Parental nutrition knowledge and nutrient intake in an atherosclerosis prevention project: the impact of child-targeted nutrition counselling

Abstract

Most of the counselling in health care targeted at child nutrition is delivered via the parents, but little is known about the effects of such counselling on the nutrition knowledge and dietary habits of the parents. In the Special Turku Coronary Risk Factor Intervention Project for Children (STRIP), we studied how 6.5 years of child-targeted nutrition counselling affected the knowledge, attitudes and dietary habits of the parent mainly responsible for food purchase and preparation. We used a questionnaire and a 24-h recall interview in a time-restricted cohort of 98 families belonging to the intervention group and 89 families belonging to the control group in the STRIP project. After controlling for background variables, the intervention parents had better knowledge than the control parents of causal relationships between food choices and coronary heart disease and of the nutritional composition of foods. Knowledge of nutrition concepts did not differ between the two groups. The quality of fat was better in the diet of the intervention parents, they consumed less salt and they also had more knowledge concerning these subjects compared to the control parents (higher behavioural capability scores). The behavioural capability scores of the total group correlated poorly with their nutrient intakes. Thus, child-targeted nutrition intervention delivered to the parents increased parental nutrition knowledge and improved the quality of the parents' diet. However, as nutrition knowledge of the parents correlated poorly with their nutrient intakes, other factors than knowledge appear to influence parental dietary decisions.

Introduction

Reaching parents in child nutrition education is important because children need parental support to make permanent changes of their eating behaviour (Contento et al., 1995, Koivisto et al., 1994). In ideal circumstances, parents purchase and prepare foods, teach children skills of food selection and preparation, discuss healthy eating habits and act as role models for eating behaviour, thereby influencing the eating behaviour of their children. Parents' attitudes and level of knowledge are important determinants of the final outcome of this process (Crockett, Mullis, & Perry, 1988).

The relationship between nutrition knowledge and dietary behaviour is complex. Nutrition knowledge and beliefs compete with other personal and with environmental factors in determining the final outcome in terms of dietary behaviour. These factors include taste preferences (Cotugna et al., 1992, Van der Veen et al., 1999), conflicting and confusing dietary advice (Cotugna et al., 1992), time constraints, and the notion that it is more difficult and expensive to eat a healthful as compared to an ordinary diet (Harnack, Block, & Lane, 1997a). Previous studies, e.g. in the USA and Finland suggest that education and income level have a major influence on nutrition knowledge and dietary practices (Cotugna et al., 1992, Harnack et al., 1997b, Palojoki, 1996).

In order to make healthy food choices, it is important to have an internalised and comprehensive structure of nutritional knowledge. This should increase the probability of healthy food choice. A person may master well some aspects of nutrition e.g. from the point of view of basic nutritional sciences or nutrition-related diseases. However, if understanding of the connections between different nutritional facts is incomplete he or she may still be unable to translate this knowledge into decisions in food choice situations (Cotugna et al., 1992, Sapp and Jensen, 1997).

Social Cognitive Theory makes distinctions between the kind of knowledge that is likely to enhance motivation to take action (motivational knowledge), and ‘behavioural capabilities’. The latter term refers to knowledge and skills needed by people in order to act in accordance with their motivation (instrumental knowledge) (Baranowski et al., 1997, Michela and Contento, 1984). Motivational knowledge includes e.g. outcome expectations (anticipated outcomes of a behaviour), outcome expectancies (the values that the person places on a given outcome) and self-efficacy (the person's confidence in performing a particular behaviour) (Baranowski et al., 1997). In the Working Well Study (Glanz et al., 1993), change-related factors such as motivation, self-efficacy for change, self-rated present diet, past success at change, and motivation to eat low-fat foods were most strongly associated with the intake of dietary fat. Predisposing factors such as perceived benefit of a healthy diet, belief in diet-disease connections and nutrition knowledge had only weak associations to fat intake.

In the prospective, randomised Special Turku Coronary Risk Factor Intervention Project for Children (the STRIP Project) child-targeted nutrition counselling has been given to the intervention families regularly for over 6 years since the child's age of 8 months. The control parents received no detailed nutritional advice. The intervention children have been shown to have a lower intake of total fat, saturated fat and cholesterol, and their serum cholesterol concentration has been 3 to 10% lower than that of the control children during the first five years of life (Lagström et al., 1997, Lapinleimu et al., 1995, Niinikoski et al., 1996, Rask-Nissilä et al., 2000). The child-targeted dietary counselling has resulted in a reduced intake of total and saturated fat also in the parents, and a lower mean serum cholesterol concentration in the intervention mothers than in the control mothers. Interestingly, the serum cholesterol values in the intervention and control fathers have not differed during the follow-up (Lagström et al., 1999).

The present study concerns the impact of nutrition counselling on parental nutrition knowledge, food-related attitudes and nutrient intakes, as well as the association between behavioural capabilities and nutrient intakes after 6.5 years of nutrition intervention aimed at lowering children's exposure to known environmental atherosclerosis risk factors. In addition, the role of socioeconomic background factors was explored.