4/11/20131Healthy Kids ProgrammeDevelopment and Evaluation ofNutrition Education Package forPrimary School ChildrenDr Zawi...
4/11/20132Overview of ActivitiesHKP (2011-2013)A. AWARENESS(On-going)Parent & Children- Website: Monthly upload onhealthy ...
4/11/201335Website for Parents & Children• Online resource onnutrition for schoolgoing children anywherein the country• Ta...
4/11/201347Website Highlights (1):Interactive Tools (For Parents)TM8Website Highlights (2):Interactive Tools (For Parents)TM
4/11/201359TMWebsite Highlights (3):Interactive Tools (For Children)10TMWebsite Highlights (4):Interactive Tools (For Chil...
4/11/2013611Website Highlights (5):Interactive Tools (For Children)TM12Website Highlights (6):Articles for ParentsTM
4/11/2013713Website Highlights (7):Articles for ChildrenTM14TMWebsite Highlights (5):Recipes for Parents
4/11/2013815B. Research ComponentLongitudinal Study to Develop and EvaluateNutrition Education Package ForPrimary School C...
4/11/2013917Our Goals1. To develop appropriate modular educationalmaterials to facilitate teaching of nutrition toprimary ...
4/11/20131019Research FrameworkExpert CommitteeDevelop researchquestionnaire &educationalmaterials tools toimprove KAPCond...
4/11/20131121Research Method (cont’d)3. Questionnaire for beginning and at the end of the year (KAP)• Part A : Socio Demog...
4/11/20131223Intervention (Educational) Sessions:Standard Module• 6 sessions per year conducted• Students are given a set ...
4/11/201313YEAR 1 & 2: 2011 -2012Pictorial ReportProps for Engagement Sessions Worksheets, Goal cards & Parent’s Leaflet...
4/11/20131427TMProps for Engagement Session Year 2 (2012)Topic 1Topic 3Topic 4Note: No props developed for Topic 2, 5 & 62...
4/11/20131529Topic 2Topic 1Topic 3Topic 4Topic 5Topic 6Worksheets for Children Year 2 (2012)TM30Goal Cards for Children Ye...
4/11/20131631Topic 1Topic 2Topic 3Topic 4Topic 5Topic 6Goal Cards for Children Year 2 (2012)TM32Leaflet for Parents Year 1...
4/11/20131733Topic 1 Topic 3Topic 2Topic 4 Topic 6Topic 5TMLeaflet for Parents Year 2 (2012)Folder of HKP Educational Modu...
4/11/20131835Photos:Survey at the Beginning of the YearWeight and Height Measurement SessionKAP SurveyTM36Photos: Interven...
4/11/20131937Photos: Intervention Session Year 2 (2012)TMEngagement sessions 201238Photos: Intervention Session Year 1 & 2...
4/11/20132039Briefing on worksheets & goal cardsPhotos: Intervention Session (2011 -2012)TM40Weight and Height Measurement...
4/11/201321Year 1 & 2: 2011-2012 Results1. Nutritional Status (BMI-for-age)2. Immediate Impact Survey on Knowledge (before...
4/11/20132243TMFigure 1.1: Nutritional status of intervention (n=153) and control (n=116) groupsin year 2011 and 2012Preva...
4/11/20132345Module TopicMean Score Mean Difference(Increment)Before edu session After edu session20111. Healthy Habits (n...
4/11/20132447TMFigure 3.1: Mean Knowledge score of intervention and control groups fromyear 2011 to 2012There was a signif...
4/11/20132549TMFigure 3.3: Mean Practice score of intervention and control groupsfrom year 2011 to 2012There was a signifi...
4/11/20132651TMTable 3.2: Top 3 most purchased food from canteen in year 2011 and 2012No. Intervention (n=151)Frequencyn (...
4/11/20132753TMTable 3.4: Top 3 most consumed breakfast in year 2011 and 2012No. Intervention (n=151)Frequencyn (%)Control...
