Nutrition Education - Design

Programs in various sectors increasingly include nutrition improvement as part of their overall objective. It is often assumed that nutrition-related problems are mainly a result of lack of knowledge. However, for improving nutrition it is also crucial to take into consideration other factors which underlie people’s food choices and habits. Studies that assess and analyze people’s nutrition, knowledge, attitudes and practices (KAP) are a useful method for gaining necessary insights.

Analyzing the situation forms the basis for planning nutrition education and should include:

Identification of local nutrition problems and the underlying social cultural and environmental factors for which secondary sources (e.g. national health statistics) can be used. Subsequently nutrition issues that are most amenable to educational means should be prioritized;
Identification of people’s practices that are underlying the nutrition problems
Identification of intrapersonal determinants of these practices, such as nutrition-related knowledge and attitudes, generating insights into the social, psychological and behavioral determinations of nutritional status.

Subsequently it is necessary to:

Identify gaps in people’s knowledge, attitudes and dietary practices
Identify priority needs in nutrition education with a view to informing project or intervention design.

Knowledge refers to an individual’s understanding on nutrition, including the intellectual ability to remember and recall food- and nutrition related terminology, specific pieces of information and facts.

Attitudes are emotional, motivational, perceptive and cognitive beliefs that positively or negatively influence the behavior or practice of an individual. Attitudes influence future behavior no matter the individual’s knowledge and help explain why an individual adopts one practice and why not other alternatives.

Practices are defined as observable actions of an individual that could affect his/her or others ‘nutrition, such as eating, feeding, washing hands, cooking and selecting foods. Practice can also be described as long-standing or commonly practices behavior.

Broader situation analysis: taking social and environmental factors into account Diet and health-related KAP studies focus on factors inherent in an individual (or group of people). For a more comprehensive understanding, one would also need to explore the relation between the different elements of the aforementioned social cultural, environmental and intrapersonal factors and the actual nutrition-related behaviors and practices. This is visualized in the figure below.

Figure: Social, environmental and intrapersonal factors affecting practices

Source: adapted from Guidelines for assessing nutrition-related knowledge, attitudes and practices. FAO. 2014.

To measure knowledge it is recommended to use partially categorized questions. This are open-ended questions that require respondents to provide short answers in their own words, accompanied by a list of correct answers plus the options “other” and “don’t know”. Predefined options make analysis easier by listing expected responses.

Example: At what age should babies start eating foods in addition to breast milk?

□ at six months
□ other
□ don’t know
Preliminary analysis: □ knows □ does not know

Attitudes are measured by asking the respondents to judge whether they are positively or negatively inclined towards:

A health or nutrition problem
An ideal or desired nutrition-related practice
Following nutrition recommendations or food-based dietary guidelines
Food preferences or
Food taboos

The respondent is asked to rate his/her answer on a three point scale, called a Likert scale. The respondent is offered three response options: 1) positive or agree , 2) ‘middle option’ – that captures attitudes that are still uncertain, and 3) negative or disagree. These options can be visualized with ‘smileys’.

Food taboos are dietary rules in a given culture, society of community that prescribe or proscribe certain food items or uses. Food taboos are often associated with special events of phases of the human life cycle, such as illness, menstruation, pregnancy, childbirth, lactation, weddings, funerals, etc. Many taboos concern the consumption of animal-source foods, often by those groups of the community most in need of protein. Food taboos can be assessed by evaluating the level of agreement with them. Only food taboos that could negatively affect nutritional status need be assessed, as these are the only ones that need to be modified.

Nutrition related practices could be assessed in terms of:

Dietary diversity (quality of the whole diet)
Intake of specific foods
Frequency of intake of specific foods
Specific observable behaviors.

For more information on tools to measure dietary diversity and infant and young child feeding practices please refer to the Food Pedia page on monitoring nutritional situation.

For more hands-on information on KAP studies please refer to the FAO KAP manual ¹, which offers guidance and practical steps for planning and conducting a KAP survey and for analyzing and reporting the survey findings.