Journal of the Korean Society of Food Science and Nutrition (한국식품영양과학회지)

The Korean Society of Food Science and Nutrition (한국식품영양과학회)
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Food Safety and Nutrition Education Program for Elderly and Assessment of Program Effectiveness Based on Health Belief Model

건강신념모델에 근거한 노인 대상 식품안전·영양교육 프로그램 효과 평가

  • Choi, Jung-Hwa (Department of Food & Nutrition, Soongeui Women's College) ;
  • Lee, Eun-Sil (Department of Food & Nutrition, Yonsei University) ;
  • Lee, Yoon-Jin (Department of Food & Nutrition, Yonsei University) ;
  • Lee, Hye-Sang (Department of Food & Nutrition, Andong University) ;
  • Chang, Hye-Ja (Department of Food Science & Nutrition, Dankook University) ;
  • Lee, Kyung-Eun (Department of Food & Nutrition, Seoul Women's University) ;
  • Yi, Na-Young (Department of Food Science & Nutrition, Daejeon University) ;
  • Ahn, Yoon (Department of Food & Nutrition, Seoul Women's University) ;
  • Kwak, Tong-Kyung (Department of Food & Nutrition, Yonsei University)
  • 최정화 (숭의여자대학교 식품영양과) ;
  • 이은실 (연세대학교 식품영양학과) ;
  • 이윤진 (연세대학교 식품영양학과) ;
  • 이혜상 (안동대학교 식품영양학과) ;
  • 장혜자 (단국대학교 식품영양학과) ;
  • 이경은 (서울여자대학교 식품영양학과) ;
  • 이나영 (대전대학교 식품영양학과) ;
  • 안윤 (서울여자대학교 식품영양학과) ;
  • 곽동경 (연세대학교 식품영양학과)
  • Received : 2016.02.15
  • Accepted : 2016.08.17
  • Published : 2016.09.30
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Abstract

Most elderly have difficulties in managing food safety and nutrition by themselves. Various nutrition educations for the elderly have been developed, but food safety and nutrition education program and educational tools for the elderly are very limited. The aim of the study was to evaluate a food safety and nutrition education program based on the Health Belief Model (HBM) for the elderly. Education program was implemented for 220 seniors (137 educated group and 83 control group) aged over 65 years at senior welfare community centers. The intervention study was carried out on a weekly basis during each of 5 weeks, and each session lasted about 35 or 40 minutes. The effectiveness of the program was assessed with a questionnaire before and after education. Education program consisted of a 5 week program, and topics were 'Dietary changes for the elderly's healthy life', 'Prevention of food poisoning in everyday life', 'Safe food handling for my health', 'Healthy dietary life to prevent chronic disease', and 'Safety! nutrition! healthy dietary life'. Education program materials such as slides, handouts, videos, leaflet, and booklets were developed. As a result, there were score improvements in knowledge, dietary behaviors, and health belief after intervention in the intervention group, which were higher than those of the control group. In particular, there was a meaningful interrelation between dietary behavior and health belief (r=0.520, P<0.001). This finding suggests that changing beliefs is very important to make desirable dietary behavioral changes. For this reason, we can conclude HBM theory is an effective model to educate nutrition and food safety for the elderly. Furthermore, food safety and nutrition education programs are implemented and delivered continuously at various settings such as a health center or community welfare center, and those will contribute significantly to enhance perception and change their desirable dietary behaviors for the elderly.

