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close this bookNutrition education for the public. Discussion papers of the FAO Expert Consultation (Rome, Italy, 18-22 September 1995) - FAO Food and Nutrition Paper 62 - (1997)
close this folderTraining needs for nutrition education: Guidelines for in-service training of nutrition educators
View the document(introduction...)
View the documentIntroduction
View the documentBackground
View the documentTraining trainers and nutrition educators
View the documentTraining programmes for nutrition educators
View the documentOther considerations
View the documentConclusions
View the documentRecommendations
View the documentReferences
View the documentDefinitions

Training programmes for nutrition educators

After the nutrition educators have been successfully trained and have demonstrated that they are knowledgeable, competent and skilled, more specific areas of expertise must be acquired before they are ready to go into communities to teach. This section addresses these more specific issues.

Base programming on knowledge of food, nutritional needs, and problems of the population and sub-groups by employing needs assessments and other techniques

At the outset, the population most in need of nutrition education needs to be identified, and nutrition educators need to know how to do this. Such needy groups often include infants and young children, pregnant and lactating women, and the elderly. Populations may also be targeted by risk factors for disease (i.e. breast cancer in the family, chronic hypertension, high cholesterol levels, etc.).

Conduct qualitative and quantitative baseline assessments of target group

Baseline assessments of the target population with respect to their food and nutrition problems, needs, and attitudes, are crucial to developing a nutrition education campaign which will change behaviour and improve health. Knowledge of the audience is critical for health messages. Such information is used widely today in social marketing as well as in product-focused messages by marketers.

Qualitative methods of needs assessment include using focus groups and surveys, or compilation of information on knowledge, attitudes, and practices of the target group. Quantitative assessment tools include anthropometric measurements, such as height and weight (plotted on growth charts), morbidity and mortality statistics, information on dietary intake, and information on biochemical and clinical measures of nutritional status from screening tests or surveys.

Identify factors to be changed in the target population

Identify barriers to better dietary habits and better health

Once the population needing help is identified and characterised through the use of qualitative and quantitative methods, the next step the nutrition educator takes is to identify major factors affecting food habits that can be changed. This information will help to identify barriers to better dietary/food habits and better health that can be overcome. In addition to lack of knowledge, other factors influencing nutritional status and dietary habits usually include economic, cultural, and social factors, individual preferences, lifestyles, and time constraints. Nutrition education cannot address all of these problems or overcome all of the barriers they create (Parlato, Green, Fishman, 1992). Therefore realistic objectives that stand a chance of success must be chosen.

Be aware of factors affecting local food supply as well as individual dietary behaviours

For solving some problems, the nutrition educator’s knowledge of diet-related factors affecting health should also include knowledge of the local food supply and of the health and education sectors. Nutrition educators must be aware of all the aspects of food-getting that may be affecting health: acquisition, selection, preparation, storage, and consumption. Their knowledge must also include a broad range of factors affecting the food supply, in addition to individual dietary behaviours. Specific information describing the food and food habits of the target population should also be available to nutrition educators. This information is summarised in Table 11.

Table 11: Knowledge of local food and foodways useful to nutrition educators

What

Includes...

Nutritional value of foods

Food tables (as relevant to country), charts, computer programmes, etc. With a proper introduction on how to use them, and opportunities for practice, evaluation and feedback, much valuable information is available

Effects of processing (preservation and cooking) on nutrient values

Knowledge of the effects of food preservation and cooking on nutrient values, to include local methods of keeping food and popular/traditional cooking methods. Relevant questions may involve issues about whether any of these compromise the nutritional value of the food such that they should be changed

Food safety and hygiene

General information on foodborne illness and pathogens most likely to affect target audience

Selecting foods for sustainability and good nutritional and economic value

Need knowledge of indigenous food supply (what is available and at what cost); seasonal trends affecting cost; how to best store foods to make them last longer and keep nutritional value

Knowledge of production and marketing of foods (“Foodways”)

Knowledge of how the food is produced, processed, distributed, regulated, marketed, etc.; and how these factors affect eating/nutrition behaviours targeted for change and health improvement

Consumer issues

Factors affecting access to food and food choices available to your target population as consumers

Practical skills as needed

How to: cook, preserve foods, practice safe food handling techniques, etc., especially skills which need to be taught or modified to improve nutritional status

Consider other influential factors that induce acceptance

A thoughtfully delivered, clear message is effective only if it addresses some factor that influences the behaviour of interest in the learner. Other factors that influence food and nutrition-related behaviours include values, attitudes, social and cultural norms, perceived social pressure, a sense of personal competency and control, and perceived rewards and other motivators that may result from following the recommended behaviour. Barriers to consumer education include, among others: language used, illiteracy, and the existence of conflicting messages (Macfarlane, 1993). Individuals with experience and insights about the target population’s views on these issues, levels of understanding, and conflicting cultural beliefs or messages, may be helpful in identifying these factors and useful in training.

