ISSN: 2347-467X, Vol. 08, No. (1) 2020, Pg.

308-317

Current Research in Nutrition and Food Science

www.foodandnutritionjournal.org

Effectiveness of Nutrition Education for Elementary School

Children Based on Theory of Planned Behavior

MOHAMMAD SAEED JADGAL1*, SOLMAZ SAYEDRAJABIZADEH2,

SAEEDEH SADEGHI3 and TAYEBEH NAKHAEI- MOGHADDAM4

1
Department of public health, Iranshahr University of Medical Sciences, Iranshahr, Iran.
2
Department of Health Education and Promotion, Science and Research
Branch, Islamic Azad University, Tehran, Iran.
3
Department of Health Education and Promotion, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran.
4
Senior expert in the food science and industry department, food and medicine
expert, Iranshahr University of Medical Sciences, Iranshahr, Iran.

Abstract
School children are facing rapid developments both mentally and physically
– thus, good nutrition is very important in this phase of life to ensure their
normal and healthy growth process. The current study aimed at examining Article History
the effect of peers education based on the Theory of Planned Behavior
Received: 27 July 2019
(TPB) on improving elementary female students’ behavioral nutrition in Accepted: 21 December
Chabahar, Iran, in 2017. In this quasi-experimental study, a total of 160 2019
female elementary fourth-grade students were sampled using multi-stage
random sampling and randomly divided into two groups of control and Keywords
intervention. Data were collected using a researcher-made questionnaire Elementary School
with confirmed validity and reliability. The questionnaire consisted of two Students;
parts, the first part consisting of demographic and awareness questions Intervention;
Nutrition Education;
and the second part related to the constructs of the theory of planned Theory of Planned
behavior. The educational intervention was performed on the intervention Behavior (TPB).
group using question and answer method by trained peers (two 45-minute
training session). Two months after the intervention, the same questionnaire
was completed for the post-test. Data were analyzed by paired and
independent t-test, Spearman correlation and regression with SPSS 16
software. The cognitive skills increased significantly from 8.01 to 9.95
after the intervention. All behavioral nutrition increased significantly from

CONTACT Mohammad Saeed Jadgal kh_jadgal@yahoo.com Department of public health, Iranshahr University of Medical
Sciences, Iranshahr, Iran.

© 2020 The Author(s). Published by Enviro Research Publishers.

This is an Open Access article licensed under a Creative Commons license: Attribution 4.0 International (CC-BY).
Doi: http://dx.doi.org/10.12944/CRNFSJ.8.1.29
 JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 309

to 11.83 after implementing the intervention. The behavioral intention rose

significantly from 8.82 to 10.05. Subjective norms showed a significant
enhancement from 9.18 to 10.42. A significant increase was found in mean
perceived behavioral control from 8.48 to 10.00. The results show that
nutrition education based on TPB through training the peers is effective in
the behavioral nutrition of elementary students that positively affects their
behavior through increasing knowledge and TPB constructs.

Introduction the table are the warning signs of an endangered

School children are facing rapid developments both
mentally and physically – thus good nutrition is very
important in this phase of life to ensure their normal
and healthy growth process.1 In general, eating
habits spread in children up to the age of juvenile
and often continue to adulthood. Therefore, nutrition
education should be conveyed to children from an
early age.1 The elementary school would be the
best strategic location to develop a healthy lifestyle
and a second front in the war against disease and
malnutrition. This is also appreciated by the School
Health Committee.2 An unhealthy diet is one of
the main risk factors for many chronic diseases, to
which the tendency of the society especially children
and adolescents indicates a warning situation.3
Many diseases of adult life originate from nutritional
practices mainly started in childhood.4
The prevalence of childhood overweight and obesity
in both developed and developing countries is rapidly
increase and is a major concern for many health
authorities.5 Changes in eating patterns towards
frequent snacking, eating out of home foods, high
energy consumption and low nutritional value of
foods and sweetened drinks along with a sedentary
lifestyle also impact the epidemic of childhood
obesity.5
According to UNICEF report, the prevalence of
highly and averagely underweight children in
Iran is estimated to be 11%, of which 5% are
highly or averagely thin and 15% are highly or
averagely small.6 In addition, the results of Caspian
studies performed on eating habits of children and
adolescents in 21 cities of Iran showed that the
poor quality of the oil consumed by most families,
frequency of whole grain consumption, inadequate
intake of milk and dairy products, unhealthy snack
food consumption, and the habit of adding salt at
health in today’s life and also an increased rate of
chronic diseases in coming years, for which the early
prevention requires attention.7
Students make up a significant portion of the
population, who are at the growth age being highly
vulnerable due to their physical, psychological and
social traits.8, 9, 10 Based on scientific studies, there
is a relationship between nutritional indicators and
educational indicators such as learning, scores,
academic achievement, IQ, intellectual and scientific
skills and concentration in the class.8, 11
There is evidence that children in developing
countries increasingly consume unhealthy foods
due to lack of information and misunderstanding
about the use of healthy foods.12, 13, 14 Based on
previous studies, education has been shown to be
effective in increasing knowledge and appropriate
nutritional performance.15 Health education focuses
on building and changing health behavior of people
through their own participation. Adopting a behavior,
especially nutritional behavior, depends on one’s
beliefs. Selecting a model for health education
is the first step in planning the process of any
educational program. Sociologists, psychologists,
and anthropologists suggest a range of different
theories and models for understanding different
factors that may influence individual behavior, one
of which is the TPB.16 The elements of this theory
has been used given that the aim of current study is
to enhance nutritional behavior in students, and that
this theory emphasizes the role of thinking in making
decisions to engage in such behaviors.16
TPB has been applied for generating health
behaviors more than any other model.16 Assuming
that individuals make rational use of available
information when making behavioral decisions
 JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020)
while examining the results of their decisions before
adoption, Ajzen and Fishbin (1975) developed the
Theory of Reasonable Action for predicting and
explaining individuals’ behaviors.17 TPB consists
of constructs including subjective norm, behavioral
intention, and perceived behavioral control.
Subjective norm is referred to as an individual’s
perception or opinion of social normative pressures
to make that person do/not do an action. Perceived
behavioral control is an actual control of people's
behavior, as well as the behavioral intention, with the
aim of doing an action.16 The influence that education
may have on children nutrition has been addressed
by different studies based on this theory, such as
people’s attitude towards breastfeeding,18 prevention
of cardiovascular risk factors,19 and the effect of
educational intervention on children nutrition.20
School-age children spend more time away from
their parents, so friends and the mass media have
a great impact on the formation and consolidation
of eating patterns.21
The peer education programs include programs
meant for peers to publish detailed information,
such as model responsible behavior, and provide
the necessary skills and motivation to their peers.22
Peer education is used in many health education
settings to change knowledge, attitudes, and
behaviors,22 and the use of peers has been utilized
in evidence-based bystander programs such as
bringing in the bystander.23, 24
Due to the sensitive nature of school age and
formation of eating habits at this age and their
continuance till adulthood as well as the difficulty
of breaking bad eating habits at this stage, it is
necessary to implement a healthy eating habit
education for students to ensure their eating
future by adopting healthier eating habits. Health
education with no program will be ineffective and
futile. 25 Selection of an education model keeps the
program in the right direction. Selection of a suitable
model, studying the behavior, a cost-effective and
efficient teaching method to teach healthy behavioral
intention and eliminating unhealthy behaviors all
increase the effect of education.26 Regarding the
unhealthy behaviors and habits among elementary
students27 the current study aimed at studying the
310
effect of peer education via TPB on improving the
behavioral nutrition of female elementary students
in Chabahar City in 2017.
Materials and Methods
The Ethics committee of the Zahedan University
of Medical Sciences approved this study. Ethic
code: IR.ZAUMS.SPH.REC.1395.241. This quasi-
experimental study (before and after) was performed
on the behavioral nutrition of 160 female elementary
students in Chabahar. Based on the study performed
on elementary students’ behavioral nutrition,
the nutritional performance of the students was
considered to be 45%,28 which was to be increased
to 70%. Therefore, the sample size was 80 students
in control group and 80 in the intervention group
selected through multi-stage random sampling.
In other words, at the first stage, two schools
were randomly selected as the intervention group
and the control group. At the second stage, the
samples were randomly selected in each school in
proportion to the number of classes. Notably, the
control group was selected from the schools close
to the intervention group so that they matched
geographically, culturally and socially. The study
inclusion criteria consisted of the ability to answer
the questionnaire items, fourth grade education,
ability to attend educational sessions. The exclusion
criteria consisted of mentally retarded students.
A questionnaire was developed and distributed
among 20 similar students not engaged in the groups
to answer the questions, based on which necessary
changes were determined and applied to the items
to make them as clearer as possible.
Data were collected using a researcher-made
questionnaire. To determine the face and content
validity of the questionnaire, 10 copies of the
questionnaire were given to 10 health and nutrition
education experts, who confirmed the face and
content validity of the questionnaire; in addition,
their comments were applied to the questionnaire.
To confirm reliability, the questionnaire was
distributed among 30 students (not included
the study groups) to be completed followed by
Cronbach's alpha test with a value of 0.79.
The whole questionnaires were then completed by
the intervention and control students. There were
two sections in the questionnaire: demographic
 JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 311

questions and knowledge questions (9 Qs), attitude
(5 Qs), behavior (6 Qs), perceived behavioral
control, subjective norms and behavioral intention
(each 5 Qs). The questions were scored as:
knowledge questions (correct answer = 2, incorrect
answers = 0 and "I do not know" = 1); attitude
questions (“I agree”=3, “no idea”=2 and “I don’t
agree”=1); behavioral questions (“the most desirable
state”=3, “lack of healthy behavior”=0); the questions
of perceived behavioral control and subjective norm
(“I agree”=3, “no idea”=2 and “I don’t agree”=1); and
the questions of behavioral intention (“always”=3,
“sometimes”=2 and “never”=1). Then, the completed
questionnaires were analyzed and, accordingly,
the training needs were determined followed by
designing the educational content. Afterward, two
45-minute training sessions (question and answer)
were held within two weeks by trained peers with the
presence of the teacher and the researcher. 27, 29 After
the end of the training session, a researcher-made
educational pamphlet on Proper nutrition and food
hygiene was distributed among students. Once the
training course was completed, the waiting period
was considered to be 2 months, after which the
same pre-test questionnaire was completed again
by the same students (intervention and control). The
results obtained from this questionnaire (post-test)
and those from completed questionnaires at the
beginning of the program (pre-test) were collected
and analyzed with SPSS software using Paired t-test,
independent t-test, regression and correlation at a
significance level of <0.05.
Results
A total of 160 female elementary students took
part in the present study. Moreover, 23% of the test
students’ fathers were illiterate, 39% of the control
students’ father had only primary level of education,
39% of the test students’ mothers were illiterate and
37% of the control students’ mothers had only
primary level of education. Based on Chi-square test,
no significant differences appeared to exist between
the two intervention and control groups in terms of
demographic data (parents’ education) (P>0.05).
Paired sample T test was used to compare the
results before and after the intervention. The findings
revealed that the mean score of knowledge and
behavior before and after intervention was not
significant in the control group (P>0.05) but it was
significant in the intervention group (P<0.001).
Independent sample T test was run to compare the
control and intervention groups and showed that the
mean score changes of knowledge and behavior
in the control group was not significant (P>0.05),
but the intervention group showed a significant
difference (P<0.001) (Table 1).

Table 1: Comparison of mean changes and standard deviations of knowledge and behavior
scores before and after intervention in the of intervention and control groups

Group Before After Mean of P value

knowledge intervention intervention the changes (Paired sample
/ behavior Mean ± SD Mean ± SD T test)

Knowledge Intervention 8.01± 6.18 9.95± 5.78 1.93± 1.61 P<0.001
Control 8.13± 6.09 8.06± 6.00 0.08± 0.37 P=0.113
P value P=0.908 P<0.001 P<0.001
(Independent sample T test)

Behavior Intervention 10.41± 4.06 11.83± 4.00 1.42± 1.27 P<0.001

Control 10.49± 4.07 10.45± 4.07 0.03± 0.19 P=0.302
P value P=0.907 P<0.001 P<0.001
(Independent sample T test)

Regarding the constructs of TPB, paired sample that the mean differences of behavioral intention,
T-test was used for comparing the results before subjective norm and perceived behavioral control
and after the intervention. The findings showed before and after intervention were significant in
 JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 312

the intervention group (P<0.001); however, the
differences were not significant in the control group
(P>0.05). Moreover, Independent sample T-test was
conducted for comparing the results between the
control and intervention groups. The results showed
that the mean differences in the scores of behavioral
intention, subjective norm and perceived behavioral
control were significant between the control and
intervention groups (P<0.05). These changes were
higher and positive in the control group suggesting
that education significantly increases behavioral
intention, subjective norm and perceived behavioral
control of the intervention students (Table 2).

Table 2: Comparison of mean scores of behavioral intention, subjective norm

and perceived behavioral control in the control and intervention groups
before and after educational intervention

Group Before After Mean of P value

intervention intervention the changes (Paired sample
Mean ± SD Mean ± SD T test)

Behavioral Intervention 8.82± 3.59 10.05± 3.48 1.23± 1.11 P<0.001
Intention Control 8.88± 3.50 8.82± 3.44 0.06± 0.06 P=0.103
P value P=0.929 P<0.001 P<0.001
(Independent sample T test)

Subjective Intervention 9.18± 3.36 10.42± 3.20 1.24± 0.16 P<0.001

Norm Control 9.26± 3.30 9.20± 3.22 0.06± 0.02 P=0.199
P value P=0.868 P<0.001 P<0.001
(Independent sample T test)

Perceived Intervention 8.48± 2.74 10.00± 2.75 1.52± 0.03 P<0.001

behavioral Control 8.53± 2.64 8.46± 2.49 0.07± 0.15 P=0.322
control P value P=0.907 P<0.001 P<0.001
(Independent sample T test)

Spearman correlation test showed positive and changes and the constructs of TPB (P<0.05)
significant correlations between the behavioral (Table 3).
changes in intervention students with knowledge

Table 3: Determination of coefficient correlation between changes in behavior and

those in knowledge and model constructs (behavioral intention, subjective norm,
and perceived behavioral control) in the intervention group

variable Knowledge Behavioral Subjective Perceived behavioral Behavior

intention norm control

Knowledge 1
Behavioral intention *0.345 1
Subjective norm *0.457 *0.293 1
Perceived behavioral *0.267 *0.257 0.135 1
control
Behavior *0.241 *0.291 *0.313 *0.303 1

*P<0/05
 JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 313

In addition, regression analysis indicated the
significance of regression model (dependent variable
of the model: behavior, independent variables
(predictors): knowledge, behavioral intention,
subjective norm and perceived behavioral control)
(P=0.002); in other words, this model can explain
(predict) the changes of dependent variable of
behavior. The value of this change based on the
adjusted coefficient of determination equals 0.11,
that is, the model can explain ≈%11 of the dependent
variable (behavior) changes.
*The dependent variable of the model: behavior;
independent variables (predictors): knowledge,
behavioral intention, subjective norm and perceived
behavioral control.
A survey of individual independent variables showed
that knowledge had the highest influence on behavior
such that for any one-unit increase in knowledge,
0.348-unit increase occurs in behavior. Then, the
highest influences go to behavioral intention and
perceived behavioral control, respectively (Table 4).

Table 4: Absolute impacts of the changes in independent variables (knowledge,

behavioral intention, and perceived behavioral control) on the changes in
dependent variable (behavior) in the intervention group

Model Variables B SE Beta T Sig

Knowledge 0.507 0.155 0.348 3.277 0.002

Behavioral intention 0.603 0.152 0.380 4.236 0.0001
Perceived behavioral control 0.397 0.142 0.254 2.553 0.034

Discussion control group, confirming the effect of educational

Findings of the current study suggested that peer
education intervention based on the TPB influenced
the improvement of health behavioral nutrition
among the study participants. Peer education
approach can be effective based on the fact that
sensitive information is more easily transferred
among individuals of the same age. In the study
conducted by Woodward30 and Maretha,31 the impact
of peer education on improving health behaviors was
confirmed compared to other techniques.
No significant differences were observed between
the control and intervention groups in terms of
the mean changes and standard deviations of
knowledge scores prior to the intervention. After the
intervention, the control group showed no significant
difference in their mean scores of knowledge,
while the intervention group displayed a significant
difference in this regard. In the intervention group,
the knowledge mean scores increased significantly
after the intervention. Our results are consistent with
findings of other studies carried out over the effect of
education on nutritional knowledge of the students
especially those reported by Alicia Raby Powers,32
Shariff,33 and Ghaffari.34 Knowledge scores were
significantly higher in the intervention group than the
intervention on the students' nutritional knowledge.
A comparison of the mean changes and standard
deviation of the behavior scores revealed that
education had a positive effect on improving the
nutritional behavior in the intervention group.
Education based on TPB increased the students’
perception of breakfast and meal. The behavior
mean scores of the intervention group increased
significantly after the intervention. Nutritional
behavior improvement was also confirmed in a study
by Vassallo.35
In the present study, mean score of the Behavioral
intention showed a significant increase among the
intervention group after the educational intervention.
The results of some studies were similar to the
findings of our research. As reported by Mohammadi
Zeidi et al.,36 and Qasvandi et al.,37 the mean score
of this construct increased significantly among
members of the intervention group.
With regard to the subjective norm, we found a
significant increase in scores of the experimental
group after the educational intervention and findings
of different studies confirmed our findings.38,39
 JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020)
However, some other studies reported contradictory
results. For example, Vakili et al., 40 as well as
Lautenschlager and Smith41 revealed that scores of
the subjective norm decreased after the educational
intervention in the experimental group. This
discrepancy can be due to application of different
educational programs, educational program
contents, study period, participants, as well as social,
cultural, and economic characteristics of the study
groups, etc.
The third construct was "perceived behavior
control", which deals with the people's beliefs about
their abilities to control behavior. This construct is
attributed to the ease or difficulty in performing a
behavior.16 In the current study, mean scores of the
perceived behavioral control increased significantly
after the intervention. In a study conducted by White,
the mean score of perceived behavioral control
showed a significant increase after the educational
intervention.15 Several studies reported increased
mean levels of perceived behavioral control after
the education.42, 43
The results of Spearman correlation test showed
that the behavior scores changed positively and
significantly by increased scores of the knowledge,
behavioral intention, subjective norm, and perceived
behavioral control constructs. The increase in
each of these constructs leads to promotion of the
healthy nutritional behavior. In addition, the results
of regression analysis showed significance of the
regression model (dependent variable: behavior;
independent variables: knowledge, behavioral
intention, subjective norm, and perceived behavioral
control). In other words, this model can predict the
References
1. Ruzita AT., Wan Azdie MAB., Ismail MN.
The Effectiveness of Nutrition Education
Programme for Primary School Children. Mal
J Nutr. 2007; 13 (1): 4-45.
2. Haldar D., Chatterjee T., Sarkar AP., Bisoi
S., Biswas AK., Sardar JC. A Study on
Impact of School-Based Health and Nutrition
Education in Control of Nutritional Anemia
among Primary School Children in Rural West
Bengal. Indian J Community Med. 2012; 37
314
changes in dependent variables of behavior. The
value of this prediction was 0.11 based on the
adjusted determination coefficient; the model can
explain 11% of the dependent variable changes
(behavior).
A survey of individual independent variables
showed that knowledge had the highest influence
on behavior, so that for a one-unit increase in
knowledge, 0.348-unit increase was observed in
the behavior. Moreover, the highest influences were
recorded for behavioral intention and perceived
behavioral control, respectively.
Conclusions
Results of the current study show that nutrition
education peer education based on the TPB
approach may influence the nutritional behavior of
the elementary students. However, it affected the
individuals' behavior positively by increasing their
knowledge, behavioral intention, and perceived
behavioral control.
Acknowledgements
Hereby, we wish to gratefully acknowledge the
managers and administrators of Sadaf and Najme
schools, the students and all those who contributed
to this study.
Funding
The author(s) received no financial support for the
research, authorship, and/or publication of this
article.
Conflict of Interest
The authors do not have any conflict of interest.
(4): 259-262.
3. World Health Organization. Nutrition in
adolescence: issues and challenges for the
health sector. Issues in adolescent health and
development. Pt. 1. Geneva: World Health
Organization, 2006. 115 p. (WHO discussion
papers on adolescence).
4. Hwenda L. Addressing diet-related risk factors
for non-communicable diseases. Glob Heal
Gov. 2013.
 JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020)
5. Mohd Shariff Z., Sabariah Bukhari S., Othman
N., Hashim N., Ismail M., Jamil Z., et al.,
Nutrition Education Intervention Improves
Nutrition Knowledge, Attitude, and Practices
of Primary School Children: A Pilot Study. Int
Electron J Health Educ. 2008; 11 (1):119-132.
6. Hazavehei SM., Taghdisi MH., Saidi M.
Application of the Health Belief Model for
osteoporosis prevention among middle
school girl students, Garmsar, Iran. Educ
Health. 2007; 20 (1): 7-30.
7. Kelishadi R., Ardalan G., Gheyratmand R.,
Sheikh al-Islam R., Majdzadeh S R., Delawari
A R., et al., Can the dietary habits of our
society provide future health of children and
adolescents? CASPIAN Study. Iran J Pediatr.
2005; 15 (2): 97-109.
8. Sharma SV., Hoelscher DM., Kelder SH.,
Diamond P., Day RS., Hergenroeder A.
Psychosocial factors influencing calcium
intake and bone quality in middle school girls.
J Am Diet Assoc. 2010; 110 (6): 6–932.
9. Hallinan MT., Williams RA. Students'
characteristics and the peer-influence
process. Sociology of education. 1990;
1:122-32.
10. Elbaum B., Vaughn S., Tejero Hughes M.,
Watson Moody S. How effective are one-
to-one tutoring programs in reading for
elementary students at risk for reading
failure? A meta-analysis of the intervention
research. J Educ Psychol. 2000; 92 (4):605.
11. Gortmaker SL., Peterson K., Wiecha J., Sobol
AM., Dixit S., Fox MK. Reducing obesity via
a school-based interdisciplinary intervention
among youth: Planet Health. Arch Pediatr
Adolesc Med. 1999; 153 (4):409-18.
12. Mirmiran P., Azadbakht L., Azizia F. Dietary
behavior of Tehranian adolescents does not
accord with their nutritional knowledge. Public
Health Nutr. 2007; 10 (9):897–901.
13. Kaushik JS., Narang M., Parakh A. Fast food
consumption in children. Indian J Pediatr.
2011; 48 (2):97-101.
14. Kar imi-Shahanjar ini A., Omidvar N.,
Bazargan M., Rashidian A., Majdzadeh R.,
Shojaeizadeh DA. Iranian female adolescent’s
views on unhealthy snacks consumption:
a qualitative study. Iran J Public Health.
2010; 39 (3):92.
315
15. Hien VTT., Khan NC., Mai LB., Lam NT.,
Phuong TM., Nhung BT., et al., Effect
of community-based nutrition education
intervention on calcium intake and bone mass
in postmenopausal Vietnamese women.
Public Health Nutr. 2009; 12 (5): 9–674.
16. Kortteisto T., Kaila M., Komulainen J.,
Mäntyranta T., Rissanen P. Healthcare
professionals' intentions to use clinical
guidelines: a survey using the theory
of planned behavior. Implement Sci.
2010; 5: 9-51.
17. Chang MK. Predicting unethical behavior: a
comparison of the theory of reasoned action
and the theory of planned behavior. J Bus
ethics. 1998; 17 (16):1825-34.
18. Giles M., Connor S., McClenahan C., Mallett
J., Stewart-Knox B., Wright M. Measuring
young people’s attitudes to breastfeeding
using the Theory of Planned Behavior.
J Public Health. 2007; 29 (1): 17-26.
19. Krones T., Keller H., Becker A., Sönnichsen
A., Baum E., Donner-Banzhoff N. The Theory
of Planned Behavior in a Randomized Trial
of a Decision aid on Cardiovascular risk
Prevention. Patient Educ Couns. 2010;
78 (2):76 -169.
20. Zhanq J., Chen D., Wanq J., Wanq Y. Using
the Theory Of planned Behavior to examine
Effectiveness Of an Educational intervention
On infant Feeding in China. Prev Med.
2009; 49 (6): 34-529.
21. Mbithe DD., Kimiywe JO., Waudo JN.,
Orodho JA. Promotion of nutrition education
interventions in rural and urban primary
schools in Machakos district. Kenya J Appl
Biosci. 2008; 6: 9–130.
22. Jennings JM., Howard S., Perotte CL.
Effects of a school-based sexuality
education program on peer educators: the
teen PEP model. Health Educ Res. 2014;
29 (2): 29–319.
23. Banyard VL., Moynihan MM., Plante EG.
Sexual violence prevention through bystander
education: an experimental evaluation.
J Community Psychol. 2007; 35 (4): 81–463.
24. Moynihan MM., Banyard VL., Cares AC.
Encouraging responses in sexual and
relationship violence prevention: what
program effects remain one year later?
 JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020)
J Interpers Violence. 2014; 30 (1): 32–110.
25. Kirk RH., Hamrick M., McAfee DC. Nutrition
in health instruction: The Tennessee
health education project. J Nutr Educ.
1975; 7 (2): 68-71.
26. Jadgal KM., Nakhaei-Moghadam T.,
Alizadeh-Seiouki H., Zareban I., Sharifi-
Rad J. Impact of educational intervention
on patients behavior with smear-positive
pulmonary tuberculosis: a study using the
health belief model. Materia socio-medica.
2015; 27 (4): 229.
27. Alizadeh Siuki H., Jadgal K., Shamaeian
Razavi N., Zareban I., Heshmati H., Saghi
N. Effects of Health Education Based
on Health Belief Model on Nutr ition
Behaviors of Primary School Students in
Torbat e Heydariyeh City in 2012. J health.
2015; 5 (4): 289-299
28. Nazari M., Niknami Sh., Alireza HR.,
Babaei Gh., Ghahramani L. the Effect of
health education on nutritional behaviors
among students of female elementary
schools in chabahar. Journal of Shahed Uni.
2006; 13 (62): 65-70.
29. Khazaei Pool M., EbadiFardAzar F., Solhi
M, AsadiLari M., Abdi N. Effect of nutritional
education through the Health Belief Model
on students' perceptions about breakfast and
snack food in the fourth year of primary school
Noshahr city. Journal of Health Research.
2009; 7 (2): 51-65
30. Woodward A., Howard N., Souare Y., Kollie
S., Roenne A., Borchert M. Reproductive
health for refugees by refugees in Guinea
IV: Peer education and HIV knowledge,
attitudes, and reported practices. Confl Health.
2011; 5 (1): 9-10.
31. Maretha J. HIV/AIDS Prevention Through
Peer Education and Support in Secondary
School in South Afr ica. SAHARA J.
2007; 4 (3): 94-678.
32. Raby Powers A., Struempler B J., Guarino A.,
Parmer S M. Effects of a nutrition education
program on the dietary behavior and nutrition
knowledge of second-grade and third-grade
students. J Sch Health. 2005; 75 (4): 129-133.
33. Shariff Z M., Bukhari S S., Othman N.,
Hashim N., Ismail M., Jamil Z., et al., Nutrition
Education Intervention Improves Nutrition
316
Knowledge, Attitude, and Practices of Primary
School Children: A Pilot Study. Int Electron J
Health Educ. 2008; 11: 119-132.
34. Ghaffari M., Tavassoli E., Esmaillzadeh A.,
Hassanzadeh A. Effect of health belief model
based intervention on promoting nutritional
behaviors about osteoporosis prevention
among students of female middle schools
in Isfahan, Iran. J Educ Health Promot.
2012; 1: 14- 22.
35. Vassallo M., Saba A., Arvola A., Dean
M., Messina F., Winkelmann M., et al.,
Willingness to use functional bread. Applying
the Health Belief Model across four European
countries. J Elsevier. 2009; 52 (2): 452–460.
36. Mohammadi-Zeidi I., Pakpour A. Effectiveness
of educational intervention based on theory
of planned behavior for promoting breakfast
and healthy snack eating among elementary
school students. Razi Journal of Medical
Sciences. 2013; 20 (112):67-78.
37. Gheysvandi E., Eftekhar-Ardebili H., Azam
K, Vafa MR., Azadbakht M., Babazadeh T.,
et al., Effect of an educational intervention
based on the theory of planned behavior on
milk and dairy products consumption by girl-
pupils. J Sch Public Health Inst Public Health
Res. 2015; 13 (2):45-54.
38. Wong CL., Mullan BA. Predicting breakfast
consumption. An application of the theory of
planned behavior and the investigation of past
behavior and executive function. Br J Health
Psychol. 2009; 14: 489 504.
39. Armitage CJ., Conner M. Efficacy of the
theory of planned behaviour. A meta analytic
review. Br J Soc Psychol. 2001; 40: 471 99.
40. Vakili M., Baghiani Moghadam MH., Pirzadeh
A., Dehghani M. Assessing the effect of
education on knowledge, attitude and practice
of guidance school students about milk and
dairy products. Knowl Health J. 2008; 2: 41 7
41. Lautenschlager L., Smith C. Understanding
gardening and dietary habits among youth
garden program participants using the
Theory of Planned Behavior. Appetite.
2007; 49:122 30.
42. Hong K., Gittelsohn J., Joung H. Determinants
of customers' intention to participate in
a Korean restaurant health promotion
program: an application of the theory
 JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 317

of planned behavior. Health Promot Int. examination: a test of the health belief model
2010; 25 (2):174-182. and the theory of planned behavior. Health
43. Mc Clenahan C., Shevlin M., Adamson Educ Res. 2007; 22 (2): 272–284.
G., Bennett C., O’Neill B. Testicular self-
 ISSN: 2347-467X, Vol. 08, No. (1) 2020, Hal. 308-317

Current Research in Nutrition and Food

Science www.foodandnutritionjournal.org

Efektivitas Pendidikan Gizi Anak Sekolah Dasar

Berdasarkan Teori Perilaku Terencana

MOHAMMAD SAEED JADGAL1*, SOLMAZ SAYEDRAJABIZADEH2,

SAEEDEH SADEGHI3 dan TAYEBEH NAKHAEI- MOGHADDAM4

1
Departemen kesehatan masyarakat, Universitas Ilmu Kedokteran Iranshahr,
Iranshahr, Iran. 2Departemen Pendidikan dan Promosi Kesehatan,Sains dan
Penelitian
Cabang, Universitas Islam Azad, Teheran, Iran.
3
Departemen Pendidikan dan Promosi Kesehatan,Shahid Sadoughi
Universitas Ilmu Kedokteran, Yazd, Iran.
4
Ahli senior di departemen ilmu pangan dan industri, ahli makanan dan
obat-obatan, Universitas Ilmu Kedokteran Iranshahr, Iranshahr, Iran.

