Testing the Russian version of Get the Best from Your Food

Yu.V. Kroupnov, I.S. Glasunov, P.V. Karpov,
N.V. Vartapetova, B.V. Krupnov, I.M. Solovjova, E.V. Oussova,
E.P. Andrianova, A. Yngre, E. Poortvliet and M. Sj�str�m

Yu. V. Kroupnov, P.V. Karpov and B.V. Krupnov are from the Paideia Institute of Learning with Textbook. I.S. Glasunov, N.V. Vartapetova, I.M. Solovjova and E.V. Oussova are from the Department of Policy and Strategy Development, National Centre of Preventive Medicine. E.P. Andrianova teaches biology at School No. 1634. A. Yngre, E. Poortvliet and M. Sj�str�m are from the Unit for Preventive Nutrition, Karolinska Institutet and University of Orebro, Sweden.

In the Russian Federation, nutrition education is important for improving dietary habits among the public at large and particularly among children and youth. General food and nutrition problems, caused by the inadequate quality and quantity of food, start early in life and continue into adulthood, and there is an urgent need to address the problems of diet-related chronic diseases through effective food and nutrition education. In December 1997, the Karolinska Institute in Sweden and the National Centre of Preventive Medicine in the Russian Federation collaborated on translating the FAO package "Get the best from your food" from English into Russian, and then tested whether it could be used in the school nutrition education curriculum. The package consists of a guide, a smaller booklet summarizing the main points from the guide and a poster illustrating the guide's four main themes: "Enjoy a variety of foods"; "Eat to meet your needs"; "Protect the quality and safety of your food"; and "Keep active - stay fit".

INVESTIGATION

The objectives of the test were to:

• investigate students', teachers' and parents' understanding of the guide;
• evaluate students', teachers' and parents' perceptions of the guide;
• study how attitudes towards diet and food could be changed after a short, four-lesson course using the guide;
• suggest ways in which the wording or design of the guide could be changed to obtain the widest possible acceptance.

A series of focus groups were held with the students. Teachers and parents were asked to read the guide and then respond to a structured questionnaire. The test groups are described in Table 1.

TABLE 1
Characteristics of the focus groups and test types

Group	School, year, municipal district	Test group	No.	Test type	Time-period
1	Experimental School No. 1314, eighth year	Students 13 to 14 years old	10	Four lessons using the booklet	Three weeks
2	Project College, Moscow Experimental School No.1314, eighth year	Parents	10	Self-study	One week
3	School No. 525, eighth year	Students 13 to 14 years old	20	Four lessons using the booklet	Three weeks
4	School No. 525, eighth year	Parents	20	Self-study	One week
5	School No. 525, tenth year	Students 15 to 16 years old	21	Four lessons using the booklet	Three weeks
6	School No. 525, tenth year	Parents	21	Self-study	One week
7	School No. 525	Teachers	28	Discussion and self-study	One week
8	School No. 1634, international baccalaureate, ninth year	Students 15 years old	12	Four lessons using the booklet	Three weeks
9	No. 1634, international baccalaureate, ninth year	Parents	12	Self-study	One week
10	School No. 1634, international baccalaureate, tenth year	Students 16 years old	18	Four lessons using the booklet	Three weeks
11	School No. 1634, international baccalaureate, tenth year	Parents	18	Self-study	One week
Total		Students	81
		Parents	81
		Teachers	28

Materials and methods

Three schools in the central and eastern districts of Moscow were chosen to investigate the usefulness of the Russian version of Get the best from your food among school students, teachers and parents. School No. 1314, in the Central district, is an experimental advanced school with a humanities curriculum. School No. 525, also in the Central district, is an average state public school. Students come from the neighbourhood and many have learning difficulties and special needs. Teachers use standard non-experimental methodology. School No. 1634, in the Eastern district, is an �lite state school for the children of relatively well-to-do families. Classes are small (15 to 18 students) and the curriculum covers primarily humanities subjects.

Testing

The testing involved three stages. In stage 1, workshops were held with the teachers who were going to carry out the experimental lessons. During stage 2, the teachers conducted four lessons (of 25 minutes each) over a three-week period. After the topic of healthy nutrition had been introduced, the children's opinions and attitudes were assessed and they were given the FAO guide. They were requested to share the information it contains with their parents, who were given questionnaires. Two of the lessons involved reading about and discussing the topics: "Enjoy a variety of foods"; "Eat to meet your needs"; "Protect the quality and safety of your food"; and "Keep active - stay fit". After each lesson, the parents were asked to give their views and, after the fourth and final lesson, parents and students discussed the information contained in the guide and lessons. Stage 3 consisted of reports from group leaders and investigators and there was a final workshop and analysis of the understanding, perception, opinions and attitudes of students, parents and teachers.

Analysis and results

The two core issues of the testing were participants' understanding and perception of the guide's contents. Participants' understanding of the guide was assessed according to the criteria given in Table 2; while their perception of the FAO information was analysed according to the parameters shown in Table 3.

