Change in Eating Behaviour

Abstract

There is a marked decline in nutritional knowledge as a prerequisite for healthy eating habits and
lifestyle. Unhealthy lifestyle and behaviours have been attributed to the high incidents of nutrition-
related diseases such as cancer and diabetes. As a result, several agencies have embarked on
behaviour change interventions that focus on dietary habits and lifestyle. One such program is the
Cook For Life session by Bartis hospital. This study sought to identify the degree of change in
eating behaviour of parents who have attended the healthy eating sessions. The study involved 137
parents living in the London Borough of Tower Hamlets. Data from the Barts NHS London
Hospital, which consisted of completed pre and post educational session questionnaires from three
years, 2012, 2013, and 2014, was used. The self-admitted questionnaires against population-based
eating guidelines by respondents who had attended a healthy eating educational programme were
then analysed using the SPSS. The findings were then analysed and interpreted using frequency
distribution tables and the respective percentages. In the past, most of the interventions aimed at
promoting healthy eating habits have been school-based. The Cook For Life intervention program
employed a totally different approach for reaching out to families, one that involved the parents as a
starting point and an avenue to bring about the desired change for the whole family. This study has
the potential to guide future research on the role and effectiveness of intervention programs on
behaviour change in eating healthily.
Keywords: healthy eating habits, self-evaluation questionnaires, cook for life, behaviour change.

Change in Eating Behaviour after Intervention 2

To Identify Through the Use of Self-Evaluation Questionnaires, the Degree of Change in Eating

Behaviour of Parents Who Have Attended Healthy Eating

Introduction

Families often have poor eating and dietary habits, making them vulnerable to the many
risks presented by nutritional inadequacies. As a result, intervention programmes such as training
and healthy living campaigns have a fundamental role in reversing these trends (Ruxton &
Derbyshire, 2014, p. 33). Most importantly, parents should be educated and trained on consumption
of fresh fruits, fresh vegetables, and fibre. One such initiative is one undertaken by Bartis NHS
London hospital whose data was used as a source of secondary data for this study. Parents, as well
as their children, require sufficient nutrients and energy to sustain the normal metabolic and
physical functioning, and more importantly to support growth and development (Schuster et al.,
2013, p. 80). For instance, children grow rapidly in their first year of their life, and this forms a
stage in which they acquired substantial physical and mental skills, before settling into more steady
growth (Winham et al., 2014, p. 99). Consequently, adolescents and young adults also require
proper nutritional balance to cater for their body needs as they transform into adults with new
emotional, mental, and physical capabilities (Park et al., 2013, p. 655). As such, nutrition
inadequacies during these very early stages can have very negative impacts on short and long-term
health and wellbeing.
While there is sufficient evidence on the ill impacts of the nutritional deficiencies in
developing countries, where food insecurity is a major concern, there are just a few studies on the
effects of poor diet and initiatives taken to address the situations in the developed world (Sperry et
al., 2014, p. 218). One such study was done by the National Diet and Nutrition Survey (NDNS) of
19 to 64-year-olds in the UK over a period of 10 years and published in 2012. Each of the age