4/11/201328Summary of Main FindingsYear 1 & Year 2 (2011 – 2012)TMMain Findings• High prevalence of overweight and obesity...
4/11/201329YEAR 3: 2013 Intervention SessionTopic of the modulesObjectives of the topicsTM572013 Intervention ModulesTMT...
4/11/20133059EndThank YouTM
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NSM-NCD2013 Symposium 2a - Healthy Kids Programme - Development and evaluation of Nutrition Education Package for Primary School Children

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NSM-NCD2013 Symposium 2a - Healthy Kids Programme - Development and evaluation of Nutrition Education Package for Primary School Children

  1. 1. 4/11/20131Healthy Kids ProgrammeDevelopment and Evaluation ofNutrition Education Package forPrimary School ChildrenDr Zawiah HashimDr Tee E SiongProf Dr Norimah A KarimDr Chin Yit SiewExpert Panel, Healthy Kids ProgrammeNutrition Society of MalaysiaPresented @ NCD conference, Renaissance Hotel KL, March 26, 2013TMTM2Healthy Kids Programme (HKP) in Malaysia• Aim to improve nutrition knowledge and promote healthy lifestyleamong school children• Consists of two main componentsTMTMJointly implemented by
  2. 2. 4/11/20132Overview of ActivitiesHKP (2011-2013)A. AWARENESS(On-going)Parent & Children- Website: Monthly upload onhealthy eating & physical activitycontent (article & interactive tools)B. RESEARCH(2011 – 2013)A longitudinal (2010-2013)intervention study to develop,implement and evaluate the nutritioneducation modules appropriate forprimary school childrenUltimate goal at the end of 3-yearstudy is to develop interactivenutrition modules that the MOE canimplement in all primary schoolsTM34A. Awareness Component(Education on healthy eating & active living)Parent – Children Websitewww.healthykids.org.myTM
  3. 3. 4/11/201335Website for Parents & Children• Online resource onnutrition for schoolgoing children anywherein the country• Target audiences:o Children and parents• Dedicated website• No mention of brands/products except forcorporate logo• Contents:o Parents:• Healthy eating (snacking tips, foodpyramid)• Meal planning (+ planner)• Measuring child’s BMI (+ BMI tool)• Exercising with children• Understanding nutrition informationpanel and food labels• Easy recipeso Children:• Understanding pyramid, digestivesystem• Interactive games on various sports• Choosing healthy snacks• Easy recipesTMwww.healthykids.org.my6TM
  4. 4. 4/11/201347Website Highlights (1):Interactive Tools (For Parents)TM8Website Highlights (2):Interactive Tools (For Parents)TM
  5. 5. 4/11/201359TMWebsite Highlights (3):Interactive Tools (For Children)10TMWebsite Highlights (4):Interactive Tools (For Children)
  6. 6. 4/11/2013611Website Highlights (5):Interactive Tools (For Children)TM12Website Highlights (6):Articles for ParentsTM
  7. 7. 4/11/2013713Website Highlights (7):Articles for ChildrenTM14TMWebsite Highlights (5):Recipes for Parents
  8. 8. 4/11/2013815B. Research ComponentLongitudinal Study to Develop and EvaluateNutrition Education Package ForPrimary School ChildrenTM16The Need to Conduct this Research• Important to increase awareness of teaching nutrition knowledge• HKP aims to develop a set of educational materials for this purpose• A longitudinal intervention progamme to:o Develop appropriate educational moduleso Evaluate effectiveness of these modules• The findings will demonstrate the effectiveness of interactivenutrition education sessions to improve nutrition knowledge andattitude of the children.• Lack of appropriateeducational module• Insufficientemphasis by schoolauthorities, parentsLack ofteaching ofhealthy eatingand physicalactivityAlarmingnutritionalproblems –obesity onthe riseHealthy lifestylepromotionamong schoolchildren isimportantTM