Abstrak
Anak sekolah menghadapi perkembangan pesat baik mental maupun fisik
sehingga nutrisi yang baik sangat penting dalam fase kehidupan ini untuk memastikanmereka
proses pertumbuhannormal dan sehat. Penelitian 45 menit). Dua bulan setelah intervensi, kuesioner
saat ini bertujuan untuk menguji pengaruh yang sama diisi untuk post-test. Data dianalisis
pendidikan teman sebaya berdasarkan Theory of dengan uji t berpasangan dan independen, korelasi
Planned Behavior (TPB) terhadap peningkatan gizi Spearman dan regresi dengan software SPSS 16.
perilaku siswa perempuan SD di Chabahar, Iran, Keterampilan kognitif meningkat secara signifikan
pada tahun 2017. sampel siswa kelas empat dari 8,01 menjadi 9,95 setelah intervensi. Semua
menggunakan multi-stage random sampling dan perilaku gizi meningkat signifikan dari
secara acak dibagi menjadi dua kelompok kontrol Artikel Riwayat
dan intervensi. Data dikumpulkan dengan
Diterima: 27 Juli 2019 Diterima: 21 Desember 2019
menggunakan kuesioner buatan peneliti dengan
validitas dan reliabilitas yang telah dikonfirmasi.
Kata Kunci
Kuesioner terdiri dari dua bagian, bagian pertama
terdiri dari pertanyaan demografi dan kesadaran SD
dan bagian kedua terkait dengan konstruksi teori Siswa;
Intervensi;
perilaku terencana. Intervensi edukasi dilakukan Pendidikan Gizi;
pada kelompok intervensi dengan metode tanya TeoriTerencana
jawab oleh rekan-rekan terlatih (dua sesi pelatihan Perilaku(TPB).
HUBUNGI Mohammad Saeed JadgalKesehatan kh_jadgal@yahoo.comMasyarakat Departemen, Universitas Ilmu
Kedokteran Iranshahr, Iranshahr, Iran.

© 2020 Penulis. Diterbitkan oleh Penerbit Enviro Research.

Ini adalah artikel Akses Terbuka yang dilisensikan di bawah lisensi Creative Commons: Attribution 4.0
International (CC-BY). Doi: http://dx.doi.org/10.12944/CRNFSJ.8.1.29
JADGAL dkk., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 309

hingga 11,83 setelah mengimplementasikan intervensi. Niat perilaku meningkat

secara signifikan dari 8,82 menjadi 10,05. Norma subjektif menunjukkansignifikan
peningkatan yangdari 9,18 menjadi 10,42. Peningkatan signifikan ditemukan padaratarata
kontrol perilaku yang dirasakan-dari 8,48 menjadi 10,00. Hasil penelitian menunjukkan bahwa
pendidikan gizi berbasis TPB melalui pelatihan teman sebaya efektif dalam
perilaku gizi siswa SD yang secara positif mempengaruhimereka
perilakumelalui peningkatan pengetahuan dan konstruksi TPB.
meningkat pesat dan menjadi perhatian utama
bagi banyak otoritas kesehatan.5 Perubahan pola
makan terhadap seringnya ngemil, makan
Pendahuluan makanan di luar rumah, konsumsi energi tinggi
Anak sekolah menghadapi perkembangan pesat dan rendahnya nilai gizi makanan dan minuman
baik mental maupun fisik – oleh karena itu nutrisi manis serta gaya hidup sedentary juga berdampak
yang baik sangat penting dalam fase kehidupan ini pada epidemi obesitas anak.5
untuk memastikan proses pertumbuhan mereka
normal dan sehat.1 Secara umum, kebiasaan Menurut laporan UNICEF, prevalensi anak-anak
makan menyebar pada anak-anak hingga usia dengan berat badan rendah dan tinggi di Iran
remaja dan sering berlanjut hingga dewasa. Oleh diperkirakan 11%, di mana 5% sangat atau
karena itu, pendidikan gizi harus disampaikan rata-rata kurus dan 15% sangat atau rata-rata
kepada anak-anak sejak usia dini.1 Sekolah dasar kecil.6 Selain itu, hasil penelitian Kaspia yang
akan menjadi lokasi strategis terbaik untuk dilakukan pada kebiasaan makan anak-anak dan
mengembangkan gaya hidup sehat dan garda remaja di 21 kota Iran menunjukkan bahwa
depan kedua dalam perang melawan penyakit dan kualitas minyak yang dikonsumsi oleh sebagian
kekurangan gizi. Hal ini juga diapresiasi oleh besar keluarga buruk, frekuensi konsumsi gandum
Komite Kesehatan Sekolah.2 Pola makan yang utuh, asupan susu dan produk susu yang tidak
tidak sehat merupakan salah satu faktor risiko memadai, camilan yang tidak sehat. konsumsi
utama berbagai penyakit kronis, dimana makanan, dan kebiasaan menambahkan garam di
kecenderungan masyarakat terutama anak-anak meja adalah tanda-tanda peringatan kesehatan
dan remaja menunjukkan situasi peringatan.3 yang terancam punah dalam kehidupan sekarang
Banyak penyakit kehidupan orang dewasa berasal dan juga peningkatan tingkat penyakit kronis di
dari praktik gizi terutama dimulai pada masa tahun-tahun mendatang, yang pencegahan dini
kanak-kanak.4 memerlukan perhatian.7

Prevalensi kelebihan berat badan dan obesitas Siswa merupakan bagian penting dari populasi,
pada anak di negara maju dan berkembang yang berada pada usia pertumbuhan yang sangat
 rentan karena sifat fisik, psikologis dan sosial model untuk pendidikan kesehatan adalah langkah
mereka.8, 9, 10 Berdasarkan kajian ilmiah, terdapat pertama dalam merencanakan proses setiap
hubungan antara indikator gizi dengan indikator program pendidikan. Sosiolog, psikolog, dan
pendidikan seperti belajar, nilai, prestasi akademik, antropolog menyarankan berbagai teori dan model
IQ, kemampuan intelektual dan ilmiah serta yang berbeda untuk memahami berbagai faktor
konsentrasi di kelas.8, 11 yang dapat mempengaruhi perilaku individu, salah
satunya adalah TPB.16 Unsur-unsur teori ini telah
Terdapat bukti bahwa anak-anak di negara digunakan mengingat bahwa tujuan studi saat ini
berkembang semakin banyak mengkonsumsi adalah untuk meningkatkan perilaku gizi pada
makanan tidak sehat karena kurangnya informasi siswa, dan bahwa teori ini menekankan peran
dan kesalahpahaman tentang penggunaan berpikir dalam membuat keputusan untuk terlibat
makanan sehat.12, 13, 14 Berdasarkan penelitian dalam perilaku tersebut.16
sebelumnya, pendidikan terbukti efektif dalam
meningkatkan pengetahuan dan kinerja gizi yang TPB telah diterapkan untuk menghasilkan perilaku
tepat.15 Pendidikan kesehatan berfokus pada kesehatan lebih dari model lainnya.16 Dengan
membangun dan mengubah perilaku kesehatan asumsi bahwa individu membuat penggunaan
masyarakat melalui partisipasi mereka sendiri. rasional informasi yang tersedia ketika membuat
Mengadopsi suatu perilaku, terutama perilaku gizi, keputusan perilaku
tergantung pada keyakinan seseorang. Memilih
JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 310

saat memeriksa hasil keputusan mereka sebelum
adopsi, Ajzen dan Fishbin (1975) mengembangkan
Theory of Reasonable Action untuk memprediksi
dan menjelaskan perilaku individu.17 TPB terdiri
dari konstruksi termasuk norma subjektif, niat
perilaku, dan kontrol perilaku yang dirasakan.
Norma subjektif disebut sebagai persepsi atau
pendapat individu terhadap tekanan normatif sosial
untuk membuat orang tersebut melakukan/tidak
melakukan suatu tindakan. Kontrol perilaku yang
dirasakan adalah kontrol aktual dari perilaku
orang, serta niat perilaku, dengan tujuan
melakukan suatu tindakan.16 Pengaruh pendidikan
terhadap gizi anak telah dibahas oleh berbagai
penelitian berdasarkan teori ini, seperti sikap
masyarakat terhadap menyusui,18 pencegahan
faktor risiko kardiovaskular,19 dan pengaruh
intervensi pendidikan terhadap gizi anak.20
Anak usia sekolah lebih banyak menghabiskan
waktu jauh dari orang tuanya, sehingga teman dan
media massa sangat berpengaruh terhadap
pembentukan dan pemantapan pola makan.21
Program pendidikan sebaya mencakup program
yang dimaksudkan untuk teman sebaya untuk
mempublikasikan informasi rinci, seperti model
perilaku yang bertanggung jawab, dan
memberikan keterampilan dan motivasi yang
diperlukan kepada teman sebayanya.22
Pendidikan sebaya digunakan di banyak
pengaturan pendidikan kesehatan untuk
mengubah pengetahuan, sikap, dan perilaku,22 dan
penggunaan rekan telah dimanfaatkan dalam
program pengamat berbasis bukti seperti
mendatangkan pengamat.23, 24
Karena sifat sensitif usia sekolah dan
pembentukan kebiasaan makan pada usia ini dan
kelanjutannya hingga dewasa serta sulitnya
menghentikan kebiasaan makan yang buruk pada
tahap ini, maka perlu diterapkan pendidikan
kebiasaan makan yang sehat kepada siswa untuk
memastikan mereka makan masa depan dengan
mengadopsi kebiasaan makan yang lebih sehat.
Pendidikan kesehatan tanpa program tidak akan
efektif dan sia-sia. 25 Pemilihan model pendidikan
menjaga program pada arah yang benar.
Pemilihan model yang cocok, mempelajari
perilaku, metode pengajaran yang hemat biaya
dan efisien untuk mengajarkan niat perilaku sehat
dan menghilangkan perilaku tidak sehat semuanya
meningkatkan efek pendidikan.26 Tentang perilaku
dan kebiasaan tidak sehat di kalangan siswa SD27
penelitian saat ini bertujuan untuk mempelajari
pengaruh pendidikan sebaya melalui TPB pada
peningkatan gizi perilaku siswa sekolah dasar di
Kota Chabahar pada tahun 2017.
Bahan dan Metode
Komite Etik Universitas Ilmu Kedokteran Zahedan
 menyetujui penelitian ini. Kode etik : dan didistribusikan di antara 20 siswa serupa yang
IR.ZAUMS.SPH.REC.1395.241. Penelitian quasi tidak terlibat dalam kelompok untuk menjawab
eksperimental ini (sebelum dan sesudah) pertanyaan, berdasarkan perubahan yang
dilakukan pada perilaku gizi 160 siswi SD di diperlukan ditentukan dan diterapkan pada item
Chabahar. Berdasarkan penelitian yang dilakukan untuk membuatnya sejelas mungkin.
pada perilaku gizi siswa SD, kinerja gizi siswa
dianggap 45%,28 yang akan ditingkatkan menjadi Pengumpulan data dilakukan dengan
70%. Oleh karena itu, besar sampel adalah 80 menggunakan kuesioner yang dibuat oleh peneliti.
siswa pada kelompok kontrol dan 80 siswa pada Untuk menentukan validitas wajah dan isi
kelompok intervensi yang dipilih melalui kuesioner, 10 eksemplar kuesioner diberikan
multi-stage random sampling. Dengan kata lain, kepada 10 ahli pendidikan kesehatan dan gizi,
pada tahap pertama, dua sekolah dipilih secara yang mengkonfirmasi validitas wajah dan isi
acak sebagai kelompok intervensi dan kelompok kuesioner; selain itu, komentar mereka diterapkan
kontrol. Pada tahap kedua, sampel dipilih secara pada kuesioner. Untuk mengkonfirmasi reliabilitas,
acak di setiap sekolah secara proporsional dengan angket dibagikan kepada 30 siswa (tidak termasuk
jumlah kelas. Khususnya, kelompok kontrol dipilih kelompok belajar) untuk diselesaikan diikuti
dari sekolah yang dekat dengan kelompok dengan uji alpha Cronbach dengan nilai 0,79.
intervensi sehingga mereka cocok secara
geografis, budaya dan sosial. Kriteria inklusi Seluruh angket kemudian diisi oleh siswa
penelitian terdiri dari kemampuan menjawab item intervensi dan kontrol. Ada dua bagian dalam
angket, pendidikan kelas IV, kemampuan kuesioner: demografi
mengikuti sesi pendidikan. Kriteria eksklusi terdiri
dari siswa tunagrahita. Kuesioner dikembangkan
JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 311
yang sama (intervensi dan kontrol). Hasil yang
pertanyaan dan pertanyaan pengetahuan (9 Qs), diperoleh dari kuesioner ini (post-test) dan
sikap (5 Qs), perilaku (6 Qs), kontrol perilaku yang kuesioner yang telah diisi pada awal program
dirasakan, norma subjektif dan niat perilaku (pre-test) dikumpulkan
(masing-masing 5 Qs). Pertanyaan diberi skor dan dianalisis dengan perangkat lunak SPSS
sebagai: pertanyaan pengetahuan (jawaban benar menggunakan Paired t-test, independent t-test,
= 2, jawaban salah = 0 dan "Saya tidak tahu" = 1); regresi dan korelasi pada a tingkat signifikansi <
pertanyaan sikap (“Saya setuju”=3, “tidak tahu”=2 0,05.
dan “Saya tidak setuju”=1); pertanyaan perilaku
("keadaan yang paling diinginkan" = 3, "kurangnya Hasil
perilaku sehat" = 0); pertanyaan tentang kontrol Sebanyak 160 siswa sekolah dasar perempuan
perilaku yang dirasakan dan norma subjektif ambil bagian dalam penelitian ini. Selain itu, 23%
(“Saya setuju”=3, “tidak tahu”=2 dan “Saya tidak ayah siswa tes buta huruf, 39% ayah siswa kontrol
setuju”=1); dan pertanyaan tentang niat perilaku hanya berpendidikan SD, 39% ibu siswa tes buta
("selalu" = 3, "kadang-kadang" = 2 dan "tidak huruf, dan 37% ibu siswa kontrol hanya
pernah" = 1). Kemudian, kuesioner yang telah diisi berpendidikan SD. tingkat pendidikan.
dianalisis dan, oleh karena itu, kebutuhan Berdasarkan uji Chi-square, tampaknya tidak ada
pelatihan ditentukan diikuti dengan merancang perbedaan yang signifikan antara kedua kelompok
konten pendidikan. Setelah itu, dua sesi pelatihan intervensi dan kontrol dalam hal data demografi
45 menit (tanya jawab) diadakan dalam waktu dua (pendidikan orang tua) (P>0,05).
minggu oleh rekan-rekan terlatih dengan
Uji T sampel berpasangan digunakan untuk
27, 29
kehadiran guru dan peneliti. Setelah sesi membandingkan hasil sebelum dan sesudah
pelatihan berakhir, pamflet edukasi tentang Gizi intervensi. Hasil penelitian menunjukkan bahwa
dan higiene makanan yang dibuat oleh peneliti rerata skor pengetahuan dan perilaku sebelum
dibagikan kepada siswa. Setelah kursus pelatihan dan sesudah intervensi tidak signifikan pada
selesai, masa tunggu dianggap 2 bulan, setelah itu kelompok kontrol (P>0,05) tetapi signifikan pada
kuesioner pra-tes yang sama diisi lagi oleh siswa kelompok intervensi (P<0,001). Uji Independent
 sample T dilakukan untuk membandingkan perilaku pada kelompok kontrol tidak signifikan
kelompok kontrol dan intervensi dan menunjukkan (P>0,05), tetapi kelompok intervensi menunjukkan
bahwa rata-rata perubahan skor pengetahuan dan perbedaan yang signifikan (P<0,001). (Tabel 1).

Tabel 1 Perbandingan Rerata Perubahan dan Standar Deviasi Skor Pengetahuan dan
Perilaku Sebelum dan Setelah Intervensi Pada Kelompok Intervensi dan Kontrol

Kelompok Sebelum Setelah Mean P value Intervensi Pengetahuan Intervensi Perubahan

Perubahan (Sampel Berpasangan/Perilaku Mean ± SD Mean ± SD T uji)

Intervensi Pengetahuan 8,01± 6,18 9,95± 5,78 1,93± 1,61 P<0,001 Kontrol 8,13± 6,09 8,06±
6,00 0,08± 0,37 P=0,113 Nilai P P=0,908 P<0,001 P<0,001
(Uji T sampel independen)

Intervensi Perilaku 10,41± 4,06 11,83± 4,00 1,42± 1,27 P<0,001 Kontrol 10,49± 4,07 10,45±
4,07 0,03± 0,19 P=0,302 Nilai P P=0,907 P<0,001 P<0,001
(Uji T sampel independen)

menunjukkan
bahwa perbedaan rata-rata niat perilaku, norma
Mengenai konstruksi TPB, uji T sampel subjektif dan kontrol perilaku yang dirasakan
berpasangan digunakan untuk membandingkan sebelum dan sesudah intervensi signifikan dalam
hasil sebelum dan sesudah intervensi. Temuan
JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 312
danperilaku yang dirasakan
kelompok intervensi (P<0,001); namun, kontrolsignifikan antara kelompok kontrol dan
perbedaannya tidak signifikan pada kelompok intervensi (P<0,05). Perubahan ini lebih tinggi dan
kontrol (P>0,05). Selain itu, Independent sample positif pada kelompok kontrol yang menunjukkan
T-test dilakukan untuk membandingkan hasil bahwa pendidikan secara signifikan meningkatkan
antara kelompok kontrol dan intervensi. Hasil niat perilaku, norma subjektif dan kontrol perilaku
penelitian menunjukkan bahwa perbedaan yang dirasakan dari siswa intervensi (Tabel 2).
rata-rata skor intensi perilaku, norma subjektif

Tabel 2: Perbandingan skor rata-rata niat perilaku, norma subjektif dan

kontrol perilaku yang dirasakan pada kelompok kontrol dan intervensi
sebelum dan sesudah intervensi pendidikan

Kelompok Sebelum Setelah Mean intervensi nilai P perubahan (Sampel berpasangan

Mean ± SD Mean ± SD T test )

Intervensi Perilaku 8.82± 3.59 10.05± 3.48 1.23± 1.11 P<0.001 Intention Control 8.88± 3.50
8.82± 3.44 0.06± 0.06 P=0.103 P value P=0.929 P<0.001 P<0.001
(Uji T sampel independen)

Intervensi Subyektif 9,18± 3,36 10,42± 3,20 1,24± 0,16 P<0,001 Kontrol Norma 9,26± 3,30
9,20± 3,22 0,06± 0,02 P=0,199 Nilai P P=0,868 P<0,001 P<0,001
(Uji T sampel independen)

Persepsi Intervensi 8,48± 2,74 10,00± 2,75 1,52± 0,03 P<0,001 Kontrol perilaku 8,53± 2,64
 8,46± 2,49 0,07± 0,15 P=0,322 kontrol Nilai P P=0,907 P<0,001 P<0,001 (T sampel independen T uji) Uji
intervensi denganpengetahuan
perubahandan konstruk TPB (P<0,05) (Tabel 3).
korelasi spearman menunjukkan korelasi positif
dan signifikan antara perubahan perilaku siswa

Tabel 3: Penentuan koefisien korelasi antara perubahan perilaku dan pengetahuan

dan konstruksi model (niat perilaku, norma subjektif, dan kontrol perilaku yang
dirasakan) padakelompok intervensi

variabelPengetahuan Perilaku Subyektif Persepsi perilaku Perilaku niat kontrol norma

Pengetahuan 1
Niat perilaku *0.345 1
Norma subyektif *0.457 *0.293 1
Persepsi perilaku *0.267 *0.257 0.135 1
Kontrol
Perilaku *0.241 *0.291 *0.313 *0.303 1 *P<0/05

JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 313
independen (prediktor): pengetahuan, niat
Selain itu, analisis regresi menunjukkan perilaku, norma subjektif dan kontrol perilaku yang
signifikansi model regresi (variabel dependen dirasakan.
model: perilaku, variabel independen (prediktor):
pengetahuan, niat perilaku, norma subjektif dan Sebuah survei terhadap variabel independen
kontrol perilaku yang dirasakan) (P=0,002); individu menunjukkan bahwa pengetahuan
Dengan kata lain, model ini dapat menjelaskan memiliki pengaruh tertinggi pada perilaku sehingga
(memprediksi) perubahan variabel dependen untuk setiap peningkatan satu unit dalam
perilaku. Nilai perubahan ini berdasarkan koefisien pengetahuan, peningkatan 0,348 unit terjadi pada
determinasi yang disesuaikan sama dengan 0,11, perilaku. Kemudian, pengaruh tertinggi pergi ke
yaitu model dapat menjelaskan ≈%11 dari niat perilaku dan kontrol perilaku yang dirasakan,
perubahan variabel dependen (perilaku). masing-masing (Tabel 4).
*Variabel terikat model: perilaku; variabel

Tabel 4 Dampak Absolut Perubahan Variabel Independen (Pengetahuan, Niat

Perilaku, dan Persepsi Kontrol Perilaku)(Perilaku) Pada Kelompok Intervensi

Variabel TerikatVariabel Model B SE Beta T Sig

Terhadap PerubahanPengetahuan 0,507 0,155 0,348 3,277 0,002 Niat Perilaku

0,603 0,152 0,380 4,236 0,0001 Perceived behavioral control 0,397 0,142 0,254
2,553 0,034
antara individu-individu pada usia yang sama.
Dalam studi yang dilakukan oleh Woodward30 dan
Diskusi Maretha,31 dampak pendidikan sebaya pada
Temuan penelitian ini menunjukkan bahwa peningkatan perilaku kesehatan dikonfirmasi
intervensi peer education berdasarkan TPB dibandingkan dengan teknik lain.
mempengaruhi peningkatan perilaku kesehatan
gizi di antara peserta penelitian. Pendekatan Tidak ada perbedaan signifikan yang diamati
pendidikan sebaya bisa efektif berdasarkan fakta antara kelompok kontrol dan intervensi dalam hal
bahwa informasi sensitif lebih mudah ditransfer di
perubahan rata-rata dan standar deviasi skor berbasis TPB meningkatkan persepsi siswa
pengetahuan sebelum intervensi. Setelah tentang sarapan dan makan. Skor rata-rata
intervensi, kelompok kontrol tidak menunjukkan perilaku kelompok intervensi meningkat secara
perbedaan yang signifikan dalam skor rata-rata signifikan setelah intervensi. Perbaikan perilaku
pengetahuan mereka, sedangkan kelompok nutrisi juga dikonfirmasi dalam sebuah studi oleh
intervensi menunjukkan perbedaan yang signifikan Vassallo.35
dalam hal ini. Pada kelompok intervensi, skor
rata-rata pengetahuan meningkat secara signifikan Dalam penelitian ini, skor rata-rata niat Perilaku
setelah intervensi. Hasil kami konsisten dengan menunjukkan peningkatan yang signifikan antara
temuan penelitian lain yang dilakukan mengenai kelompok intervensi setelah intervensi pendidikan.
pengaruh pendidikan pada pengetahuan gizi siswa Hasil beberapa penelitian serupa dengan temuan
terutama yang dilaporkan oleh Alicia Raby penelitian kami. Seperti dilansir Mohammadi Zeidi
Powers,32 Syarif,33 dan Ghafari.34 Skor pengetahuan et al.,36 dan Qasvandi dkk.,37 skor rata-rata
secara signifikan lebih tinggi pada kelompok konstruk ini meningkat secara signifikan di antara
intervensi dibandingkan anggota kelompok intervensi.
kelompok kontrol, mengkonfirmasikan pengaruh
intervensi pendidikan pada pengetahuan gizi Berkenaan dengan norma subjektif, kami
siswa. menemukan peningkatan yang signifikan dalam
skor kelompok eksperimen setelah intervensi
Perbandingan perubahan rata-rata dan standar pendidikan dan temuan studi yang berbeda
deviasi skor perilaku mengungkapkan bahwa mengkonfirmasi temuan kami.38,39
pendidikan memiliki efek positif pada peningkatan
perilaku gizi pada kelompok intervensi. Edukasi
JADGAL dkk., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 314
dengan peningkatan skor pengetahuan, niat
Namun, beberapa penelitian lain melaporkan hasil perilaku, norma subjektif, dan konstruk kontrol
yang bertentangan. Misalnya, Vakili et al.,40 serta perilaku yang dirasakan. Peningkatan
Lautenschlager dan Smith 41
mengungkapkan masing-masing konstruksi ini mengarah pada
bahwa skor norma subjektif menurun setelah promosi perilaku gizi yang sehat. Selain itu, hasil
intervensi pendidikan pada kelompok eksperimen. analisis regresi menunjukkan signifikansi model
Perbedaan ini dapat disebabkan oleh penerapan regresi (variabel terikat: perilaku; variabel bebas:
program pendidikan yang berbeda, isi program pengetahuan, niat perilaku, norma subjektif, dan
pendidikan, masa studi, peserta, serta karakteristik kontrol perilaku yang dirasakan). Dengan kata lain,
sosial, budaya, dan ekonomi kelompok studi, dll model ini dapat memprediksi
perubahan variabel dependen perilaku. Nilai
prediksi ini adalah 0,11 berdasarkan koefisien
. Konstruk ketiga adalah "kontrol perilaku yang
determinasi yang disesuaikan; model dapat
dirasakan", yang membahas dengan keyakinan
menjelaskan 11% dari perubahan variabel
orang tentang kemampuan mereka untuk
dependen (perilaku).
mengontrol perilaku. Konstruk ini dikaitkan dengan
kemudahan atau kesulitan dalam melakukan suatu
Sebuah survei variabel independen individu
perilaku.16 Dalam studi saat ini, skor rata-rata dari
kontrol perilaku yang dirasakan meningkat secara menunjukkan bahwa pengetahuan memiliki
signifikan setelah intervensi. Dalam sebuah pengaruh tertinggi pada perilaku, sehingga untuk
penelitian yang dilakukan oleh White, skor peningkatan satu unit pengetahuan, peningkatan
rata-rata dari kontrol perilaku yang dirasakan 0,348 unit diamati dalam perilaku. Selain itu,
menunjukkan peningkatan yang signifikan setelah pengaruh tertinggi dicatat untuk niat perilaku dan
intervensi pendidikan.15 Beberapa penelitian kontrol perilaku yang dirasakan, masing-masing.
melaporkan peningkatan rata-rata tingkat kontrol
perilaku yang dirasakan setelah pendidikan.42, 43 Kesimpulan
Hasil penelitian ini menunjukkan bahwa
Hasil uji korelasi Spearman menunjukkan bahwa pendidikan gizi sebaya dengan pendekatan TPB
skor perilaku berubah secara positif dan signifikan dapat mempengaruhi perilaku gizi siswa sekolah
 dasar. Namun, itu mempengaruhi perilaku individu yang berkontribusi pada penelitian ini.
secara positif dengan meningkatkan pengetahuan
mereka, niat perilaku, dan kontrol perilaku yang Pendanaan
dirasakan. Penulis tidak menerima dukungan finansial untuk
penelitian, kepenulisan, dan/atau publikasi artikel
Ucapan Terima Kasih ini.
Dengan ini, kami ingin mengucapkan terima kasih
kepada para manajer dan administrator sekolah Konflik Kepentingan
Sadaf dan Najme, para siswa dan semua pihak Penulis tidak memiliki konflik kepentingan.
Ismail MN.