Change in Eating Behaviour after Intervention 3
groups failed to meet dietary targets especially for sugars and fibre. Intake of fruit and vegetables
were particularly very low in adults at only two portions per day (Ostbye et al., 2012, p. 186).
On the basis of evidence from such findings concerning dietary intakes, it is necessary to
develop health promotion initiatives for target groups. Godsey (2013, p. 430) postulates that such
programs should include advice on reduction of the consumption of sugar, saturated fat, salt, and
alcohol. Families should be advised and trained to instead develop new dietary habits such as intake
of fibre-rich foods, important micronutrients, as well as fruits and vegetables (Tatlow-Golden et al.,
2013, p. 164). Papaioannou et al. (2013, p. 645) note that an analysis of studies on the most
successful dietary interventions undertaken across the world shows the most common interventions
to be educational sessions, distribution of brochures and newsletters, and teacher training programs.
A fruit and vegetable sense session conducted in Australia targeted at parents resulted in significant
improvements in children intake of fruits and vegetables increasing servings by about 0.62 (Bean et
al., 2014, p. 315).
This study sought to identify the degree of change in eating behaviour of parents who have
attended healthy eating education groups. The analysed data focused on evaluating the health
changes achieved by parents who were involved in a healthy eating session that was aimed at
improving their dietary intake. The healthy eating sessions focused on educating the participants on
reducing the sugar intakes, and increase in the consumption of fresh fruits, consumption of fresh
vegetables, and fibre intake as well as the overall changes in the eating behaviour of the families of
the participating parents after intervention. The use of secondary data from the hospital was found
effective due to the nature of the information required for this study. The hospital provided credible
data concerning dietary intervention that would not have been found elsewhere, and that was
relevant for the purpose of the study (Chahal et al., 2014, p. 190). It also saved time and provided a
cost efficient source of the required data. Data acquired from the hospital offered an opportunity to
compare the impact of the three different years of intervention as a basis for understanding how
effective and successful such initiatives are in addressing the dietary problem.

Change in Eating Behaviour after Intervention 4

Methods

The study involved 137 parents with children aged between 0-5 years of age and living in
the London Borough of Tower Hamlets. Data from the Barts NHS London Hospital was used for
the analysis. The data consisted of completed pre and post educational session questionnaires from
three years, 2012, 2013, and 2014. The questionnaires, which were self-admitted against
population-based eating guidelines by respondents who had attended a healthy eating educational
programme, were then analysed using the SPSS to acquire a statistical outcome. The findings were
then analysed and interpreted using frequency distribution tables and the respective percentages.

Analysis

Descriptive statistics (frequencies and mean) were used for the analysis of the findings.
Analyses are organized in demographics, sugar intakes, fruits and vegetables intakes, and fibre
intakes. Respondents consisted of 137 parents who had participated in a Cook For Life program in
2011, 2012, and 2013. They comprised of adults of origins ranging from Bangladeshi, Chinese,
Indian, Pakistan, other Asian backgrounds, Caribbean, Somalis, other Africans, other Blacks,
British, and other White background.
Demographics
Table 1: Ethnicity population representations of the study

Ethnicity Percent
Bangladeshi 28.5
Chinese 5.1
Indian 8.0
Pakistani 1.5

Change in Eating Behaviour after Intervention 5
Other Asian background 13.1
Caribbean .7
Somali 7.3
Other African 3.6
Other black .7
British 13.9
Other white background 14.6
White and Black Caribbean .7
Not known 2.2
Total 100.0

The study population was representative in terms of racial characteristics as indicated in the table 1
above with respondents comprising of Europeans, African Americans, Africans, Asians, and
Caribbean.

Table 2: Respondents treated for co-morbidities
Conditions Yes No
Treated for any heart conditions 0% 100%
Treated for stroke 0.7 % 99.3%
Treated for high-blood pressure 2.2% 97.8%
Treated for diabetes 4.4% 95.6%
Treated for high-blood cholesterol 1.5% 98.5%
Treated for bone and muscle problems 10.2 % 89.8%
Treated for asthma or other respiratory diseases 3.6 % 96.4%
Treated for overweight 6.6% 92.7%

Change in Eating Behaviour after Intervention 6
Table 3: General health at present

Percent

Good for my age 29.9
Average for my age 42.3
Very good for my age 22.6
Poor for my age 2.9
Very poor for my age 2.2
Total 100.0

Table 4: Do you know how to improve your/your family eating habit?

Percent
Pre Post
Yes No Yes No

52.6 47.4 99.3 0.7

McNemar Test for table 4

Value df p-value

McNemar-Browker
Test

Not given Not given 0.000
(binominal
distribution used)

Change in Eating Behaviour after Intervention 7

Health statistics reveals that a cross-section of the respondents has been treated for
nutritional related diseases such as diabetes, muscle and bone problems, and high-cholesterol
problems. Diabetes, respiratory diseases, and high-blood pressure forms the largest proportions of
the diseases treated in table 2. Most of the respondents feel that their current health is only average
42.3% compared with only 22.6% who believe that their health is very good for their age. The
impact of the session is also evident on the great change demonstrated by the responses of the
parents concerning whether they know how to improve the family’s eating habits pre at 52.6% and
after 99.3% the programme.

