in the study conducted by Alizadeh et al. (6) in which 10 copies of the questionnaire were provided to 10 health and nutrition education specialists, and the formal and content validity was confirmed.The data were analyzed in SPSS software (version 20), and the students' mean scores of awareness, behavior, perceived benefits, and perceived barriers were initially calculated. Measures of Central Tendency and dispersion were used for data presentation, and the data were finally analyzed using multivariate linear regression tests, independent t-test, and one-way analysis of variance.
It is noteworthy that the present study was approved by the Ethics Committee of Kashan University of Medical Sciences with the code IR.KAUMS.REC.1395.28. Ethical considerations were also observed by explaining the objectives of the study to patients, voluntary nature of participation, and obtaining informed consent.
|
Results
|
Based on the results of the study, 108 (36%) of students were female and 192 (64%) were male. Regarding economic status, 71 (23.7%), 96 (32%), 43 (14.3%), and 90 (30%) of cases were very good, good, average, and poor, respectively. In terms of parents' education, 123 (41%), and 132 (44%) of fathers and mothers had an academic education, respectively. Considering parents profession, 92 (30.7%), and 45 (15%) of fathers and mothers were employees, respectively. (Table 1).
The mean scores of students 'nutritional awareness and nutritional behavior were obtained at 28.66±3.77 and 28.99±3.99 (Table 2).
The ANOVA test revealed that none of the variables of awareness (P=0.0575), performance (P=0.193), perceived barriers (P=0.401), and perceived benefits (P=0.466) was associated with mother's occupation. According to the results, there is no relationship between mother's education and awareness (P=0.379), and
Table 1) Demographic characteristics of participants
| Demographic variables | Number(percent) | ||
| Father’s education | Academic education | 123(41%) | |
| High school | 55 (18.3%) | ||
| Junior high school | 47 (15.7%) | ||
| Primary school | 39 (13%) | ||
| Illiterate | 7 (2.3%) | ||
| Mother’s education | Academic education | 132 (44%) | |
| High school | 60 (20%) | ||
| Junior high school | 31 (10.3%) | ||
| Primary school | 40 (13.3%) | ||
| Illiterate | 8 (2.7%) | ||
| Father’s occupation | Employee | 92 (30.7%) | |
| Laborer | 59 (19.7%) | ||
| Free-lancer | 125 (41.7%) | ||
| Others | 9 (3%) | ||
| Mother’s education | Employee | 45 (15%) | |
| Housewife | 226 (75.3%) | ||
| Others | 21 (7%) | ||
perceived barriers (P=0.641). Nonetheless, perceived benefits (P=0.004) and nutritional behavior (P=0.046) are associated with mother's education. In this regard, the mean score of nutritional behavior and perceived benefits in students with illiterate mothers was lower, compared to other students (Table 3).
As illustrated in Table 3, the ANOVA test found a relationship between the perceived benefits (P=0.001) and father's occupation. In this connection, the children whose fathers were laborers had less perceived benefits; nonetheless, father's occupation showed no significant relationship with perceived barriers, awareness, and behavior (P<0.05). Moreover, father's education was found to be significantly correlated with awareness (P=0.014), perceived benefits (P=0.017), and nutritional behavior (P<0.001). In this regard, students with illiterate fathers had less nutritional awareness, nutritional behavior, and perceived benefits. In addition, there was no significant relationship between perceived barriers (P=0.054) with father's education.
