The Nutrition Education DESIGN Procedure

Nutrition Education:
Linking Research, Theory, and Practice
Isobel R. Contento
with contributions from
Pamela Koch and Marissa Burgermaster
Teachers College Columbia University

| Assessment | | Intervention | | Evaluation |

D ecide Explore Select Indicate Generate Nail down

behavior(s) determinants theory & clarify general plans evaluation
of change philosophy objectives plan

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Nutrition education is a valuable part of improving the health and well-being of people everywhere. The Nutrition
Education DESIGN Procedure provides a simple and systematic way to link behavioral theory with your creativity as
a nutrition educator to generate educational plans that are engaging, evidence-based, and meaningful in promoting
healthful eating.

During the course of six easy steps, you will learn a good deal about your audience and use that information to design
group sessions, anywhere from one session to multi-session intervention. First, you will examine your audience’s issues
and behaviors of concern and their assets and decide on the behavior change focus of your session(s) or intervention.
Next, you will seek out information about how the audience might effectively be motivated to change their behavior
as well as what information and skills they need to learn in order to be empowered to do so. Then, you will use the
information you have gathered to choose an appropriate behavior change theory to guide your session or interven-
tion design. At this point you will also reflect on your personal perspectives on nutrition education. Next you will
indicate the objectives for your session(s) or intervention, and generate the educational plans you will use to teach
your session(s) or intervention. Finally, you will conclude the procedure by developing a plan for evaluating your
session(s) or intervention.

Throughout the procedure you should refer to corresponding chapters in Nutrition Education: Linking Research,
Theory, and Practice. As you learn about your audience through research literature, web sites, and stakeholders
themselves, be sure to cite these information sources as appropriate in the bibliography at the end of the workbook.

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 Nutrition Education DESIGN D ecide Explore Select I ndicate Generate Nail down
behavior(s) determinants theory & clarify general plans evaluation
Procedure of change philosophy objectives plan

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Step 1: Decide behavior change or action goal(s).

Before you design any nutrition education intervention, whether it is a few sessions or a larger intervention with several
components, it is important to learn about your primary audience. From this you will be able to determine the behaviors
and issues upon which to focus your intervention.

The Decide Behavior Change Worksheet will help you conduct assessments to obtain the information you will need
within a framework that allows for your creativity. Use this worksheet as a guide to help you decide behavioral goals for
your educational session.

Who is your audience? For example, moms, teens, older adults, diabetics, Head Start teachers
The desired audience for nutrition education intervention is school-aged children from lower income families.

What can you learn about your audience in general? What do general sources, including the research
literature and policy documents, tell you about your audience’s issues and behaviors of concern? Consider demographics,
eating patterns, and health risks. Remember, issues are health problems such as diabetes and obesity, food system
problems such as excessive energy use from over processed food, and societal issues such as unfair wages for food
workers. Behaviors include not enough fruits and vegetables, too many energy-dense snacks, etc.
Research and policies show that this pediatric population suffers from health issues such as increasing childhood obesity,
cardiovascular disease, and Type 2 Diabetes.(1)
Poor eating and general health habits going into adulthood are a possible side effect of poor nutrition issues and behaviors as
a child. (2) These behavioral issues include an increase in added sugar intake, sugar-sweetened beverages, increased
processed and fast food intake, and lower than recommended fruit and vegetable intake. (1)
Low-income families and food insecurity are shown to be an additional risk factor to obesity and poor nutritional choices. (3)

References:
1. Vos M, Kaar J, Welsh J. Added sugars and cardiovascular disease risk in children: A scientific statement from the American
Heart Association. Circulation. 2016; 135(19): e1017-e1034.
2. Dudley D, Cotton W, Peralta L. Teaching approaches and strategies that promote healthy eating in primary school children:
A systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2015; 12(28). doi: 10.1186/s12966-015-0182-8.
3. Kaur J, Lamb M, Ogden C. The association between food insecurity and obesity in children: The National Health and
Nutrition Examination Survey. J Acad Nutr Diet. 2015; 115(5): 751-758.

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 Nutrition Education DESIGN D ecide Explore Select I ndicate Generate Nail down
behavior(s) determinants theory & clarify general plans evaluation
Procedure of change philosophy objectives plan

Step 1 Step 2 Step 3 Step 4 Step 5 Step 6

What can you learn about your specific audience? What do you learn from your specific audience about
their issues and behaviors of concern through questionnaires, focus groups, interviews, and visiting the neighborhood?
From the above methods, I could learn more about why they choose higher sugar or higher fat foods, parenting styles and
education levels, household incomes that may be barriers to healthy eating, amount of people in the family to feed, food
preferences, thoughts about healthy eating, food preparation methods or abilities, and availability of healthy food options or
presence of food deserts.

What could be the behavioral goals for your session? Given the assets and concerns you described
on the previous page, list potential behavior change goals for your session(s) or intervention in the left column of
the table. Then, in the right column, consider the importance, feasibility, and desirability of each of these potential
behavior change goals and think about how modifiable and measurable each would be.

Potential Goal Considerations

Behaviors • How important is this behavior in addressing the issues of concern?
• How feasible is changing this behavior, given the time allotted and resources available?
• How desirable is changing this behavior from the audience’s point of view?
• How modifiable is this behavior by educational means?
• How measurable is change in this behavior?

To decrease added The importance of this would be to reduce obesity and diabetes risk in children by reducing the
sugar intake. food that could potentially exacerbate those conditions. This is a feasible behavior change with
parental help and support. This may not be very desirable for a child, however with education and
alternatives may be more exciting. This is modifiable and measurable.
To decrease The importance of this would be similar to the above potential goal. While a child may not be
sugar-sweetened inclined to make this change on their own and used to this taste, with parental support, education,
beverage intake. and alternative food tasting options, this could be feasible, modifiable, and measurable.

To decrease fast food This is important to reducing childhood risks of obesity, diabetes, and heart disease from high
and convenience food sugar and fat intake. Change is feasible if other low cost healthy food options are discussed for
intake. alternatives and if parents are willing to cook/prepare more at home. This is feasible, modifiable,
and measurable. This may or may not be desirable depending on current frequency of this
To increase whole fruit behavior.
This is important in meeting national guidelines for healthy intake and reducing other unhealthy
and vegetable intake. intake. This change may lower the risk of obesity, diabetes, and heart disease. This is feasible to
do with education and availability. It may be desirable if made exciting and tasty enough, as well as
including children in the selection of which ones. It is modifiable and measurable.

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 Nutrition Education DESIGN D ecide Explore Select I ndicate Generate Nail down
behavior(s) determinants theory & clarify general plans evaluation
Procedure of change philosophy objectives plan

Step 1 Step 2 Step 3 Step 4 Step 5 Step 6

What is your behavior change goal? Evaluate the information in the above table and decide on the
behavioral goal(s) for your session(s) or progam. This decision will guide you as you complete the DESIGN Procedure.

The behavior change goals are:

1. To reduce the intake of sugar-sweetened beverages. This includes soda, juices, energy drinks, and other
sugar-sweetened beverage options available to children in America.
2. To increase fruit and vegetable intake among school-aged children.

How would adopting this behavior benefit your audience? What issues of concern* will be made
better if your audience reaches your behavior change goal(s)?
Adopting this behavior could benefit school-aged children reduce overall added sugar intake and potentially reduce the
occurrence in childhood or future risk of occurrence of obesity and Type 2 Diabetes in adulthood. Additionally, this would likely
increase hydration with water or other healthier beverage options by reducing the sugar-sweetened beverage intake.

* Note: You may or may not discuss these issues of concern with your audience.

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