TABLE 2
Parameters for measuring participants' understanding of the FAO guide

Concept	Element	Message(s) from the guide
Active-functional approach to food consumption and nutrition	An active attitude to nutrition	"Get the best from your food"; "So, enjoy food but eat wisely; know how to get the best from your food."
	Variety of foods	"To get the best from your food, eat a wide variety of the food that is available to you."
	Careful selection of food	"You may need to take extra care at some times of your life to make sure that you get the right amounts of certain nutrients."
	Food safety	"To reduce the risk of food poisoning it is important to follow the basic rules of good hygiene."
	Keep active and stay fit	"Stay fit and keep physically active to keep your body working properly and to get the best from your food."
Improved nutrition quality as a function of getting the best from food	Enjoy a variety of foods	"Your body needs a variety of nutrients and these come from the food you eat."
	Eat to meet your needs	Specific advice directed towards people who are: pregnant; breastfeeding; very young; adolescent; elderly; elderly women; very active; underweight; overweight; general public.
	Protect the quality and safety of your food	Store food with care Handle food with care. "Keep food at the right temperature"
	Keep active - stay fit	"Physical activity will help regulate your appetite so that you eat the right amounts of food for your energy needs."
The energy model of food consumption	Value of foods	"Food is the source of the energy and nutrients that your body needs to grow and develop."
	Power and material balance	"It is important to balance the food you eat with the energy you use up to avoid becoming too thin or too fat."
	Information about the composition of food and biochemical processes in the body	"Proteins are needed to..." "Carbohydrates and fat..." "Exercise more to use up energy stores."
Recommendations, advice, instructions	Advice on how to organize your own nutrition	"It is best to divide your daily food into more than one meal and always try to start your day with breakfast."
	Recommendations for weight control	"If you need to gain weight..."

TABLE 3
Parameters for assessing participants' perceptions of the FAO guide

Parameters	Relevant questions
Complexity	Are there any unexplained, unfamiliar words?
Novelty	Is the information in the booklet familiar to you?
Importance of the information	How important is the information that the guide provides?
Perception of the illustrations	Are the illustrations appropriate?
Number of illustrations	Are there the right number of illustrations?
Format	Is the format of the guide convenient?
Colour scheme	How acceptable do you find the colour scheme used?
Font size	Is the font size comfortable to read?

A total of 81 teenagers (from 13 to 16 years of age) took part in the testing. Of the 28 teachers and 81 parents who were asked to study the guide themselves, 18 teachers (64 percent) and 59 parents (73 percent) filled in assessment questionnaires. The students', parents' and teachers' responses are presented in Tables 4, 5 and 6, respectively.

TABLE 4
Students' understanding and perceptions

TABLE 5
Parents' understanding and perceptions

TABLE 6
Teachers' comprehension and perceptions

Fifty parents (86 percent) liked the way the guide looked. Seventy-three parents (90 percent) said that there were no unfamiliar, unexplained words in its text (Table 5). Sixteen teachers (88.5 percent) approved of the appearance of the guide; 14 (77.5 percent) enjoyed the illustrations, although some found the untraditional style - "the face-scheme" - difficult to view. All the teachers considered the print size appropriate for the students to read. Eight teachers (44.5 percent) liked the enclosed poster, while the remainder expressed no opinion on this subject (Table 6).

DISCUSSION

The active-functional approach to food consumption and nutrition was assessed. Before testing, it was assumed that the students did not have a consciously active attitude to food and nutrition as aspects of health. Researchers believed that the majority of the students had no awareness of health, and the FAO materials were regarded as a valuable means of changing this situation and stimulating interest in the issue of nutrition. It was also necessary to decide how the materials could best be used for working with students, parents and teachers.

Among the students, it was a group from School No. 1314 who achieved the greatest understanding of the active-functional approach to food contained in the FAO materials. These students were able to draw their own conclusions about the importance of nutrition, even though they had not thought about this issue before. Testing in the other two schools showed the same initial lack of consideration of food issues. In other words, the tests showed that most of the students did not consider their diet and nutrition to be under their own control and had a completely passive attitude towards nutrition.

Students reported that their parents were interested in discussing food and nutrition with them at home, which led researchers to conclude that the educational programmes based on the FAO materials should be developed and adapted in order to involve parents.

The teachers discussed how they could use the guide and booklet. They considered them to be useful sources of information, which would enable them to establish healthy eating habits among the students.

The concept of improving dietary quality by getting the best from food with regard to the four key areas was assessed. Analysis showed, however, that the nutrition messages in the educational programme did not raise the quality of knowledge about nutrition. Although the teachers followed instructions and paid much attention to the four main points, the majority of the students expressed their opinions on the basis of personal experience or the experiences of relatives and friends alone, without considering the contents of the guide.

The most considered judgements were those made by the students from School No. 1314. The majority of these students noted that this was the first time that they had dealt with a systematic presentation of information about nutrition. During the lessons, students expressed their attitudes towards the information in the guide, criticized some points and asked questions (see Box).