노인은 면역취약집단으로 다른 인구 집단보다 만성질환과 식품매개 질병에 걸릴 위험이 크며 식행동은 오랜 세월 굳어져 왔기 때문에 변화하기가 쉽지 않다. 노인을 대상으로 건강신념모델을 적용하여 식품안전 영양교육 프로그램을 시범 적용하고 그 효과를 평가하였다. 식품안전 영양 시범 교육은 서울 마포, 충북 청주, 경북 의성, 충북 진천의 노인복지관을 이용하는 65세 이상 노인을 대상으로 2011년 7월 28일부터 9월 9일까지 총 5주간 매주 1회, 35~40분씩 교육을 시행하였다. 교육 전후 조사가 완료된 최종 연구대상은 교육군이 5회 교육 중 3회 이상 교육에 참여하고 교육 전후 평가를 마친 대상자로 137명, 대조군은 사후 설문조사를 하지 않거나 불성실한 응답자를 제외한 83명으로 총 220명이었다. 교육은 건강신념모델을 적용하여 노인들이 식습관을 변화하지 않을 경우 질병 가능성을 알려 심각성을 인지하도록 하였으며 노인들이 식행동 수정 시 얻게 되는 이들을 알려주고 행동을 실행할 수 있도록 자아효능감을 제공해주고자 하였다. 교육 후 식품안전 영양지식은 모든 항목에서 향상을 보였으며, 식품안전 영역 5문항 중 4문항, 영양 영역 3문항 중 2문항에서는 유의적인 향상을 보였다. 식행동은 교육군에서 '고기, 생선류는 조리 시 속까지 완전히 익힌다'를 제외한 모든 항목에서 유의적인 향상을 보였다. 건강신념은 식품안전의 영역에서는 인지된 심각성과 자아효능감, 영양 영역에서는 인지된 민감성, 인지된 장애, 자아효능감에서 유의적인 향상을 보였다. 지식, 식행동, 건강신념 변화량의 상관관계를 분석한 결과 건강신념의 변화량과 식행동의 변화 가능성 간의 유의적인 상관관계를 보였다(P<0.001). 본 연구의 참여 대상자들이 일반 재가 노인보다 복지관에서 봉사하거나 활동하는 노인이었기 때문에 표본의 대표성이 떨어져 결과를 일반화하기에 어려움이 있다. 또한, 교육기간이 5주로 비교적 짧았기 때문에 오랜 기간에 걸쳐 형성된 식행동이 쉽게 변화하거나 개선되기 어려우므로 장기간에 걸친 반복교육이 필요할 것으로 생각한다. 본 연구에서 개발된 교육프로그램을 향후 보건소나 복지관 등을 통해 지속해서 시행 된다면 노인의 식품안전 영양에 대한 인식을 높이고 바람직한 식행동 변화에 긍정적인 기여를 할 수 있을 것으로 생각된다.

