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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. Sjöström

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. Sjöström 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:

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 élite 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

Questions

Responses

 

Yes

No

 

%

Number

%

Number

Are there unexplained, unfamiliar words?

35

28

65

53

Are there the right number of illustrations?

80

65

20

16

Is the format convenient?

100

81

-

-

How acceptable do you find the colour scheme used?

90

73

10

8

Is the font size comfortable to read?

100

81

-

-

Are the illustrations appropriate?

56

45

44

36

TABLE 5
Parents' understanding and perceptions

Questions

Responses

 

Yes

No

Don't know

 

%

Number

%

Number

%

Number

Are there unexplained, unfamiliar words?

7

4

90

53

3

2

Do you approve of the appearance of the booklet?

86

51

9

5

5

3

Do you like the enclosed poster?

73

43

20

12

7

4

TABLE 6
Teachers' comprehension and perceptions

Questions

Responses

 

Yes

No

 

%

Number

%

Number

Are there unexplained, unfamiliar words?

25.0

5

75.0

13

Do you approve of the appearance of the booklet?

88.5

16

11.5

2

Do you like the enclosed poster?

44.5

8

55.5

10

Are the illustrations appropriate?

77.5

14

22.5

4

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).

STUDENTS' REACTIONS TO THE GUIDES

This educational programme excited interest among all the groups taking part in the testing, as became clear during the first lessons, in which participants' existing knowledge of food and nutrition was tested in connection with the information provided by the FAO guide. It was clear that all the students were interested in healthy nutrition. They asked many questions and paid much attention to the contents of the guide. In addition, in spite of the fact that the testing was voluntary, no one refused to take part. This interest remained throughout the whole period of testing, although some of the schoolchildren stated that almost all of the given information was familiar to them.

Some of the comments from the discussions are provided below.

From discussions in the group of 13- to14-year-olds (the eighth year):

  • "Much of the information in the booklet is familiar to everybody. For example, we have been taught since childhood to wash our hands before eating and to take more exercise." (girl, 14)
  • "In general, I already knew all of this, but had not thought about it. Now, having read the booklet, I realize that the problem is actually very important." (boy, 13)
  • "In general, there was no new information for me in the booklet. It just helped me to remember the things I had forgotten." (boy, 13)
  • "I have learned how to feed a small baby." (boy, 13)
  • "I have managed to correct my nutrition with the help of this booklet. I take lots of exercise and now know which food products, and in what quantities, I should eat." (boy, 14)
  • "It would be better if it contained less information - I'm not going to calculate calories and fats." (boy, 13)
  • "The smaller booklet is more convenient. The bigger one is impossible to carry around and creases easily. A hard cover would be preferable." (girl, 14)
  • "The first picture does not help you to guess the contents." (girl, 14)

From discussions in the group of 14- to 15-year-olds (ninth year):

  • "For me the most valuable information in the booklet is the information about healthy nutrition, how to lose weight, and how to store food products. This information was not new for me but it was still interesting to read the booklets." (boy, 15)
  • "The most valuable information for us was about how to control weight, and the tables reflecting the correlation between height and weight." (girl, 15)
  • "The topic on different people's problems with the wrong nutrition could be widened and made more specific." (girl, 14)
  • "What's the use of telling small children how a pregnant woman should eat?" (boy, 15)
  • "The pictures are not very real, but I think that it is good that they are this way. Generally speaking, the pictures are not the main thing, the main thing is the content, which is good." (boy, 14)

From discussions in the group of 15- to 16-year-olds (tenth year):

  • "This sort of information should be given as early as possible, that way we would be healthier by our age." (boy, 15)
  • "Healthy food days can be organized in schools." (girl, 16)
  • "It would be great if teenagers were given detailed information about what to eat and how much." (boy, 15)

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:

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:

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:


Summary/Résumé/Resumen

Testing the Russian version of Get the Best from Your Food

In collaboration with the Karolinska Institute in Sweden, the National Centre of Preventive Medicine in the Russian Federation tested the FAO package Get the best from your food in Moscow. The aim of the investigation was to determine whether the guide was understood by Russian school students, teachers and parents. The study evaluated perceptions of the nutrition education guide; studied changes in attitudes to diet and food after four short lessons using the guide; and proposed changes in wording or design to make the guide more widely acceptable.
The focus groups were selected from three schools in the Central and Eastern districts of Moscow. The groups included 81 students (13 to 15 years of age), 81 parents and 28 schoolteachers. Two leaders conducted a series of four lessons (25 minutes each), while teachers and parents were asked to study the booklet by themselves. The most important points of the lessons derived from the FAO guide were defined as: taking an active, conscious approach to food consumption and nutrition; improving diet to reflect the four key concepts of enjoyment of dietary diversity, conformity with needs, maintenance of quality, and the interdependence of food quality and physical activity; an understanding of the concepts of energy balance and the functions of the human body; awareness of recommendations, advice, facts, data and sources of useful information.
The test results showed that the guides were well understood and accepted in the test groups of students, parents and teachers. Most of the information was not new to the students, although they noticed that it was presented more systematically than they had seen previously. The lessons helped students to perceive food consumption as an active process depending on themselves. The 13- to 14-year-olds were the most appropriate group for the nutrition education programme and guide. Involving parents, as well as students, in discussions about food consumption seemed to be very effective. Parents showed a great interest in problems related to food consumption and a readiness to work towards better nutrition with their children. The Russian version of the FAO guide was considered suitable for nutrition education programmes among the Russian population. The guide could be made more effective if it were adapted to population subgroups, determined by age, educational level, etc. Further work should be done on regional and socio-cultural analysis of the applicability of these materials throughout the Russian Federation.