Referensi

(4): 259-262.
1. Ruzita AT., Wan Azdie MAB.,
Efektivitas Program Pendidikan Gizi Anak 3. Organisasi Kesehatan Dunia. Gizi pada masa
Sekolah Dasar. Mal J Nutr. 2007; 13 (1): remaja: isu dan tantangan bagi sektor
4-45. kesehatan. Masalah kesehatan dan
2. Haldar D., Chatterjee T., Sarkar AP., Bisoi S., perkembangan remaja. Pt. 1. Jenewa:
Biswas AK., Sardar JC. Studi Dampak Organisasi Kesehatan Dunia, 2006. 115 hal.
Pendidikan Kesehatan dan Gizi Berbasis (Makalah diskusi WHO tentang remaja).
Sekolah dalam Pengendalian Anemia Gizi 4. Hwenda L. Mengatasi faktor risiko terkait diet
pada Anak Sekolah Dasar di Pedesaan untuk penyakit tidak menular. Glob
Benggala Barat. Med Komunitas J India. MenyembuhkanGov.2013.
2012; 37
JADGAL dkk., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 315
Sosiologi pendidikan. 1990; 1:122-32.
5. Mohd Shariff Z., Sabariah Bukhari S., Othman 10. Elbaum B., Vaughn S., Tejero Hughes M.,
N., Hashim N., Ismail M., Jamil Z., dkk., Intervensi Watson Moody S. Seberapa efektif program
Pendidikan Gizi Meningkatkan Pengetahuan Gizi , bimbingan belajar satu-satu dalam membaca
Sikap, dan Praktik Anak Sekolah Dasar: Studi untuk siswa SD yang berisiko gagal membaca?
Percontohan. Int Electron J Health Education. Sebuah meta-analisis dari penelitian intervensi. J
2008; 11 (1):119-132. Pendidikan Psikolog. 2000; 92 (4):605.
6. Hazavehei SM., Taghdisi MH., Saidi M. 11. Gortmaker SL., Peterson K., Wiecha J., Sobol
Penerapan Health Belief Model untuk AM., Dixit S., Fox MK. Mengurangi obesitas
pencegahan osteoporosis di kalangan siswi melalui intervensi interdisipliner berbasis
SMP, Garmsar, Iran. Kesehatan Pendidikan. sekolah di kalangan pemuda: Planet Health.
2007; 20 (1): 7-30. Arch Pediatr Adolsc Med. 1999; 153
7. Keishadi R., Ardalan G., Gheyratmand R., (4):409-18.
Sheikh al-Islam R., Majdzadeh S R., 12. Mirmiran P., Azadbakht L., Azizia F. Perilaku
Delawari A R., et al., Dapatkah kebiasaan diet remaja Teheran tidak sesuai dengan
makan masyarakat kita memberikan pengetahuan gizi mereka. Nutrisi
kesehatan masa depan anak-anak dan Kesehatan Masyarakat. 2007; 10
remaja? Studi CASPIAN. Iran J Pediatr. (9):897–901.
2005; 15 (2): 97-109. 13. Kaushik JS., Narang M., Parakh A. Konsumsi
8. Sharma SV., Hoelscher DM., Kelder SH., makanan cepat saji pada anak. India J
Diamond P., Hari RS., Hergenroeder A. Pediatr. 2011; 48 (2):97-101.
Faktor psikososial yang mempengaruhi 14. Karimi-Shahanjarini A., Omidvar N., Bazargan
asupan kalsium dan kualitas tulang pada M., Rashidian A., Majdzadeh R.,
gadis sekolah menengah. J Am Diet Assoc. Shojaeizadeh DA. Pandangan remaja
2010; 110 (6): 6–932. perempuan Iran tentang konsumsi makanan
9. Hallinan MT., Williams RA. Karakteristik siswa ringan yang tidak sehat: studi kualitatif.
dan proses pengaruh teman sebaya. Kesehatan Masyarakat Iran J.
 2010; 39 (3):92. Pendidikan Pasien. 2010; 78 (2):76 -169.
15. Hien VTT., Khan NC., Mai LB., Lam NT., 20. Zhanq J., Chen D., Wanq J., Wanq Y.
Phuong TM., Nhung BT., et al., Pengaruh Menggunakan Teori Perilaku terencana
intervensi pendidikan gizi berbasis untuk menguji Efektivitas Intervensi
masyarakat pada asupan kalsium dan Pendidikan Pada Pemberian Makan Bayi di
massa tulang pada wanita Vietnam Cina. Sebelumnya Med.
pascamenopause. Nutrisi Kesehatan 2009; 49 (6): 34-529.
Masyarakat. 2009; 12 (5): 9–674. 21. Mbithe DD., Kimiywe JO., Waudo JN., Orodho
16. Kortteisto T., Kaila M., Komulainen J., JA. Promosi intervensi pendidikan gizi di
Mäntyranta T., Rissanen P. Niat profesional sekolah dasar pedesaan dan perkotaan di
kesehatan untuk menggunakan pedoman distrik Machakos. Kenya J Appl Biosci.
klinis: survei menggunakan teori perilaku 2008; 6: 9-130.
terencana. Menerapkan Sains. 22. Jennings JM., Howard S., Perotte CL. Efek dari
2010; 5: 9-51. program pendidikan seksualitas berbasis
17. Chang MK. Memprediksi perilaku tidak etis: sekolah pada pendidik sebaya: model PEP
perbandingan teori tindakan beralasan dan remaja. Pendidikan Kesehatan Res. 2014;
teori perilaku terencana. J. Etika Bus. 1998; 29 (2): 29–319.
17 (16):1825-34. 23. Banyard VL., Moynihan MM., Plante EG.
18. Giles M., Connor S., McClenahan C., Mallett Pencegahan kekerasan seksual melalui
J., Stewart-Knox B., Wright M. Mengukur pendidikan pengamat: evaluasi
sikap anak muda untuk menyusui eksperimental. J Psikolog Komunitas.
menggunakan Teori Perilaku yang 2007; 35 (4): 81–463.
Direncanakan. J. Kesehatan Masyarakat. 24. Moynihan MM., Banyard VL., Peduli AC.
2007; 29 (1): 17-26. Mendorong tanggapan dalam pencegahan
19. Krones T., Keller H., Becker A., ​Sönnichsen A., kekerasan seksual dan hubungan: efek
Baum E., Donner-Banzhoff N. Teori Perilaku program apa yang tersisa satu tahun
yang Direncanakan dalam Percobaan Acak kemudian?
dari Bantuan Keputusan tentang
Pencegahan Risiko Kardiovaskular. Jumlah
JADGAL dkk., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 316
kesehatan pada perilaku gizi di kalangan
J Interpers Kekerasan. 2014; 30 (1): siswa sekolah dasar perempuan di
32–110. 25. Kirk RH., Hamrick M., McAfee DC. chabahar. Jurnal Shahed Uni. 2006; 13
Nutrisi dalam instruksi kesehatan: Proyek (62): 65-70.
pendidikan kesehatan Tennessee. J Nutr 29. Khazaei Pool M., EbadiFardAzar F., Solhi M,
Pendidikan. 1975; 7 (2): 68-71. AsadiLari M., Abdi N. Pengaruh pendidikan
26. Jadgal KM., Nakhaei-Moghadam T., gizi melalui Health Belief Model terhadap
Alizadeh-Seiouki H., Zareban I., Sharifi Rad persepsi siswa tentang sarapan dan
J. Dampak intervensi pendidikan pada makanan jajanan di kelas empat sekolah
perilaku pasien dengan TB paru BTA-positif: dasar kota Noshahr. Jurnal Penelitian
studi menggunakan model kepercayaan Kesehatan. 2009; 7 (2): 51-65
kesehatan. Materia sosio-medika. 2015; 27 30. Woodward A., Howard N., Souare Y., Kollie S.,
(4): 229. Roenne A., Borchert M. Kesehatan
27. Alizadeh Siuki H., Jadgal K., Shamaeian reproduksi bagi pengungsi oleh pengungsi
Razavi N., Zareban I., Heshmati H., Saghi di Guinea IV: Pendidikan sebaya dan
N. Pengaruh Pendidikan Kesehatan pengetahuan, sikap HIV , dan praktik yang
Berbasis Health Belief Model Terhadap dilaporkan. Kesehatan Confl.
Perilaku Gizi Siswa Sekolah Dasar di Torbat 2011; 5 (1): 9-10.
e Heydariyeh City pada tahun 2012. J 31. Maretha J. Pencegahan HIV/AIDS Melalui
health. 2015; 5 (4): 289-299 Pendidikan Sebaya dan Dukungan di
28. Nazari M., Niknami Sh., Alireza HR., Babaei Sekolah Menengah di Afrika Selatan.
Gh., Ghahramani L. Pengaruh pendidikan SAHARA J. 2007; 4 (3): 94-678.
32. Raby Powers A., Struempler B J., Guarino A., 37. Gheysvandi E., Eftekhar-Ardebili H., Azam K,
Parmer S M. Pengaruh program pendidikan Vafa MR., Azadbakht M., Babazadeh T., et
gizi pada perilaku diet dan pengetahuan gizi al., Effect of an educational intervention
siswa kelas dua dan kelas tiga. J based on the theory of planned behavior on
SchKesehatan.2005; 75 (4): 129-133. milk and dairy products consumption by girl
33. Shariff Z M., Bukhari S S., Othman N., Hashim pupils. J Sch Public Health Inst Public
N., Ismail M., Jamil Z., dkk., Intervensi Health Res. 2015; 13 (2):45-54.
Pendidikan Gizi MeningkatkanGizi 38. Wong CL., Mullan BA. Predicting breakfast
Pengetahuan, Sikap, dan PraktikAnak consumption. An application of the theory of
Sekolah Dasar: Pilot Belajar. Pendidikan planned behavior and the investigation of
Kesehatan Elektron J Int. 2008; 11: past behavior and executive function. Br J
119-132. Health Psychol. 2009; 14: 489 504.
34. Ghaffari M., Tavassoli E., Esmaillzadeh A., 39. Armitage CJ., Conner M. Efficacy of the theory
Hassanzadeh A. Effect of health belief of planned behaviour. A meta analytic
model based intervention on promoting review. Br J Soc Psychol. 2001; 40: 471 99.
nutritional behaviors about osteoporosis 40. Vakili M., Baghiani Moghadam MH., Pirzadeh
prevention among students of female A., Dehghani M. Assessing the effect of
middle schools in Isfahan, Iran. J Educ education on knowledge, attitude and
Health Promot. practice of guidance school students about
2012; 1: 14- 22. milk and dairy products. Knowl Health J.
35. Vassallo M., Saba A., Arvola A., Dean M., 2008; 2: 41 7
Messina F., Winkelmann M., et al., Willingness to 41. Lautenschlager L., Smith C. Understanding
use functional bread. Applying the Health Belief gardening and dietary habits among youth
Model across four European countries. J Elsevier. garden program participants using the
2009; 52 (2): 452–460. Theory of Planned Behavior. Nafsu makan.
36. Mohammadi-Zeidi I., Pakpour A. Effectiveness 2007; 49:122 30.
of educational intervention based on theory 42. Hong K., Gittelsohn J., Joung H. Determinants
of planned behavior for promoting breakfast of customers' intention to participate in a
and healthy snack eating among elementary Korean restaurant health promotion
school students. Razi Journal of Medical program: an application of the theory
Sciences. 2013; 20 (112):67-78.
JADGAL et al., Curr. Res. Nutr Food Sci Jour., Vol. 8(1), 308-317 (2020) 317

of planned behavior. Health Promot Int.

2010; 25 (2):174-182.
43. Mc Clenahan C., Shevlin M., Adamson G.,
Bennett C., O'Neill B. Testicular self
examination: a test of the health belief
model and the theory of planned behavior.
Health Educ Res. 2007; 22 (2): 272–284.
Original Article
Clin Nutr Res 2012;1:49-57
http://dx.doi.org/10.7762/cnr.2012.1.1.49
pISSN 2287-3732 ∙ eISSN 2287-3740

Effect of Workplace-Visiting Nutrition Education on

Anthropometric and Clinical Measures in Male Workers
Hye-Jin Kim, Jeong-Im Hong*, Hee-Jung Mok, Kyung-Mi Lee
Department of Nutrition, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul 150-713, Korea

The purpose of this study was to investigate effect of nutrition education at worksite program in male workers. The subjects
were 75 male workers who had received nutrition education by a clinical dietitian for 4 months. The anthropometric data, blood
pressure and biochemical blood indices were measured before and after nutrition education. Dietary habits and lifestyle were
investigated by self-administered questionnaires. Nutrients intake was determined by 24-hour dietary recall method. The results
showed significant decreases in body mass index (p < 0.05), fasting blood sugar (p < 0.01), total cholesterol (p < 0.05), and LDL-
cholesterol (p < 0.05) after nutrition education. The correlation analyses among anthropometric and clinical parameters after
nutrition education indicated that there was a significantly positive correlations between blood pressure and weight, r-GTP. A
significantly positive correlations was observed between fasting blood sugar and triglycerides. A significantly positive correla-
tions was observed between triglycerides and body mass index, r-GTP, SGPT. A significantly positive correlations was observed
between SGPT and weight, body mass index. A significantly negative correlations was observed between HDL-cholesterol and
weight. It could be concluded that nutrition education might be effective tool to improve anthropometric measures and clini-
cal parameters in male workers. Continuing and systematic nutritional management programs should be developed and imple-
mented for male workers at the worksites to maintain optimal health status.

Key Words: Body mass index, Blood lipids, Blood pressure, Blood glucose, Liver function tests, Nutrition eduction

*Corresponding author Jeong-Im Hong Introduction

Address Department of Nutrition, Yeouido St. Mary‘s Hospital, 10,
63-ro Yeongdeungpo-gu, Seoul 150-713, Korea Tel +82-2-3779-
1482 Fax +82-2-3779-1795
E-mail hjeongim@hanmail.net
Received June 9, 2012
Revised July 5, 2012
Accepted July 9, 2012
This is an Open Access article distributed under the terms of the Creative Commons
Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/)
which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.
© 2012 The Korean Society of Clinical Nutrition
The rapid economic growth and westernized diet of Korea
have triggered energy overconsumption [1], whereas the
convenient modern lifestyle has led to the lack of exercise
to increase metabolic syndromes, such as hypertension,
diabetes and dyslipidemia [2,3]. Wilson et al. [4] defined
metabolic syndrome as metabolic disorders that increase the
risk of chronic diseases in which hypertension, hyperglyce-
mia, dyslipidemia and abdominal obesity are simultaneously
generated and progressed. Metablic syndromes are viewed
as diseases that can be prevented by managing risk factors
including obesity, drinking, smoking and wrong dietary hab-
its to raise the importance of managing chronic illnesses and
providing medical service [5].
The National Health Promotion Act enacted in 1995 regu-
lates the nation and local autonomous entities to actively
promote the regional society health project for improving

http://e-cnr.org 49

the health of the public. This act has promoted the activation
of health projects. As a part of the health project, nutrition
education and consulting programs help subjects with nutri-
tional issues to analyze their own dietary habits, learn proper
living habits and solve problems. In particular, nutrition
education provided in the workplace is especially beneficial
to office workers that are unable to visit the hospital due to
their work schedule. In the welfare aspect, it can also boost
the work ambition of workers [6].
According to the study conducted by Lee & Suh [7], of-
fice workers began to become more interested in health as
the society began to place greater emphasis on individual
engagement and responsibility for health in relation to the
increase in chronic diseases. However, due to various envi-
ronmental factors, such as irregular work time, poor dietary
habits, low nutrition knowledge, stress due to overwork and
lack of health management efforts, chronic illnesses can
be easily progressed among office workers. In fact, among
chronic diseases, the prevalence rate of dyslipidemia is con-
tinuously increasing among men aged 30 and higher [8].
In particular, low HDL-cholesterolemia was increased from
22.8% in 1998 to 47.6% in 2007, thus presenting a 25.4%
increase in 10 years (Ministry for Health, Welfare and Family
Affairs & Korea Centers for Disease Control and Prevention,
2008). However, the opportunity of nutrition education, an
essential factor in preventing and treating such diseases, re-
mains insufficient [9].
According to precedent studies conducted on workers,
providing a fixed period of nutrition education improved the
dietary habits and lifestyles of subjects and positively influ-
enced the clinical standard, thus reporting that significant
effects can be acquired by implementing nutrition education
in work places that provide at least one meal a day [10,11]. In
a study conducted on office workers, Lee et al. [11] reported
that providing a fixed period of nutrition education produced
positive effects in reducing the weight and obesity of sub-
jects, enhancing healthy behaviors and improving clinical
standards [11-15]. In particular, by developing, systemizing
and implementing an appropriate nutrition education pro-
gram for workers according to workplace characteristics, the
health conditions and the work morale of employees will be
boosted increasing the pride for the company and productiv-
ity and reducing of national medical expenses. Furthermore,
if the education content can be appropriately delivered to
households, the nutrition education program implemented
50 http://e-cnr.org
Kim HJ et al.
in the workplace after health check-up can also contribute
to the improvement of domestic dietary life [16]. Thus, it is
stipulated that providing an appropriate nutrition manage-
ment education related with diseases and implementing
continuous nutritional care and education through clinical
nutritionists are not only essential for improving the health
of office workers, enhancing company welfare and reduc-
ing medical costs, important for work efficacy. Furthermore,
the role of the clinical nutritionist is to coach the subjects to
independently find answers to change their dietary behaviors
and maintain such changes in their dietary behaviors.
According to the results of the 2007 National Health Pro-
motion Act, the obesity rate of Korean adults is gradually
increasing from 30.6% in 2001, 31.5% in 2005 and 31.7% in
2007, along with the increased prevalence rate of obesity-
related diseases. In case of metabolic syndromes, the preva-
lence rate of men have continuously increased from 20.8%
to 32.9% after 1998 [17]. Furthermore, the study conducted
by Bae et al. [18] on the changes in the obesity prevalence
rate for 10 years (1997-2007) indicated that the obesity
rate of men aged between 30-39 was increased 11.2% in a
decade, from 20.7% in 1997 to 31.8% in 2007, whereas the
obesity rate of men aged between 40-49 was increased 9.2%,
from 25.6% in 1997 to 34.8% in 2007. The study also re-
ported that it is necessary to evaluate and intervene dietary
habits and health-related behaviors in order to reduce the
obesity trend.
Hereupon, this study carried out health examination on
male office workers with higher risk of having metabolic
syndrome and classified subjects with abnormal findings
(hypertension, diabetes, dyslipidemia, abnormal liver func-
tion indices). This study implemented the workplace-visiting
nutrition education program based on the self-directed
coaching method for changing poor dietary habits to proper
dietary behaviors and attempted to analyze the effectiveness
of the program.
Materials and Methods
Subjects and period
This study selected subjects with abnormal laboratory
findings (hypertension, diabetes, dyslipidemia, abnormal
liver function indices) among employees of L Company that
received health examination and comprehensive medical
checkup implemented by the National Health Insurance
http://dx.doi.org/10.7762/cnr.2012.1.1.49
Effect of Workplace-Visiting Nutrition Education for Male Workers
Workplace-visiting nutrition eduction program was imple-
mented from June to September 2011. A total of 75 male
office workers were included to evaluate the effectiveness of
nutrition education. Subjects with abnormal findings related
with metabolic syndromes were classified into the metabolic
syndrome group if there were relevant to at least 3 out of 5
items in the NCEP ATPⅢ (Executive Summary of the Third
Report of The National Cholesterol Education Program,
2001). The standards are as follows.
1) Fasting blood sugar ≥110 mg/dL
2) Waist circumference >90 cm (Men)
3) Blood pressure ≥130/85 mmHg
4) Triglycerides ≥150 mg/dL
5) HDL-cholesterol <40 mg/dL (Men)
Survey content and method
This study was conducted in a process consisting of basic
survey, consulting of examination results, nutrition education
and assessment. In the basic survey, the general information,
physical measurement, meal journal, life styles, clinical and
biochemical parameters were obtained. Nutrition education
was conducted in a self-directed coaching method according
to metabolic syndrome types based on examination results.
Afterward, the final examination and assessment were car-
ried out.
Anthropometric and biochemical measurements
Age and anthropometric measures including height (HT),
weight (WT), waist circumference (WC) were obtained and
body mass index was calculated. Subjects were asked to re-
cord the meal journal written based on the food intake sur-
vey chart of the 2009 Korean National Health and Nutrition
Examination Survey developed by using the 24-hour recall
method. The regularity of meals, drinking and smoking hab-
its were asked. Systolic blood pressure (SBP), diastolic blood
pressure (DBP), and fasting blood sugar (FBS) were measured.
Serum glutamic oxalacetic transaminase (SGOT), serum
glutamic pyruvic transaminase (SGPT) and r-GTP (Gamma-
glutamyl transpeptidase) were analyzed. As measures of liver
function test. total cholesterol (TC), triglycerides (TG), high
density lipoprotein cholesterol (HDLc), low density lipoprotein
cholesterol (LDLc) were determined before and after the nu-
trition education.
http://dx.doi.org/10.7762/cnr.2012.1.1.49
Nutrition education program
Dietary habits were analyzed using the nutrition consult-
ing program. Based on the dietary habits of study subjects,
the clinical nutritionist implemented meal therapy consult-
ing. Afterward, clinical nutritionists visited the workplace to
provide nutrition assessment and education to observe the
progress of subjects every month. Nutrition analysis program
CAN-Pro version 3.0 (computer aided nutritional analysis
program, Korean Nutrition Society, 2005) was used to ana-
lyze the nutrient intake. Based on nutritional intake data and
clinical measures including blood pressure, blood lipids and
blood glucose, nutrition consulting was conducted. Each
educational session was carried out for 20 minutes and sub-
jects received consulting 2 times on average. For educational
tools, this study used the self-developed nutrition education
leaflet.
Life style and nutrient intake analyses
To analyze life styles, this study asked subjects to fill out
questionnaires based on the medical examination chart pro-
vided by the National Health Insurance during health check-
up. The regularity of meals, drinking and smoking habits of
subjects were included in the questionnaire. We used the
CAN-Pro version 3.0 to analyze the average daily nutrient
intake based on the meal journals recorded during the first
examination.
Statistical analysis
This study used SPSS Statistic 18 (Statistical Package for
the Social Sciences, SPSS Inc., Chicago, IL, USA) for statisti-
cal processing. This study used descriptive statistics of mean
and standard deviation to analyze general characteristics, the
non-parametric wilcoxon signed ranked test of the paired
t-test was used to analyze clinical and biochemical measure-
ments including blood pressure, blood lipids, blood glucose,
and liver function indicators. This study classified body mass
index (BMI) according to normal weight (BMI < 23.0 kg/m2),
overweight (23.0 ≤ BMI < 25.0 kg/m2) and obese (BMI ≥ 25.0
kg/m2) and used the non-sequential variable with the non-
parametric method for analysis. Spearman’s correlation was
used to verify factors that influence clinical indicators related
with metabolic syndrome in the significance level of p < 0.05.
http://e-cnr.org 51
 Kim HJ et al.

Results
General characteristics and anthropometric measurement
The general characteristics of research subjects are pre-
sented in Table 1. All subjects were male and the average age
was analyzed to be 41. The height was measured as 172.2
cm. The weight was reduced from 76.2 kg to 75.6 kg after
nutrition education. The body mass index was significantly
reduced from 25.7 kg/m2 to 25.4 kg/m2 after nutrition edu-
cation (p < 0.05). The waist circumference of subjects was
reduced from 88.4 cm to 87.1 cm after nutrition education,
which was lower than the 90 cm, the diagnostic standard
component of metabolic syndrome as established by NCEP
ATPⅢ (Executive Summary of the Third Report of The Na-
tional Cholesterol Education Program, 2001).
Characteristics of life style
The life study of study subjects are presented in Table 2.
The proportion of study subjects having 3 meals a day with
regularity was 59.6%, whereas the remaining 40.4% an-
swered that they did not regularly eat 3 meals a day. Regular
drinkers were 86.3% of the study subjects and only 13.7%
did not drink at all. Smokers were 51.9% of the subjects
whereas 48.1% were non-smokers.
Changes in blood pressure before and after nutrition
education
The changes in blood pressure before and after nutrition
education are presented in Table 3. The systolic blood pres-
sure was reduced from 120.0 mmHg to 117.8 mmHg after
nutrition education. The diastolic blood pressure was also
reduced from 79.1 mmHg to 77.0 mmHg after nutrition edu-
cation, however, no significant difference was found.
Changes in fasting blood sugar before and after nutrition
education
The changes in fasting blood sugar, the diabetes indica-
tor, before and after nutrition education, were presented in
Table 4. Fasting blood sugar was significantly reduced from
100.5 mg/dl to 97.0 mg/dL after nutrition education (p < 0.01).
This shows that the workplace-visiting nutrition education
of hospital clinical nutritionists is effective in reducing the
blood sugar of subjects with impaired fasting blood sugar.