Keywords

References

  1. Statistics Korea. 2011. Population projections for Korea: 2010-2060 (based on the 2010 census). http://kostat.go.kr/portal/korea/kor_nw/2/2/6/index.board?bmode=read&aSeq=252623 (accessed Nov 2015).
  2. Jung HY, Yang IS, Lee HY, Chae IS. 2003. Analyzing the current congregate meal service program for homebound elderly. Korean J Community Nutr 8: 919-926.
  3. de Luis D, Lopez Guzman A; Nutrition Group of Society of Cstilla-Leon (Endocrinology, Diabetes and Nutrition). 2006. Nutritional status of adult patients admitted to internal medicine departments in public hospitals in Castilla y Leon, Spain-A multi-center study. Eur J Intern Med 17: 556-560. https://doi.org/10.1016/j.ejim.2006.02.030
  4. Yang EJ, Bang HM. 2008. Nutritional status and health risks of low income elderly women in Gwangju area. Korean J Nutr 41: 65-76.
  5. Altekruse SF, Street DA, Fein SB, Levy AS. 1996. Consumer knowledge of foodborne microbial hazards and foodhandling practices. J Food Prot 59: 287-294. https://doi.org/10.4315/0362-028X-59.3.287
  6. Gettings MA, Kiernan NE. 2001. Practices and perceptions of food safety among seniors who prepare meals at home. J Nutr Educ 33: 148-154. https://doi.org/10.1016/S1499-4046(06)60184-X
  7. Fein SB, Lando AM, Levy AS, Teisl MF, Noblet C. 2011. Trends in U.S. consumers' safe handling and consumption of food and their risk perceptions, 1988 through 2010. J Food Prot 74: 1513-1523. https://doi.org/10.4315/0362-028X.JFP-11-017
  8. Pastorino CA, Dickey T. 1990. Health promotion for the elderly: issues and program planning. Orthop Nurs 9: 36-42. https://doi.org/10.1097/00006416-199011000-00007
  9. Lee YW, Hwang WS, Choe SJ, Lee DH, Kim DH, Lee EH, Hong EG, Noh HL, Chung YS, Lee KW, Kim HM. 2003. The effect of intensive education on glycemic control in type 2 diabetic patients. J Korean Soc Endocrinol 18: 63-72.
  10. Mo S. 1990. The present status and a future scheme in nutrition education. Korean J Nutr 23: 208-212.
  11. Sheahan SL, Fields B. 2008. Sodium dietary restriction, knowledge, beliefs, and decision-making behavior of older females. J Am Acad Nurse Pract 20: 217-224. https://doi.org/10.1111/j.1745-7599.2008.00307.x
  12. Yim KS, Min YH, Lee TY. 1997. Evaluations of the Elderly Nutrition Improvement Program in the community health center: Effects of nutrition counseling and education program on elderly dietary behavior. J Korean Diet Assoc 3: 197-210.
  13. Son SM, Kim MJ. 2001. The effect of nutrition education program for various chronic disease in elderly visiting public health center. Korean J Community Nutr 6: 668-677.
  14. Janz NK, Becker MH. 1984. The Health Belief Model: A decade later. Health Edu Q 11: 1-47. https://doi.org/10.1177/109019818401100101
  15. Kim MH. 1997. Health Belief Model approach to health beliefs, attitude, and health behaviors concerning HIV/AIDS. J Korean Soc Health Edu 14: 125-147.
  16. Hanson JA, Benedict JA. 2002. Use of the Health Belief Model to examine older adults' food-handling behaviors. J Nutr Educ Behav 34: S25-S30. https://doi.org/10.1016/S1499-4046(06)60308-4
  17. Kang NE, Lee JY. 2005. The analysis of effect on nutrition education program for the elderly in Sung-nam area. Korean J Food Nutr 18: 357-366.
  18. Park PS, Chun BY, Jeong GB, Hun CH, Joo SJ, Park MY. 2007. The effect of follow-up nutrition intervention programs applied aged group of high risk undernutrition in rural area (I). Korean J Food Cult 22: 127-139.
  19. Kim MS, Kim JY. 2012. Development of nutrition education material for nutrient intake and prevention of disease and the effects of nutrition education for the elderly-focused on items related to health and nutrients intake-. Korean J Community Living Sci 23: 467-478. https://doi.org/10.7856/kjcls.2012.23.4.467
  20. Choi JH, Lee ES, Lee YJ, Lee HS, Chang HJ, Lee KE, Yi NY, Ahn Y, Kwak TK. 2012. Development of food safety and nutrition education contents for the elderly-by focus group interview and Delphi technique-. Korean J Community Nutr 17: 167-181. https://doi.org/10.5720/kjcn.2012.17.2.167
  21. Yang IS, Lee JM, Chae IS. 1998. Nutrition knowledge and attitude analysis of elderly people for the development of nutrition education program. J Korean Diet Assoc 4: 76-87.
  22. Medeiros LC, Hillers VN, Chen G, Bergmann V, Kendall P, Schroeder M. 2004. Design and development of food safety knowledge and attitude scales for consumer food safety education. J Am Diet Assoc 104: 1671-1677. https://doi.org/10.1016/j.jada.2004.08.030
  23. Almanza BA, Namkung Y, Ismail JA, Nelson DC. 2007. Clients' safe food-handling knowledge and risk behavior in a home-delivered meal program. J Am Diet Assoc 107: 816-821. https://doi.org/10.1016/j.jada.2007.02.043
  24. McCarthy M, Brennan M, Kelly AL, Ritson C, de Boer M, Thompson N. 2007. Who is at risk and what do they know? Segmenting a population on their food safety knowledge. Food Qual Prefer 18: 205-217. https://doi.org/10.1016/j.foodqual.2005.10.002
  25. Lee KE, Yi NY, Park JY. 2009. Food safety knowledge and home food safety practices of home-delivered meal service recipients. J Korean Soc Food Sci Nutr 38: 618-625. https://doi.org/10.3746/jkfn.2009.38.5.618