Tester la version russe de Profitons au mieux de notre nourriture

En collaboration avec l'Institut Karolinska (Suède), le Centre national de médecine préventive de la Fédération de Russie a testé le guide FAO «Profitons au mieux de notre nourriture» à Moscou. L'objectif était de déterminer si le guide de la FAO était bien compris par les collégiens, enseignants et parents russes. On a donc évalué la manière dont il était perçu; étudié les changements de comportement vis-à-vis des régimes alimentaires et de la nourriture en général après quatre cours portant sur le guide; et proposé des changements dans la rédaction ou la conception de la brochure afin d'améliorer son acceptation.
Les groupes cibles ont été choisis dans trois écoles situées dans les quartiers du centre et de l'est de Moscou. Ils comptaient 81 collégiens (âgés de 13 à 15 ans), 81 parents et 28 enseignants. Deux responsables ont dirigé une série de quatre cours (de 25 minutes chacun), tandis que les enseignants et les parents ont été priés d'étudier la brochure tout seuls. Les quatre points les plus importants des cours, inspirés du guide de la FAO, ont été définis comme suit: adopter une démarche active et consciente face à la consommation alimentaire et à la nutrition; améliorer les régimes alimentaires pour tenir compte des quatre concepts clés du plaisir d'une alimentation variée, de la satisfaction des besoins, de la protection de la qualité et de la reconnaissance du lien entre qualité des aliments et activité physique; comprendre le principe d'équilibre énergétique et de fonctionnement de l'organisme; être conscient des recommandations, orientations, faits, données et sources d'informations utiles.
Les résultats du test ont montré que le guide a été bien compris et bien accepté par les groupes cibles de collégiens, de parents et d'enseignants. La plupart des informations contenues dans la brochure n'étaient pas nouvelles pour les collégiens, qui ont fait remarquer en revanche qu'elles étaient présentées de façon plus systématique que précédemment. Les cours ont aidé les collégiens à percevoir la consommation alimentaire comme un processus actif dépendant d'eux-mêmes. Le groupe des 13 à 14 ans a été le plus réceptif au programme d'enseignement nutritionnel fondé sur le guide. La participation des parents ainsi que des collégiens à des débats sur la consommation alimentaire a été très efficace. Les parents se sont beaucoup intéressés aux problèmes liés à la consommation alimentaire et se sont dits prêts à coopérer avec leurs enfants afin d'améliorer la nutrition. On a conclu que la version russe du guide de la FAO convenait au travail d'enseignement de la population russe en matière de nutrition. L'efficacité du guide pourrait être améliorée si l'on devait l'adapter à des sous-groupes de population, déterminés en fonction de leur âge, de leur niveau d'éducation, etc. Il faudrait poursuivre l'analyse régionale et socioculturelle de l'applicabilité de cet outil de par la Fédération de Russie.

Ensayo de la versión rusa de Saque el máximo provecho de los alimentos que come

En colaboración con el Instituto Karolinska (Suecia), el Centro Nacional de Medicina Preventiva de la Federación de Rusia realizó un ensayo en Moscú sobre la guía de la FAO Saque el máximo provecho de los alimentos que come. La investigación se llevó a cabo para determinar si escolares, maestros y padres rusos comprendían la guía de la FAO. En el estudio se evaluaron las opiniones acerca de la guía de educación nutricional, se estudiaron los cambios en las actitudes hacia el régimen alimenticio y los alimentos después de cuatro breves lecciones y los cambios propuestos en la redacción o el diseño de la guía para mejorar su aceptación.
Se seleccionaron grupos en tres escuelas de los distritos central y oriental de Moscú. Los grupos estaban integrados por 81 estudiantes (de 13 a 15 años de edad), 81 padres y 28 maestros. Dos directores impartieron una serie de cuatro lecciones (de 25 minutos cada una). Se pidió a los maestros y padres que estudiaran por su cuenta el folleto. Los puntos más importantes de las enseñanzas derivadas de la guía de la FAO fueron los siguientes: adoptar un enfoque activo y consciente con respecto al consumo de alimentos y la nutrición; mejorar el régimen alimenticio teniendo en cuenta cuatro ideas fundamentales: disfrutar de la diversidad, atenerse a las necesidades, mantener la calidad y reconocer la interdependencia entre calidad de los alimentos y actividad física; comprender el concepto de equilibrio energético y funciones del organismo humano; estar al corriente de las recomendaciones, consejos, instrucciones y hechos y datos científicos y empíricos como fuentes de información útil.
Los resultados del ensayo indicaron que la guía había sido bien comprendida y aceptada por los grupos de escolares, padres y maestros. La mayor parte de la información no era nueva para los escolares, aunque advirtieron que estaba presentada de forma más sistemática que la que habían visto anteriormente. Las lecciones ayudaron a los estudiantes a comprender que el consumo de alimentos es un proceso activo que depende de uno mismo. Los escolares de 13 a 14 años de edad fueron el grupo más idóneo como destinatario del programa de educación nutricional con ayuda de la guía. La incorporación de los padres al debate sobre el consumo de los alimentos junto con los escolares fue al parecer muy eficaz. Los padres manifestaron un gran interés por los problemas del consumo de alimentos y se mostraron disponibles a colaborar en la mejora de la nutrición de sus hijos. Se consideró que la versión rusa de la guía de la FAO era adecuada para actividades de educación nutricional de la población. La eficacia de la guía podría mejorarse si se adaptara a subgrupos de la población, divididos por edades, nivel educacional, etc. Se seguirá trabajando en un análisis regional y sociocultural de la aplicabilidad de este material en Rusia.

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