Table 1. General characteristic and anthropometric parameters of subjects before and after nutrition education*
Variables Before nutrition education (n = 75) After nutrition education (n = 75) p-value
Age, yr 41.1 ± 5.6 -
Height, cm 172.2 ± 6.3 -
Weight, kg 76.2 ± 10.2 75.6 ± 10.2 0.093
2 †
BMI, kg/m 25.7 ± 2.9 25.4 ± 2.8 0.031
Normal weight (BMI < 23.0 ) 17 (22.7) 17 (22.7)
Over weight (23.0 ≤ BMI < 25.0) 16 (21.3) 17 (22.7)
Obesity (BMI ≥ 25.0) 42 (56.0) 41 (54.6)
WC, cm 88.4 ± 7.7 87.1 ± 6.2 0.083
BMI: body mass index, WC: waist circumference.
*Values are presented as mean ± SD or N (%); †Significantly different at a p < 0.05.

Table 2. Life style and dietary habits* Table 3. Changes in blood pressure before and after nutrition
education*
Variables Criteria N (%)
Before nutrition After nutrition education
Regularity of meals Yes 34 (59.6) Variables
education (n = 75) (n = 75)
No 23 (40.4)
SBP, mmHg 120.0 ± 10.0 117.8 ± 10.4
Alcohol drinking Drinker 63 (86.3)
DBP, mmHg 79.1 ± 6.8 77.0 ± 9.2
Non-drinker 10 (13.7)
SBP: systolic blood pressure, DBP: diastolic blood pressure.
Smoking status Smoker 28 (51.9) *Values are presented as mean ± SD.
Non-smoker 26 (48.1)
* Values are presented as N (%).

52 http://e-cnr.org http://dx.doi.org/10.7762/cnr.2012.1.1.49
Effect of Workplace-Visiting Nutrition Education for Male Workers

Changes in serum lipid before and after nutrition educa-
tion
The changes in serum lipid, the indicator for dyslipidemia,
before and after nutrition education are presented in Table
5. The total cholesterol was significantly reduced from 211.3
mg/dL to 204.4 mg/dL (p < 0.05), whereas triglycerides was
reduced from 216.6 mg/dL to 204.0 mg/dL after nutrition
education without showing a significant difference. High
density lipoprotein cholesterol was similar before and after
nutrition education, whereas low density lipoprotein cho-
lesterol was significantly reduced from 131.1 mg/dL to 123.6
mg/dL after nutrition education (p < 0.05).
Changes in liver function indicators before and after nu-
trition education
The changes in liver function indicators of subjects are
presented in Table 6. As indicators for liver function, serum
glutamic oxalacetic transaminase, serum glutamic pyruvic
transaminase and r-GTP were reduced after nutrition educa-
tion, but did not present significant difference.
Nutrient intake analysis
The nutrient intake of study subjects is presented in Table
7. The meal intake survey presented that subjects consumed
2,160 kcal on average, which is 90% of the nutrient intake
standards for men aged between 30-49. Subjects consumed
321.3 g of carbohydrate (60% of total calories) and 79.7 g
of protein (15% of total calories), consisting of 57% animal
protein and 43% of plant protein. The average fat consump-
tion was 61.8 g, which is 26% of total calories, thus present-
ing that subjects ingested 15-25% more than the nutrient
intake standard of Koreans. Subjects consumed 312.9 mg of
cholesterol, which exceeded the 200 mg, the recommended
quantitiy for dyslipidemia patients, and 15.6 g of dietary fiber
per day, which was 25 g less than the daily nutrient intake
standard for Koreans. Thus, the nutrition education placed
emphasis on the increased intake of vegetables (especially
seaweed) for dietary fiber intake. Dyslipidemia patients were
educated to increase the intake of vegetables and fruits es-
pecially to increase the consumption of water-soluble dietary
fiber. Subjects consumed 900.7 μg RE of vitamin A, which
exceeds the recommended intake for men aged between

Table 4. Changes in blood glucose concentration before and after nutrition education*
Variables Before nutrition education (n = 75) After nutrition education (n = 75) p-value
†
FBS, mg/dL 100.5 ± 13.9 97.0 ± 12.0 0.002
FBS: fasting blood sugar.
*Values are presented as mean ± SD; †Significantly different at a p < 0.01.

Table 5. Changes in serum lipid profile before and after nutrition education*
Variables Before nutrition education (n = 75) After nutrition education (n = 75) p-value
†
TC, mg/dL 211.3 ± 35.9 204.4 ± 43.0 0.047
TG, mg/dL 216.6 ± 125.8 204.0 ± 128.8 0.287
HDLc, mg/dL 44.5 ± 8.6 44.5 ± 9.4 0.949
LDLc, mg/dL 131.1 ± 36.4 123.6 ± 39.7† 0.017
TC: total cholesterol, TG: triglycerides, HDLc: high density lipoprotein cholesterol, LDLc: low density lipoprotein cholesterol.
*Values are presented as mean ± SD; †Significantly different at a p<0.05.

Table 6. Changes in liver function indicators before and after nutrition education*
Variables Before nutrition education (n = 75) After nutrition education (n = 75)
SGOT, IU/L 29.7 ± 16.9 28.7 ± 14.0
SGPT, IU/L 39.6 ± 27.9 38.3 ± 23.8
r-GTP, IU/L 60.4 ± 53.7 56.3 ± 46.1
SGOT: serum glutamic oxaloacetic transaminase, SGPT: serum glutamic pyruvic transaminase, r-GTP: r-glutamyl transpeptidase.
*Values are presented as mean ± SD.

http://dx.doi.org/10.7762/cnr.2012.1.1.49 http://e-cnr.org 53
 Kim HJ et al.

Table 7. Average daily nutrients intake* 30-49 (750 μg RE). The intake of vitamins B1, B2, E met the
Nutrients Intake nutrient intake standards of Koreans. However, subjects con-
Energy, kcal 2160.0 ± 198.8 sumed 63.2 mg of vitamins C, which is less than the recom-
CHO, g 321.3 ± 56.4 mended intake quantity of men aged between 30-49 (100
Protein, g 79.7 ± 12.9 mg). This is stipulated to be related with the low dietary fiber
Animal protein, g 45.8 ± 9.9 intake. Study subjects consumed appropriate level of calorie/
Plant protein, g 33.9 ± 8.6 protein, higher level of fat/cholesterol and lower level of di-
Fat, g 61.8 ± 13.2 etary fiber.
Animal fat, g 37.8 ± 8.9
Plant fat, g 24.2 ± 11.5
Correlation of factors that influence clinical indicators
Cholesterol, mg 312.9 ± 115.2
related with metabolic syndrome after nutrition educa-
Fiber, g 15.6 ± 3.2
tion
Na, mg 3294.1 ± 250.1
The factors that influence clinical indicators related with
K, mg 2573.7 ± 537.0
metabolic syndrome after nutrition education are presented
Vitamin A, μg RE 900.7 ± 359.9
in Table 8. Results showed that systolic blood pressure pre-
Vitamin B1, mg 1.39 ± 0.28
sented a significantly positive correlation with weight (p <
Vitamin B2, mg 1.27 ± 0.33
0.05), whereas diastolic blood pressure presented a signifi-
Vitamin C, mg 63.2 ± 30.5
cantly positive correlation with r-GTP (p < 0.05). Fasting
Vitamin E, mg 15.2 ± 6.5 blood sugar presented a significantly positive correlation
CHO: carbohydrates.
*Values are presented as mean ± SD or N (%).
with weight (p < 0.05) and body mass index (p < 0.05). As

Table 8. Correlation coefficient between clinical indicators and WT, r-GTP, BMI, TG, HDLc, SGPT after nutrition education*
Dependent variables Independent variables Coefficient p-value
Blood pressure
SBP, mmHg WT, kg 0.285 p < 0.05
DBP, mmHg r-GTP, IU/L 0.240 p < 0.05
Glycemic control
FBS, mg/dL WT, kg 0.235 p < 0.05
2
BMI, kg/m 0.233 p < 0.05
Lipid profile
TC, mg/dL TG, mg/dL 0.270 p < 0.05
2
TG, mg/dL BMI, kg/m 0.341 p < 0.01
r-GTP, IU/L 0.330 p < 0.01
HDLc, mg/dL -0.258 p < 0.05
SGPT, IU/L 0.272 p < 0.05
HDLc, mg/dL WT, kg -0.240 p < 0.05
Liver function indicators
SGPT, IU/L WT, kg 0.327 p < 0.01
2
BMI, kg/m 0.259 p < 0.05
r-GTP, IU/L WT, kg 0.307 p < 0.01
2
BMI, kg/m 0.255 p < 0.05
SBP: systolic blood pressure, DBP: diastolic blood pressure, WT: weight, r-GTP: r-glutamyl transpeptidase, FBS: fasting blood sugar, BMI: body mass index, TC:
total cholesterol, TG: triglycerides, HDLc: high density lipoprotein cholesterol, SGPT: serum glutamic pyruvic transaminase.
*Analyzed with Spearman’s correlation coefficient.

54 http://e-cnr.org http://dx.doi.org/10.7762/cnr.2012.1.1.49
Effect of Workplace-Visiting Nutrition Education for Male Workers
a clinical indicator for dyslipidemia, total cholesterol pre-
sented a significantly positive correlation with triglycerides
(p < 0.05). Triglycerides presented a significantly positive
correlation with body mass index (p < 0.01), serum glutamic
pyruvic transaminase (p < 0.05), and r-GTP (p < 0.01). On
the other hand, blood total cholesterol showed significantly
negative correlation with high density lipoprotein cholesterol
(p < 0.05). High density lipoprotein cholesterol presented a
significantly negative correlation with weight (p < 0.05). As
an indicator for liver function, serum glutamic pyruvic trans-
aminase presented a significantly positive correlation with
weight (p < 0.01) and body mass index (p < 0.05) whereas
r-GTP also presented a significantly positive correlation with
weight (p < 0.01) and body mass index (p < 0.05). These
results show that among subjects with one or more of meta-
bolic syndrome criteria, it is important to provide specified
nutrition education based on risk factors related to clinical
and biochemical parameters.
Discussion
Office workers frequently drink, dine out, miss breakfast,
lack exercise and experience nutritional imbalance. The life
style is formed based on such experiences cause chronic
degenerative diseases including metabolic syndrome and
cardiovascular diseases during middle and old age. Nutri-
tion education helps subjects to correct life styles to lower
metabolic syndromes. Hereupon, among subjects that pre-
sented abnormal clinical findings in the health examination
and comprehensive medical checkup implemented by the
National Health Insurance, the workplace-visiting nutri-
tion eduction was implemented for 75 male office workers,
and the effectiveness was analyzed. We used self-directed
coaching method based on metabolic syndrome components
that each study subjects possess.
By analyzing the changes in anthropometric measurement,
clinical and biochemical measurement before and after the
4-month nutrition education program, it is concluded that
the body mass index (p < 0.05), fasting blood sugar (p <
0.01), total cholesterol (p < 0.05) and low density lipoprotein
cholesterol (p < 0.05) were significantly reduced. The signifi-
cant decrease in fasting blood sugar (p < 0.01) was similar
to the study of Kim [19], which emphasized the significance
of nutrition education and exercise in regulating blood sugar
http://dx.doi.org/10.7762/cnr.2012.1.1.49
of diabetes patients. Decreases in serum lipid and total
cholesterol is viewed as the effect produced by weight loss
which is accomplished by nutrition education. The study
conducted by Briley et al. [20] also indicated the decrease in
weight and total cholesterol after nutrition education, and
the study conducted by Epstein et al. [21] and Choi [22] also
reported that weight loss can reduce total blood cholesterol
and triglycerides concentration. Summer et al. [23] reported
that the nutrition education provided for office workers was
effective in reducing the weight and cholesterol standard of
subjects. Low density lipoprotein cholesterol was also signifi-
cantly reduced after nutrition education (p < 0.05), which is
viewed to be related with weight loss.
The nutrient intake of subjects was presented as follows:
calories 2160 kcal, carbohydrate 321.3 g, protein 79.7 g, fat
61.8 g. The ratio of carbohydrate, protein and fat to total
calories was presented as 60%:15%:26%, respectively. When
compared with the nutrient intake standard of Koreans (55-
70%:7-20%:15-25%), subjects presented a higher fat ratio.
Hunink et al. [24] reported that the increase in total fat intake
increased the synthesis of chylomicron and very low density
lipoprotein (VLDL) to increase the concentration of blood tri-
glycerides and cholesterol. Subjects ingested 312.9 mg of to-
tal cholesterol, which is higher than the recommended intake
for dyslipidemia patients (200 mg). The 2001 NCEP (National
Cholesterol Education Program) reported that increased cho-
lesterol intake in meals presented increased concentration of
total cholesterol and low density lipoprotein cholesterol [25].
As results showed that subjects ingested 15.6 g of dietary
fiber per day, which was 25 g less than the daily nutrient
intake standard for Koreans [26], education to increase the
intake of dietary fiber was also carried out during the nutri-
tion education. The results of factor analysis, which influence
clinical indicators related with metabolic syndrome after
needs of providing, raise the needs of providing education on
weight loss for subjecits with metabolic disorders.
However, the subjects of this study experienced difficul-
ties in writing the meal journal during the basic survey.
Requesting male office workers who possess low knowledge
of food to write time-consuming meal journals can reduce
the participation rate. In this regard, it is urgent to develop
a program in consideration of the unique characteristics of
subjects to help subjects to write easily and to view results
immediately. Furthermore, to efficiently implement nutrition
education to a large number of subjects in a fixed period
http://e-cnr.org 55

of time, it is necessary to develop various nutrition educa-
tion and assessment programs of outstanding quality and
content to help subjects take interest and stay motivated.
In addition, as the 4-month nutrition education effectively
reduced body mass index, fasting blood sugar, total choles-
terol and low density lipoprotein cholesterol, the nutrition
education was verified to be effective in that experienced
clinical nutritionists actively encouraged subjects through
the self-directed coaching method. Thus, it can be stipulated
that a customized nutrition education program must be im-
plemented to reduce medical costs, improve work efficiency
and enhance quality of life in the long run through enhanced
health of subjects.
Conclusion
The results of this study verified that the visiting nutrition
education provided to male workers through the individual-
based, self-directed was effective in reducing body mass
index and improving clinical quality index. In Korea, nutrition
education and consulting have been mostly provided in hos-
pitals. However, when considering the fact that the health
of workplace workers, which compose a very large group, is
directly connected with their work efficiency, it is important
to achieve nutrition management through systematic educa-
tion or consulting. Such nutrition education and consulting
programs can be efficiently implemented by nutritionists
within the workplace and thus requires the development of
a program suitable for the workplace and the regular imple-
mentation of the program. However, as professional clinical
nutritionists are absent in most work places, it is possible
to consider the method of connecting hospitals with health
check-up programs of work places. As health care profes-
sionals, nutritionists will actively contribute to the improve-
ment of national health.
References
1. Jung MS, Bae JH, Kim YH. Relationships between dietary intake and
serum lipid profile of subjects who visited health promotion center. J
Korean Soc Food Sci Nutr 2008;37:1583-8.
2. Ministry of Health and Welfare. Report on 2005 National health and
nutrition survey. Seoul: Ministry of Health and Welfare; 2006.
3. Van Gaal L, Vansant G, Van Campenhout G, Lepoutre L, De Leeuw
56 http://e-cnr.org
Kim HJ et al.
I. Apolipoprotein concentrations in obese subjects with upper and
lower body fat mass distribution. Int J Obes 1989;13:255-63.
4. Wilson PW, Kannel WB, Silbershatz H, D’Agostino RB. Clustering
of metabolic factors and coronary heart disease. Arch Intern Med
1999;159:1104-9.
5. Marmott MG, Poulter NR. Primary prevention of stroke. Lancet
1992;339:344-7.
6. Park HD, Kim EJ, Hwang MO, Paek YM, Choi TI, Park YK. Effets of
Workplace nutrition education program tailored for the individual
chronic disease risks. Korean J Nutr 2010;43:246-59.
7. Lee SY, Suh I. Relationship of health status and health practices. Ko-
rean J Epidemiol 1995;17:48-63.
8. Choi MK, Kim JM, Kim JK. A study on the dietary habit and health of
office workers in Seoul. Korean J Food Cult 2003;18:45-55.
9. Sim KS, Lee KH. The effect of nutrition education on nutrition
knowledge and health improvement in dyslipidemic industrial em-
ployees. J Korean Diet Assoc 2012;18:43-58.
10. Jang JH, Cho SH. Effectiveness of worksite nutrition counselling for
hyperlipidemic employees in Kyung-buk area. J Korean Diet Assoc
1999;5:1-9.
11. Lee MS, Kang HJ, Oh HS, Paek YM, Chou RW, Park YK, Choi TI. Effects
of worksite nutrition counseling for health promotion; Twelve-weeks
of nutrition counseling has positive effect on metabolic syndrome
risk factors in male workers. Korean J Community Nutr 2008;13:46-
61.
12. Son SM, Kim HJ. Effect of 12-week low calorie diet and behav-
ior modification on the anthropometric indices and biochemical
nutritional status of obese woman. Korean J Community Nutr
2005;10:525-35.
13. Cho KO, Jeong SY. The effect of regular dietary habits on obesity
indices and nutrition intakes in adult males. J Korean Diet Assoc
2007;13:114-22.
14. Moon HK, Lee HJ, Park Y. Comparison of health status and dietary
habits by percent body fat (PBF) changes for adult women in the
weight control program by the community health center. Korean J
Community Nutr 2007;12:477-88.
15. Lee YA, Kim KN, Chang N. The effect of nutrition education on
weight control and diet quality in middle-aged women. Korean J
Nutr 2008;41:54-64.
16. Woo MK, Jegal SA, Kim SA. Development and evaluation of nutri-
tion education program for middle agged men at worksite. Korean J
Community Nutr 1998;3:261-72.
17. Ministry of Health and Welfare. Report on 2007 National health and
nutrition survey. Seoul: Ministry of Health and Welfare; 2008. p. 56-
7.
18. Bae NK, Kim KH, Kwon IS, Cho YC. Changes in prevalence of obe-
sity for 10 years (1997~2007) and its related factors in health
checkup examinees. J Korean Academia-Industrial Cooperation
2009;10:1091-9.
19. Kim HI. The effect of 12 weeks aerobic exercise on body composition
blood glucose and lipoprotein in middle-age, menopause and elderly
women. J Korea Sport Res 2004;15:3-12.
20. Briley ME, Montgomery DH, Blewett J. Worksite nutrition education
can lower total cholesterol levels and promote weight loss among
police department employees. J Am Diet Assoc 1992;92:1382-4.
21. Epstein LH, Wing RR, Koeske R, Valoski A. Long term effects of
family-based treatment of childhood obesity. J Consult Clin Psychol
1987;55:91-5.
22. Choi MJ. Relations of life style, nutrient intake, and blood lipids in
middle-aged men with borderline hyperlipidemia. Korean J Commu-
nity Nutr 2005;10:281-9.
23. Summer SK, Schiller EL, Marr ER, Thompson DA. A weight control
and nutrition education program for insurance company employees.
http://dx.doi.org/10.7762/cnr.2012.1.1.49
Effect of Workplace-Visiting Nutrition Education for Male Workers
J Nutr Educ 1986;18:S60-2.
24. Hunink MG, Goldman L, Tosteson AN, Mittleman MA, Goldman PA,
Williams LW, Tsevat J, Weinstein MC. The recent decline in mortality
from coronary heart disease, 1980-1990. The effect of secular trends
in risk factors and treatment. JAMA 1997;277:535-42.
http://dx.doi.org/10.7762/cnr.2012.1.1.49
25. National Cholesterol Education Program. 2001. Third report of the
expert panel on detection evaluation and treatment of high blood
cholesterol in adults. Bethesda: Maryland; 2001.
26. The Korean Nutrition Society. Dietary Reference Intakes for Koreans.
Seoul: Hanarum Publishers; 2010.
http://e-cnr.org 57
Original Article
Clin Nutr Res 2012; 1: 49-57
http://dx.doi.org/10.7762/cnr.2012.1.1.49
pISSN 2287-3732 ∙ eISSN 2287-3740

Pengaruh Kerja-Visiting Nutrisi Pendidikan

tentang antropometri dan Tindakan Klinis in
Male Workers
*
Hye-Jin Kim, Jeong-Im Hong , Hee-Jung Mok, Kyung-Mi Lee
Departemen Nutrisi, Rumah Sakit St. Mary Yeouido, Universitas Katolik Korea, Seoul
150-713, Korea

Tujuan dari ini Penelitian ini bertujuan untuk mengetahui pengaruh pendidikan gizi pada program tempat
kerja pada pekerja laki-laki. Subjek penelitian adalah 75 orang pekerja laki-laki yang telah mendapatkan
pendidikan gizi oleh ahli gizi klinik selama 4 bulan. Data antropometri, tekanan darah dan indeks biokimia
darah diukur sebelum dan sesudah pendidikan gizi. Kebiasaan diet dan gaya hidup diselidiki dengan
kuesioner yang dikelola sendiri. Asupan zat gizi ditentukan dengan metode recall diet 24 jam. Hasil penelitian
menunjukkan penurunan yang signifikan pada indeks massa tubuh (p < 0,05), gula darah puasa (p < 0,01),
kolesterol total (p < 0,05), danLDL
kolesterol(p < 0,05) setelah pendidikan gizi. Analisis korelasi antara parameter antropometri dan klinis
setelah pendidikan gizi menunjukkan bahwa ada korelasi positif yang signifikan antara tekanan darah dan
berat badan, r-GTP. Sebuah korelasi positif yang signifikan diamati antara gula darah puasa dan trigliserida.
Korelasi positif yang signifikan diamati antara trigliserida dan indeks massa tubuh, r-GTP, SGPT. Sebuah
korelasi positif yang signifikan diamati antara SGPT dan berat badan, indeks massa tubuh. Sebuah korelasi
negatif yang signifikan diamati antara HDL-kolesterol dan berat badan. Dapat disimpulkan bahwa pendidikan
gizi dapat menjadi alat yang efektif untuk meningkatkan ukuran antropometri dan parameter klinis pada
pekerja laki-laki. Program manajemen gizi yang berkesinambungan dan sistematis harus dikembangkan dan
diterapkan bagi pekerja laki-laki di tempat kerja untuk mempertahankan status kesehatan yang optimal.