As displayed in Table 4, the ANOVA test showed that awareness (P = 0.052), perceived barriers (P=0.989), and perceived benefits (P=0.137) are not significantly associated with economic status. Nevertheless, a significant relationship was observed between nutritional behavior and economic situation, and the mean nutritional behavior is higher in people who are in a very good economic situation. The independent t-test demonstrated that gender had a significant relationship with students' awareness (P=0.003), nutritional behavior (P=0.010), perceived benefits (P<0.001), and perceived barriers (P<0.001). Furthermore, the mean score of girls in all four variables was
Table 2) Mean and standard deviations of awareness, health behavior, perceived barriers, and perceived benefits
Table 3) Relationship of demographic characteristics with awareness, perceived barriers, and perceived benefits
Table 4) Relationship of demographic characteristics with awareness, perceived barriers, and perceived benefits
Table 5) Results of the linear regression of factors related to students' nutritional behavior
| Variables | Minimum | Maximum | Mean | Standard Deviation | Range |
| 8 | 32 | 28.66 | 0-34 | ||
| Nutritional behavior | 20 | 35 | 28.99 | 0-36 | |
| Perceived barriers | 0 | 10 | 9.03 | 0-10 | |
| Perceived benefits | 2 | 12 | 9.6 | 0-12 |
| Demographic characteristics | Awareness | Perceived barriers | Perceived benefits | Nutritional behavior | |||||
| Mean±SD | Significance level | Mean±SD | Significance level | Mean±SD | Significance level | Mean±SD | Significance level | ||
| Father’s occupation | Employee | 28.98±3.56 | P=0.206 | 9.51±2.19 | P=0.065 | 9.25±1.50 | P=0.001 | 29.47±2.79 | P=0.065 |
| Laborer | 27.75±4.48 | 9.09±2.37 | 8.03±3.05 | 28.19±3.2 | |||||
| Free-lancer | 28.82±3.16 | 9.86±2.17 | 9.24±1.72 | 28.77±3.49 | |||||
| Others | 29.37±3.66 | 11.0±1.82 | 9.55±1.33 | 31.5±2.50 | |||||
| Mother’s occupation | Employee | 29.02±3.26 | 0.575=P | 9.26±2.06 | P=0.401 | 8.73±2.16 | P=466 | 29.8±3.03 | P=0.193 |
| Housewife | 28.60±3.78 | 9.64±2.31 | 9.11±1.93 | 28.83±3.07 | |||||
| Other | 28.61±3.79 | 10.04±1.46 | 8.80±2.61 | 29.62±3.1 | |||||
| Father’s education | Illiterate | 23.66±8.52 | 0.014=P | 10.4±1.14 | P=0.524 | 6.66±5.1 | P=0.017 | 25.33±2.51 | P<0.001 |
| Elementary school | 29.16±2.70 | 9.62±2.66 | 9.43±1.50 | 29.36±2.21 | |||||
| Junior high school | 29.9±2.45 | 9.29±2.43 | 8.59±2.44 | 27.56±3.24 | |||||
| High school | 28.63±3.84 | 10.01±1.74 | 9.07±1.89 | 27.92±3.09 | |||||
| Academic education | 28.74±3.75 | 9.55±2.28 | 9.14±1.76 | 29.86±3.04 | |||||
| Mother’s education | Illiterate | 25.71±4.53 | P=0.379 | 9.32±2.94 | P=0.641 | 6.0±4.89 | P=0.004 | 26.5±3.0 | P=0.046 |
| Elementary school | 28.97±4.03 | 10.0±2.35 | 9.42±1.25 | 29.32±2.34 | |||||
| Junior high school | 28.51±4.38 | 9.17±2.56 | 8.67±2.31 | 28.33±3.0 | |||||
| High school | 28.74±3.43 | 9.70±1.95 | 9.07±1.99 | 28.09±3.30 | |||||
| Academic education | 28.61±3.92 | 9.62±2.1 | 9.06±1.95 | 29.6±3.152 | |||||
Table 4) Relationship of demographic characteristics with awareness, perceived barriers, and perceived benefits
| Demographic characteristics | Awareness | Perceived barriers | Perceived benefits | Nutritional behavior | |||||
| Mean±SD | Significance level | Mean±SD | Significance level | Mean±SD | Significance level | Mean±SD | Significance level | ||
| Economic status | Very good | 29.04±3.28 | P=0.528 | 9.55±2.32 | P=0.989 | 9.38±1.13 | 0.137=P | 30.15±3.06 | P=0.015 |
| Good | 28.86±4.39 | 9.60±1.99 | 9.09±2.0 | 28.46±3.25 | |||||
| Average | 28.56±3.09 | 9.6±2.30 | 9.16±1.72 | 28.13±2.89 | |||||
| Poor | 28.19±3.70 | 9.68±2.30 | 8.63±2.56 | 28.88±3.06 | |||||
| Gender | Female | 29.51±3.74 | P=0.003 | 10.37±1.93 | P˂0.001 | 9.78±0.872 | P<001 | 29.75±2.98 | P=0.010 |
| Male | 28.14±3.71 | 9.14±2.24 | 8.57±2.35 | 28.51±3.22 | |||||
Table 5) Results of the linear regression of factors related to students' nutritional behavior
| Variable | non-standardized β | Standard deviation | P-value | confidence interval | |
| Minimum | Maximum | ||||
| Constant value | 19.51 | 2.62 | P<0.001 | 14.3 | 24.69 |
| Awareness | 0.157 | 0.077 | P=0.04 | 0.004 | 0.310 |
| Perceived benefits | 0.352 | 0.147 | P=0.018 | 0.061 | 0.642 |
| Perceived barriers | 0.165 | 0.113 | P=145 | -0.058 | 0.388 |
higher, compared to boys (Table 4).