An "energy model" of food consumption, food flows and the functions of the human body were all addressed. On the whole, students of all ages already had a good knowledge of the information contained in the guide, approximately 57 of them (70 percent) saying that it was familiar. After four lessons, the researchers concluded that almost all of the students had previously been exposed to the information contained in the guide, through biology and chemistry lessons, discussions with their parents, etc. However, students noted that the guide follows a systematic approach to knowledge about nutrition which they had not seen before.

About 41 parents (70 percent) said that the guide's information was not new to them. Thirty-eight parents (64 percent) expressed an interest in obtaining such information, and 46 (78 percent) noted its usefulness. This led researchers to conclude that parents need this kind of information.

Almost all of the teachers were interested in obtaining the information and approved of its systematic, practical approach and advice (e.g. the concept of interchangeable food products). They also noted that the small booklet was simple and could be used by students in the sixth year, while the larger guide was appropriate for the seventh year and beyond.

The recommendations, advice, facts, data and sources of useful information given in the guides were evaluated, and all of the students noted that they were useful. Some of the students had personal experience of specific nutritional problems and issues, such as diseases of the gastro-intestinal tract, small babies in the family and special dietary practices (including vegetarianism), and were able to give advice to their schoolmates. The "Eat to meet your needs" section of the guide attracted particular interest. For many of the students, this was the first time that they had been informed about the special needs of various population groups. Almost all of the students paid special attention to the advice concerning nutrition and regulation of their own weight. The guide stimulated 45 parents (76 percent) to reconsider their own diets, and 44 parents (75 percent) said that they intended to apply the recommendations. Notably, 14 teachers (77.5 percent) said that the guide made them reconsider their diets, and ten teachers (55 percent) said that they would apply some of the recommendations given.

PROPOSALS

During the course of the testing, students demonstrated a good mastery of the guide's information on healthy nutrition. However, the visual presentation of the package's innovative message (to be more diet conscious) was not adequate. The overall concept and messages were emphasized during staff training, but the results of the tests showed that the active-functional approach had not been fully understood by all the groups. It would be helpful to add a section to the guide that illustrates the active-functional approach to nutrition more clearly. Such a section should include:

• special instructions on how to apply the guide in Russian schools as a means of systematizing knowledge on healthy nutrition among students of 13 to 15 years old;
• a special curriculum on acquiring healthy nutrition habits, based on the FAO materials.

The parents were invited to take part in the testing of FAO materials. The mere fact of being invited to take part in the educational process and receiving the guides through their children aroused considerable interest which was demonstrated by the parents' response to the survey - 73 percent - and by the fact that, although most of the guide's information was not new to them (70 percent), 60 percent of parents were interested in receiving it. It is recommended that special information packages for parents and families, based on the FAO materials, be developed.

During the lessons, students expressed their opinions and proposals on how to modify the contents of the Russian version of the FAO guide. Teenagers (especially those between 13 and 14 years of age) would like to have more information about food patterns that are suitable for people of their age. It would, therefore, be advisable to give special attention to the nutrition issues of this age group by:

• supplementing the relevant sections of the guide and notes with more detailed advice on healthy diets for 13- to 14-year-olds;
• developing a special supplementary sheet directed towards this age group.

There was some disagreement among the participants about the design of the FAO materials. It should be remembered that such a form of education, using information materials, is relatively new and unusual in the Russian Federation. More work with Russian audiences is required, so that the specific characteristics, tastes and preferences of Russian schoolchildren, their parents and teachers can be taken into account. In the meantime, it is worth noting that none of the test groups objected to the format of the booklet or the fonts used.

CONCLUSIONS

The FAO package Get the best from your food is suitable material for nutrition education among the Russian population. It could be made more effective by adapting it to population subgroups defined in terms of age, educational level, etc. The educational programme carried out on the basis of the FAO guide aroused substantial interest among the participants of the test groups, who indicated a need for programmes that give integrated information on nutrition. To create an active approach to food, basic educational programmes on the self-evaluation of diet are needed, as well as training in the skills necessary for following a nutritional strategy. The interest that parents expressed in the FAO guide demonstrates the potential for using it more broadly among the adult population, but the optimal age for appreciating the guide's materials was found to be 13 to 14 years old. Some participants were of the opinion that younger children could also be involved in the test.

The general conclusion is that, in order to make the FAO guide more widely understood, a range of different educational programmes, aimed at different categories of schoolchildren, should be developed. It is also important to note that teachers need special training in working with these materials. The following developments would increase the usefulness of the FAO guide in the Russian Federation:

• a regional and socio-cultural analysis of the applicability of the materials;
• a nutrition education network that promotes good nutrition and healthy eating habits in the Russian Federation;
• new ways of using the FAO educational materials - different study methods, analysis of their applicability, etc.;
• adapting the information materials for use with different population groups and communities - teachers, parents, students, administrative and medical workers, etc.

Summary/R�sum�/Resumen