Kata Kunci: Indeks massa tubuh, Lipid darah, Tekanan darah, Glukosa darah, Tes fungsi hati, Edukasi
nutrisi
media apa pun, asalkan karya asli dikutip dengan benar.
© 2012 The Korean Society of Clinical Nutrition
Pendahuluan
*Penulis koresponden Jeong-Im Hong
Alamat Departemen Nutrisi, Rumah Sakit Yeouido St. Pertumbuhan ekonomi yang cepat dan pola
Mary, 10, 63-ro Yeongdeungpo-gu, Seoul 150-713, Korea makan kebarat-baratan Korea telah memicu
Telp +82-2-3779- 1482 Fax +82-2-3779-1795
konsumsi energi yang berlebihan [1], sedangkan
E-mail hjeongim@hanmail.net
gaya hidup modern yang nyaman telah
Diterima 9 Juni 2012 menyebabkan kurangnya olahraga untuk
Direvisi 5 Juli 2012 meningkatkan sindrom metabolik, seperti hipertensi,
Diterima 9 Juli 2012
diabetes, dan dislipidemia [2,3]. Wilson dkk. [4]
mendefinisikan sindrom metabolik sebagai
gangguan metabolisme yang meningkatkan risiko
penyakit kronis di mana hipertensi, hiperglikemia
Ini Terbuka Akses artikel yang didistribusikan di bawah ketentuan Lisensi
, dislipidemia dan obesitas perut secara bersamaan
Non-Komersial Atribusi Creative Commons dihasilkan dan berkembang. Sindrom metabolik
(http://creativecommons.org/licenses/by-nc/3.0/) yang mengizinkan
penggunaan, distribusi, dan reproduksi non-komersial tanpa batas dalam dipandang sebagai penyakit yang dapat dicegah
 dengan mengelola faktor risiko termasuk obesitas,
minum, merokok dan kebiasaan makan yang salah
sehingga meningkatkan pentingnya pengelolaan
penyakit kronis dan memberikan pelayanan medis
[5].
Undang-undang Promosi Kesehatan Nasional yang
disahkan pada tahun 1995 mengatur negara dan
kesehatan masyarakat. Tindakan ini telah
mempromosikan aktivasi proyek kesehatan.
Sebagai bagian dari proyek kesehatan, pendidikan
gizi dan program konsultasi membantu subjek
dengan masalah gizi untuk menganalisis kebiasaan
makan mereka sendiri, mempelajari kebiasaan
hidup yang benar dan memecahkan masalah.
Secara khusus, pendidikan gizi yang diberikan di
tempat kerja sangat bermanfaat bagi pekerja
kantoran yang tidak dapat mengunjungi rumah sakit
karena jadwal kerja mereka. Dalam aspek
kesejahteraan juga dapat mendongkrak ambisi kerja
para pekerja [6].
Menurut penelitian yang dilakukan oleh Lee & Suh
[7], pekerja kantoran mulai menjadi lebih tertarik
pada kesehatan karena masyarakat mulai lebih
menekankan pada keterlibatan individu dan
tanggung jawab untuk kesehatan dalam kaitannya
dengan peningkatan penyakit kronis. Namun,
karena berbagai faktor lingkungan, seperti waktu
kerja yang tidak teratur, kebiasaan makan yang
buruk, pengetahuan gizi yang rendah, stres karena
terlalu banyak bekerja dan kurangnya upaya
manajemen kesehatan, penyakit kronis dapat
dengan mudah berkembang di kalangan pekerja
kantoran. Faktanya, di antara
penyakit kronis, tingkat prevalensi dislipidemia terus
meningkat di antara pria berusia 30 tahun ke atas
[8]. Secara khusus, kolesterol HDL rendah
meningkat dari 22,8% pada tahun 1998 menjadi
47,6% pada tahun 2007, sehingga menunjukkan
peningkatan 25,4% dalam 10 tahun (Kementerian
Kesehatan, Kesejahteraan dan Urusan Keluarga &
Pusat Pengendalian dan Pencegahan Penyakit
Korea, 2008). Namun, kesempatan pendidikan gizi,
faktor penting dalam mencegah dan mengobati
penyakit tersebut, tetap tidak mencukupi [9].
Menurut studi preseden yang dilakukan pada
pekerja, memberikan periode tetap pendidikan gizi
meningkatkan kebiasaan diet dan gaya hidup
subyek dan secara positif mempengaruhi standar
entitas otonom lokal untuk secara aktif
mempromosikan proyek kesehatan masyarakat
regional untuk meningkatkan
http://e-cnr.org 49
Kim HJ et al.
klinis, sehingga melaporkan bahwa efek yang
signifikan dapat diperoleh dengan menerapkan
pendidikan gizi di tempat kerja yang menyediakan
setidaknya satu kali makan sehari [10,11]. Dalam
sebuah penelitian yang dilakukan pada pekerja
kantoran, Lee et al. [11] melaporkan bahwa
memberikan periode tetap pendidikan gizi
menghasilkan efek positif dalam mengurangi berat
badan dan obesitas
subjek, meningkatkan perilaku sehat dan
meningkatkan standar klinis [11-15]. Secara khusus,
dengan mengembangkan, mensistematisasikan dan
melaksanakan program pendidikan gizi yang tepat
bagi pekerja sesuai dengan karakteristik tempat
kerja, maka kondisi kesehatan dan moral kerja
karyawan akan terdorong meningkatkan
kebanggaan bagi perusahaan dan produktivitas
serta mengurangi biaya pengobatan nasional.
Selanjutnya, jika konten pendidikan dapat
disampaikan secara tepat ke rumah tangga,
program pendidikan gizi yang dilaksanakan
di tempat kerja setelah pemeriksaan kesehatan
juga dapat berkontribusi pada peningkatan pola
makan rumah tangga. Dengan demikian, ditetapkan
bahwa memberikan pendidikan manajemen gizi
yang tepat terkait penyakit dan menerapkan asuhan
dan pendidikan gizi berkelanjutan melalui ahli gizi
klinis tidak hanya penting untuk meningkatkan
kesehatan pekerja kantor, meningkatkan
kesejahteraan perusahaan dan mengurangi biaya
medis, penting untuk pekerjaan. kemanjuran.
Selanjutnya, peran ahli gizi klinis adalah untuk
melatih subjek untuk secara mandiri menemukan
jawaban untuk mengubah perilaku diet mereka
dan mempertahankan perubahan tersebut dalam
perilaku diet mereka. Menurut hasil Undang-Undang
Promosi Kesehatan Nasional 2007, tingkat obesitas
orang dewasa Korea secara bertahap meningkat
dari 30,6% pada tahun 2001, 31,5% pada tahun
2005 dan 31,7% pada tahun 2007, seiring dengan
peningkatan tingkat prevalensi penyakit terkait
obesitas. Dalam kasus sindrom metabolik, tingkat
 prevalensi pria terus meningkat dari 20,8% menjadi
32,9% setelah tahun 1998 [17]. Selanjutnya,
penelitian yang dilakukan oleh Bae et al. [18]
tentang perubahan angka prevalensi obesitas
selama 10 tahun (1997-2007) menunjukkan bahwa
angka obesitas pria berusia antara 30-39 meningkat
11,2% dalam satu dekade, dari 20,7% pada tahun
1997 menjadi 31,8% pada tahun 2007, sedangkan
angka obesitas pria usia 40-49 tahun meningkat
9,2%, dari 25,6% pada tahun 1997 menjadi 34,8%
pada tahun 2007. Penelitian ini juga melaporkan
bahwa perlu dilakukan evaluasi dan intervensi
terhadap kebiasaan makan dan perilaku terkait
kesehatan untuk mengurangi tren obesitas.
Selanjutnya, penelitian ini melakukan
pemeriksaan kesehatan pada pekerja kantoran
laki-laki dengan risiko lebih tinggi mengalami
sindrom metabolik dan mengklasifikasikan subjek
dengan temuan abnormal (hipertensi, diabetes,
50 http:// e-cnr.org http://dx.doi.org/10.7762/cnr.2012.1.1.49
Pengaruh Pendidikan Gizi Kunjungan Kerja Bagi Pekerja Laki-Laki
Program penyuluhan gizi kunjungan kerja
dilaksanakan dari bulan Juni sampai September
2011. Sebanyak 75 pekerja kantor laki-laki
dilibatkan untuk mengevaluasi efektivitas
pendidikan gizi. Subyek dengan temuan abnormal
terkait dengan sindrom metabolik diklasifikasikan ke
dalam kelompok sindrom metabolik jika ada relevan
dengan setidaknya 3 dari 5 item dalam NCEP
ATPⅢ (Ringkasan Eksekutif Laporan Ketiga
Program Pendidikan Kolesterol Nasional, 2001).
Standarnya adalah sebagai berikut.
1) Gula darah puasa 110 mg/dL
2) Lingkar pinggang >90 cm (Pria)
3) Tekanan darah 130/85 mmHg
4) Trigliserida 150 mg/dL
5) Kolesterol HDL <40 mg/dL (Pria)
Isi dan metode survei
Penelitian ini dilakukan dalam suatu proses yang
terdiri dari survei dasar, konsultasi hasil
pemeriksaan, pendidikan gizi dan penilaian. Dalam
survei dasar, informasi umum, pengukuran fisik,
jurnal makan, gaya hidup, parameter klinis dan
biokimia diperoleh. Edukasi gizi dilakukan dengan
metode self-directed coaching menurut jenis
dislipidemia,fungsi hati abnormal
indeks). Studi ini menerapkan program pendidikan
gizi mengunjungi tempat kerja berdasarkan metode
pembinaan mandiri untuk mengubah kebiasaan diet
yang buruk menjadi perilaku diet yang tepat dan
mencoba menganalisis efektivitas program.
Bahan dan Metode
Subjek dan periode
Penelitian ini memilih subjek dengan temuan
laboratorium abnormal (hipertensi, diabetes,
dislipidemia, indeks fungsi hati abnormal) di antara
karyawan Perusahaan L yang mendapatkan
pemeriksaan kesehatan dan pemeriksaan
kesehatan komprehensif yang dilaksanakan oleh
Jaminan Kesehatan Nasional
sindrom metabolik berdasarkan hasil pemeriksaan.
Setelah itu dilakukan ujian akhir dan penilaian.
Pengukuran antropometri dan biokimia Pengukuran
umur dan antropometri termasuk tinggi badan (HT),
berat badan (WT), lingkar pinggang (WC) diperoleh
dan indeks massa tubuh dihitung. Subyek diminta
untuk mencatat jurnal makanan yang ditulis
berdasarkan bagan survei asupan makanan dari
Survei Pemeriksaan Kesehatan dan Gizi Nasional
Korea 2009 yang dikembangkan dengan
menggunakan metode recall 24 jam. Keteraturan
makan, minum dan kebiasaan merokok ditanyakan.
Tekanan darah sistolik (SBP), tekanan darah
diastolik (DBP), dan gula darah puasa (FBS) diukur.
Serum glutamic oxalacetic transaminase (SGOT),
serum glutamic pyruvic transaminase (SGPT) dan
r-GTP (Gamma glutamyl transpeptidase) dianalisis.
Sebagai ukuran tes fungsi hati. kolesterol total (TC),
trigliserida (TG), kolesterol lipoprotein densitas
tinggi (HDLc), kolesterol lipoprotein densitas rendah
(LDLc) ditentukan sebelum dan sesudah pendidikan
gizi.
Program pendidikan gizi
Kebiasaan makan dianalisis menggunakan
program konsultasi gizi. Berdasarkan kebiasaan diet
subjek penelitian, ahli gizi klinis menerapkan
 konsultasi terapi makan. Setelah itu, ahli gizi klinis
mengunjungi tempat kerja untuk memberikan
penilaian gizi dan pendidikan untuk mengamati
kemajuan mata pelajaran setiap bulan. Program
analisis nutrisi CAN-Pro versi 3.0 (program analisis
nutrisi berbantuan komputer, Korean Nutrition
Society, 2005) digunakan untuk menganalisis
asupan nutrisi. Berdasarkan data asupan gizi dan
tindakan klinis termasuk tekanan darah, lipid darah
dan glukosa darah, konsultasi gizi dilakukan. Setiap
sesi pendidikan dilakukan selama 20 menit dan
mata pelajaran mendapatkan konsultasi rata-rata 2
kali. Untuk perangkat pendidikan, penelitian ini
menggunakan leaflet pendidikan gizi yang
dikembangkan sendiri.
Analisis gaya hidup dan asupan gizi
Untuk menganalisis gaya hidup, penelitian ini
meminta subjek untuk mengisi kuesioner
berdasarkan grafik pemeriksaan kesehatan yang
disediakan oleh Jaminan Kesehatan Nasional
selama pemeriksaan kesehatan. Keteraturan
makan, minum dan kebiasaan merokok subjek
dimasukkan dalam kuesioner. Kami menggunakan
http://dx.doi.org/10.7762/cnr.2012.1.1.49 http://e-cnr.org 51
Hasil
Karakteristik umum dan pengukuran
antropometri Karakteristik umum subjek penelitian
makan 3 kali sehari. Peminum teratur adalah 86,3%
disajikan pada Tabel 1. Semua subjek berjenis
kelamin laki-laki dan usia rata-rata dianalisis adalah
41. Tinggi badan diukur 172,2 cm. Berat badan
berkurang dari 76,2 kg menjadi 75,6 kg setelah
pendidikan gizi. Indeks massa tubuh berkurang
secara signifikan dari 25,7 kg/m2 menjadi 25,4 kg/m2
setelah pendidikan gizi (p < 0,05). Lingkar pinggang
subjek berkurang dari 88,4 cm menjadi 87,1 cm
setelah pendidikan gizi, yang lebih rendah dari 90
cm, komponen standar diagnostik sindrom
metabolik yang ditetapkan oleh NCEP ATPⅢ
(Ringkasan Eksekutif Laporan Ketiga The National
Cholesterol Education Program, 2001).
Karakteristik gaya
CAN-Pro versi 3.0 untuk menganalisis asupan
nutrisi harian rata-rata berdasarkan jurnal makanan
yang dicatat selama pemeriksaan pertama.
Analisis statistik
Penelitian ini menggunakan SPSS Statistic 18
(Statistical Package for the Social Sciences, SPSS
Inc., Chicago, IL, USA) untuk pemrosesan statistik.
Penelitian ini menggunakan statistik deskriptif mean
dan standar deviasi untuk menganalisis karakteristik
umum, uji peringkat bertanda wilcoxon
non-parametrik dari uji t berpasangan digunakan
untuk menganalisis pengukuran klinis dan biokimia
termasuk tekanan darah, lipid darah, glukosa darah,
dan hati. indikator fungsi. Penelitian ini
mengklasifikasikan indeks massa tubuh (IMT)
menurut berat badan normal (BMI < 23,0 kg/m2),
kelebihan berat badan (23,0 BMI < 25,0 kg/m2) dan
obesitas (BMI 25,0 kg/m2) dan menggunakan non
-variabel sekuensial dengan metode non parametrik
untuk analisis. Korelasi Spearman digunakan untuk
memverifikasi faktor-faktor yang mempengaruhi
indikator klinis yang berhubungan dengan sindrom
metabolik pada tingkat signifikansi p <0,05.
Kim HJ dkk.
hidup Studi kehidupan subjek penelitian disajikan
pada Tabel 2. Proporsi subjek penelitian yang
makannya teratur 3 kali sehari adalah 59,6%,
sedangkan sisanya 40,4% menjawab tidak teratur
dari subjek penelitian dan hanya 13,7% yang
tidak minum sama sekali. Perokok adalah 51,9%
dari subyek sedangkan 48,1% adalah non-perokok.
Perubahan tekanan darah sebelum dan sesudah
penyuluhan gizi
Perubahan tekanan darah sebelum dan sesudah
penyuluhan gizi disajikan pada Tabel 3. Tekanan
darah sistolik menurun dari 120,0 mmHg menjadi
117,8 mmHg setelah penyuluhan gizi. Tekanan
darah diastolik juga berkurang dari 79,1 mmHg
menjadi 77,0 mmHg setelah diberikan pendidikan
gizi, namun tidak ditemukan perbedaan yang
signifikan.

Perubahan gula darah puasa sebelum dan
sesudah penyuluhan gizi
Perubahan gula darah puasa, indikator diabetes,
sebelum dan sesudah penyuluhan gizi disajikan
pada Tabel 4. Penurunan gula darah puasa secara
signifikan dari 100,5 mg/dl menjadi 97,0 mg/dL
setelah pendidikan gizi (p < 0,01). Hal ini
menunjukkan bahwa pendidikan gizi kunjungan
kerja ahli gizi klinik rumah sakit efektif dalam
menurunkan gula darah subjek dengan gangguan
gula darah puasa.

Tabel 1. Karakteristik umum dan parameter antropometri mata pelajaran sebelum dan sesudah
pendidikan gizi* Variabel Sebelum pendidikan gizi (n = 75) Setelah pendidikan gizi (n = 75) p-value Umur, thn
41,1 ± 5,6 - Tinggi Badan, cm 172,2 ± 6,3 - berat, kg 76,2 ± 10,2 75,6 ± 10,2 0,093 BMI, kg / m2 25,7 ± 2,9 25,4 ±
2,8† 0,031
berat badan normal (BMI <23,0) 17 (22,7) 17 (22,7) Selama berat badan (23,0 ≤ BMI
<25,0) 16 ( 21,3) 17 (22,7) Obesitas (BMI 25,0) 42 (56,0) 41 (54,6)
WC, cm 88,4 ± 7,7 87,1 ± 6,2 0,083
IMT: indeks massa tubuh, WC: lingkar pinggang.
*Nilai disajikan sebagai mean ± SD atau N (%); †Secara signifikan berbeda pada ap <0,05.
Tabel 3. Perubahan tekanan darah sebelum dan

Tabel 2. Gaya hidup dan kebiasaan makan* sesudahgizi

penyuluhan*
Variabel Kriteria N (%)
Setelah penyuluhan gizi (n = 75)
Keteraturan makan Ya 34 (59.6) Variabel Sebelum penyuluhan gizi (n
= 75)
Tidak 23 (40,4) * Nilai disajikan sebagai N (%).
Peminum alkohol Peminum 63 (86,3) Bukan SBP, mmHg 120,0 ± 10,0 117,8 ± 10,4 DBP,
peminum 10 (13,7) mmHg 79,1 ± 6,8 77,0 ± 9,2
Status merokok Perokok 28 (51,9) Bukan perokok SBP: tekanan darah sistolik, DBP: tekanan darah
26 (48,1) diastolik. *Nilai disajikan sebagai mean ± SD.

52 http://e-cnr.org http://dx.doi.org/10.7762/cnr.2012.1.1.49
Pengaruh Edukasi Gizi Kunjungan Kerja Bagi Pekerja Laki-Laki

Perubahan indikator fungsi hati sebelum dan

Perubahan lipid serum sebelum dan sesudah
pendidikan gizi
Perubahan lipid serum, indikator dislipidemia,
sebelum dan sesudah pendidikan gizi disajikan
pada Tabel 5. Kolesterol total berkurang secara
signifikan dari 211,3 mg/dL menjadi 204,4 mg/dL (p
< 0,05), sedangkan trigliserida berkurang dari 216,6
mg/dL menjadi 204,0 mg/dL setelah pendidikan gizi
tanpa menunjukkan perbedaan yang signifikan.
Kolesterol lipoprotein densitas tinggi adalah serupa
sebelum dan sesudah pendidikan gizi, sedangkan
kolesterol lipoprotein densitas rendah berkurang
secara signifikan dari 131,1 mg/dL menjadi 123,6
mg/dL setelah pendidikan gizi (p <0,05).
sesudah pendidikan trition nu
Perubahan indikator fungsi hati dari mata
pelajaran disajikan pada Tabel 6. Sebagai indikator
untuk fungsi hati, serum glutamic oxalacetic
transaminase, serum glutamic piruvat transaminase
dan r-GTP berkurang setelah pendidik gizi
tion , tetapi tidak menunjukkan perbedaan yang
signifikan.
Analisis asupan
gizi Asupan gizi subjek penelitian disajikan pada
Tabel 7. Survei asupan makan menunjukkan bahwa
subjek mengkonsumsi rata-rata 2.160 kkal, yang
merupakan 90% dari standar asupan gizi untuk pria
berusia antara 30-49. Subyek mengkonsumsi 321,3
g karbohidrat (60% dari total kalori) dan 79,7 g
 protein (15% dari total kalori), yang terdiri dari 57%
protein hewani dan 43% protein nabati. Konsumsi
lemak rata-rata
adalah 61,8 g, yang merupakan 26% dari total
kalori, sehingga menunjukkan bahwa subjek
menelan 15-25% lebih banyak dari standar asupan
nutrisi orang Korea. Subyek mengkonsumsi 312,9
mg kolesterol, yang melebihi 200 mg, jumlah yang
direkomendasikan untuk pasien dislipidemia, dan
15,6 g serat makanan per hari, yang 25 g kurang
dari standar asupan nutrisi harian untuk orang
Korea. Oleh karena itu, pendidikan gizi
menekankan pada peningkatan asupan sayuran
(terutama rumput laut) untuk asupan serat pangan.
Pasien dislipidemia dididik untuk meningkatkan
asupan sayur dan buah
terutama untuk meningkatkan konsumsi serat
pangan larut air. Subjek mengkonsumsi vitamin A
900,7 g RE melebihi asupan yang dianjurkan untuk
laki-laki berusia antara

Tabel 4. Perubahan konsentrasi glukosa darah sebelum dan sesudah pendidikan gizi*
Variabel Sebelum pendidikan gizi (n = 75) Setelah pendidikan gizi (n = 75) p-nilai, FBS mg / dL 100,5 ± 13,9
97,0 ± 12,0† 0,002
FBS: gula darah puasa.
*Nilai disajikan sebagai mean ± SD; †Secara signifikan berbeda pada ap <0,01.

Tabel 5. Perubahan profil lipid serum sebelum dan sesudah pendidikan gizi *
Variabel Sebelum pendidikan gizi (n = 75) Setelah pendidikan gizi (n = 75) p-nilai TC, mg / dL 211,3 ± 35,9
204,4 ± 43,0† 0,047 TG, mg / dL 216,6 ± 125,8 204,0 ± 128,8 0,287 HDLC, mg / dL 44,5 ± 8,6 44,5 ± 9,4 0,949
LDLC, mg / dL 131,1 ± 36,4 123,6 ± 39,7 † 0,017
TC: kolesterol total, TG: trigliserida, HDLC: high density lipoprotein kolesterol, LDLc: kolesterol
lipoprotein densitas rendah. *Nilai disajikan sebagai mean ± SD; †Secara signifikan berbeda pada p
<0,05.

Tabel 6. Perubahan indikator fungsi hati sebelum dan sesudah penyuluhan gizi*
Variabel Sebelum penyuluhan gizi (n = 75) Setelah penyuluhan gizi (n = 75) SGOT, IU/L 29,7 ± 16,9 28,7 ±
14,0 SGPT, IU/L 39,6 ± 27,9 38,3 ± 23,8 r-GTP, IU/L 60,4 ± 53,7 56,3 ± 46,1
SGOT: serum glutamic oxaloacetic transaminase, SGPT: serum glutamic pyruvic transaminase, r-GTP:
r-glutamyl transpeptidase. *Nilai disajikan sebagai mean ± SD.

http://dx.doi.org/10.7762/cnr.2012.1.1.49 http://e-cnr.org 53
Kim HJ dkk.
30-49 (750 g RE). Asupan vitamin B 1, B2, E
memenuhi standar asupan gizi orang Korea.
Tabel 7. Rata-rata AsupanHarian*
Namun, mata pelajaran con sumed 63,2 mg vitamin
GiziAsupan Gizi Energi, kkal 2160.0 ± 198.8 C, yang kurang dari recom yang diperbaiki kuantitas
CHO, g 321.3 ± 56,4 asupan pria berusia antara 30-49 (100
Protein,g 61,8 ± 13,2 37,8 ± 8,9 24,2 ± 11,5 tinggi dan kadar serat pangan yang
proteinHewan, protein g Tanaman, g mg). Hal ini diduga terkait dengan lebih rendah.
Lemak, g rendahnya asupan serat pangan.
Animal lemak,g Subyek penelitian mengkonsumsi Korelasi faktor-faktor yang
lemakPlant, g kadar kalori/protein yang sesuai, mempengaruhi indikator klinis
79,7 ± 12,9 45,8 ± 9,9 33,9 ± 8,6 kadar lemak/kolesterol yang lebih
Kolesterol, mg 312,9 ± 115,2 Serat, g 15,6 ± 3,2 C, mg 63,2 ± 30,5 Vitamin E, mg 15,2 ± 6,5
Na, mg 3294,1 ± 250,1 K, mg 2573,7 ± 537,0 CHO: karbohidrat.
Vitamin A, g RE 900,7 ± 359,9 Vitamin B 1, mg *Nilai disajikan sebagai mean ± SD atau N (%).

1,39 ± 0,28 Vitamin B2, mg 1,27 ± 0,33 Vitamin berhubungan dengan sindrom metabolik
 setelah pendidikan gizi
Faktor-faktor yang mempengaruhi indikator klinis
yang berhubungan dengan sindrom metabolik
setelah pendidikan gizi disajikan pada Tabel 8. Hasil
penelitian menunjukkan bahwa tekanan darah
sistolik menunjukkan korelasi positif yang signifikan
dengan berat badan (p < 0,05), sedangkan darah
diastolik tekanan menunjukkan korelasi positif yang
signifikan dengan r-GTP (p <0,05). Gula darah
puasa menunjukkan korelasi positif yang signifikan
dengan berat badan (p <0,05) dan indeks massa
tubuh (p <0,05). Seperti

Tabel 8. Koefisien korelasi antara indikator klinis dan WT, r-GTP, BMI, TG, HDLc, SGPT setelah
pendidikan gizi* Variabel terikat Variabel bebas Koefisien p-value Tekanan darah
SBP, mmHg WT, kg 0,285 p < 0,05 DBP, mmHg r-GTP, IU/L 0,240 p < 0,05 Kontrol glikemik
FBS, mg/dL WT, kg 0,235 p < 0,05 BMI, kg/m 2 0,233 p < 0,05
Profil lipid
TC, mg/dL TG, mg/dL 0,270 p < 0,05 TG, mg/dL BMI, kg/m 2 0,341 p < 0,01 r-GTP, IU/L 0,330 p < 0,01
HDLc, mg/dL -0,258 p < 0,05
SGPT, IU/L 0,272 p < 0,05
HDLc, mg/ dL WT, kg -0,240 p < 0,05 Indikator fungsi hati
SGPT, IU/L WT, kg 0,327 p < 0,01 BMI, kg/m 2 0,259 p < 0,05
r-GTP, IU/L WT, kg 0,307 p < 0,01 BMI, kg/m 2 0,255 p < 0,05
SBP: tekanan darah sistolik, DBP: tekanan darah diastolik, WT: berat badan, r-GTP: r-glutamyl transpeptidase, FBS: gula darah puasa,
BMI: indeks massa tubuh, TC: kolesterol total, TG: trigliserida, HDLc: kolesterol lipoprotein densitas tinggi, SGPT: serum glutamic
pyruvic transaminase. *Dianalisis dengan koefisien korelasi Spearman.

54 http://e-cnr.org http://dx.doi.org/10.7762/cnr.2012.1.1.49
Pengaruh Pendidikan Gizi Berkunjung ke Tempat Kerja pada Pekerja Pria
parameter klinis dan biokimia.