The results of the regression model showed that an increase in awareness (P=0.04) and the perceived benefits (P=0.018) scores was significantly associated with an increase in students' nutritional behavior. However, perceived barriers displayed no effect on students' nutritional behavior (Table 5).
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Discussion
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In the current study, the mean score of students' nutritional awareness was relatively good. In line with our study results, the mean score of awareness was relatively good in the study performed by Khakpour et al. (1). Nevertheless, inconsistent with the results of the present study, in their research, O'Brien et al. and Parameter et al. indicated that students did not have sufficient nutritional awareness (17,18). Studies on the nutritional status of students in Iran are indicative of the low level of awareness and nutritional performance in this age group, and most researchers have emphasized that further studies should be conducted in this filed (19-22).
It seems that food and nutrition information in science books, as well as the sensitivity of school health educators to students' nutritional knowledge, has led to a relatively favorable nutritional awareness in students included in the present study. In the present study, the mean score of students' nutritional behavior was at a desirable level. In a study carried out by Ostad Rahimi et al. (23), despite the favorable level of awareness and nutritional knowledge, most subjects had unbalanced eating behaviors. In a study conducted by Talatappeh et al. (3), the level of awareness and performance was reported to be at a moderate level, while in our study, awareness and performance were at good levels.
These discrepancies can be ascribed to differences in the research setting, sample, and time. Sometimes such factors as friends' tastes or lack of access to healthy food or good packaging affect students' eating behaviors. It seems that students' desirable nutritional behavior is related to their high level of awareness. Awareness can be a determining factor in nutritional behaviors. Furthermore, in the present study, the mean score of the perceived barriers and the perceived benefits were relatively favorable.
It can be said that school health educators and students' parents have greatly increased children's knowledge about the beneficial effects of eating breakfast on school performance and using fruit, milk, and yogurt to keep your bones and muscles strong and healthy. Moreover, they discouraged students from eating unhealthy and available foods, such as chips and cheese puffs, and skipping breakfast. The present study showed that nutritional behavior has a significant relationship with awareness.
The results of studies conducted by Alizadeh (24), Yoon (25), Wardle (11), Huang (26) Koci (27) showed that increased awareness has a significant relationship with student's nutritional behavior. In this regard, students with higher nutritional awareness demonstrated better nutritional behavior. The results of the present study revealed that behavior has a significant relationship with nutritional awareness. These results are in line with the results of the study performed by Alizadeh (24). Good performance has not been reported in numerous studies despite high awareness (28,29).
Contrary to the findings of the current study, the results of studies carried out by Rasouli
(30) and Niknami (31) noted that increased nutritional awareness does not necessarily bring about a change in behavior. Nutritional knowledge is not the only factor that can affect people's nutritional behavior. In other words, unhealthy nutrition is a multifactorial problem which can be affected by other factors. It seems that in the present study, the nutritional awareness of students, which was at a relatively good level, resulted in a favorable level of students' nutritional behavior.
Because nutritional awareness can be a predictor of healthy eating behavior. The results of the present study showed that behavior has a significant relationship with perceived benefits, while there was no significant relationship between behavior and perceived barriers. These results are consistent with the results of the study by Alizadeh in terms of the relationship between behavior and perceived benefits. At the same time, these results are contrary to the results of the mentioned study regarding the relationship between behavior and perceived barriers.
In the study by Alizadeh, a significant relationship was observed between nutritional behavior and perceived barriers (24). Examining this result, it can be concluded that students who are aware of the benefits of eating breakfast and healthy foods such as milk, yogurt, bread, cheese, and walnuts do so in practice. On the other hand, they may be aware of the dangers of eating unhealthy foods, such as chips and cheese puffs, and skipping breakfast; nonetheless, they do not observe it in practice. It seems that chips and cheese puffs with delicious flavors are appealing to students and this interest has discouraged them from healthy eating.
