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Which type of educator, who delivers nutrition education, is most effective for changing children’s dietary intake-related behaviors?

Conclusion

There is insufficient evidence to determine whether certain types of educators who deliver nutrition education are more effective in changing children’s dietary intake-related behaviors.

 

Grade

V- Grade Not Assignable

 

Evidence Summary Overview

The literature search for studies that tested the effects of nutrition education delivered to children and adolescents by different types of educators identified 3,538 articles, 432 of which were selected for review (Click Fig. 4-C.1 for image). Of these 432 articles, one was selected for inclusion in the systematic review. A detailed description of literature search results, including the databases searched and the number of articles identified using each database, articles identified using hand search, a list of citations for all included articles, and a table that lists excluded studies with rationale for exclusion can be found in Appendix F.

The purpose of this research question was to investigate whether different types of educators (e.g., teachers, nutritionists, parents, health care providers) may be more effective when delivering nutrition education, therefore resulting in greater improvements to children’s dietary intake-related behaviors. Because the literature search identified one study (Panunzio et al, 2007) that tested the effects of a nutrition education intervention delivered by two different types of educators, it was not possible to draw any conclusions. Therefore, more research is needed to determine whether different types of educators are more effective when delivering nutrition education to children.

Evidence Summary Paragraph

Panunzio et al, 2007 (positive quality) conducted a group randomized controlled trial in Italy to compare the effectiveness of a school-based intervention delivered by a classroom teacher to an intervention delivered by a nutritionist to increase fruit and vegetable consumption among children. Two fourth grade classrooms from each of ten schools were randomly assigned to one of two intervention groups that received the same nutrition education curriculum, delivered by either the regular classroom teacher or a nutritionist. There was no control group in this study. The teacher-delivered intervention consisted of three periods:

  • In the first 12-week period, teachers attended a basic nutrition training course (one two-hour meeting per week)
  • In the second 12-week period, teachers participated in additional training sessions (one two-hour meeting per week) emphasizing nutrition teaching aids
  • In the third 12-week period, teachers provided nutrition education to students by integrating the nutrition concepts into all school curricula.

The nutritionist-delivered intervention consisted of three periods:

  • During the first two 12-week periods, nutritionists taught nutrition classes to students (one two-hour class per week).
  • During the third 12-week period, no classes or activities took place.

The final sample included 471 fourth grade school children (10 years). There were no significant differences in dietary intake between the intervention groups in period 1 (weeks 0 to 12) and period 2 (weeks 12 to 24), or between period 1 (weeks 0 to 12) and period 3 (weeks 24 to 36). Between period 2 and period 3, in both intervention groups, the number of subjects consuming ≥2 portions per day of fruits and vegetables increased and the number consuming ≥2 portions per day of chips and sugar-sweetened beverage decreased. Also, the number of subjects consuming ≥2 portions per day of legumes increased in the Teacher group, but decreased in the Nutritionist group. However, for all food categories changes in dietary intake were significantly greater in the Teacher group compared to the Nutritionist group (P<0.0001).

This study had several limitations to consider. Children in each intervention group received different levels of education duration across the three periods, with the children in the Nutritionist group receiving the nutrition education during periods 1 and 2 (24 weeks), while children in the Teacher group only received nutrition education during period 3 (12 weeks). In addition, during periods 1 and 2, children in the Nutritionist group received the nutrition education once a week for two hours, while children in the Teacher group had the nutrition education integrated into all classroom curriculum over the third period. Therefore, in addition to the type of educator, the timing, dose, and format of nutrition education differed between the groups. These differences limit the conclusions that can be drawn from the results of this study.



View table in new window
Author, Year,
Study Design,
Class,
Rating
Participants Methods Outcomes Strengths and Limitations
Panunzio MF, Antoniciello A et al, 2007 

Study Design: Randomized Controlled Trial

Class: A 

Rating: Positive

N=471.               

Age: Eight to 11 years.

Attrition rate: 9.6 %.

Location: Italy.

 

Methods: Two fourth-grade classrooms in each of 10 schools randomly assigned to one of two intervention groups that received the same nutrition education curriculum, delivered by either the regular classroom teacher or a nutritionist.

Outcomes Measures: Diet records (daily for 12 weeks). 

Duration Intensity: The Teacher Intervention was 12 weeks (integrated into all classroom curricula); the Nutritionist Intervention was 24 weeks (2-hours once per week).

Teacher-delivered intervention:

1) First period: Teachers were trained (two-hour classes, weekly for 12 weeks)

2) Second period: Teachers received additional training  (two-hour classes, weekly for 12 weeks)

3) Third period: Children received nutrition education integrated into all classroom curricula.

Nutritionist-delivered intervention:

1) First period: Nutritionists taught nutrition classes for two hours a week for 12 weeks

2) Second period: Nutritionists continued teaching, two hours per week

3) Third period: No classes held.

 

NS differences in dietary intake between the teacher and nutritionist groups during periods one and two.

In period three, teacher group had significant improvements in dietary intake compared to the nutritionist group.

 

Ethnic and socioeconomic factors not reported for this population of children from southern Italy.

Teacher involvement in data collection could bias results. 

In addition to the type of educator, both the timing and dose of nutrition education differed between the study group, limiting the conclusions that can be drawn from this study.

 

Research Design and Implementation
For a summary of the Research Design and Implementation results, click here.