sebagai indikator klinis dislipidemia, kolesterol total

menunjukkan korelasi positif yang signifikan dengan Diskusi
trigliserida (p <0,05). Trigliserida menunjukkan
korelasi positif yang signifikan dengan indeks
Pekerja kantoran sering minum, makan di luar,
massa tubuh (p <0,01), serum glutamic pyruvic
melewatkan sarapan, kurang olahraga dan
transaminase (p <0,05), dan r-GTP (p <0,01). Di sisi
mengalami ketidakseimbangan nutrisi. Gaya hidup
lain, kolesterol total darah menunjukkan korelasi
yang terbentuk berdasarkan pengalaman
negatif yang signifikan dengan kolesterol lipoprotein
menyebabkan penyakit degeneratif kronis termasuk
densitas tinggi (p <0,05). Kolesterol lipoprotein
sindrom metabolik dan penyakit kardiovaskular
densitas tinggi menunjukkan korelasi negatif yang
pada usia paruh baya dan lanjut usia.Nutri
signifikan dengan berat badan (p <0,05). Sebagai
Pendidikan tionmembantu subyek untuk gaya hidup
indikator fungsi hati, serum glutamic pyruvic trans
yang benar untuk menurunkan sindrom metabolik.
aminase menunjukkan korelasi positif yang
Selanjutnya, di antara subjek yang menunjukkan
signifikan dengan berat badan (p <0,01) dan indeks
temuan klinis abnormal dalam pemeriksaan
massa tubuh (p <0,05) sedangkan r-GTP juga
kesehatan dan pemeriksaan kesehatan
menunjukkan korelasi positif yang signifikan dengan
komprehensif yang diselenggarakan oleh Jaminan
berat badan (p <0,01). dan indeks massa tubuh (p <
Kesehatan Nasional, pendidikan gizi mengunjungi
0,05). Hasil ini menunjukkan bahwa di antara subjek
tempat kerja dilakukan untuk 75 pekerja kantor pria,
dengan satu atau lebih
dan dianalisis efektivitasnya. Kami menggunakan
kriteria sindrom metabolik, penting untuk metode self-directed coaching berdasarkan
memberikan pendidikan gizi yang ditentukan komponen sindrom metabolik yang dimiliki setiap
berdasarkan faktor risiko yang terkait dengan subjek penelitian.
 Dengan menganalisis perubahan pengukuran
antropometri, pengukuran klinis dan biokimia
sebelum dan sesudah program pendidikan gizi 4
bulan, disimpulkan bahwa indeks massa tubuh (p <
0,05), gula darah puasa (p < 0,01), kolesterol total
(p < 0,05), <0,05) dan kolesterol lipoprotein densitas
rendah (p <0,05) berkurang secara signifikan. The
signifi
kan penurunan gula darah puasa (p <0,01) mirip
dengan studi Kim [19], yang menekankan
pentingnya pendidikan gizi dan latihan dalam
mengatur gula darah
pasien diabetes. Penurunan serum lipid dan
kolesterol total dipandang sebagai efek yang
dihasilkan oleh penurunan berat badan yang dicapai
dengan pendidikan gizi. Penelitian yang dilakukan
oleh Briley et al. [20] juga menunjukkan penurunan
berat badan dan kolesterol total setelah pendidikan
gizi, dan penelitian yang dilakukan oleh Epstein et
al. [21] dan Choi [22] juga melaporkan bahwa
penurunan berat badan dapat menurunkan kadar
kolesterol total dan trigliserida darah. Musim panas
dkk. [23] melaporkan bahwa pendidikan gizi yang
diberikan untuk pekerja kantoran efektif dalam
menurunkan standar berat badan dan kolesterol
subjek. Kolesterol lipoprotein densitas rendah juga
berkurang secara signifikan setelah pendidikan gizi
(p <0,05), yang dipandang berhubungan dengan
penurunan berat badan.
Asupan zat gizi subjek disajikan sebagai berikut:
kalori 2160 kkal, karbohidrat 321,3 g, protein 79,7 g,
lemak 61,8 g. Rasio karbohidrat, protein dan lemak
terhadap total kalori disajikan sebagai 60%:
15%:26%, masing-masing. Jika dibandingkan
dengan standar asupan gizi orang Korea (55-70
%:7-20%:15-25%), subjek menunjukkan rasio lemak
yang lebih tinggi. Hunink dkk. [24] melaporkan
http://dx.doi.org/10.7762/cnr.2012.1.1.49 http://e-cnr.org 55
Dari waktu ke waktu, perlu untuk mengembangkan
berbagai program pendidikan dan penilaian gizi
dengan kualitas dan konten yang luar biasa untuk
membantu subjek tertarik dan tetap termotivasi.
Selain itu, karena pendidikan nutrisi selama 4 bulan
secara efektif mengurangi indeks massa tubuh, gula
darah puasa, kolesterol total, dan kolesterol
bahwa peningkatan asupan lemak total
meningkatkan sintesis kilomikron dan very low
density lipoprotein (VLDL) untuk meningkatkan
konsentrasi
trigliserida dan kolesterol darah. Subyek menelan
312,9 mg kolesterol total, yang lebih tinggi dari
asupan yang direkomendasikan untuk pasien
dislipidemia (200 mg). The 2001 NCEP (Program
Pendidikan Kolesterol Nasional) melaporkan bahwa
peningkatan asupan kolesterol dalam makanan
disajikan peningkatan konsentrasi kolesterol total
dan kolesterol lipoprotein densitas rendah [25]. Hasil
penelitian menunjukkan bahwa subjek yang
mengonsumsi 15,6 g serat makanan per hari, yaitu
25 g kurang dari standar asupan nutrisi harian untuk
orang Korea [26], pendidikan untuk meningkatkan
asupan serat makanan juga dilakukan selama
pendidikan gizi. Hasil analisis faktor yang
mempengaruhi indikator klinis yang berhubungan
dengan sindrom metabolik setelah
kebutuhanmeningkatkan kebutuhan pemberian
edukasi tentang
asuhanpenurunan berat badan pada penderita
gangguan metabolisme. Namun, subjek penelitian
ini mengalami kesulitan dalam menulis jurnal makan
selama survei dasar. Meminta pekerja kantor
laki-laki yang memiliki pengetahuan rendah tentang
makanan untuk menulis jurnal makan yang
memakan waktu dapat mengurangi tingkat
partisipasi. Dalam hal ini, sangat mendesak untuk
mengembangkan program dengan
mempertimbangkan karakteristik unik mata
pelajaran untuk membantu mata pelajaran menulis
dengan mudah dan melihat hasilnya dengan
segera. Selanjutnya, untuk secara efisien
melaksanakan pendidikan gizi untuk sejumlah besar
mata pelajaran dalam jangka waktu tertentu
Kim HJ et al.
lipoprotein densitas rendah, pendidikan nutrisi
terbukti efektif karena ahli gizi klinis yang
berpengalaman secara aktif mendorong subjek
melalui self-directed metode pembinaan. Dengan
demikian, dapat ditetapkan bahwa program
pendidikan gizi yang disesuaikan harus
dilaksanakan untuk mengurangi biaya pengobatan,
meningkatkan efisiensi kerja dan meningkatkan
kualitas hidup dalam jangka panjang melalui
peningkatan kesehatan mata pelajaran.
Kesimpulan
Hasil penelitian ini membuktikan bahwa
pendidikan gizi kunjungan yang diberikan kepada
pekerja laki-laki melalui individu berbasis mandiri
efektif dalam menurunkan indeks massa tubuh dan
meningkatkan indeks kualitas klinis. Di Korea,
pendidikan dan konsultasi gizi sebagian besar
diberikan di rumah sakit. Namun, ketika
mempertimbangkan fakta bahwa kesehatan pekerja
di tempat kerja, yang merupakan kelompok yang
sangat besar, berhubungan langsung dengan
efisiensi kerja mereka, penting untuk mencapai
manajemen gizi melalui pendidikan atau konsultasi
yang sistematis. Program pendidikan dan konsultasi
gizi tersebut dapat dilaksanakan secara efisien oleh
ahli gizi di tempat kerja dan dengan demikian
memerlukan pengembangan program yang sesuai
untuk tempat kerja dan pelaksanaan program
secara teratur. Namun, karena ahli gizi klinis
profesional tidak ada di sebagian besar tempat
kerja, adalah mungkin untuk mempertimbangkan
metode menghubungkan rumah sakit dengan
program pemeriksaan kesehatan di tempat kerja.
Sebagai tenaga kesehatan profesional, ahli gizi
akan berperan aktif dalam peningkatan kesehatan
nasional.
Referensi
1. Jung MS, Bae JH, Kim YH. Hubungan antara asupan
makanan dan profil lipid serum subjek yang mengunjungi
pusat promosi kesehatan. J Korean Soc Food Sci Nutr
2008;37:1583-8.
2. Kementerian Kesehatan dan Kesejahteraan. Laporan Survei
Kesehatan dan Gizi Nasional 2005. Seoul: Kementerian
Kesehatan dan Kesejahteraan; 2006. 3. Van Gaal L, Vansant
G, Van Campenhout G, Lepoutre L, De Leeuw
I. Konsentrasi apolipoprotein pada subjek obesitas dengan
distribusi massa lemak tubuh bagian atas dan bawah. Int J
Obes 1989;13:255-63. 4. Wilson PW, Kannel WB, Silbershatz
H, D'Agostino RB. Pengelompokan faktor metabolik dan
penyakit jantung koroner. Arch Intern Med 1999;159:1104-9.
5. Marmott MG, Poulter NR. Pencegahan primer stroke. Lancet
1992;339:344-7.
56 http://e-cnr.org http://dx.doi.org/10.7762/cnr.2012.1.1.49
Effect of Workplace-Visiting Nutrition Education for Male Workers
6. Park HD, Kim EJ, Hwang MO, Paek YM, Choi TI, Park YK.
Efek program pendidikan gizi di Tempat Kerja yang
disesuaikan dengan risiko penyakit kronis individu. Korea J
Nutr 2010;43:246-59.
7. Lee SY, Suh I. Relationship of health status and health
practices. Ko rean J Epidemiol 1995;17:48-63.
8. Choi MK, Kim JM, Kim JK. A study on the dietary habit and
health of office workers in Seoul. Korean J Food Cult
2003;18:45-55. 9. Sim KS, Lee KH. The effect of nutrition
education on nutrition knowledge and health improvement in
dyslipidemic industrial em ployees. J Korean Diet Assoc
2012;18:43-58.
10. Jang JH, Cho SH. Effectiveness of worksite nutrition
counselling for hyperlipidemic employees in Kyung-buk
area. J Korean Diet Assoc 1999;5:1-9.
11. Lee MS, Kang HJ, Oh HS, Paek YM, Chou RW, Park YK,
Choi TI. Effects of worksite nutrition counseling for health
promotion; Twelve-weeks of nutrition counseling has
positive effect on metabolic syndrome risk factors in male
workers. Korean J Community Nutr 2008;13:46-
61.
12. Son SM, Kim HJ. Effect of 12-week low calorie diet and
behav ior modification on the anthropometric indices and
biochemical nutritional status of obese woman. Korean J
Community Nutr 2005;10:525-35.
13. Cho KO, Jeong SY. The effect of regular dietary habits on
obesity indices and nutrition intakes in adult males. J
Korean Diet Assoc 2007;13:114-22.
14. Moon HK, Lee HJ, Park Y. Comparison of health status and
dietary habits by percent body fat (PBF) changes for adult
women in the weight control program by the community
health center. Korean J Community Nutr 2007;12:477-88.
15. Lee YA, Kim KN, Chang N. The effect of nutrition education
on weight control and diet quality in middle-aged women.
Korean J Nutr 2008;41:54-64.
16. Woo MK, Jegal SA, Kim SA. Development and evaluation of
nutri tion education program for middle agged men at
worksite. Korean J Community Nutr 1998;3:261-72.
17. Ministry of Health and Welfare. Report on 2007 National
health and nutrition survey. Seoul: Ministry of Health and
Welfare; 2008. hal. 56- 7.
18. Bae NK, Kim KH, Kwon IS, Cho YC. Changes in prevalence
of obe sity for 10 years (1997~2007) and its related factors
in health checkup examinees. J Korean Academia-Industrial
Cooperation 2009;10:1091-9.
19. Kim HI. The effect of 12 weeks aerobic exercise on body
composition blood glucose and lipoprotein in middle-age,
menopause and elderly women. J Korea Sport Res
2004;15:3-12.
20. Briley ME, Montgomery DH, Blewett J. Worksite nutrition
education can lower total cholesterol levels and promote
weight loss among police department employees. J Am Diet
Assoc 1992;92:1382-4.
21. Epstein LH, Wing RR, Koeske R, Valoski A. Long term
effects of family-based treatment of childhood obesity. J
Consult Clin Psychol 1987;55:91-5.
22. Choi MJ. Relations of life style, nutrient intake, and blood
lipids in middle-aged men with borderline hyperlipidemia.
Korean J Commu nity Nutr 2005;10:281-9.
23. Summer SK, Schiller EL, Marr ER, Thompson DA. A weight
control and nutrition education program for insurance
company employees.

J Nutr Educ 1986;18:S60-2.
24. Hunink MG, Goldman L, Tosteson AN, Mittleman MA,
Goldman PA, Williams LW, Tsevat J, Weinstein MC. The
recent decline in mortality from coronary heart disease,
1980-1990. The effect of secular trends in risk factors and
treatment. JAMA 1997;277:535-42.
25. National Cholesterol Education Program. 2001. Third report
of the expert panel on detection evaluation and treatment of
high blood cholesterol in adults. Bethesda: Maryland; 2001.
26. The Korean Nutrition Society. Dietary Reference Intakes for
Koreans. Seoul: Hanarum Publishers; 2010.

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CHAPTER 6 Foundation in Theory and Research: Promoting Environmental Supports for Action
127

described earlier in this chapter in the section titled “Social Support in Workplaces.")
prices on more healthful foods resulted in stable food service revenues and more
nutritious foods being sold (Hannan et al. 2002). Another one-year study with both high
schools and workplaces found that lower prices were effective in promoting choices of
targeted food items in vend ing machines and that signage had a smaller but
significant independent effect on sales (French et al. 2001). By providing such
information to school administrators or school food service mangers, nutrition educa
tors can help them in their decisions.
Local Foods at Workplaces Increasing the purchase of locally grown produce
through worksite sales was the objective of another intervention (Ross et al. 2000).
Here, work ers were given the opportunity to order local produce, which was then
delivered to the worksite. This environmental change was accompanied by promotional
materials about the farms that grew the produce and an opportunity to sample the produce.
The delivery was very public so that friends' ordering and satisfaction could be
observed to provide a social normative influence. Results showed that workers who
ordered local foods at the worksite were motivated to purchase locally grown
produce outside the worksite as well.
Promotional Activities A study in high schools focused on implementing a large
number of school-wide promotional activities rather than pricing. It found that over a
two-year period, the number of promotions was associated with the increase in
percentage of sales of lower-fat foods in à la carte areas of school cafeterias (Fulkerson et al.
2004). These results suggest that intense promotion can be an effective strategy in both
elementary and secondary schools.
COMMUNITY-LEVEL ACTIVITIES A community refers to both a physical locality
where a group of people live and to a group of people who share cominon interests. Nutrition
educators work in almost every community, so community projects abound.
Awards to Health Promoting Schools Some communities have initiated awards to
recognize schools that make efforts to improve the food environment. One example is the
Healthy Eating Champions Award for Elementary Schools program that recog. nizes and rewards
schools for their outstanding commitment to the promotion of nutrition, for nutrition
education, and for making healthy foods and beverages available (He et al. 2009). It
was found that schools that participated had increased student awareness about
healthy eating, more student involvement in healthy eating initiatives, and the creation of
opportunities for goal setting and spirit boosting.
Community Capacity Building Community capacity may be described as
the characteristics of commu nities that affect their ability to identify, mobilize, and
address social and public health problems (Goodman et al. 1999). It is similar to
the idea of social capital, where the structure of social relationships facilitates
coordination and cooperation for mutual benefit. Nutrition educators can participate in
the process by working in coalition with others to enhance collective efficacy and
empowerment to increase community capacity.
Workplaces A majority of adults are employed in workplaces of some sort. Hence, what is
available in and around such places can have an impact on food choices. A number of health
promotion interventions in work places have attempted to make changes in the food
environment by increasing the number of healthful low-fat and high-fiber foods and fruits and
vegetables available in the employee cafeteria and other sources
of food at work, such as
vending machines (e.g., Sorensen et al. 1990; Sorensen et al. 1996). Nutrition and
health professionals work with worksite decision makers to develop a variety of
activities for the worksite. Along with other educational, promotional, organizational, and
policy activities, these interventions have had a positive impact on eating patterns
(Sorensen et al. 1999; Engbers et al. 2005). Here are a couple of examples.
Collective Efficacy Collective efficacy is the belief of groups and community
members that they have the capacity to take collective action to create change in their
environment. Bandura (2001) notes that because human functioning is rooted in social systems,
personal agency operates within a broad net work of social structures that individuals, in
turn, also help to create. Thus, personal agency and social structures operate
interdependently. According to Bandura (2001), personal agency is not about
self-centered individualism; rather, studies show that a high sense of efficacy tends to
promote a prosocial orientation, involving cooperativeness and an interest in each
other's welfare.
Collective efficacy can be enhanced by "equipping people with a firm belief that they can
produce valued effects by their collective action and providing them with the means to do so"
(Bandura 1997). This is a group enablement process. Group efficacy becomes more than
the sum of the personal efficacies of group members because there is an interaction
among members and a coordination of their skills, competencies, and activities. In parallel to
personal self-efficacy, the strength of individuals' belief in their collective efficacy determines the
goals they are willing to set, how much effort they put into the group's endeavors, how much
they are willing to persist in the face of difficulties, their morale and resilience, and their
level of performance.
Treatwell Program An example of a worksite program to increase fruit and vegetable
con sumption that addressed multiple levels of influence is summarized in Nutrition
Education in Action 6-1. The Treatwell program randomly assigned 22 worksites into three groups:
minimal intervention controls, worksite intervention, and worksite-plus-family (Sorensen et al.
1998; Sorensen et al. 1999). The worksites were community health centers with racially and
ethnically diverse employees, providing services to low-income community residents. The
behavioral goal of the program and hence the expected outcome of the intervention was that
the employees in these worksites would increase their consumption of fruits and vegetables.
Nutrition Education in Action 6-1 lists the theoretical models that were used. The
study also tested whether the intervention had an impact on the potential mediators of
behavior change. These are shown in the table, along with how the changes were
measured. (The results were
Building Collective Efficacy Through Group Goal Setting Collective efficacy
involves the power to produce change in the social or political environment. Social
cognitive theory suggests that to build collective efficacy, individuals need to learn how to
exert influence

128
PART I Linking Research, Theory, and Practice: The Foundations

NUTRITION EDUCATION IN ACTIO

Theories Used and Potential Mediators of Behavior Change in

the Treatwell 5-a-Day Worksite Program
Level of Influence
Intervention Audience
Theoretical Models

Intrapersonal
• Worker
Social cognitive theory Health belief model
Measures Self-efficacy Knowledge (outcome expectations)

Interpersonal
Family Coworkers
social support Social networks and ties social cognitive theory
Family support Coworker support Social norms Availability of fruits and
vegetables in the home Type of family ties
OOO.

Organizational
Worksite
Hypotheses About Mediators of Behavior Change Higher self-efficacy about dietary
change is associated with increased fruit and vegetable consumption. Knowledge of
the diet-cancer link (outcome expectations: perceived risk) is associated with increased
fruit and vegetable consumption. High family and coworker support for dietary
change is associated with increased fruit and vegetable consumption. High family
support for dietary change is associated with increased availability of fruits and
vegetables in the home. The type of family ties will influence the strength of the
relationships between family support and changing eating habits. Worksite mean
increases in fruit and vegetable consumption will be greatest where fruits and
vegetables are most available and a catering policy supports the purchase of healthy
foods. Program implementation and participation will be highest where effective
communication channels exist and policies permit employee change agents to
participate. Coworker support for dietary changes will be highest in worksites with
high coworker cohesion and positive labor-management relations. Workers
reporting awareness of the national campaign are more likely to increase
consumption of fruits and vegetables. Workers reporting participating in grocery store
programs . are more likely to report increased consumption of fruits and
vegetables.
Organizational change and development Policy
Worksite characteristics

Community
Media (national - Social campaign) marketing Grocery store
Awareness of grocery store campaign Participation in grocery store campaign

Source: Sorensen, G., M. K. Hunt, N. Cohen, et al. 1998. Worksite and family education for
dietary change: The Treatwell 5-a-Day program. Health Education Research 13:577-591. Used
with permission.
.........
...
..........
.
.
.
.
.
.

over community practices that affect their lives. The process for build- ing
collective efficacy is rather like a group goal-setting process: group
inembers identify the issue of concern, set small goals to address the concern,
and, when these produce tangible results, come to believe that they have
the capability to change the social and political environments in which they live.
This leads them to believe that they can overcome even more difficult
problems and hence to set more ambitious goals. Other processes are also
hancing individuals' sense of
used. However, they all work, in part, by en
efficacy that they can bring about tangible changes in their lives. There
is evidence that skills in advocacy and com munity building raise both personal
and collective efficacy, which can result in collective actions that may in turn change
community practices and policies.
Empowerment What is empowerment? Empowerment, a term that is used
loosely and has many definitions, is similar to the process of group enablement
of social cognitive theory. Many see it as largely a personal process in
which individuals develop and use needed knowledge, competence, or
confidence for making their own decisions (somewhat like self-efficacy). Some
may even refer to learning to read food labels as empowerment. However,
empowerment is generally described as “a social process through which
individuals, communities, and organizations gain mas tery over their lives,
in the context of changing their social and political environment to improve
quality of life” (Wallerstein 1992). That is, it is a social process of recognizing
and enhancing people's abilities as a group to meet their own needs and
to mobilize the necessary resources

CHAPTER 6 Foundation in Theory and Research: Promoting Environmental Supports

for Action
129
to take more control of their environment. It is about political and social power, not just
personal power.
tive breakfast program in another, and a no-cook cookbook for those not allowed to
cook in their hotels. As they developed more collective efficacy and became more
empowered, they took more control of the project and the health education staff
decreased their roles, serving primarily as resource persons.
Education for Social Action The concept of empowerment education was
originally developed by Paolo Freiere of Brazil as a “pedagogy of the oppressed,” or
education for critical consciousness, that involves developing an understanding of root
causes of problems. The central method for empowerment is conscientizacion, or
group consciousness-raising (Friere 1970, 1973). Empowerment education is a
process whereby the group members de velop identity and social support for each
other, specify the problems in their lives, reflect on the root causes of these
problems, and develop plans of social or political action. It is thus education for social
change. It emphasizes the importance of social context in food- and nutrition related practices
and shifts the viewpoint away from victim blame and toward system blame. However,
the social context is not to be seen as a structural barrier to good health that needs to
be changed by health promotion interventions much the way a wall needs to be torn
down, but as something to be understood and transformed by people and com munities
through the process of empowerment (Travers 1997a).
Parent Center Another nutrition education program for social change involved low
income women who met weekly informally over coffee at a Parent Cen ter (Travers
1997b). The issue of common concern to them was feeding their families on a low
income. The nutrition educator posed questions that led to group dialogue and
discussion, out of which emerged the group's perception that foods cost more in
low-income neighborhoods. This led them to make a structured comparison study of
prices for foods in their local stores and prices in stores of the same chain in middle
income neighborhoods.
Strategies to Strengthen Empowerment Nutrition educators may facilitate this
educational process, when ap propriate, or provide technical assistance. More
specifically, in this con sciousness-raising process, the educator poses problems to the
group participants, who draw upon their own knowledge and experiences to try to
understand their lives in relation to the problem. Group members, through
dialogue, come to a collective understanding of the root causes of the problem and
begin to see how they can make changes in their situation. They become
empowered to transform their reality through change in the social or political condition of
their lives. Such an em powerment process can bring about not only personal
empowerment but also empowerment at the organizational level, where the influence of
the organization in broader society is enhanced, and at the community level, where
individuals and organizations work together to bring about desired outcomes in the
community (Israel et al. 1994). As the word power in the term empowerment suggests,
the process is ultimately about changed power relationships between individuals within
groups and between groups and social structures. Such an approach has been
advocated for nutrition education (Kent 1988; Rody 1988; Travers 1997a;
Arnold et al. 2001).
Role of the nutrition educator. The nutrition educator provided technical assistance
on this task. When their findings showed that prices in inner-city stores were
consistently higher than in middle-income neighborhoods, the women came to realize
that the difficulty they had in getting adequate nutrition was partly the result of social
inequities. They came to the decision to write to the stores to express their concern about
inequities in pricing and quality. This resulted in the chain store lowering the prices within
the low-income neighborhoods. The nutrition educator facilitated the process by
obtaining a word processor and writing the letter with them. This success led to a sense
of empower ment. The activity also led them to recognize that their welfare allowances
were not adequate to meet their needs. The impact of this information on them
personally was a relief from self-blame as they realized that their inability to purchase
enough food for their families was not because of their personal inadequacies but
because of government policy. Parent action. This then led them to decide to take action
toward change. They wrote letters to political leaders and worked with other community
groups, resulting in some increase in the welfare allowances. Finally, when some time later
there was an attempt to close the Parent Center because of budget cuts, the women
organized a march on city hall and got media attention, which prevented closure.
Projects Focusing on Empowerment Several examples from the food and
nutrition field illustrate this approach.

Senior Citizens Project The Tenderloin Senior Organizing Project (TSOP)

involved older adults who lived isolated lives in hotel residences in a crime-ridden
neighbor hood (Minkler 1997). Health educators used a combination of educa tional and
organizing approaches to assist residents to identify issues of importance to them,
understand the root causes of these issues in the political and social structures of the
community, and develop social support and a sense of community through group
discussions and tasks. The hotel residents recognized the need to work with other
hotels and community groups on shared problems, such as crime. As they achieved
success on this issue, including convincing the mayor to put more beat patrol
officers in the neighborhood, they took on the issue of poor food availability. They
established mini-markets in three hotels, a coopera
School-Based Intervention In a more formal setting of a school, an
empowerment process was used in a curriculum development project (da Cunha,
Contento, & Morin 2000). In this process, the nutrition educator first met with the teach
ers, school food personnel, and administrators in several high-poverty schools to raise
questions about the problem of poor nutrition among the students. The members of the
school staff were concerned. The schools nominated a small group, made up of teachers,
school food service personnel, and a parent, to meet with the nutrition educator to
address their concerns. They realized that they needed to find out more about the
problem, so they designed and conducted a comprehensive needs assessment among the
students and their families. From this needs assessment they then designed a nutrition
education curriculum to address the needs identified and helped each other in the
implemen tation of the curriculum. The group met weekly after school on their own
time for seven months. The nutrition educator used a conscious ness-raising and
empowerment process throughout, helping the group,

130
PART I Linking Research, Theory, and Practice: The Foundations

through dialogue and interpretations based on their own experience and knowledge, to
make their own decisions. The nutrition educator acted as a facilitator and provided
technical assistance in conducting the needs assessment and developing the curriculum but
did not direct the choice of content.
RICE

Youth Empowerment Empowerment of youths was the basis of a project in which high
school students operated farm stands in low-income communities (Hughes, Blalock, &
Strieter 2005). The youths made changes in their communities by creating access to
affordable, locally grown food and supporting local fariners and growers. At the
same time, the youths learned important skills in business, finance, and working
together in mature and produc tive ways, preparing them for the workforce.

Summary In all the food-related cases just described, we can see that the specific
issues of concern are identified by the people in the community rather than the
intervention staff, that the process aims to bring about social change through the
empowerment of individuals and groups, that the role of the nutrition educator is to facilitate
and advocate rather than to be the expert who provides all the information, and that forming
col laborations may enhance effectiveness of action. It should also be noted that collective
efficacy and empowerment approaches work on a long time frame, often involving months
and years, but the environmental changes brought about are more likely to be long-lasting.
Aschool food chef demonstrates a new lunch recipe and provides opportunities for children to
taste.

Building Coalitions and Collaborations In organizational-level interventions,

working in collaboration with decision makers and policy makers is vital. This is even
more true at the community level. Here, nutrition educators in most cases develop
partnerships and participate in coalitions with other groups who have similar goals to bring
about community changes that are supportive of the behavioral goals of the nutrition
education program. Nutrition educators participate in numerous coalitions. Here are a
few examples to illustrate the types of collaborations in which individual nutrition
educators or programs can participate.
munity members. Share Our Strength is a national organization with a presence in
many communities that seeks to inspire and organize individuals and businesses to
share their strengths to help end hunger. Its national nutrition education program,
Operation Frontline, mobilizes volunteer chefs, nutritionists, and financial planners to
teach nutrition, healthy cooking, and food budgeting classes to individuals at risk of hun
ger. Head Start provides education and meals to low-income preschool children.
Operation Frontline teaches its six-week curriculum to Head Start program parents,
providing an example of a partnership between a government program and a
community program to enhance the reach and effectiveness of both organizations
(Jones 2005). The program has resulted in increased parental knowledge and skills.

Community Coalitions and Partnerships: Examples Building

Breastfeeding-Friendly Communities An example in the United States of a
collaboration regarding a very specific behavior is a program wherein WIC
nutritionists worked with other food assistance programs and a variety of community
partners to build breastfeeding-friendly communities (Singleton et al. 2005). The aim was to
increase public awareness, acceptance, and community sup port for breastfeeding. The
program in one state included a public forum with 145 key community stakeholders to
develop a blueprint for action to assist communities, families, schools and child-care
centers, health care systems, policy makers, and worksites in their efforts to make
breastfeeding the norm for infant feeding. The partnership also initiated a public
awareness campaign and activities to advocate for changes in health care systems, the
insurance industry, the business community, and educational systems to encourage
breastfeeding, and advocacy for changes in the availability of resources for community
organizations and families.
Working in Coalitions: Benefits and Costs The attempts of any given group to
bring about social change are greatly enhanced by building coalitions with other
groups who have similar goals. Coalitions and collaborations can mobilize material
resources and peoples' knowledge, skills, and enthusiasms to achieve desired goals in
a way that is not possible for small groups alone. There are costs as well, however.
Collaborative efforts are complex, and leadership roles, deci sion making, social
support, and social network concerns are issues that must be addressed satisfactorily
for all collaborating groups involved; working these out may take time and effort. Even
when coalition mem bers are satisfied and actively involved, this does not guarantee
that the coalition will be effective in achieving agreed-upon goals. Leadership and
management must also be effective.

Successful Partnerships Factors that are likely to enhance successful collaboration

include the following: a shared and agreed-upon vision and mission, reached by
consensus through open dialogue, negotiation, and problem solving; a unique purpose that is
meaningful to members; tasks that are clear and empowering; a sense of productivity
and efficiency; a skilled convener and facilitator of team building and conflict
resolution; broad-based involvement in decision making; open, frequent communication,
with communication feedback loops; benefits that accrue to members for par
Working with Low-income Audiences Another example is a partnership between two
organizations-Share Our Strength and Head Start--to improve the diets of low-income
com

CHAPTER 6 Foundation in Theory and Research: Promoting Environmental

Supports for Action
31

ticipation; relationships that are based on trust, openness, and respect; power sharing;
and adequate resources (Rosenthal 1998).
health and social/economic improvement and learned about healthy eating, physical
activity, economic empowerment, financial literacy, and developing small businesses.
The program evaluation involved surveys, pedometers, food diaries, and weight
measurements. Preliminary results showed that HOPE Circle participants decreased
their body mass index (BMI) compared to comparison women and significantly
increased their fruit and vegetable intake and physical activity. They also started small
businesses (Benedict & Campbell 2009).
Nutrition Education Networks Nutrition education networks have also come into
existence in many states in the United States, with funding from the USDA and other
sources. These networks are partnerships and coalitions among the Supplemental
Nutrition Assistance Program, the Cooperative Extension Service, private volunteer
organizations such as the American Cancer Society or American Heart Association,
grocery stores, universities, and others with the aim of fostering collaboration among food
assistance programs and developing and delivering consistent nutrition messages
across network partnerships to low-income, Supplemental Nutrition Assistance
Program (SNAP) audiences. These partnerships have used a variety of
channels to reach these audiences--direct and indirect nu trition education as well as
social marketing (http://www.csres.usda .gov/nea/food/isne/fsne.html).
Nutrition education networks often work with physicians, health departments, school
districts, and community-based organizations to promote healthy eating and physical activity
habits in school-aged chil dren and their parents. They have also initiated a wide range
of activities to promote policy initiatives and to empower people to be advocates for
healthier food and activity environments in their schools and communi ties. They
often have worked to change organizational policies and the physical environment
to help low-income families eat healthier diets, be more active, and participate in
USDA nutrition assistance programs. An example is the California Nutrition Network,
which sponsors a wide range of nutrition education activities (California Department of
Public Health 2007).
Farmers Markets Many communities now have initiated farmers' markets where local
growers can bring their produce and other farm products into cities at markets set
up by the community. Supplemental Nutrition Assistance Program Electronic Benefit
Transfer (EBT) cards often are accepted at these markets, making fresh local foods
available to low-income resi dents in communities.