Sugar

Tables for Sugar
Table 5: Use of sugar in cooking pre and post course
Description Percent

Pre Post
Too little sugar 20.4 1.5
About the right amount of
sugar

57.7 15.3

Too much sugar 13.1 81.0
Don’t know about sugar 8.8 2.2

Change in Eating Behaviour after Intervention 8

McNemar Test of Table 5

value df P value
McNemar-Bowker 89.645 5 0.000

Table 6: Do you measure sugar before you add them? Pre and post
Description Percent

Pre Post
Yes 24.8 73
No 75.2 27

McNemar Test of Table 6

value df P value
McNemar-Bowker not given Not given 0.000

Table 7 (a): Teaspoons of sugar in tea/coffee pre-course before attending the course
Number of teaspoons (n=137)

Percent
3 2.2
4 0.7
5 or more 2.2
none 38.0

Change in Eating Behaviour after Intervention 9
1 36.5
2 20.4

Table 7 (b): Teaspoons of sugar in tea/coffee post course after attending the course
Number of teaspoons (n=137)

Percent
none 40.9
1 53.3
2 5.8

Table 8 (a): Parents intake of confectionary, cakes and biscuits before attending course

Confectionary
(n=137)

Cakes and biscuits
(n=137)
Frequency Percent Percent
>once per day 7.3 10.9
Daily 8.8 17.5
5-6 times a week 5.1 8
3-4 times a week 13.1 13.9
1-2 times a week 29.2 32.8
Once per month 16.8 8.8
< once per month 4.4 2.2
Rarely or never 15.3 5.8

Change in Eating Behaviour after Intervention 10
Table 8 (b): Parent’s intake of confectionary, cakes and biscuits after attending course

Confectionary
(n=137)

Cakes and biscuits
(n=137)
Frequency Percent Percent
More often 0.7 1.5
About the same 13.9 10.9
Less often 78.1 83.9
Don’t know 7.3 3.6

Table 9 (a): Child’s intake of confectionary, cakes and biscuits before attending course

Confectionary
(n=137)

Cakes and biscuits
(n=137)
Frequency Percent Percent
>once per day 2.9 2.9
Daily 8.0 19.0
5-6 times a week 3.6 5.1
3-4 times a week 13.9 14.6
1-2 times a week 27.7 36.5
Once per month 10.2 4.4
< once per month 2.9 1.5
Rarely or never 30.7 16.1

Table 9 (b): Child’s intake of confectionary, cakes, and biscuits after attending course

Confectionary Cakes and biscuits

Change in Eating Behaviour after Intervention 11

(n=137) (n=137)
Frequency Percent Percent
More often 0 2.2
About the same 15.3 13.1
Less often 77.4 79.6
Don’t know 7.3 5.1

The impact of the change in eating habit is again evident from the statistics about the sugar
intake levels before and after the programme. One of the aims of the study was to reduce sugar
intake. The drop in sugar intake levels and change in eating habit in the use of sugar by measuring
before use are significant as represented by the P-value of 0.00. The results also reveal that parents
were able to significantly adjust the amount of sugar added into tea/coffee with a shift of those who
used one teaspoon before the study rising from 36.5% to 53.3% and those who used two reducing
from 20.4% to 5.8%. Consequently, the use of confectionary cakes, and biscuits on very regular
basis for both parents and children improved greatly.
Fruits and Vegetables

Table 10: McNemar Test – Parents portions of fresh fruits a day before and after attending cook for
life course

Value df p-value

McNemar-Browker
Test

60.492 14 0.000

Table 11: McNemar Test – Parents portions of dried fruits a day before and after attending cook for
life course