  9. 9. 4/11/2013917Our Goals1. To develop appropriate modular educationalmaterials to facilitate teaching of nutrition toprimary school children2. To share with the Ministry of Education thedeveloped educational materials for teaching ofnutrition in all primary schools in the countryTM184 Key Objectives of the Research1. To determine the level of knowledge, attitude and practiceson nutrition and physical activity2. To determine the nutritional status through body mass index(BMI) measurements.3. To develop modular educational materials to improvenutrition and physical activity knowledge and practices4. To evaluate the effectiveness of these educationalinterventions.TM
  10. 10. 4/11/20131019Research FrameworkExpert CommitteeDevelop researchquestionnaire &educationalmaterials tools toimprove KAPConduct“Educational”Intervention(every 2 weeks,6 times per year)Conduct KAPsurvey &measure BMI(end of the year)Selection of 6intervention schools(~ total of 200subjects)Repeat for 2nd &3rd Year.Data analysisBaselinedata Collection :Conduct KAP survey& measure BMI(beginning ofthe year)Intervention (2011-2013)Step 1Step 2Step 3Step 4Step 5Step 6TM20Research Method1. Study subjects and study duration (3 years)2. Sample Size (Random sampling)2011207 students from 6 schoolsStandard 3(2011)Standard 4(2012)Standard 5(2013)TM2012189 students from 6 schools
  11. 11. 4/11/20131121Research Method (cont’d)3. Questionnaire for beginning and at the end of the year (KAP)• Part A : Socio Demographic Data• Part B : Nutrition Knowledge• Part C : Nutrition Attitude• Part D : Nutrition Practice• Part E : Anthropometry Data4. Questionnaire before and after each educational sessions5. Data analysis• Using SPSS version 15TM22Knowledge, Attitude & Practice Survey –at the Beginning & End of Each Year• Conducted at the beginning of year (Feb) and at the end of year (Oct)• 26 questions to determine status of nutrition knowledge, attitudeand practices (KAP) among subjects.NutritionKnowledge• Covering healthyhabits, foodpyramid, functionof food group,healthier foodchoices, physicalactivity andhygieneNutritionAttitude• Perception ofwhat is healthyand unhealthylifestyle habitsNutritionPractice• Questions onstudents eatinghabits (eg.breakfastconsumption) aswell as physicalactivityTM
  12. 12. 4/11/20131223Intervention (Educational) Sessions:Standard Module• 6 sessions per year conducted• Students are given a set of educational materials after each session“Engagement”Session(Learning ThroughGames, Q&A)Introduction &Refresher Sessions(Going Through WorksheetsOf Previous Topic)Immediate ImpactSurvey onKnowledge (5Q)Before intervention“Educational” Session(Short PPT To RecapMessages Based On“Engagement” SessionBriefing & Disseminationof materials(Worksheets, Goal Cards &Leaflet For Parents)7 mins 5 mins 15 mins5 mins5 mins5 minsImmediate ImpactSurvey onKnowledge (5Q)After interventionTM24No EducationalAreaTOPICS2011 (Standard 3) 2012 (Standard 4) 2013 (Standard 5)1 Health/Nutrition 1Healthy Habits Cereals & Cereal Products forEnergyHealthy Cooking Methods2 Nutrition 2 Food Pyramid Fruits And Veggies For Health Read Food Labels And ChooseWisely3 Nutrition 3 Eating Regular Meals Grow Stronger with Fish, Meat,Poultry, Milk & Dairy ProductsEating Out Healthily4 Nutrition 4 Choosing HealthierMealsLimit Fats, Sugar & Salt Eating Problems And ItsImplications5 PhysicalActivityBe Active Everyday Let’s Exercise & Participate inSports (5- 6 X A Week)Increase Strength &Flexibility6 Food Safety& HygienePersonal Hygiene Prepare And Consume Safe& Clean F&BRecap of 3 Years TopicsEducational Modules: TopicsYear 1:Laying the foundationon healthy eating(& keeping active)Year 2:Understanding functions ofvarious food group(& active in sports)Year 3:Applying healthy eatingin daily life(& increase strength)TM