Community-Level Interventions Numerous community-level interventions have

been conducted over the years, including early large-scale projects such as the
Stanford, Minne sota and Pawtucket heart health programs (Shea & Basch 1990a,
1990b). Community-based interventions are those in which the community is very much
involved in the design, implementation, and evaluation of the program through
partnerships and coalitions. This allows for the intervention to be based on the
assets of the community as well as the deep understanding members of the
community have about them selves. Many recent interventions have addressed the issue
of obesity (Economos & Irish-Hauser 2007; DeMattia & Denney 2008). Here are a
couple of examples.
Physical Locality Effects There is evidence that neighborhoods have an impact on
obesity and health (Harrington & Eliot 2009; Dengel et al. 2009). Within neighbor
hoods are many retail food stores such as supermarkets and grocery stores, and
restaurants and fast food outlets. There is an association between access to supermarkets
and healthier food intakes, such as increased fruit and vegetable intakes, mostly because
supermarkets tend to offer a greater variety of foods at a lower cost. Nutrition
interven tions within grocery stores using point-of-choice information, increased
availability, increased variety, pricing, and promotional strategies have resulted in
moderate improvements in healthy eating behavior such as fruit and vegetable
consumption (Glanz et al. 2007).
The term food deserts has come to describe areas within urban centers as well as in
rural areas where low-income people do not have access to fruits, vegetables, and
other wholesome, healthful foods at affordable costs (Smith & Morton 2009).
Researchers are using geographic infor mation systems (GISs) to map locations of
supermarkets in geographic areas to identify such deserts. Nutrition educators have
worked in coali tion with others to change policies so as to encourage supermarkets to
locate in these deserts.
The built environment and walkability of neighborhoods have also been shown to be
associated with health conditions. Walkability in cludes the notion of safe streets,
attractive sidewalks with places of inter est, and connections to places people need
to go. Higher neighborhood walkability, for example, is associated with more walking,
lower BMI, and lower blood pressure (Rohere, Pierce, & Dennison 2004; Rundle et al.
2008; Li et al. 2009). Again, in coalition with others, nutrition educa tors have
worked to increase availability of safe and attractive places for people to walk.
Shape Up Somerville (SUS): Eat Smart, Play Hard SUS was a
community-based participatory research project that illus- trates the social ecological
approach. It addressed the concerns about childhood obesity by addressing children's before
school, during school, after school, home, and community environments. It is described in
Nutrition Education in Action 6-2.

HOPE (Health Opportunities, Partnerships, Empowerinent) Works HOPE Works

was a community-based participatory research project that recognized the importance
of positive psychology and hope to make health and life changes. It involved low-income,
ethnically diverse rural women. The model used the idea of “talking circles" in Native
Ameri can communities. Community women were trained to organize and facilitate
HOPE circles of 8 to 12 women from their social networks. These circles met twice a
month for 6 months, where they set goals for
Investment in Community-Level Actions A number of foundations have
invested grant funding to improve com munity empowerment and changes in policy
and environment to sup port healthy eating and physical activity. Among them is the
Robert Wood Johnson Foundation's (RWJF) Active Living and Healthy Eating (Sallis et
al. 2009) and Bridging the Gap (Chaloupka & Johnston 2007) initiatives, which support
research to identify promising policy and en vironmental strategies for increasing physical
activity, promoting healthy eating, and preventing obesity (http://www.rwjf.org).
The W. E. Kellogg Foundation's national Food & Fitness Initiative within its Food and
Community Program has invested locally in several communities around the United
States in collaborative efforts dedicated
132 PART I Linking Research, Theory, and Practice: The
Foundations
.
.
.
.
.
.

NUTRITION EDUCATION IN ACTION 6-2

Shape Up Somerville (SUS)—Eat Smart, Play Hard: A
Social Ecological Approach
.
.
.
.
.
.
.
.

Evaluation
.
.
.
.
.
.
.
.

Environmental factors at the community level may contribute to the

development and maintenance of obesity. Children, in particular, have very
little control over their food choices and options for physical activity.
School-based programs have been developed, but school time accounts for less
than 50% of children's waking hours. Shape Up Somerville was developed
to change the environment to prevent obesity in elementary school children.
Three matched, culturally diverse communities were assigned to
intervention and control conditions. About 1,200 children in public schools
in the intervention community participated in the classroom curriculum and
pre and post evaluations.
.
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.
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Results
.
Program
..
.....
..........

This three-year program was directed at children in grades 1 through 3 and

was designed to bring about energy balance by increasing physical activity
options and availability of healthful foods within children's before-, during-,
and after-school, home, and community environments. It used a
multifaceted collaborative community participatory research (CBPR)
approach. The community was involved in all phases: designing,
implementing, and evaluating the intervention, and identifying how the data
would be used to improve the health of the community. The intervention
involved not only children, parents, and teachers but also food service
providers, city departments, policy makers, health care providers,
restaurants, and the media.
. Students: The intervention resulted in a significant decrease in
the BMI z-scores in children (P=.001). School environment: More fruits,
vegetables, and whole-grain and low-fat milk products were available;
menus and à la carte items were brought into closer compliance with
guidelines; attitudes of students, parents and guardians, school faculty, and
food service staff improved; and policies related to food in schools were
adopted.
• Restaurants: About one third of restaurants actively recruited
became SUS-approved restaurants, agreeing to serve smaller portions and
offer healthier options. SUS approval was marketed to the community.
....
....
.
..
....

Components of the SUS program

....

Home
..
...

Before School
· Breakfast program

· Walk to school campaign

..
• Parent outreach and education

• Family events
• Child's "Health Report Card"
....
9
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During School

• School health office

School food service

• SUS classroom curriculum
--- 30-minute nutrition and physical activity lesson each week – 10-minute daily
"Cool Moves"

Enhanced recess
• School Wellness policy development
.
.

Community
• SUS community advisory Council
· Ethnic-minority group collaborations
City employee wellness campaign Farmers' market initiative SUS “approved"
restaurants Annual 5K family fitness fair Media--columns and ads
City ordinances on walkability/bikeability
.
.
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.
.
.
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.
.

After School
SUS after-school curriculum Walk from school campaign
Sources: Economos, C. D., R. R. Hyatt, J. P. Goldberg, et al. 2007. A community
intervention reduces BMI z-score in children: Shape Up Somerville first year
results. Obesity 15:1325-1336; Economos, C. D., S. C. Folta, J. P. Goldberg, et
al. 2009. A community-based restaurant initiative to increase availability of
healthy menus options in Somerville, Massachusetts: Shape Up Somerville.
Prevention of Chronic Disease 6(3).
http://www.cdd.gov/pcd/issues/2009/jul/o8_0165.htm; and Goldberg, J. P., J. J. Collins,
S. C. Folta, et al. 2009. Retooling food service for early elementary school in
Somerville, Massachusetts: The Shape Up Somerville experience.
Prevention of Chronic Disease 6(3):A103.
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CHAPTER 6 Foundation in Theory and Research: Promoting

Environmental Supports for Action
B3

to changing the policies, practices, and systems that prevent communi ties from
being healthy. The foundation aims to create vibrant com munities that
provide equitable access to affordable, healthy, locally grown food and safe and
inviting places for physical activity and play (http://www.kkf.org/faf).
Organizational-Level Policy Activities Organizational policies
regarding school, worksite, and community food environments influence
people's food choices and eating patterns. Thus, an important venue for nutrition
education is to work with policy makers to develop or modify existing policies to make
them more supportive of healthy eating and active living.
I POLICY AND SYSTEMS CHANGE ACTIVITIES Policy activities
are extremely important to help make the healthful choices the easy ones. They enable
changes in systems and social struc tures to facilitate the enactment of healthful
food and physical activity behaviors. Policy complements education and
environmental change (Rothschild 1999).
School Policies School Food Environment Many food-related environmental issues that
influence youth food intake in schools need to be addressed by institutional policy action
rather than, or in addition to, classroom education because the school food
environment is challenging:

• Food used in school fundraising. Short of funds, many schools

sell food products to raise money; these products are usually high-fat or high-sugar
items such as candy, chips, or sweetened
beverages.
• Food is often used in the classroom as a reward or incentive. Again,
most often such foods tend to be high-fat and high-sugar, largely because
these are liked by students. Food advertising. In schools, advertising of food occurs
directly on vending machines, book covers, wall boards, hallway decorations, sports
scoreboards, and in student publications and yearbooks, and indirectly through
coupons to fast food outlets given for aca
demic achievement.
• Contracts for beverage sales. In schools, contracts, usually for soft
drinks, have been common in exchange for signing bonuses and a percentage of the profits.
Beverage contracts present a nutri tion education challenge because the schools must urge
students to consume these beverages to guarantee contracted minimum purchases, yet
nutrition guidelines would advocate for healthier options on a regular basis.
Relationship Among Education, Environmental Change, Policy, and Systems
Education, as we have seen, involves a combination of theory-based strategies to
increase awareness, enhance motivation, and facilitate the voluntary adoption or
maintenance of behaviors that are conducive to health. Some researchers note that it
does not provide, on its own, direct or immediate reward or punishment (Rothschild
1999). Sometimes, the anticipated outcomes nutrition educators bring to the public's attention
are far into the future, such as “If you drink milk now, you are less likely to develop
osteoporosis when you are old.”
Environmental change attempts to make the environment favorable for the new
behavior. Changing the environment can promote voluntary changes in behavior by
offering audiences the benefits people want and reducing the barriers they are
concerned about, accompanied, in social marketing, by effective communications or
persuasion to enhance moti vation. Environmental changes reduce barriers by
providing the products or services that would make enacting the behavior easier, for
example, by increasing the availability of fruits and vegetables in grocery stores in the
audience's community and making them more accessible through pricing incentives or
the use of coupons. In this case, the anticipated outcomes or rewards are more
immediate.
Policy complements these approaches and can also have an im portant and positive
role here. Policies and regulations can ensure the performance of a desirable behavior
when it would be difficult to carry out because of social pressure to conform to a different stan
dard. For example, food policies or nutrition standards for all foods available in
school could make it easier for students to eat more fruits and vegetables or
drink fewer sweetened beverages, even though less healthy options might be more
appealing to students and financially desirable to schools. Nutrition educators need to
participate in relevant food policy decisions. This may require them to serve as
advocates for healthy policies to policy makers and even lawmakers at the local or
national level.
Systems changes, often linked to policy change, can be made to be more supportive of
healthful action. A system is a group of independent but interrelated and interacting
elements-individuals, institutions, and infrastructure—that form a unified whole.
Examples include the school system, the transportation system, and the parks and
recreation system. Thus the individuals, institutions, and infrastructure that make up the
food system are involved in the interconnected activities of produc ing, processing,
distributing, retailing, preparing, and consuming food. Systems are not static but
constantly changing and evolving. Public policy, organizational policy, and other actions
can bring about changes in systems. System change complements other venues
for facilitating healthful action.
In response to these challenges, the Institute of Medicine developed recommendations
for nutritional standards for foods and beverages available in the school environment
outside the USDA school meals pro gram (Institute of Medicine 2007). These include
making only healthful foods and drinks available in all venues during the school
day.
Local Wellness Policies Over the years, nutrition educators have advocated that
schools form school nutrition advisory councils or health councils made up of teachers,
administrators, parents, students, and intervention staff to assess the over all school
food environment, consider and discuss issues, and advance school-level policy that
promotes a healthful food environment so as to make the healthful choice the easy
choice (Kubik, Lytle, & Story 2001; Lytle et al. 2004). In the United States, such an
approach has become reality. The Child Nutrition and WIC Reauthorization Act of 2004
required each local educational agency participating in a program authorized by the
National School Lunch Act or the Child Nutrition Act to establish a local school wellness
policy. The policy at a minimum has to include the following (Child Nutrition and WIC
Reauthorization Act 2004):

Goals for nutrition education, physical activity, and other school

based activities that are designed to promote student wellness
• Nutrition guidelines selected by the local school for all foods
available on campus during the school day, with the objectives of promoting student
health and reducing childhood obesity

134 PART I Linking Research, Theory, and Practice: The

Foundations
"employee advisory board” at each site and through delivery of the intervention
by peers. The employee advisory board chooses the intervention components to be
implemented in the individual worksite setting, disseminates program messages and
information throughout the worksite, and encourages long-term incorporation of the
program into the worksite (Sorensen et al. 1990; Sorensen
et al. 1992; Cousineau et al. 2008). The more that employees are involved, the
greater are the number of activities implemented (Hunt et al. 2000). Worksite
management must put in place policies to permit and encourage employees to take work time
to participate in these health promotion activities (Williams et al. 2007).

Local school wellness policies have improved the nutritional value of school lunches

Guidelines for reimbursable school meals that are no less re strictive than
regulations and guidance of the USDA for program
requirements and nutrition standards
• A plan for measuring implementation of the local wellness
policy The law requires the following participants to be involved in the well ness policy
process: parents, students, representatives of the school food authority, the school board,
school administrators, and the public. A nutrition educator is not specifically required to
be part of the team, but can offer his or her services as a member of the public or as a
parent.
Although all schools or school districts have such policies in place, the
comprehensiveness of the policies differ and the degree to which they are
implemented in schools also differ. In a survey of schools across the United States,
changes in food service operations included the use of nutrition guidelines for à la carte
foods, beverages, fundraisers, par ties, and vending (Longley & Sneed 2009). Other
research also shows some progress (U.S. Department of Agriculture 2005; Story,
Nanney, & Schwartz 2009), but much still needs to be done and nutrition educators can
help with the process in collaboration with the schools.
Community- and City-Level Food Policy Activities Many community
organizations focus on food policy. For example, the food policy council is
composed of stakeholders from various segments of a state or local food system. Councils
can be officially sanctioned through a government action such as an executive order or can
be grassroots efforts. The primary goal of many food policy councils is to examine the
operation of a local food system and provide ideas or recommendations for how it can be
improved. Nutrition educators are often members of such councils to broaden the scope of
the councils, in which members may be more concerned with emergency food as
sistance or agriculture policy in the most traditional sense (see http://
www.statefoodpolicy.org).
Various food security coalitions and farin and food projects also work to analyze and
develop policy initiatives to link local farmers and communities so as to rebuild and restore
regional food and agriculture systems to enhance the economic livelihoods of family
farms and rural communities and at the same time provide healthy and affordable food
for the community (e.g., see http://www.foodsecurity.org).
Cities have also become involved in food and physical fitness policy. Some cities such as
New York City have initiated regulations that require chain fast food restaurants to post calorie
counts of food items on the menu board itself. Cities can also enact regulations so that
mobile carts get perinits to sell fresh fruits and vegetables in city streets, becoining green
carts. Another example is a recommendation of the president of Manhattan borough,
New York City, that one fifth of foods used in government-related venues come from
local “food sheds,” a term that is analogous to watersheds (Stringer 2009).

National-Level Public Policy The main vehicle for national public policy in relation to
food is through advocacy action in relation to proposed or existing legislation.
These activities are described in Chapter 18.
Workplace Policies Many interventions in the worksite have tested a comprehensive, multi
level approach to creating an environment supportive of healthy eating by
addressing organizational issues as well as the physical and social environments
(Sorensen et al. 1998; Beresford et al. 2001). Health profes sionals are very
important for educating decision makers and manage ment about the
importance of food and health issues and convincing them to take action. They also can
initiate programs and provide services and technical support. However, they need to
work in collaboration with both employees and management to develop policies and
procedures so as to implement and institutionalize programs
A review of such studies finds that a number of organizational factors are related to
program effectiveness (Sorensen et al. 2002):
STRATEGIES TO IMPROVE ENVIRONMENTAL AND POLICY SUPPORTS
FOR ACTION OR BEHAVIOR CHANGE

Management commitment and supervisory support are essen tial. Policies need to be modified
and this requires management
support.
• Worker involvement in planning and implementation is just as
important. This can be done through such mechanisms as an
Based on the considerations just discussed, nutrition educators can use many different kinds
of activities to address environmental determinants of health actions or behavior change. In
most of these activities, nutrition educators need to work in collaboration with others, such as
food or service providers and decision makers. This usually involves educating decision
makers or policy makers in organizations and communities about the importance of
food and nutrition issues, and then building coalitions with them to develop and
implement plans to enhance the

CHAPTER 6 Foundation in Theory and Research: Promoting

Environmental Supports for Action
135

opportunities for individuals to engage in identified health-promoting actions. It

also means collaborating with program participants and other like-minded
community groups to work toward developing or revising public policies,
or even legislation, to support the behaviors or issues that are of concern to the
program.
Figure 6-2 shows how nutrition education can be directed at various levels of
influence using the logic model: the individual and household level; the
interpersonal level; the institutional, organizational, and com munity level;
and the social structures, policies, and systems level. The educational
activities at both the individual and interpersonal levels
Inputs
Outputs
Outputs

Resources
Activities
Participants
Short-Term
Medium-Term
Long-Term

Individuals

Take action:
Learning and motivation:
Improved health:
Individual Level Theory-based Identified educational audiences such as programs
children, youth, using direct
adults, diverse in-person and cultural groups indirect methods (e.g., materials)
• Awareness
• Motivation

• Values
• Skills
• Incorporate
skills
• Take action
• Change
behaviors
• Decreased risk
factors for health conditions

Social marketing directed at identified program behaviors/issues

Interpersonal Level
Financial
resources
Social support, social networks
Identified audiences such as families and social networks
People (staff
and volunteers)
Partners
Time

Materials
Gain awareness:
commit to change:
Solve community problems:

Needs/issues
identification process
Institution, Organization, and
Community Levels Strategies to Community groups develop partner- and
leaders, local ships, and together agencies, build community institutions, capacity,
collective organizations in efficacy, and the partnerships empowerment; and reduce
environmental barriers for action by identified audiences
• Understanding
of issues
• Involvement of
partners, community groups
• Partners adopt
plans to address program behaviors/
issues
· Community
actions improve targeted behaviors/ issues

Identify and define issues

Policymakers Work toward needed change
Social Structures, Systems, and Policy Efforts to create/ Policymakers revise
social systems and public policies related to core behaviors/issues
Revise/adopt policies and practices related to targeted behaviors/issues

FIGURE 6-2 A nutrition education logic model framework addressing multiple levels of
intervention. Source: Based on Helen Chipman (national coordinator),
Supplemental Nutrition Assistance Program Education (SNAP-Ed), NIFA/USDA,
and Land Grant University System Partnership. 2006, January. Community Nutrition
Education (CNE) Logic Model, Version 2: Overview.
http://www.nifa.usda.gov/nea/food/fsne/logic.html. Used with permission.

136
PART I Linking Research, Theory, and Practice: The Foundations
address personal mediators of action or behavior change, such as be- liefs, attitudes, affect, and skills,
with immediate-, intermediate-, and extended outcomes for individuals. The activities at the other
are directed at environmental determinants of behavior change and are
levels
also designed to affect individuals, but in this case by making the healthy action
also the easy action through changes in policy, systems, and social structures.
to subsidize more healthful, but higher-priced foods such as fruits and vegetables or lower-fat
alternatives (sold at, say, 15% lower than oth erwise) in such a way as to be revenue neutral to
the organization in which the food sales occur. Attractive presentation of the foods and
promotional activities can further increase the choice of these foods. Again, nutrition educators
need to work with food providers to bring about such changes.

Nutrition Education Activities Directed at the Interpersonal Level Social

Networks and Social Support Enhancing Existing Social Networks To
enhance social support for the key food- and nutrition-related be havior or behaviors
that have been identified as of concern to the pro gram (e.g., increasing
breastfeeding rates, increasing the consumption of fruits and vegetables), existing social
networks can be called upon and expanded. For example, parent associations in
schools, employee associations at workplaces, and groups that meet regularly in communi ties
and organizations may be interested in nutrition issues. Nutrition education programs can
work with these groups to make them more supportive of the targeted behaviors or practices.
Community-Level Activities Building Community Capacity: Facilitating
Collective Efficacy and Empowerment Collective Efficacy The processes of
enhancing collective efficacy and empowerment are somewhat similar. In the
process of enhancing collective efficacy, group members, with the technical
assistance of the nutrition educator, iden tify the issue of concern to them in the social
and political environments. They can start out by setting small goals that will help to address the
concern. When these are accomplished, the group members can pose even more difficult
problems and set more ambitious goals. Such an approach can be effective with many
age groups, particularly youth.
Empowerment strategies generally involve some sort of conscious ness-raising process,
whereby the educator poses problems to the group participants and asks them to draw
on their own knowledge and ex periences to try to understand their lives in relation to
the problem. Group members, through dialogue, come to a collective understanding of
the root causes of the problems and begin to see how they can make changes in their situation.
They then set goals for actions that they will take to transform their reality through
making changes in the social or political condition of their lives. In these settings, the
role of the nutri tion educator is to facilitate the process at the beginning, if needed, until
the group has developed its own agendas and procedures and no longer needs the nutrition
educator. Another possibility is that a group has already initiated community action and
needs the nutrition educator as a resource person.
Developing New Social Network Linkages Programs frequently create social support for
program participants by initiating a social support group through which new social network linkages
are built. For example, a group can be developed for those in a workplace who are
interested in weight control or weight acceptance. Support groups can be developed at a
health center for those with HIV/ AIDS, or cooking classes and behavioral change sessions
can be created for participants in a program.

Organizational-Level Activities Changing the Food Environment Foods

offered at nutrition education program sites, such as schools, workplaces, communities,
soup kitchens, or food banks, can be modi fied to make them more supportive of the
healthful behaviors identified as important by nutrition educators or by participants. In
schools, this means making changes in the school meal offerings, vending
machines, à la carte offerings, and food items sold in school stores.
Bringing about changes at such sites may require the use of both mo tivational- and
action-phase activities, this time directed at the providers of food as the audience so that
they are motivated to make changes in the foods offered. Professional development
workshops and incentives are important here. Changes in the food offered may require
changes in organizational policy and union rules so that food service staff can make the changes,
which will require negotiations and advocacy. Making such food changes possible
may also require changes in physical facilities at sites such as schools or other
locations so that foods can actually be cooked or prepared on site. All of these
actions require coalition building with groups that have authority in the relevant
areas.

Pricing and Promotional Activities Changes in the pricing of food items

can be helpful in supporting health ful eating. As we have seen, large price changes
are effective in increas ing the sales of healthy items in organizations but are not financially
sustainable over the long term. A more sustainable strategy is to raise prices slightly (5% to 10%)
on more popular, high-fat, high-sugar foods
Playgrounds in a community encourage physical activity.

CHAPTER 6 Foundation in Theory and Research: Promoting Environmental Supports

for Action
37

Fruits & Vegetables Available Here

Se Vende Frutas & Vegetales Aqui

Move to
Muévete a Fruits & Vegetables Frutas
Vegetales
Your Heart
Tu Corazón and Your Waistline
y tu Cintura te lo Will Thank You
Agradecerán
NYC
CARE
CUÍDATE
The new torx Cty Department of heats and Mental Hygiene
Depxterio de Salud y Salud Mental de
Ciutad de Rosa York

FIGURE 6-3 New York City Department of Health and Mental Hygiene: Diet. Source: Courtesy of the New
York City Department of Health and Mental Hygiene.

Burn Calories, Not Electricity

Community-Based Programs Developing community-based interventions requires that nutrition
educators work in collaboration or partnership with various sectors within the community,
perhaps community centers, health centers, food banks, churches, community gardens,
schools, restaurants, and so forth. The role of the nutrition educator can vary considerably, from being a
member of the team and only providing technical expertise in the food, nutrition, and activity
areas, to providing more of a coordinating or organizing role. This means that the nutrition educator must have a
deep understanding of the community and respect for a diversity of backgrounds.

Inforinational Environment Information provided in public forums serves several purposes. It can
provide motivational (why-to) or instrumental (how-to) information on an important issue. However, the information
can also help to establish social and community norms that are supportive of dietary change. For
example, numerous posters about breastfeeding or eating fruits and vegetables can encourage
people to see these behaviors as the social norm. They can also serve as cues to action. In addition
to posters in schools, at work, or in community centers, billboards in the commu nity can help
establish norms and serve as cues to action. Promotions through other media, such as radio and
magazines, can be supportive of the behavior change that is targeted by the intervention. Studies have shown
that posters could increase stair use in blue- and white-collar worksites, shopping centers, and other
locations (Kerr et al. 2000, 2001; Kwak et al. 2007).
The New York City Department of Health has provided posters for use in multiple settings. Two are
shown in Figure 6-3 and Figure 6-4: one

Take the Stairs!

Walking up the stairs just 2 minutes a day helps prevent wakati gans, it also help, the
an aronne si. learn more at woonvertit
e n una

FIGURE 6-4 New York City Department of Health and Mental Hygiene: Exercise. Source:
Courtesy of the New York City Department of Health and Mental Hygiene.

138
PART I Linking Research, Theory, and Practice: The Foundations
about policies and issues as they come up and participate, where pos sible and
appropriate, to have a voice in how these policies will be developed and implemented. Some of
these national policy activities are described in Chapter 18 of this book.
poster is for use in small neighborhood grocery stores. As you can see, the graphic
provides why-to, or motivational, information: "Move to Fruits & Vegetables. Your Heart and
Your Waistline Will Thank You,” and how-to, or instrumental, information: “Fruits &
Vegetables Available Here.” The second poster is about taking the stairs rather than taking
the elevator and can be used in any building. It links a “green” message with a health
message: “Burn Calories, Not Electricity. Take the Stairs.”
Information on the number of calories on menu items in fast food res taurants has
become available in some communities. This can signal to people that this is an
important feature to consider and may have some impact on food choices (Bassett et
al. 2008; Harnack et al. 2008).
SUMMARY
Environmental interventions and policy and system change activities seek to enhance
opportunities for people to engage in healthful food and activity behaviors. Addressing
environmental determinants of people's health-related action takes many different approaches
and involves a variety of venues. Nutrition educators inform, educate, and form part nerships with
others—food and service providers, decision makers with authority and power, and policy
makers—to address the environmental determinants that mediate the behaviors or practices
targeted by nutri tion programs. Thus, nutrition educators work with schools, Head Start
programs, workplaces, and communities to make healthful foods avail able and
accessible and to develop policies and system changes that encourage and reinforce
healthful eating practices, as follows:
Policy and System Changes Organizational Food Policy Nutrition
educators can assist organizations to develop appropriate poli cies with respect to
foods offered on site. Thus, in schools, they can work with local wellness councils made
up of teachers, school food service staff, administrators, community members, and
students. They can pro vide technical assistance to these councils to review and help
evaluate the effectiveness of policies to encourage healthful food environments that address the
following issues: food used in school fundraising or in the classroom as a reward or incentive,
food advertising in schools, and beverage sales in schools. The Centers for
Disease Control and Prevention (CDC) has developed a monitoring tool that schools
can use to assess the school health environment and evaluate how they are doing (Centers for
Disease Control and Prevention 2004a, 2004b). Within workplaces and other settings, vendors
are usually for-profit operations. However, even here food policies can be developed so
that healthful foods are more available and accessible.
Schoolwide Policies and System Change Activities In schools, schoolwide
food-related policies about beverage availability, vending machines, and school stores, as
well as school cafeteria policies, should
provide students the opportunity to have easy access
to healthful food choices and to see healthful food practices modeled.