Change in Eating Behaviour after Intervention 12

Value df p-value

McNemar-Browker
Test

23.905 12 0.021

Table 12: McNemar Test – Parents portions of vegetables a day before and after attending cook for
life course

Value df p-value

McNemar-Browker
Test

34.128 14 0.002

Table 13: McNemar Test – Parents portions of fruit juice a day before and after attending cook for
life course

Value df p-value

McNemar-Browker
Test

15.043 13 0.305

Table 14: McNemar Test – Child portions of fresh fruits a day before and after attending cook for
life course

Value df p-value

McNemar-Browker
Test

41.010 13 0.000

Change in Eating Behaviour after Intervention 13
Table 15: McNemar Test – Childs portions of dried fruits a day before and after attending cook for
life course

Value df p-value

McNemar-Browker
Test

14.814 12 0.252

Table 16: McNemar Test – Childs portions of vegetables a day before and after attending cook for
life course

Value df p-value

McNemar-Browker
Test

29.870 13 0.005

Table 17: McNemar Test – Childs portions of fruit juice a day before and after attending cook for
life course

Value df p-value n

McNemar-
Browker Test

12.986 15 0.603 137

Change in Eating Behaviour after Intervention 14
Another main aim guiding the study was to analyse the degree of increase of the intake of
fruits and vegetables for parents and their children after attending cook for life programme and
compare that with statistics of habits before the session. The findings showed that the session had a
great impact in the proportions of fruits and vegetables. The change in the parent’s portions of fresh
fruits and vegetables intake a day is valid as indicated by a P-value of 0.000 and that of 0.002
respectively). For children, the change in the proportions of fresh fruits and vegetables intake a day
is also significant (P-value of 0.000 and 0.005). However, there impact seems not to be significant
in the uptake of fruit juice a day for both children and parents (P-value of 0.603 and 0.305
respectively).

Fibre

Table 18 (a): Parents’ intake of fibre containing foods before attending Cook For Life

Wholemeal Bread
(n=137)

Brown Rice
(n=137)

Wholewheat Pasta
(n=137)
Frequency Percent Percent Percent
>once per day 5.8 0.7 0
Daily 42.3 8.0 1.5
5-6 times a week 5.8 0 1.5
3-4 times a week 13.1 0.7 4.4
1-2 times a week 10.2 9.5 27.7
Once per month 2.2 8.0 11.7
< once per month 2.2 5.8 6.6
Rarely or never 18.2 67.2 46.7

Table 18 (b): Parents’ intake of fibre containing foods after attending Cook For Life

Change in Eating Behaviour after Intervention 15

Wholemeal Bread
(n=137)

Brown rice
(n=137)

Wholewheat Pasta
(n=137)
Frequency Percent Percent Percent
More often 46.0 32.1 31.4
About the same 38.0 33.6 37.2
Less often 8.0 16.1 14.6
Don’t know 8.0 18.2 16.8

Table 19 (a) : Child intake of fibre containing foods before attending Cook For Life

Wholemeal Bread
(n=137)

Brown Rice
(n=137)

Wholewheat Pasta
(n=137)
Frequency Percent Percent Percent
>once per day 6.6 2.2 1.5
Daily 30.7 4.4 0.7
5-6 times a week 8.8 0.7 4.4
3-4 times a week 16.1 4.4 9.5
1-2 times a week 9.5 6.6 20.4
Once per month 0.7 9.5 8.8
< once per month 2.2 4.4 6.6
Rarely or never 25.5 67.9 48.2

Table 19 (b): Child intake of fibre containing foods after attending Cook for Life

Wholemeal Bread
(n=137)

Brown rice
(n=137)

Wholewheat Pasta
(n=137)

Change in Eating Behaviour after Intervention 16
Frequency Percent Percent Percent
More often 33.6 24.8 28.5
About the same 36.5 32.8 38.0
Less often 18.2 21.2 16.1
Don’t know 11.7 21.2 17.5