  13. 13. 4/11/201313YEAR 1 & 2: 2011 -2012Pictorial ReportProps for Engagement Sessions Worksheets, Goal cards & Parent’s LeafletsPhotos during beginning of the year survey Photos during intervention sessionsPhotos during at the end of the year survey Results overviewTM26Props for Engagement Session Year 1 (2011)Topic 1 Topic 2Topic 3Note: No props developed for Topic 5Topic 4Topic 6TM
  14. 14. 4/11/20131427TMProps for Engagement Session Year 2 (2012)Topic 1Topic 3Topic 4Note: No props developed for Topic 2, 5 & 628Worksheets for Children Year 1 (2011)Topic 2Topic 1Topic 3Topic 4Topic 5Topic 6TM
  15. 15. 4/11/20131529Topic 2Topic 1Topic 3Topic 4Topic 5Topic 6Worksheets for Children Year 2 (2012)TM30Goal Cards for Children Year 1 (2011)Topic 1Topic 2Topic 3Topic 4Topic 5Topic 6TM
  16. 16. 4/11/20131631Topic 1Topic 2Topic 3Topic 4Topic 5Topic 6Goal Cards for Children Year 2 (2012)TM32Leaflet for Parents Year 1 (2011)Topic 1Topic 3Topic 2Topic 4Topic 6Topic 5TM
  17. 17. 4/11/20131733Topic 1 Topic 3Topic 2Topic 4 Topic 6Topic 5TMLeaflet for Parents Year 2 (2012)Folder of HKP Educational Modules34TM
  18. 18. 4/11/20131835Photos:Survey at the Beginning of the YearWeight and Height Measurement SessionKAP SurveyTM36Photos: Intervention Session Year 1 (2011)TMEngagement sessions 2011
  19. 19. 4/11/20131937Photos: Intervention Session Year 2 (2012)TMEngagement sessions 201238Photos: Intervention Session Year 1 & 2 (2011 - 2012)TMPower Point Presentation and Q & A session
  20. 20. 4/11/20132039Briefing on worksheets & goal cardsPhotos: Intervention Session (2011 -2012)TM40Weight and Height Measurement SessionKAP Questionnaire SessionPhotos: Survey at the End of the YearTM
  21. 21. 4/11/201321Year 1 & 2: 2011-2012 Results1. Nutritional Status (BMI-for-age)2. Immediate Impact Survey on Knowledge (beforeand after each intervention sessions)3. Nutrition Knowledge, Attitude & Practices (KAP)Results (year 2011 - 2012)TM1. Nutritional StatusWeight and height measurement (BMI)conducted at the beginning andat the end of the yearTM
  22. 22. 4/11/20132243TMFigure 1.1: Nutritional status of intervention (n=153) and control (n=116) groupsin year 2011 and 2012Prevalence of overweight and obesity was high, but the control group was higher than intervention group.Note: BMI at 2011 was collected in Feb 2011; BMI at 2012 was collected in Sept-Nov 2012.2. Immediate Impact Survey onKnowledge for Year 1 and Year 2 TopicsKnowledge survey conducted before andafter each intervention sessionsTM
  23. 23. 4/11/20132345Module TopicMean Score Mean Difference(Increment)Before edu session After edu session20111. Healthy Habits (n=187) 87.2 95.6 8.42. Food Pyramid (n=189) 77.6 85.1 7.53. Eating Regular Meals (n=180) 86.4 88.6 4.64. Choosing Healthier Meals (n=189) 77.4 78.7 1.35. Be Active Everyday (n=187) 87.4 98.2 9.86. Personal Hygiene (n=194) 87.0 90.1 3.120121. Grains & Tubers for Energy (n=182) 85.6 (19.8) 87.4 (17.0) 1.82. Fruits & Vegetables for Health (n=170) 77.5 (15.1) 90.8 (13.6) 13.33. Grow stronger with Protein Food (n=165) 64.7 (17.8) 80.5 (14.7) 15.84. Limit Fats, Sugar & Salt Intake (n=167) 61.8 (15.3) 80.0 (18.9) 18.25. Let’s Exercise & Participate in Sports (n=158) 85.8 (16.3) 88.5 (13.8) 2.76. Consume Safe & Clean F & B (n=155) 92.1 (18.2) 93.3 (12.7) 1.2TMTable 2.1: Mean of knowledge survey score before and after interventionin year 2011 and 2012Increased in mean IIS score after intervention session for all modules.3. Nutrition Knowledge, Attitude &Practices (KAP) ResultsKAP survey conducted at the beginning ofthe year and at the end of the yearTM
