Self lf-efficacy efficacy & ho & home me fo food od avai ailabi labilit lity y is s ass ssociat ociated ed wi with th health althy me meal l pre repa paratio ration n pra ractices ctices in Kua uala la Lum umpur pur child ldren ren Presented by, Asst. Prof. Dr. Satvinder Kaur
In Introduction Increased in fruits & vegetables preference and intake Increased food group intake: grains & milk Willingness to taste novel foods Healthy Meal Preparation in Children Chu et. al. 2013, Chu et. al. 2014, Van der Horst et. al. 2014, Allirot et al. 2016, Cunningham-Sabo and Lohse 2013.
Conceptual Framework Knowledge, Attitude & Self-efficacy towards healthy meal preparation Home Food Availability Fruits, vegetables, ready-to-eat Practices of Healthy (healthful & less healthful) Meal Preparation
Objectives To determine children’s knowledge, attitude, practice and self- efficacy towards healthy meal preparation To determine home food availability of children aged 9 to 11 in Kuala Lumpur To identify factors associated with good practices of healthy meal preparation among children
Cross-Sectional Study Convenienc Stratified Simple e Sampling Random Random to recruit Sampling: Sampling to eligible Bangsar-Pudu select children in Keramat schools from ‘ Sekolah schools Sentul each zones Kebangsaan ’ in Kuala Lumpur Jabatan Pendidikan Wilayah Persekutuan Kuala Lumpur 2011.
In Inclusion & Exclusion Criteria Inclusion Exclusion Malaysian children aged 9-11 Physically & mentally disabled children Able to read, write understand Children with any co-morbidities English/Malay language Without parent’s consent Children that expressed interest to participate 6
Data Collection Healthy meal preparation questionnaire was distributed to children Children were guided to complete the questionnaire Anthropometry assessment • Height: Portable stadiometer Seca 213 • Weight Tanita body composition analyzer SC-330 Parents received & submitted the home food environment questionnaire via their child 7
Eth thic ics Medical Ministry of Kuala Lumpur Research & Education Education Ethics Malaysia Department Committee Approval Information Assent from from Principal Sheet & Eligible of Primary Consent Form Students Schools for Parents
Results & Discussions
Children Characteristics (n (n=200) Characteristics n (%) Age 9 (Standard 3) 113 (56.5) 10 (Standard 4) 58 (29.0) 11 (Standard 5) 29 (14.5) Gender Boy 85 (42.5) Girl 115 (57.5) Monthly Household Income ≤ RM 2500 62 (31.0) RM2501-RM5500 73 (36.5) > RM5500 65 (32.5)
Children Weight Status (n (n=200) Parent’s concern of child 60 becoming overweight 49.5 50 47.5% of parents Percentage % 40 33.5 were concerned of their 30 child becomes overweight 20 14.0 21.5% of parents 10 [VALUE].0 were very concerned of their child becomes overweight 0 Thinness Normal Overweight Obese *According to BMI z-score
Chil ildren Psychosocial Scores* (n (n=200) 𝑵𝒇𝒃𝒐 𝑵𝒃𝒔𝒍𝒕 *Score= 𝑼𝒑𝒖𝒃𝒎 𝑵𝒃𝒔𝒍𝒕 x 100% 78.97 75.93 62.78 60.97 Percentage % Knowledge Attitude Self-efficacy Practice
Home Food Avail ilabili lity Score* 𝑵𝒇𝒃𝒐 𝑵𝒃𝒔𝒍𝒕 *Score= 𝑼𝒑𝒖𝒃𝒎 𝑵𝒃𝒔𝒍𝒕 x 100% 50.81 50.18 44.44 Percentage % 30.56 Fruits at Home Vegetables at Ready-to-eat Ready-to-eat Home Food (Healthful) Food (Less Healthful)
Factors Correlated wit ith Healt lthy Meal l Preparation Practic ices Social Cognitive Theory Variables Pearson p-value correlatio n Individual Factors (Attitude, Self- Knowledge 0.133 0.061 efficacy) Attitude 0.344 <0.001* Self-efficacy 0.501 <0.001* Fruits at Home 0.304 <0.001* Environment Behaviour Vegetables at Home 0.248 <0.001* (Home Food (Practice) Ready-to-eat (Healthful) 0.227 0.001* Availability) Ready-to-eat (Less Healthful) -0.017 0.811 n=200, p significant at <0.05 Bandura 1999.
Factors Associated with Healthy Meal Preparation Practices Variables β 95% Cl p-value Knowledge - -0.38-0.18 0.497 0.04 Attitude 0.06 -0.12-0.28 0.416 Self-efficacy 0.43 0.24-0.49 <0.001* Fruits at Home 0.21 0.11-0.68 0.007* Vegetables at Home 0.89 -0.09-0.34 0.251 Ready-to-eat Food 0.03 -0.23-0.41 0.662 (Healthful) Ready-to-eat Food (Less - -0.64-(-0.07) 0.015* Healthful) 0.36 𝑆 2 =.325, dependant variable= healthy meal preparation practices, p significant at <0.05
Discussions In this study, higher self-efficacy was associated with increased frequency of healthy meal preparation ( β =0.43) A study conducted among Canadian children showed that preparing meals at home daily is achieved through high self-efficacy ( β =2.88) Children’s confidence & belief that they can accomplish healthy meal preparation tasks may be a driving force that lead to the behaviour Children with higher self-efficacy may also be healthier eaters who are more interested in food-related activities (meal preparation) Chu et at. 2013, Woodruff and Kirby 2013, Bandura 1999.