This study also sought to identify the impact of the dietary education after the sessions in
increasing the intake of fibre containing foods as compared with the same before the programme.
The findings demonstrate a contrasting trend from that of the other two categories; consumption of
vegetables and fruits, and sugar intakes where significant change in behaviour was reported. In this
case, the change in behaviour was considerately on the minimal. The number of parents who
consumed about the same amount of whitemeal bread, brown rice, wholewheat pasta after the
intervention remained substantially high with a percentage of 38%, 33.6%, 37.2% respectively. The
same scenario was reported with the case of the children. The number of children who consumed
about the same amount of whitemeal bread, brown rice, and wholewheat pasta remained high as
demonstrated by the high percentages of 36.5%, 32.8%, and 38% respectively.

Discussion

The main findings of the study showed a decrease in the amount of sugar consumption,
increase in fruit and vegetable consumption, and little increase in fibre intake. Indeed, the drop in
sugar intake levels and change in eating habit in the use of sugar exhibited a notable change. Again,
parents were able to significantly adjust the amount of sugar added into tea/coffee while the use of
confectionary cakes, and biscuits on very regular basis for both parents and children improved
greatly. The findings also showed that the session had a great impact in the proportions of fruits and
vegetables consumption among the parents and children. The change in the parent’s portions of
fresh and dried fruits and fresh fruit juice intake a day was found to have increased significantly.

Change in Eating Behaviour after Intervention 17
Although, the change in the proportions of fresh fruits and vegetables intake a day for children had
a positive outcome there was little impact on the intake of fruit juice. Concerning fibre intake, there
was little change in habit in consumption of about the same amount of whitemeal bread, brown rice,
wholewheat pasta after the intervention among the parents and children.
About 70 percent of adults have been found to engage in unhealthy behaviours including
poor diet, smoking, and lack of exercise leading to obesity and overweight (Mazzeo et al., 2013, p.
176). The situation is worse for those in the lower socioeconomic groups contributing to the huge
gap in the younger onset morbidity in the society (Frankel et al., 2014, p. 170). Behaviour
influencing health interventions to address such issues include eating healthily, regular exercise,
attending screening appointments, and harm avoidance (Johnson et al., 2013, p. 567). The eating
healthily intervention program, Cook For Life, was found to be successful in changing habits
concerning the levels of sugar consumption among the parents who participated in the study. The
intervention was also effective in increasing the consumption of fruits and vegetables although there
was little change recorded in fibre intake among the participants. More importantly, respondents
overwhelmingly reported being better placed now to take care of their family’s dietary needs than
before the intervention. This implies the effectiveness of such a program.
Theoretical Background of Behaviour Change Interventions
Notably, Belansky (2013, p. 201) contends that understanding the factors that influence the
way people behave would be a good starting point for such change initiatives. There are three major
cognitive theories seeking to explain behaviour, including; the health belief model, the social
cognitive theory, and the theory of reasoned action and planned behaviour (Lochrie et al., 2013, p.
165). Succinctly, the theory of reasoned action posits that an action is dependent on a person’s
acting intention. The theory emphasizes that a person’s intention is determined by their attitude to
behaviour and subjective norms (Peters et al., 2014, p. 131). This theory adds the idea of self-