  24. 24. 4/11/20132447TMFigure 3.1: Mean Knowledge score of intervention and control groups fromyear 2011 to 2012There was a significant improvement in mean knowledge score in both groups.The improvement among intervention group was significantly higher than control.The mean knowledge score of the intervention group is always higher than that of the control group.Within groupF(55.7), p<0.001Between groupF(4.9), p<0.0148TMFigure 3.2: Mean Attitude score of intervention and control groupsfrom year 2011 to 2012There was no significant difference in attitude score between both group.The mean attitude score among the intervention group was higher than control group.Within groupF(1.9), p=0.13Between groupF(1.7), p=0.17
  25. 25. 4/11/20132549TMFigure 3.3: Mean Practice score of intervention and control groupsfrom year 2011 to 2012There was a significant improvement in mean practice score in both groups.The mean practice score of the intervention group is always higher than that of the control groupWithin groupF(37.8), p<0.001Between groupF(1.7), p=0.1850TMNo. Intervention (n=151)Frequencyn (%)Control (n=121)Frequencyn (%)Beginning of the year 20111. Snacks (chips, keropok,kerepek) 81 (53.6) Snacks (chips, keropok,kerepek) 89 (73.6)2. Sweets 42 (27.8) Sweets 28 (23.1)3. Ice-cream 37 (24.5) Chocolate 25 (20.7)End of the year 20121. Snacks (chips, keropok,kerepek) 114 (75.5) Snacks (chips, keropok,kerepek) 119 (98.3)2. Biscuit 46 (30.5) Chocolates 24 (19.8)3. Bread 42 (27.8) French fries 22 (18.2)Table 3.1: Top 3 most favourite snacks in year 2011 and 2012• Improvement of snack option (bread, biscuit) among the intervention group.• Intervention group had better snack option than the control group.Note: KAP at 2011 was collected in Feb 2011.; KAP at 2012 was collected in Sept-Nov 2012.
  26. 26. 4/11/20132651TMTable 3.2: Top 3 most purchased food from canteen in year 2011 and 2012No. Intervention (n=151)Frequencyn (%)Control (n=121)Frequencyn (%)Beginning of the year 20111. Nasi lemak 72 (47.7) Nasi lemak 41 (33.9)2. Sausage 38 (25.2) Sausage 22 (18.2)3. Nugget 33 (21.9) French Fries 22 (18.2)End of the year 20121. Nasi lemak 81 (53.6) Nasi lemak 45 (37.2)2. Sausage 39 (25.8) Nugget 39 (32.2)3. Fried noodle 31 (20.5) Bread 38 (31.4)Nasi lemak and sausage remained as the most purchased food in year 2012 for intervention group.Note: KAP at 2011 was collected in Feb 2011.; KAP at 2012 was collected in Sept-Nov 2012.52TMTable 3.3: Top 3 most frequent drinks in year 2011 and 2012No. Intervention (n=151)Frequencyn (%)Control (n=121)Frequencyn (%)Beginning of the year 20111. Cordial drinks 109 (72.2) Plain water 77 (63.6)2. Plain water 104 (68.9) Cordial drinks 69 (57.0)3. Milo 65 (43.0) Milo 49 (40.5)End of the year 20121. Plain water 96 (63.6) Cordial drinks 74 (61.2)2. Milo 83 (55.0) Plain water 71 (58.)3. Cordial drinks 60 (39.7) Milo 57 (47.1)• Percentage of student in intervention group drinking cordial drinks has decreased tremendously.• Intervention group children showed better drink option than control group.Note: KAP at 2011 was collected in Feb 2011.; KAP at 2012 was collected in Sept-Nov 2012.