  26. Sanlier N. 2009. The knowledge and practice of food safety by young and adult consumers. Food Control 20: 538-542. https://doi.org/10.1016/j.foodcont.2008.08.006
  27. Ferrini R, Edelstein S, Barrett-Connor E. 1994. The association between health beliefs and health behavior change in older adults. Prev Med 23: 1-5. https://doi.org/10.1006/pmed.1994.1001
  28. Hanson JA, Benedict JA. 2002. Use of the Health Belief Model to examine older adults' food-handling behaviors. J Nutr Educ Behav 34: S25-S30. https://doi.org/10.1016/S1499-4046(06)60308-4
  29. Hudson PK, Hartwell HJ. 2002. Food safety awareness of older people at home: a pilot study. J R Soc Promot Health 122: 165-169. https://doi.org/10.1177/146642400212200312
  30. Abood DA, Black DR, Feral D. 2003. Nutrition education worksite intervention for university staff: application of the health belief model. J Nutr Educ Behav 35: 260-267. https://doi.org/10.1016/S1499-4046(06)60057-2
  31. Lee MJ, Kim JH, Park OJ, Lee YM. 2016. A study on the needs for nutrition management program for elderly who use welfare facilities. Korean J Community Nutr 21: 65-74. https://doi.org/10.5720/kjcn.2016.21.1.65
  32. Jevsnik M, Ovca A, Bauer M, Fink R, Oder M, Sevsek F. 2013. Food safety knowledge and practices among elderly in Slovenia. Food Control 31: 284-290. https://doi.org/10.1016/j.foodcont.2012.10.003
  33. Eppright ES, Fox HM, Fryer BA, Lamkin GH, Vivian VM. 1970. The North Central Regional Study of diets of preschool children. 2. Nutrition knowledge and attitudes of mothers. J Home Econ 62: 327-332.
  34. Jang JY, Kim MJ, Han JS. 2009. A study on food frequency, dietary habits and nutrition knowledge of the elderly who intake high sodium. J Korean Soc Food Sci Nutr 38: 1362-1372. https://doi.org/10.3746/jkfn.2009.38.10.1362
  35. Choi JH, Lee YJ, Lee ES, Lee HS, Chang HJ, Lee KE, Yi NY, Kwak TK. 2016. Investigation of food safety knowledge, attitudes, and behavior for analyzing food safety risk factors in the elderly. J Korean Soc Food Sci Nutr 45: 746-756. https://doi.org/10.3746/jkfn.2016.45.5.746
  36. Kim BH, Yang J, Kye SH, Lee Y. 2014. The effect of a community-based nutrition intervention program on dietary behavior and nutritional status of low-income elderly women in Gwangju city. Korean J Food Nutr 27: 495-506. https://doi.org/10.9799/ksfan.2014.27.3.495
  37. Jung EJ, Kwon JS, Ahn SH, Son SM. 2013. Blood pressure, sodium intake and dietary behavior changes by session attendance on salt reduction education program for pre-hypertensive adults in a public health center. Korean J Community Nutr 18: 626-643. https://doi.org/10.5720/kjcn.2013.18.6.626
  38. Kang NE, Lee JY. 2005. The analysis of effect on nutrition education program for the elderly in Sung-nam area. Korean J Food Nutr 18: 357-366.
  39. Boonyasopun U, Aree P, Avant KC. 2008. Effect of an empowerment-based nutrition promotion program on food consumption and serum lipid levels in hyperlipidemic Thai elderly. Nurs Health Sci 10: 93-100. https://doi.org/10.1111/j.1442-2018.2008.00375.x
  40. Kendall PA, Hillers V, Medeiros LC. 2006. Food safety guidance for older adults. Clin Infect Dis 42: 1298-1304. https://doi.org/10.1086/503262
  41. Kendall P, Medeiros LC, Hillers V, Chen G, DiMascola S. 2003. Food handling behaviors of special importance for pregnant women, infants and young children, the elderly, and immune-compromised people. J Am Diet Assoc 103: 1646-1649. https://doi.org/10.1016/j.jada.2003.09.027
  42. Orji R, Vassileva J, Mandryk R. 2012. Towards an effective health interventions design: An extension of the Health Belief Model. Online J Public Health Inform 4: ojphi.v4i3.4321.
  43. Baghianimoghadam MH, Shogafard G, Sanati HR, Baghianimoghadam B, Mazloomy SS, Askarshahi M. 2013. Application of the health belief model in promotion of self-care in heart failure patients. Acta Med Iran 51: 52-58.
  44. Iranagh JA, Rahman HA, Motalebi SA. 2016. Health Belief Model-based intervention to improve nutritional behavior among elderly women. Nutr Res Pract 10: 352-358. https://doi.org/10.4162/nrp.2016.10.3.352
  45. Rajgopal R, Cox RH, Lambur M, Lewis EC. 2002. Costbenefit analysis indicates the positive economic benefits of the Expanded Food and Nutrition Education Program related to chronic disease prevention. J Nutr Educ Behav 34: 26-37. https://doi.org/10.1016/S1499-4046(06)60225-X
  46. Contento I, Balch GI, Bronner YL, Lytle LA, Maloney SK, Olson CM, Swadener SS. 1995. The effectiveness of nutrition education and implications for nutrition education policy, programs, and research: a review of research. J Nutr Educ 27: 275.
  47. Worsley A. 2002. Nutrition knowledge and food consumption: can nutrition knowledge change food behaviour?. Asia Pac J Clin Nutr 11: S579-S585. https://doi.org/10.1046/j.1440-6047.11.supp3.7.x
  48. Sin EK, Lee YK. 2006. Development and application of a health belief model based nutrition education program for day care center children. Korean J Community Nutr 11: 488-501.
  49. Lee KS, Kim KN. 1997. Effects of nutrition education on nutrition knowledge, dietary attitudes, and food behavior of college students. Korean J Community Nutr 2: 86-93.

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