Change in Eating Behaviour after Intervention 18
efficacy, the individual’s perceived control over skills, resources, and opportunities at their disposal
to perform the behaviour.
As Eumark-Sztainer et al. (2010, p. 273) note, the social cognitive theory holds that
behaviour is founded on environmental factors, personal factors, self-efficacy, and the attributes of
the given behaviour itself. As such, successful behaviour change would require an individual to
believe in their ability to perform the behaviour, should feel the projected positive outcome
outweigh the negative (Swanson et al., 2013, p. 149). According to Cohen et al. (2014, p. 51) self-
belief in successfully undertaking behaviour is necessary for determining a successful behaviour
change. In the light of this standpoint, the parents in the study felt the need to change the way they
handled their nutritional needs. They believed in the cause of the undertaking and the benefits of the
outcome following behaviour change.
The health belief model proposes that beliefs are the basic cues to action and includes self-
efficacy (Prelip et al., 2012, p. 310). The theory holds that the four major beliefs are concerned with
the perceived sickness severity, an individual’s perceived susceptibility to it, as well as what they
believes are the likely benefits and barriers to taking action. The likely cues for action could be
media campaigns, life-changing events, sticky notes, or habitual cues. On the basis of this concept,
it can be argued that that the educational session acted as one of the cues for action. The parents
shared the belief that the dietary issue required their effort to address to avoid some likely negative
impacts.
Basic Principles to the Success of the Intervention
Seeking to understand the perspective of individuals is the basic starting point in delivering
and supporting behaviour change interventions. Some of the important factors influencing people’s
behaviour are, respecting the messenger, individual’s weighing of the interventions and the
disincentives of a behaviour or change, norms and behaviours surrounding an individual, individual

Change in Eating Behaviour after Intervention 19
effort and determination, importance, subconscious, emotional associations, ego, and commitments
(Van Grieken et al., 2014, p. 1).
More importantly, behaviour change intervention should focus on generic competencies that
cover: helping people to develop accurate knowledge about the short and long-term health
consequences of their own behaviours on themselves and others. They should work with what is
relevant to the individual and be capable of enhancing people’s self-efficacy (Loeb et al., 2012, p.
22). The programmes should raise awareness of the positive behaviour and role models in the
individual’s social group and support moral and personal commitment to change (Garcia et al.,
2014, p. 1013). Additionally, the initiatives should assist people to make changes while identifying
realistic goals as well as developing supportive plans in specific contexts over time (Jaballas et al.,
2011, p. 301). People carrying out the intervention programmes must not be coercive, patronizing,
or coercive when trying to influence behaviour change among the participants (Morgan et al., 2014,
p. 94). Instead, it would be more effective to adopt strategies that are used more regularly in
motivational and coaching interviewing such as listening to understand, building rapport, building
self-efficacy and supporting change, and assessing readiness of participants to change.
The results in this study concurred with the findings of an earlier study involving 3059
young women of ages 17 to 21 attending a virus trial of a population-based human papilloma virus
in Finland. The study which focused on developing and evaluating the effectiveness of an
individualized lifestyle counselling approach in improving dietary behaviour, preventing weight
gain, and physical activity established positive correlation between nutritional intervention and
behaviour change. The proportion of the girls physically inactive decreased from 34% to 23%
following the initiative (Janicke et al., 2013, p. 191). The study also confirmed the argument that
the success of lifestyle programs and interventions in helping people to achieve dietary change
depended on the intensity of the intervention. In addition, it was also identified that self-reported
behaviour is affected by the measurement process itself in that repeated assessment on health
behaviours may have some motivating factor for participants to increase the intensity of behaviour

Change in Eating Behaviour after Intervention 20
change interventions (McGowan et al., 2013, p. 769). The findings in the two studies form a strong
basis for future intervention through self-evaluation questionnaires to nutritional behaviour change.
In a study where four focus groups were conducted in 2012 at worksites during the lunch
break showed positive correlation between the eating habits and practices of children and the role of
parents in the same. A total of 21 randomly picked parents of primary school children were chosen
(15 mothers and 6 fathers) (Morin et al., 2013, p. 46). These results concurred with the rationale of
the Cook For Life campaign to use parents as a starting point for addressing nutritional
inadequacies in families. Parents cited rules and regulations as some of the factors contributing to
healthy dietary habits to their children. They reported that some of the rules involved limiting the
consumption of soft drinks (Talvia et al., 2011, p. 2065). Some stated applying strict rules about
when and how much their child is allowed to consume a soft drink. Other argued that it is important
that parents the role of good models for their children eating behaviour by not consuming soft
drinks, eating fruits, and drinking water at dinner (Turner et al., 2013, n.p). These findings
demonstrate the important role that parent’s influence has on their children. By targeting the parents,
then the whole family is likely to benefit from the intervention.