  27. 27. 4/11/20132753TMTable 3.4: Top 3 most consumed breakfast in year 2011 and 2012No. Intervention (n=151)Frequencyn (%)Control (n=121)Frequencyn (%)Beginning of the year 20111. Bread 86 (57.0) Bread 80 (66.1)2. Sandwich 43 (28.5) Cereals 22 (18.2)3. Cereals 40 (26.5) Biscuit 21 (17.4)End of the year 20121. Bread 98 (64.9) Bread 75 (62.0)2. Biscuit 49 (32.5) Cereals 36 (29.8)3. Cereals 41 (27.2) Fried rice 29 (24.0)• Increased in percentage of bread and cereals consumption among intervention group.• Percentage of bread and cereals consumption among intervention group was higher than thecontrol group.Note: KAP at 2011 was collected in Feb 2011.; KAP at 2012 was collected in Sept-Nov 2012.54TMTable 3.5: Top 3 most favourite leisure time activities in year 2011 and 2012No. Intervention (n=151)Frequencyn (%)Control (n=121)Frequencyn (%)Beginning of the year 20111. Football 71 (47.0) Football 53 (43.582. Badminton 58 (38.4) Badminton 47 (38.8)3. Cycling 54 (35.8) Cycling 45 (37.2)End of the year 20121. Badminton 78 (51.7) Badminton 62 (51.2)2. Football 65 (43.0) Football 52 (43 .0)3. Cycling 62 (41.1) Cycling 43 (35.5)Increased in percentage of choosing badminton, football and cycling as their leisure time activitiesamong the intervention groupNote: KAP at 2011 was collected in Feb 2011.; KAP at 2012 was collected in Sept-Nov 2012.
  28. 28. 4/11/201328Summary of Main FindingsYear 1 & Year 2 (2011 – 2012)TMMain Findings• High prevalence of overweight and obesity among the students.o Overweight & obese child will most likely to become overweight teenager andif not curb, will become a overweight adult and at risk of chronic diseases(hypertension, heart disease, diabetes, etc)o There is an urgent need to promote healthy eating and active living practicesamong school children.• Nutrition knowledge score increased in all 12 topics after each intervention.o This shows that the children in the intervention group learned from eacheducational session.• Nutrition knowledge, attitude and practices scores improved after 2 years.o The knowledge gain should be put into daily practice and should benefit thechildren in many years to come.o With better nutritional status, children’s health will improve, schoolperformance also will improve as they will pay attention better, lessabsenteeism.o In summary, the educational modules have shown some benefit and the studyshould be continued to the final year (year 3).TM
  29. 29. 4/11/201329YEAR 3: 2013 Intervention SessionTopic of the modulesObjectives of the topicsTM572013 Intervention ModulesTMTopicsHealthyFoodPreparationRead FoodLabels andChooseWiselyEating OutHealthilyProblemsRelated toNutrientImbalanceIncreaseStrenght andFlexibilityRecap ofYear 1 –Year 3ModulesObjectivesTo educatestudents onhealthy cookingmethods /preparationTo educatestudents tomake use of theinformation onfood labelswhen choosingpackaged foodsTo educatestudents onhealthierfood choicewhile eatingoutTo educatestudents on theproblems relatedto nutrientimbalances andthe implicationsTo educatestudents andencourage themto participate inactivities thatincreaseflexibility andstrengthTo recap thetopics learntby thestudents fromyear 1 to year3• Learning through fun and engaging games• Worksheets to reinforce messages• Letter-cum-leaflet to parents to encourage home practice58
  30. 30. 4/11/20133059EndThank YouTM

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