In accordance with the results of a study conducted by Peyman et al., in the present study, no significant relationship was detected between mother's education and nutritional awareness (32). Furthermore, gender was found to be directly and significantly associated with awareness, behavior, perceived barriers, and perceived benefits. Consistent with the results of our study, in a study performed by Isazadeh et al. (33), the difference between gender and the nutritional behavior score was statistically significant.
In line with the results of our study, Sharifnia et al. (34) found no significant relationship between parental occupations and health awareness. In accordance with the results of the present study, Khazaie et al. (35) observed a significant relationship between father's job and perceived benefits. Similar to the results of our study, Peyman et al. (32) state that there is no significant difference between mother's education and nutritional awareness. The mentioned study also found that perceived awareness and benefits were associated with father's education, and perceived benefits were associated with mother's education and father's employment.
However, mother's education and occupation displayed no significant relationship with perceived awareness and barriers. In a study performed by Vafaee-Najar et al. (36), there was no significant relationship between students' awareness score with mother's education and occupation. Nonetheless, consistent with our study results, a significant relationship was observed between father's education and students' awareness score. It can be attributed to the fact that educated fathers, who are also employees, pay more attention to the nutritional status of their children due to their higher awareness of the harmful effects of poor nutrition and unhealthy eating.
Nutritional awareness in the father of the family can raise the nutritional awareness of children. In the present study, a significant relationship was observed between the economic status of the family and the nutritional behavior of students. This result can be ascribed to the fact that economically well-off families pay more attention to breakfast and eating healthy foods, such as milk and yogurt, which are essential for the mental well-being and growth of bones, compared to low-income families. Low-income families may not be able to provide their children with healthy foods such as milk and walnuts at high prices.
Every study has some limitations which should be addressed in the paper. One of the limitations of the current study is the self-report nature of the questionnaire, which is often relied upon in most behavioral studies. Moreover, the present research was performed only on students. Nevertheless, families, especially mothers, play a peculiar role in shaping students' eating habits. Therefore, it is required to conduct further studies with the cooperation of students and their mothers.
The executive limitations of this program include the non-cooperation of school officials and the allocation of incentives to school officials who have had good cooperation in this regard. The strengths of the current study entailed a sufficiently large sample size and multi-stage sampling.
|
Conclusion
|
The results of the present study pointed to a significant relationship between nutritional awareness and nutritional behavior. In other words, increased nutritional awareness can improve students' eating behavior. Students perform a critical role in the future of the country and a large part of nutritional habits are formed in childhood and adolescence, and these habits form food preferences in the coming years. Therefore, it is recommended that students and their parents receive educational training regarding healthy eating patterns, the use of breakfast and snacks, and prohibition of malnutrition-providing foods based on behavior change models that promote nutritional behaviors in other educational levels and others regions of the country, especially the deprived areas.
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Footnotes
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Acknowledgements
The current article was extracted from a research project approved by the Research Vice-Chancellor of Kashan University of Medical Sciences (IR.KAUMS.REC.1395.28). The authors' deepest appreciation goes to all students, school authorities, Kashan Department of Education, and all those who sincerely helped us in different stages of this research project.
Funding
The current study was financially supported by a grant from Kashan University of Medical Sciences.
Conflict of Interest
The authors declare that they have no conflict of interest regarding the publication of the current article.
Type of Study: Original Article |
Subject:
General
Received: 2020/02/7 | Accepted: 2020/06/29 | Published: 2020/07/18
Received: 2020/02/7 | Accepted: 2020/06/29 | Published: 2020/07/18
References
1. Khakpour S, Tavafian S, Niknami S, Mohammadi S. Effect of combined education on promoting nutritional behaviors of female students. J Educ Community Health. 2016;3(2):41-6. (In Persian) Link [DOI:10.21859/jech-03026]
2. Barati F, Shamsi M, Khorsandi M, Ranjbaran M. Measuring the Constructs of Planned Behavior Theory Regarding the Behaviors Preventing of Junk Food Consumption in Elementary Students in Arak in 2015. Arak Medical University Journal (AMUJ). 2016;18(104):10-8. (In Persian)Link
3. Talatappeh D, Tavakoli H, Rahmati Najarkolaei F, Dabbagh Moghadam A, Khoshdel A. Knowledge, beliefs and behavior of food consumption among students of Military University: the application of health belief model (HBM). Iranian Journal of Military Medicine Vol. 2012;14(3):192-9. (In Persian) Link
4. el Hussein S, Naccache H, sarout S. Nutritional knowledge, conception and behavior of Lebanese students, a comparative study. International Journal of Advanced Research. 2019;6. Link [DOI:10.21474/IJAR01/8196]
5. Amini a, Shamseddin, n, Ata B. The effect of nutritional intervention on the behavior of secandery school girl student of chabahar. Journal of Sabzevar University of Medical Sciences. 2018;25:127 To 33. (In Persian) Link.