Use the media effectively

Rules of thumb for appropriate use of the media to communicate the message are included in Table 5. Local media channels used most frequently by the target population should be considered (within budgetary constraints). The use of “mini-media”, such as church bulletins, worksite publications, and bulletin boards at various organisations, can also be very useful in reaching individuals where they work and play, although they are often underused in public health programmes (Lasater, 1988).

In-service education of nutrition educators should be accompanied by back-up assistance for communicating, disseminating and marketing their messages. One way to help them is to identify local channels of communication, such as local media (radio, TV, newspaper), some basic community action skills including locally appropriate methods of contacting key leaders in the field and political figures with whom it may be helpful to network.

Develop support strategies

Look within the community to develop support for interventions

Apply interventions with, rather than to, a community or group. This implies developing supportive structures in the community. Sophisticated health education efforts involving many aspects of the community have been well reported in the literature (Pirie et al., 1986; Linnan, 1990; Flora, Maccoby, Farquhar, 1990). Looking to the community for involvement is advantageous because communities can provide both valuable human resources and sources of support among the target audience that cannot be simulated or equalled by external efforts. The nutrition educator needs to know how to select and implement appropriate support strategies for education and communication efforts. These include skills in mobilising social support, using home gardening, school meals, and otherwise involving the community through organisations and community leaders.

Reach audiences beyond health systems in places that are familiar

Adult learning theories emphasise the advantage of working in a relaxed, trusting, mutually respectful, informal, warm, and collaborative climate, which supports efforts to reach people in their day-to-day comfortable, relevant settings. This is what is meant by a “supportive environment”. Educating people where they work, live and play rather than just within health systems must be considered. Such settings include households, local communities, schools, worksites, markets and shops, and recreational and cultural settings which are closer to the point at which food choices are actually made. The United States’ “5-A-Day” Campaign for increasing the consumption of fruits and vegetables targeted people in a work setting and has made use of the particular attributes of this environment for a nutrition education campaign (Sorenson, 1990).

Know and choose appropriate networks and contacts for nutrition education

Develop skills for long term collaboration and institutionalisation of programmes into community life

Community interventions seek to change organisations and environments as well as individuals. The nutrition educator must keep in mind that his or her work is in a long time frame since the aim is for permanence in community life. The goal is community improvement over the long run (Parlato, Green, Fishman, 1992). Therefore the nutrition educator needs to develop skills that permit collaboration with a range of different organisations and disciplines over a long time.

Influence and seek co-operation with community leaders and pro-established networks

Community leaders and networks are often effective channels for promoting solutions to nutrition problems. Community involvement and commitment should therefore be sought at various levels. The accomplished nutrition educator uses the influence of community members, such as officials, elders, group leaders, and community health volunteers, as well as contacts with “higher ups” in the community who can make efforts work more smoothly, and without whose co-operation the efforts may be difficult or impossible. For example, the Pawtucket Heart Health Programme in the United States turned to the community for volunteers and was able to staff many programmes with these resources. It also formed alliances with organisations including the local Department of Parks and Recreation, which provided facilities for unique opportunities in the campaign (Lasater, 1988). The Thailand vitamin A project integrated many influential people from all parts of the community and used them as channels in their efforts to reach village residents with their messages. Some of these channels included: district agriculture and primary school offices; district education offices; school and village communities; village volunteers; health centres; Buddhist monks; mobile drama groups; folk singers; and public address systems, radio spots and programmes, audio-visual materials and billboards.

Collaborate with other organisations/or more efficient and effective use of resources

The nutrition educator needs to know where and how to obtain an appropriate audience. Other agencies may share concern about the target population and may be ripe for collaboration. Sharing outreach efforts, facilities, channels of communication, and even education campaigns, are opportunities for using resources more efficiently and perhaps increasing effectiveness.

Ensure that specific knowledge needs for the task at hand have been imparted

Content as well as process are important in nutrition education. After assessment and targeting of those in need of nutrition education, some information and skills need to be transmitted. The subject matter detail that is necessary depends on the prior skills and knowledge of the nutrition educators who are trainees, and also the task at hand. While providing more facts in training does not increase effectiveness as educators, more knowledgeable educators may have more credibility with their audience and should be included in the training as appropriate.