Dis iscussions There are limited studies that explored home food availability as a factor for healthy meal preparation practices among children Studies demonstrated that home food availability can influence the development of nutrition-related behaviors in children Less availability of obesity-protective food predict lower consumption levels . Higher availability of obesity risk-factor food predict higher consumption. Modifying the ‘obesogenic’ environment could produce a more lasting effect on behaviour change – consumption & practice of healthy meal preparation Osei-Assibey et. al . 2013, Jin and Jones-Smith 2015, Savage et. al. 2007, Rosenkranz and Dzewaltowski 2008, Swinburn 2011 et. al. 2011.
Conclusion Children’s knowledge, attitude & self-efficacy score towards healthy meal preparation were moderate Parents reported a variety of fruits & vegetables available in their home, however, they also had various unhealthy snack & drink options The practice of healthy meal preparation among children was lacking Self-efficacy & home food availability should be improved to encourage the practices of healthy meal preparation in children
References 1. Chu, Y.L., Farmer, A., Fung, C., Kuhle, S., Storey, K.E. and Veugelers, P.J., 2013. Involvement in home meal preparation is associated with food preference and self-efficacy among Canadian children. Public Health Nutrition , 16(01), 108-112. 2. Chu, Y.L., Storey, K.E. and Veugelers, P.J., 2014. Involvement in meal preparation at home is associated with better diet quality among Canadian children. Journal of nutrition education and behavior , 46(4), 304-308 3. Van der Horst, K., Ferrage, A. and Rytz, A., 2014. Involving children in meal preparation. Effects on food intake. Appetite , 79(1), 18-24. 4. Allirot, X., da Quinta, N., Chokupermal, K. and Urdaneta, E., 2016. Involving children in cooking activities: A potential strategy for directing food choices toward novel foods containing vegetables. Appetite , 103 (1), 275-285. 5. Cunningham-Sabo, L. and Lohse, B., 2013. Cooking with kids positively affects fourth graders' vegetable preferences and attitudes and self- efficacy for food and cooking. Childhood Obesity , 9(6), 549-556. 6. Jabatan Pendidikan Wilayah Persekutuan Kuala Lumpur 2011. Sekolah-Sekolah Wilayah Persekutuan Kuala Lumpur. [online] Jpwpkl.moe.gov.my. Available at: http://jpwpkl.moe.gov.my/index.php/sekolah [Accessed 1 Jan. 2018]. 7. Bandura, A., 1999. Social cognitive theory: An agentic perspective. Asian Journal of Social Psychology , 2(1), 21-41. 8. Woodruff, S.J. and Kirby, A.R., 2013. The associations among family meal frequency, food preparation frequency, self-efficacy for cooking, and food preparation techniques in children and adolescents. Journal of nutrition education and behavior, 45(4), 296-303. 9. Osei-Assibey, G., Dick, S., Macdiarmid, J., Semple, S., Reilly, J.J., Ellaway, A., Cowie, H. and McNeill, G., 2012. The influence of the food environment on overweight and obesity in young children: a systematic review. BMJ open , 2(6), e001538. 10. Swinburn, B.A., Sacks, G., Hall, K.D., McPherson, K., Finegood, D.T., Moodie, M.L. and Gortmaker, S.L., 2011. The global obesity pandemic: Shaped by global drivers and local environments. The Lancet , 378(9793), 804-814. 11. Jin, Y. and Jones-Smith, J., 2015. Associations between family income and children’s physical fitness and obesity in California, 2010 – 2012. Preventing Chronic Disease , 12(1), 1-9. 12. Savage, J.S., Fisher, J.O. and Birch, L.L., 2007. Parental influence on eating behavior: conception to adolescence. The Journal of Law, Medicine & Ethics , 35(1), 22-34. 13. Rosenkranz, R.R. and Dzewaltowski, D.A., 2008. Model of the home food environment pertaining to childhood obesity. Nutrition reviews , 66(3), 123-140.
Sample Size Determination 𝑎 2 𝑄 1−𝑄 n = 𝑒 2 [34] Where n is the sample size, Z = Statistic corresponding to level of confidence of 95%, Z value is 1.96. P = Expected prevalence 0.148, National prevalence of childhood obesity in Malaysia (aged 5 to 9) is 14.8% [1] d = Precision of 5%, thus 0.05 Hence: n = 1.96 2 0.148 (1-0.148) 0.05 2 n = 193.7642 ≈ 194 To avoid of non-compliance & non-response, sample size is increased (±20%) to 233
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