6. Alizadeh Siuki H, Jadgal K, Shamaeian Razavi N, Zareban I, Heshmati H, Saghi N. Effects of health education based on health belief model on nutrition behaviors of primary school students in Torbat e Heydariyeh city in 2012. Journal of Health. 2015;5(4):289-99. (In Persian) Link
7. Franko DL, Cousineau TM, Trant M, Green TC, Rancourt D, Thompson D, et al. Motivation, self-efficacy, physical activity and nutrition in college students: Randomized controlled trial of an internet-based education program. Preventive medicine. 2008;47(4):369-77. Link. [DOI:10.1016/j.ypmed.2008.06.013]
8. Long JD, Stevens KR. Using technology to promote self‐efficacy for healthy eating in adolescents. Journal of Nursing Scholarship. 2004;36(2):134-9. Link. [DOI:10.1111/j.1547-5069.2004.04026.x]
9. Mohamadi N, Shobeiri F, Khirolahei A, Roshanaie G. Nutritional patterns in Iranian university students: comparison between dormitory and non-dormitory states. E3 J Med Res. 2014;3(1):1-5(In Persian). Link
10. Shim E, Kim J-S, Ji S-M, Sohn T-Y, Hwang J, Chung E-J. The effects of a nutrition and body shape education program as part of health promoting projects in an elementary school. Korean Journal of Nutrition. 2010;43(4):382-94. Link [DOI:10.4163/kjn.2010.43.4.382]
11. Wardle J, Parmenter K, Waller J. Nutrition knowledge and food intake. Appetite. 2000;34(3):269-75. Link [DOI:10.1006/appe.1999.0311]
12. Farhadlo R, Vahedian M, Sadeghi R, Mohebi S, Mohammad. Comparison of two education methods (lecture session and booklet) on nutritional knowledge, attitude and behavior in secondary school students Qom, 2012. J Health Syst Res. 2013;9:1032-40. (In Persian) Link
13. Vahedian M, Sadeghi R, Farhadlu R, Nazeri A, Dehghan A, Barati MH. Effect of Educational Booklet and Lecture on Nutritional Behavior, Knowledge and Attitude on Third-Grade Male Guidance School Students. 2014. (In Persian) Link
14. Karimi M, Eshrati B. The effect of health promotion model-based training on promoting students' physical activity. Journal of Kermanshah University of Medical Sciences. 2012;16(3):192-200. (In Persian) Link
15. Chenary R, Noroozi A, Tahmasebi R. Effective factors of health promotion behaviors based on Health Promotion Model in chemical veterans of Ilam province in 2012-13. scientific journal of ilam university of medical sciences. 2013;21(6):257-67. (In Persian).Link
16. Alizadeh Siuki H, Keshavarz M, Jafari A, Ramezani H, Sayadi A. Effects of nutritional education on knowledge and behaviors of Primary Students in Torbat-e-Heydariyeh. Journal of Torbat Heydariyeh University of Medical Sciences. 2013;1(1):44-51. (In Persian).Link
17. O'Brien G, Davies M. Nutrition knowledge and body mass index. Health education research. 2007;22(4):571-5. Link [DOI:10.1093/her/cyl119]
18. Parmenter K, Waller J, Wardle J. Demographic variation in nutrition knowledge in England. Health education research. 2000;15(2):163-74. Link [DOI:10.1093/her/15.2.163]
19. fateme E, Banafshe G, Katibe D, Roshanak R, Bahare R. Do the adolescent girls bear a desirable nutrional health state? . Researcher bulletin of medical sciences ( pejouhandeh). 2005;10(45). (In Persian) Link
20. Choobineh M, Hesari S, Hossain D, Haghighizadeh M. Study of nutritional knowledge of Ahwaz high school girls and the education effect. Journal of Birjand University of Medical Sciences. 2009;16(1):23-30.(In Persian) Link
21. Azadbakht L, Mirmiran P, Momenan A, Azizi F. Assessment of the knowledge, attitude and performance of high school students in district No. 13 of Tehran about healthy nutrition. IJEM. 2004;5:416-09. (In Persian) Link