A recent report by Scientific Advisory Committee on Nutrition recommends the dietary
reference value for total carbohydrates at a population average be maintained at about 50% of
dietary energy. it also recommends that the dietary reference value for free sugars be set at a
population average of approximately 5% of the dietary energy for all age-groups from 2 years
upwards. Following the reductions in the intake of free sugars, then that energy should be replaced
with starches found in cellular structures sugar-containing foods such as milk and milk products. In
addition, the consumption of soft drinks should be minimized for both parents and adults (Draft
Carbohydrates and Health Report, 2014).
Another study that had similar results is one of a pilot nutrition intervention on knowledge,
attitudes, and behaviour change of female combat soldiers in Israeli army in 2013. The results of the

Change in Eating Behaviour after Intervention 21
intervention strongly indicate meaningful improvements in daily food consumption. Before the
intervention programme, the subjects had very limited knowledge of the basic nutrition and few
tools for making informed choices in their mess hall. The intervention was also found to improve
attitude and knowledge significantly towards healthy eating (Wright et al., 2013, p. 730). However,
in the Cook For Life intervention it was noted that the percentage of the parents and children who
took about the same amount of whitemeal bread, brown rice, wholewheat pasta after the
intervention remained substantially high. Some of the reasons to explain this little change could be
the preference issues where most people see the white rice and the white bread as more appealing
than brown rice and white bread. Another explanation could be that whitemeal bread, brown rice,
wholewheat pasta are quite expensive and cooking becomes very time consuming. Although, most
interventions are effective in increasing knowledge, the true challenge lies with impacting the
decision-making process as well as changing eating behaviours.
A study evaluating the impacts of an intervention carried on 5-year olds to investigate child
health behaviours by youth health care professionals found no significant outcomes on behaviour
change. The study involved counselling for 637 parents of overweight children on lifestyle
according to the invention protocol and follow-up questionnaires for a two-year follow-up (Ohly, et
al., 2013, p. 9). The results reflected the findings of this study concerning the behaviour change in
fruit juice intake where no significant change was reported for both parents and children. One of the
likely explanations for this outcome can be based on the health belief model where barriers to
achieving the behaviour change greatly affect the outcome. Some of the barriers could be that fresh
fruit juice is not readily available or could be expensive. It could that parents are preferring to use
fruits instead.

Study Limitations

The rather small sample size of 137 participants used for the study is not so representative,
and it would not qualify for generalization of the entire population. The study was limited in

Change in Eating Behaviour after Intervention 22
capacity due to failure to evaluate other factors that might be crucial in determining behaviour
change such as economic status and literacy levels. In addition, the study might have been limited
by the subjective nature of self-reported dietary intake assessment as used in the study. The validity
of the study is, therefore, questionable since there was no clinical validity biomarker used making it
prone to underestimates resulting from bias and imprecision of the actual change.

Conclusion

The findings of this and other studies have demonstrated the effectiveness of intervention
programs such as Cook For Life in bringing about a great impact in terms of behaviour change
among parents and children. However, the success of such interventions is dependent on a number
of rationales on behaviour change. Educational sessions have the capacity to address nutritional
deficiencies in families through behaviour change (Robertson, 2012, p. 230). The Cook For Life
intervention was able to achieve the intended outcomes of reducing sugar consumption, increasing
intake of fruits and vegetables, and fibre intake. Similar programs should be guided by the
identified basics such as listening to understand, building rapport, building self-efficacy and
supporting change, and assessing readiness of participants to change behaviour.

Change in Eating Behaviour after Intervention 23

ACKNOWLEDGEMENTS

First and foremost, I would like to thank God for His goodness and faithfulness, divine
strength, provision, and ever-present help all through my studies and also for the idea of this study.
Secondly, I would like to acknowledge several people for whom their support, encouragement, help
and assistance made this work possible: my parents, instructor, as well as my lecturer (enter names).
.

Change in Eating Behaviour after Intervention 24

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