Analysis Of Nutrition Education In Pupils' Guardians Of Poor Rural Areas

Objective:To assess the nutrition knowledge-attitude-practice(K-A-P)and physical activity status and the influencing factors of pupils' guardians in poor rural areas of China,and to evaluate the effects of nutrition and health intervention on nutrition K-A-P and physical activity among pupils' guardians,in order to provide scientific basis for further improvement of the nutrition and health status of pupils' guardians in poor rural areas.Methods:This was an intervention study for two school years without a randomized control group.The multi-stage cluster sampling method was used to select three representative primary schools from Pingquan County(Hebei Province),Wufeng County(Hubei Province),Longyang County(Yunnan Province),Pingjiang County(Hunan Province),and Dunhua County(Jilin Province),individually.In each school,one class from each grade of Grade 2 to 6 was selected.All the pupils' guardians(including parents,grandparents or other guardians)in the class were the subjects.In the past two school years,the guardians were educated directly through parents'meetings,lectures,posters and other forms of education.At the same time,the students were educated through the nutrition and health class and passed the knowledge to their guardians,therefore,the guardians were educated indirectly.Questionnaires were conducted to survey the nutrition K-A-P and physical activity time,and to evaluate the effect of intervention among pupils' guardians before the intervention,at one school year of the intervention,and at two school years of the intervention.Used generalized estimating equation and random slope model with SAS9.4 to explore the influencing factors of guardians' nutrition knowledge,dietary behavior and physical activity.Results:At baseline,2,471 pupils' guardians(pupils were from Grade 2 to 6)participated in the survey.There were 2,673 guardians(pupils were from Grade 2 to 6)after one school year and 1999 guardians(pupils were from Grade 2 to 5)after two school years,individually participated in the surveys.The guardians of the pupils of the original Grade 6 were dropped out because of the graduation of the pupils.In baseline survey,the proportion of guardians in Hubei area was 24.7%,and the proportion of guardians in Hebei was 22.7%,the proportion of guardians in Yunnan was 20.5%,the proportion of guardians in Hunan was 17.8%,and the proportion of guardians in Jilin was 14.3%.The proportion of male guardians was 50.1%,while the proportion of female guardians was 49.9%.The proportion of parents was 83.7%,the proportion of grandparents was 11.5%,and the proportion of other guardians was 4.8%.1.The nutrition knowledge of the guardiansAt baseline,the guardians' correct answer rates were 20.8%?96.6%for the ten questions of nutrition knowledge.After intervention started,the correct rates were significantly increased with the time of the intervention(P<0.05).The correct rates were 40.3%?97.7%at two school years of the intervention.The baseline average score of nutrition knowledge among guardians was(6.9±1.7).During the intervention period,the average score of guardians increased with time(P<0.05),and increased to(7.6±1.6)after two school years.The intervention time,area,gender,and kinship were the influencing factors of guardians'nutrition knowledge score.The score of the guardians in Hunan was the lowest,the score of female guardians was higher than that of the male guardians,and grandparents had the lowest score than parents and other type of guardians(P<0.05).2.The nutrition attitude of the guardiansAt baseline,the proportion of the guardians who believed that diet was very important for pupils was 74.8%,and the proportion was increased to 84.3%at the final survey(P<0.05).The main sources of nutrition knowledge for the guardians were television and radio(52.1%),network(36.4%),and newspapers and magazines(29.4%).The proportion of the guardians who obtained nutrition knowledge through expert lectures was the smallest(19.2%).3.The dietary behaviors of the guardiansAfter intervention,intake frequencies of breakfast,milk,meat,eggs,vegetables and fruits were all increased(P<0.05).Intake frequencies of breakfast,meat,eggs and milk were increased from 6.0,2.5,4.7,4.0 times per week,respectively at baseline survey to 6.4,3.4,5.6,4.4 times per week,respectively after two school years.The varieties of vegetables and fruits were increased from 3.2 and 2.1 kinds per day,respectively at baseline survey to 3.6 and 2.3 kinds per day,respectively after two school years.The dietary behaviors of guardians in different areas were significantly different(P<0.05).The meat intake frequency was significantly higher in male guardians compared to female guardians(P<0.05).The intake frequencies of milk,meat,and eggs were the lowest and the intake frequencies of vegetables and fruits were the highest in grandparents(P<0.05).4.The physical activity of the guardiansAfter two school years' intervention,the average daily physical exercise time of the guardians was increased(P<0.05).It was increased from 44.9 minutes per day at baseline survey to 64.1 minutes per day at the final survey.The guardians in Yunnan had the longest exercise time,compared to the guardians in other areas.Male guardians' daily physical exercise time was longer than female guardians.The grandparents' daily physical exercise time was the shortest(P<0.05).The average sedentary time of the guardians was 120 minutes per day.There were no statistically significant differences after intervention(P>0.05).Conclusion:The nutrition knowledge level of pupils' guardians in poor rural areas needs to be improved.The dietary behaviors need to be improved.The physical activity time should be increased.Through the nutritional health intervention,guardians' nutrition K-A-P was improved,physical activity level increased,but sedentary time did not decrease.The intervention time,area,gender,and kinship are main influencing factors of nutrition K-A-P and physical activity.It is important to further carry out nutrition and health education,to increase the intensity and pertinence,and to improve the nutrition and health status of pupils' guardians in poor rural areas finally.