22. Chaleshgar M, Hosseini M. shojaiezadeh D, Pishva H. A Study of Knowledge, Attitude and Practice of Girl Students of Guidance Schools in Ghaemshahr on Iron Deficiency Anemia. Toloo-e-Behdasht. 2006;2(5):1-12. (In Persian) Link
23. Ostad Rahimi A, Safaeian A. Modaresi Zh, Pourabdelahi P, Mahdavi R.[Effect of nutrition education intervention on nutritional knowledge, attitude and practice (KAP) among female employees of Tabriz University of Medical Sciences]. Medical Journal of Tabriz University of Medical Sciences. 2010;31(4):12-7. (In Persian) Link
24. Alizadeh Siuki H, Heshmati H, Khademi H, Shamayianrazavi N, Khalafi A. Knowledge and perceived benefits and perceived barriers of students in relationship with their behavior in context of consumption of breakfast and snack in primary schools in Torbat heydariyeh. 2013. (In Persian) Link
25. Yoon H, Yang H, Her E. Effect of nutrition education program on nutrition knowledge, dietary diversity of elementary school children. Korean Journal of Community Nutrition. 2000;5(3):513-21. Link
26. Huang C, Liu Y, Tsou H. The study in change of nutrition knowledge, attitude, and behavior of college students as affected by different method of nutrition education. The Journal of Human Resource and Adult Learning. 2013;9(2):80. Link
27. Koci J. Relationship Between Nutrition-Related Knowledge and Nutritional Behavior of Students in Czech Republic (P16-037-19). Current developments in nutrition. 2019;3(Supplement_1):nzz050. P16-37-19. Link [DOI:10.1093/cdn/nzz050.P16-037-19]
28. Angoorani P, Keshavarz A, Sadrzadeh H. The effect of a nutritional teaching booklet concerning breakfast on the knowledge of fourth grade girls: Tehran's sixth educational and teaching district. Tehran University Medical Journal TUMS Publications. 2008;65(14):49-53. (In Persian).Link
29. Alavi NA, Jazayeri AA, Chamari M, Hamedi S. Comparison of the nutritional status of adolescent girls in the secondary schools of two educational districts of Kerman, Iran. 2008. (In Persian). (In Persian)Link
30. Rasouli A, Tavafian S. The Effect of Integrated Health Education Program on Knowledge, Attitude and Nutrition Function of Female Students of Middle Schools in Bojnourd. Journal of North Khorasan University of Medical Sciences. 2010;2(2):73-7. (In Persian). (In Persian)Link [DOI:10.29252/jnkums.2.2.3.73]
31. Niknami. SH. Traditional and modern teaching methods in improving eating behaviors of female elementary school students in Chabahar, Iran. Military Caring Sciences Journal. 2016;3(1):41-6. (In Persian). (In Persian)Link [DOI:10.18869/acadpub.mcs.3.1.41]
32. Peyman N, Mahdizadeh M, Mahdizadeh M. Evaluation of education in promoting healthy lifestyle behaviors among adolescent girls, according to the Health Belief Model. 2014. (In Persian). (In Persian)Link
33. Iesazadeh N, Barzegaran M, Rahmanian V, Delavari S, Marzban A, Ayasi M, et al. Relationship between Religious Attitude and Nutritional Behavior in in High School Students. 2019. (In Persian).Link
34. Sharifnia H, Hojati H, Sharifnia M. The role of pre primary school education on health awareness of first grade students. Journal of Urmia Nursing And Midwifery Faculty. 2011;9(2):0-.(In Persian).Link
35. khazaee-pool M. A Study in the Efect of Education Through Health Belief Model on the Perceptions of Girl Students in Primary School about Breakfast and Snack in Noshahr. Journal of School of Public Health, Yazd. 2008;7. (In Persian).Link
36. Vafaee-Najar A, Baghan MS, Ebrahimipour H, Miri MR, Esmaily H, Lael-Monfared E, et al. Effect of nutrition education during puberty on nutritional knowledge and behavior of secondary school female students in Birjand in 2012. Journal of Birjand University of Medical Sciences. 2014;21(02). (In Persian).Link
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