Worksite Interventions In workplaces, healthful alternatives should be made

available in the cafeteria and in vending machines and should be promoted.

Community and National Policy Many community organizations and national

organizations focus on food policy. Nutrition educators can work within them to advocate
for, create, or revise policies that are supportive of the behaviors or issues that are
important for nutritional health. Here, nutrition educators can provide technical
assistance as well as influence. Nutrition educators also can bring their
knowledge and skills to food assistance programs and public health agencies.
Nutrition educators need to stay informed
Making the Healthful Choice the Easy Choice In all settings, the
healthful choice should be an easy choice. Active participation of community
members and worksite employees as well as leaders must be incorporated into any
interventions. Indeed, commu nity empowerment and collective efficacy are high
priorities. Adopting these comprehensive approaches enhances the likelihood of
improving the effectiveness of nutrition education interventions for individual and
environmental change.

CHAPTER 6 Foundation in Theory and Research: Promoting Environmental

Supports for Action
39
Questions and Activities
1. Think about one or two dietary changes you have tried to
make.
What factors in the environment have been helpful in supporting your
change, and what factors have not been helpful? List five of each. Based on
this chapter, what do you think that nutrition educators could have done to be
helpful to you? What would the ideal healthful food and activity environment look
like to you-at work or school or in the community? What role do you think nutrition
educators should play in promoting an
environment that is supportive of healthful eating? 3. What is the social ecological
approach to nutrition education?
Describe the levels of influence in this approach and the role of
nutrition educators in each. 4. Define the following terms and describe how they relate
to nutri
tion education. Give examples: a. Social networks b. Social support
C. Collaboration 5. What is community capacity? How can it be strengthened?
What
is the role of nutrition educators in the process? 6. “Local wellness
policies” are required in the United States. What
are these? How are nutrition educators involved? 7. If you were asked to
name five things that schools could do to
support healthy eating and active living, what would they be?
What is the evidence for your recommendations? 8. If you were asked to name
three things that worksites could do
to support healthy eating and active living, what would they be?
What is the evidence for your recommendations? 9. Describe
"community-based participatory research." How might
nutrition educators be involved? 10. What do we mean by policy in relation to diet
and physical activ
ity? How are education, environmental change, and policy related?
What is the role of nutrition educators in policy making? 11. What skills do you think
 nutrition educators should have to be
able to work in collaboration with others to bring about environ ments and policy
that are supportive of health? What role would
you like to see yourself play in these activities?
Benedict, S., and M. K. Campbell. 2009. HOPE Works: A successful community based
project to address obesity, hope, and economic determinants of health among low income,
rural, ethnically diverse women. Paper presented at the International
Society for Behavioral Nutrition and Physical Activity Annual Meeting, Portugal.
Beresford, S. A., B. Thompson, 2. Feng, A. Christianson, D. McLerran, and D. L.
Patrick. 2001. Seattle 5 a Day worksite program to increase fruit and vegetable
consumption. Preventive Medicine 32(3):230-238. Berge J. M., M. Wall, K.W. Bauer,
and D. Neumark-Sztainer. 2009. Parenting
characteristics in the home environment and adolescent overweight: a latent
class analysis. Obesity Oct 8 (Epub ahead of print). Berkman, L. F., and T. Glass.
2000. Social integration, social networks. social
support, and health. In Social Epidemiology, edited by L. F. Berkman and I.
Kawachi. New York: Oxford Press. Burgess-Champoux, T. L., N. Larson, D. Neumark-Sztainer, P. J.
Hannan, and M.
Story. 2009. Are family meal patterns associated with overall diet quality during the transition from
early to middle adolescence? Journal of Nutrition Education
and Behavior 41(2):79-86. California Department of Public Health. 2007. Network for a Healthy
California.
http://www.dhs.ca.gov/ps/cdic/cpns/network. Center for Food and Justice. 2010. About the
national Farm to School program. http://
www.farmtoschool.org/about.htm. Centers for Disease Control and Prevention. 2004a.
School Health Index: A self
assessment and planning guide. Elementary school version. Atlanta, GA: Author.
- 2004b. School Health Index: A self-assessment and planning guide. Middle
school/high school version. Atlanta, GA: Author. Chaloupka, F. J., and L. D.
Johnston. 2007. Bridging the Gap: Research informning
practice and policy for healthy youth behavior. American Journal of Preventive
Medicine 33(4 Suppl):S147-5161. Child Nutrition and WIC Reauthorization Act. 2004,
June 30. Local wellness policy.
Section 204 of Public Law 108-265. Enacted by the 108th Congress of the United
States of America. Cohen, D. A. 2008. Obesity and the built environment: Changes in
environmental
cues cause energy imbalances. International Journal of Obesity 32:S137-S142. Contento, I.
R., S. S. Williams, J. L. Michela, and A. B. Franklin. 2006.
Understanding the food choice process of adolescents in the context of family
and friends. Journal of Adolescent Health 38(5):575-582. Council of Economic Advisors.
2000. Teens and their parents in the 21st century:
An examination of trends in teen behavior and the role of parental involvement.
Washington, DC: Author. Cousineau, T., B. Houle, J. Bromberg, K. C. Fernandez,
and W. C. Kling. 2008. A pilot
study of an online workplace nutrition program. Journal of Nutrition Education
and Behavior 40:160-167. Cullen, K. W., T. Baranowski, E. Owens, T. Marsh, L.
Rittenberry, and C. de Moor.
2003. Availability, accessibility, and preferences for fruit, 100% fruit juice, and vegetables
influence children's dietary behavior. Health Education and Behavior
30(5):615-626. Cullen, K. W., and I. Zakeri. 2004. Fruits, vegetables, milk, and
sweetened beverages
consumption and access to a la carte/snack bar meals at school. American
Journal of Public Health 94(3):453-467. da Cunha, Z., 1. R. Contento, and K. Morin. 2000.
A case study of a curriculum
development process in nutrition education using empowerment as
organizational policy. Ecology of Food and Nutrition 39:417-435. Davis, E. M., K. W. Cullen,
K. B. Watson, M. Konarik, and J. Radcliffe. 2009. A Fresh
Fruit and vegetable Program improves high school students' consumption of
fresh produce. Journal of the American Dietetic Association 109(7):1227-1231.
DeMattia, L., and S. L. Denney. 2008. Childhood obesity prevention: Successful
community-based efforts. Annals of the American Academy of Political and Social
Science 615:83-99. Dengel, D. R., M. O. Hearst, J. H. Harmon, A. Forsythe, and L. A.
Lytle. 2009. Does
the built environment relate to the metabolic syndrome in adolescents? Health Place
15(4):946-951.
References Abratt, R., and S. D. Goodey. 1990. Unplanned buying and in-store
stimuli in
supermarkets. Managerial Decisions and Economics 11:111-121. American Academy
of Pediatrics Committee on Environmental Health. 2009. The
built environment: Designing communities to promote physical activity in
children. Pediatrics 126(6):1591-1598. Ammerman, A. S., C. H. Lindquist, K. N. Lohr, and J. Hersey. 2002. The
efficacy of
behavioral interventions to modify dietary fat and fruit and vegetable intake: A
review of the evidence. Preventive Medicine 35(1):25-41. Arnold, C. G., P. Ladipo, C.
H. Nguyen, P. Nkinda-Chaiban, and C. M. Olson. 2001.
New concepts for nutrition education in an era of welfare reform. Journal of
Nutrition Education 33(6):341-346. Bandura, A. 1997. Self efficacy: The exercise of
control. New York: WH Freeman.
- . 2001. Social cognitive theory: An agentic perspective. Annual Review of
Psychology 51:1-26. Bassett, M. T., T. Dumanovsky, C. Huang, et al. 2008.
Purchasing behavior and
calorie information at fast-food chains in New York City, 2007. American Journal of Public
Health 98(8):1457-1459.

140
PART I Linking Research, Theory, and Practice: The
Foundations
Economos, C. D., and S. Irish-Hauser. 2007. Community interventions: A brief
overview and their application to the obesity epidemic. Journal of Law and
Medical Ethics 35(1):131-137. Edmundson, E., G. S. Parcel, H. A. Feldman, et al.
1996. The effects of the Child and
Adolescent Trial for Cardiovascular Health upon psychosocial determinants of
diet and physical activity behavior. Preventive Medicine 25(4):442-454. Engbers, L. H.,
M. N. van Poppel, A. Paw, M. J. Chin, and W. van Mechelen. 2005.
Worksite health promotion programs with environmental changes: A systematic
review. American Journal of Preventive Medicine 29(1):61-70. Feuenekes, G.I. J., C. De Graff. S.
Meyboom, and W. A. Van Staveren. 1998. Food
choice and fat intake of adolescents and adults: Association of intakes within
social networks. 26:645-656 French, S. A., R. W. Jeffery, M. Story, et al. 2001. Pricing and
promotion effects on
low-fat vending snack purchases: The CHIPS Study. American Journal of Public
Health 91(1):112-117. French, S. A., and G. Stables. 2003. Environmental interventions to
promote
vegetable and fruit consumption among youth in school settings. Preventive
Medicine 37(6 Pt 1):593-610. French, S. A., M. Story, R. W. Jeffery, P. Snyder, M. Eisenberg, A.
Sidebottom, and D.
Murray. 1997. Pricing strategy to promote fruit and vegetable purchase in high
school cafeterias. Journal of the American Dietetic Association 97(9):1008-1010.
French, S. A., and H. Wechsler. 2004. School-based research and initiatives: Fruit
and vegetable environment, policy, and pricing workshop. Preventive Medicine
39 (Suppl 2):S101-S107. Friere, P. 1970. Pedagogy of the oppressed. New York:
Continuum.
- 1973. Education for critical consciousness. New York: Continuum.
Fulkerson, J. A., S. A. French, M. Story, H. Nelson, and P. J. Hannan. 2004.
Promotions to increase lower-fat food choices among students in secondary schools:
Description and outcomes of TACOS (Trying Alternative Cafeteria
Options in Schools). Public Health Nutrition 7(5):665-674. Fulkerson, J. A., D.
Neumark-Sztainer, P. J. Hannan, and M. Story. 2008. Family
meal frequency and weight status among adolescents: Cross-sectional and 5-year
longitudinal associations. Obesity (Silver Spring) 16(11):2529-2534. Furst, T.,
M. Connors, C. A. Bisogni, J. Sobal, and L. W. Falk. 1996. Food choice: A
conceptual model of the process. Appetite 26(3):247-265. Gillespie, A. H.,
and G. W. Gillespie, 2007. Family food decision-making: An
ecological systems framework. Journal of Family and Consumer Sciences 99(2):
22-28. Gillespie, A. H., and W. L. Johnson-Askew. 2009. Changing family food and eating
practices: The family food decision-making system. Annual Review of Behavioral
Medicine Nov 3 (Epub ahead of print). Glanz, K., J. F. Sallis, B. E. Saelens, and L. D.
Frank. 2005. Healthy nutrition
environments: Concepts and measures. American Journal of Health Promotion 19(5):330-333,
ii. ----. 2007. Nutrition Environment Measures Survey in stores (NEMS-S):
Development and evaluation. American Journal of Preventive Medicine
32(4):282-289. Goodman, R. M., et al. 1999. Identifying and defining the dimensions
of community
capacity to provide a basis for measurement. Health Education and Behavior
25:258-278. Gottlieb, B. H. 1985. Social networks and social support: An overview of
research,
practice, and policy implications. Health Education Quarterly 12(1):5--22. Green, L. W.,
and M. W. Kreuter. 2004. Health promotion planning: An educational
and ecological approach. 4th ed. New York: McGraw-Hill Humanities/Social
Sciences/Languages. Hannan, P., S. A. French, M. Story, and J. A. Fulkerson. 2002.
A pricing strategy
to promote sales of lower fat foods in high school cafeterias: Acceptability and
sensitivity analysis. American Journal of Health Promotion 17(1):1-6, ii. Harnack, L.
J., S. A. French, J. M. Oakes, M. T. Story, R. W. Jeffery, and S. A. Rydell.
2008. Effects of calorie labeling and value size pricing on fast food meal choices:
Results from an experimental trial. International Journal of Behavior Nutrition
and Piysical Activity 5:63. Harrington, D. W., and S. J. Eliot. 2009. Weighing the
importance of neighborhood:
A multilevel exploration of the determinants of overweight and obesity. Social
Science and Medicine 68(4):593-600. Harrington, K. F., F. A. Franklin, S.
L. Davies, R. M. Shewchuk, and M. B. Binns.
2005. Implementation of a family intervention to increase fruit and vegetable
intake: The Hi5 + experience. Heaith Promotion Practice 6(2):180-189. He, M., C.
Callaghan, A. Evans, and G. Mandich. 2009. Healthy eating champions
award for elementary schools. Canadian Journal of Dietetic Practice and Research
70(2):101-104. Hearn, D. M., T. Baranowski, J. Baranowski, et al. 1998. Environmental
influences
on dietary behavior among children: Availability and accessibility of fruits and
vegetables enable consumption. Journal of Health Education 29:26-32. Hoelscher, D. M.,
P. Mitchell, J. Elder, A. Clesi, and P. Snyder. 2003. How the CATCH
Eat Smart program helps implement the USDA regulations in school cafeterias.
Health Education and Behavior 30:434-446. Hughes, L. J., L. Blalock, and L.
Strieter. 2005. Youth-oriented farm stands as a
vehicle for improving food security in targeted low-income communities. Journal
of Nutrition Education and Behavior 37(Suppl 1):S36. Hunt, M. K., R. Lederman, S.
Potter, A. Stoddard, and G. Sorensen. 2000. Results
of employee involvement in planning and implementing the Treatwell 5-a-Day
work-site study. Health Education and Behavior 27(2):223--231. Institute of Medicine.
2007. Nutrition standards for foods in schools: Leading the way
towards healthier youth. Washington, DC: National Academies Press. Israel, B., B.
Checkoway, A. Schulz, and M. Zimmerman. 1994. Health education
and community empowerment: Conceptualizing and measuring perceptions of individual,
organizational, and community control. Health Education Quarterly
21(2):149-170. Israel, B. A, and K. A. Rounds. 1987. Social networks and
social support: A synthesis
for health educators. Health Education and Promotion 2:311-351. Jones, A. S.
2005. Start by eating right: Promoting healthy eating in young children
through partnerships between Share Our Strength and Head Start and other community
agencies. In National nutrition education conference. Washington,
DC: U.S. Department of Agriculture, Food and Nutrition Service. Jordan, A. B.
2008. Overweight and obesity in America's children: Causes,
consequences, solutions. Annals of the American Academy of Political and Social
Science 615:225-243. Kent, G. 1988. Nutrition education as an instrument of
empowerment. Journal of
Nutrition Education 20:193-195. Kerr, J., F. Evans, and D. Carroll. 2000. Posters
can prompt less active individuals to
use the stairs. Journal of Epidemiology and Community Health 54:942-943. Kerr, J.,
F. Evans, and D. Carroll. 2001. Six-month observational study of promoted
stair climbing. Preventive Medicine 33:422-427. Kistin, N., M. S. Abramson, and N.
Dublin. 1994. Effect of peer counselors on
breastfeeding initiation, exclusivity, and duration among low-income urban
women. Journal of Human Lactation 10:11-16. Kremers. S. P. J., G-J. de Bruijn, T. L.
S. Visscher, W. van Mechelen, N. K. de
Vries, and J. Brug. 2006. Environmental influences on energy-balance-related behaviors: A
dual-process view. International Journal of Behavioral Nutrition and
Physical Activity 3:9. Kubik, M. Y., L. A. Lytle, and M. Story. 2001. A practical,
theory-based approach to
establishing school nutrition advisory councils. Journal of the American Dietetic
Association 101(2):223-228. Kwak, L., S. P. J. Kremers, M. A. van Baak, and J. Brug.
2007. A poster-based
intervention to promote stair use in blue- and white collar worksites. Preventive
Medicine 45(2-3):177-181. Li, F., P. Harmer, B. J. Cardinal, and N. Vongjaturapat. 2009.
Built environment and
changes in blood pressure in middle aged and older adults. Preventive Medicine
48(3):237-241.
CHAPTER 6 Foundation di Theory dan Penelitian: Mempromosikan Lingkungan Supports Aksi
127

dijelaskan sebelumnya dalamini bab di bagian yang berjudul Sosial “Dukungan

di TempatKerja.")
Harga yang lebih sehat makanan mengakibatkan yang stabil makanan layanan
pendapatan dan lebih yangbergizi makanan yang dijual (Hannan et al, 2002) lagi
Satu-..tahun Studi dengan kedua tinggi sekolah dan tempat kerja menemukan bahwa
yang lebih rendah harga yang efektif dalam mempromosikan pilihan yang ditargetkan
makanan item dalam menjaja ing mesin dan signage memiliki lebih kecil tapi
signifikan independen efek pada penjualan (Perancis et al. 2001). dengan
memberikan tersebut informasi kepada sekolah administrator atau makanan
pelayanan mangerssekolah, gizi pendidik tordapat membantu mereka dalam keputusanmereka.
lokal Foods di Tempat kerja Peningkatan pembelian lokal berkembang
produk melalui tempat kerja penjualan adalah tujuan lain intervensi (Ross et al.
2000). disini, kerja ers diberi kesempatan untuk memesan produklokal,
merupakan yangn dikirim ke tempat kerja. ini lingkungan perubahan didampingi oleh
promosi materi tentang peternakan yang tumbuh hasil dan kesempatan untuk mencicipi
hasil. pengiriman itu sangat pub lic sehingga teman-teman 'pemesanan dan
kepuasan dapat diamati untuk memberikan sosial pengaruhnormatif. Hasil
penelitian menunjukkan bahwa pekerja yang memerintahkan lokal makanan di
tempat kerja termotivasi untuk pembelian lokal berkembang produk di luar tempat
kerja juga.
Promotional Activities Sebuah studi di tinggi sekolahdifokuskan pada
pelaksanaan besar sejumlah sekolah-lebar promosi kegiatan daripada harga. Ini
ditemukan that selama dua- periodetahun, jumlah promosi dikaitkan dengan
peningkatan persentase penjualan yang lebih rendah-lemak makanan di à la carte daerah dari
SCHool kafetaria (Fulkersonet al 2004.). ini Hasil suggest bahwa yang
intens promosi dapat
menjadi yang efektif strategi di baikdasar dan sekolahmenengah.
COMMUNITY-TINGKAT KEGIATAN A community mengacu pada kedua fisik
wilayah di mana sekelompok orang hidup dan sekelompok orang yang berbagi minatcominon.
gizi Pendidik bekerja di hampir setiap masyarakat, sehingga masyarakat proyek-proyek
abound.
awARDS untuk Kesehatan Mempromosikan SchoOLS Beberapa komunitas telah
melakukan penghargaan untuk mengenali sekolah yang melakukan upaya untuk
memperbaiki lingkunganmakanan. Salah satu contoh adalah Sehat Makan Champions Award
untuk Dasar Sekolah program yang Lat. nizes dan imbalan sekolah atas mereka yang luar biasa
komitmen untuk promosi gizi, pendidikangizi, dan untuk membuat sehat foods dan
minuman tersedia (Dia et al. 2009). Ditemukan bahwa sekolah yang ikut memiliki
peningkatan siswa kesadaran tentang yang makansehat, lebih siswa keterlibatan dalam
makan inisiatifsehat, dan penciptaan peluang bagi tujuan penetapan dan
semangat meningkatkan.
masyarakat Kapasitas Gedung Community capacity dapat digambarkan
sebagai karakteristik ko nities yang mempengaruhi mereka kemampuan untuk
mengidentifikasi, memobilisasi, dan alamat sosial dan masyarakat kesehatan
masalah (Goodman et al. 1999). Hal ini mirip dengan ide of sosial capitul, di
mana struktur sosial hubungan memfasilitasi koordinasi dan kerjasama untuk
salingmenguntungkan. nutrisi Pendidik dapat berpartisipasi dalam proses dengan
bekerja dalam koalisi dengan orang lain untuk meningkatkan kolektif efikasi dan
pemberdayaan untuk meningkatkan kapasitasmasyarakat.
Tempat kerja Mayoritas daridults bekerja di tempat kerja dari beberapa macam. Oleh
karenaitu, apa yang tersedia di dalam dan sekitar tersebut tempat-tempat dapat berdampak
pada pilihanmakanan. Sejumlah kesehatan promosi intervensi di kerja tempat telah
berusaha untuk make perubahan di makanan lingkungan dengan meningkatkan jumlah sehat
rendah-lemak dan tinggi-serat makanan dan buah-buahan dan vegetables tersedia di karyawan
sumber makanan di tempat kerja, seperti penjual mesin (eg, Sorensen et al
kantin dan
Sorensen et al1990;.... 1996). Gizi dan kesehatan profesional bekerja dengan tempat
kerja keputusan para pengambil untuk mengembangkan berbagai kegiatan
untuk tempat kerja. Seiring pendidikan lainnya promosidengan,,, dan kebijakan
kegiatanorganisasi, ini intervensi memiliki positif dampak pada makan pola
(Sorensen et al 1999;. Engbers et al 2005.). Berikut adalah beberapa contoh.
Kolektif Khasiat Collective khasiat adalah kepercayaan dari kelompok dan
masyarakat anggota bahwa mereka memiliki kapasitas untuk mengambilkolektif tindakan
untuk menciptakan perubahan di lingkunganmereka. Bandura (2001) catatan bahwa karena manusia
fungsi berakar dalam sistemsosial, pribadi agen beroperasi dalam bersih usaha luas sosial
struktur yang individu, pada gilirannya, juga membantu untuk membuat. Dengan
demikian, pribadi agensi dan sosial struktur beroperasi secara saling bergantung.
Menurut Bandura (2001), pribadi agen bukan tentang diri-yang
individualismeberpusat; bukan, studi menunjukkan bahwa rasa tinggi kemanjuran
cenderung untuk mempromosikan orientasiprososial, yang melibatkan kooperatif
dan minat di setiap kesejahteraanlain.

kolektif Khasiat dapat ditingkatkan dengan "memperlengkapi orang-orang dengan

perusahaan keyakinan bahwa mereka dapat menghasilkan dihargai efek oleh mereka tindakan
kolektif dan menyediakan mereka dengan sarana untuk melakukannya" (Bandura 1997). Ini
adalah pemberdayaan proseskelompok. kelompok Khasiat menjadi lebih th n sum dari
khasiat pribadi group anggota karena ada interaksi antara anggota dan koordinasi
keterampilanmereka, kompetensi, dan kegiatan. Sejalan dengan dirikhasiatpribadi, kekuatan
individu keyakinan dalam mereka kolektif keberhasilan menentukan tujuan mereka bersedia
untuk set, berapa banyak usaha mereka dimasukkan ke dalam kelompok's upaya, berapa
banyak mereka bersedia untuk bertahan dalam menghadapi kesulitan, mereka semangat dan
ketahanan, dan tingkat kinerja.
Treatwell Program Contoh tempat kerja program untuk peningkatan buah dan
sayuran con sangkaan yang ditujukan beberapa tingkat pengaruh diringkas dalam
Nutrisi Pendidikan dalam Aksi 6-1. The Treatwell Program randomly assigned 22 tempat kerja menjadi
tiga kelompok: minimal kontrolintervensi, tempat intervensikerja, dan tempat
kerja-ditambah-keluarga Sorensen et al 1998; Sorensen et al(.. 1999). The tempat kerja adalah
masyarakat kesehatan pusat dengan ras dan etnis yang beragam karyawan, menyediakan
layanan untuk rendah- masyarakat wargaberpenghasilan. The perilaku goal program dan
karenanya yang diharapkan hasil dari intervensi adalah bahwa karyawan di ini tempat kerja
akan meningkatkan mereka konsumsi dari buah-buahan dan sayuran. gizi Pendidikan
dalam Aksi 6-1 daftar teoritis model yang digunakan. ini Penelitian juga menguji
apakah intervensi berdampak pada potensial mediator dari perubahanperilaku. Ini
ditampilkan dalam tabel, bersama dengan bagaimana perubahan diukur. (The hasil berada
Bangunan Kolektif Khasiat Melalui Goal Grup Menetapkan Kolektif khasiat
melibatkan kekuatan untuk hasil perubahan di sosial o politik lingkunganr. sosial
kognitif Teori menunjukkan bahwa ke build khasiatkolektif, individu perlu belajar
bagaimana exert pengaruh

128
PART I Menghubungkan Penelitian, Teori, dan Praktek: Yayasan

NUTRITION EDUCasi dI Actio

Theatauies Digunakan dan Potensi mediator Perilaku Change

di Treatwell 5-a-Hari Worksite Program
Lmenjelangl Pengaruh
Intervensi Pemirsa
teoritis Models

Intrapersonal
• Pekerja
sosial kognitif teori Kesehatan keyakinan model
Measures Diri-efficacy Pengetahuan (harapanhasil)

Interpersonal
Keluarga Rekan Kerja
sosial dukungan sosial jaringan dan hubungan sosial kognitif teori
Keluarga dukungan Kolega dukungan sosial nataums Ketersediaan
buah-buahan dan sayuran di rumah ketik dari keluarga ikatan
OOO.

Organisasi
Worksite
Hipotesis Tentang mediator Perilaku Perubahan Higher diri-khasiat sekitar makanan
chsebuahge dikaitkan dengan peningkatan buah dan konsumsisayur. Pengetahuan
tentang diet-kanker Link (harapanhasil: yang risikodirasakan) dikaitkan dengan
peningkatan buah dan konsumsisayur. Tinggi keluarga dan rekan kerja dukungan
untuk diet perubahan dikaitkan dengan peningkatan buah dan konsumsisayur.
HiGh keluarga dukunganuntuk diet perubahan berhubungan dengan
peningkatan ketersediaan fru dan sayuran di rumah. Jenis keluarga ikatan
akan mempengaruhi kekuatan hubungan antara keluarga dukungan dan
makan kebiasaanberubah. Tempat kerja berarti peningkatan buah dan sayur
konsumsi akan terbesar di mana buah nd sayur yang paling tersedia dan katering
kebijakanmendukung pembelian sehat makanans. program Pelaksanaan dan
partisipasi akan tertinggi di mana yang efektif komunikasi saluran ada dan kebijakan
mengizinkan karyawan change agen untuk berpartisipasi. rekan kerja Dukungan
untuk pola makan perubahan akan tertinggi di tempat kerja dengan yang tinggi
rekan kerja kohesi dan yang positif tenaga kerja- hubunganmanajemen. Wopara
tenaga melaporkan kesadaran nasional campaign lebih mungkin untuk
meningkatkan konsumsi buah-buahan dan sayuran. Pekerja melaporkan
berpartisipasi dalam kelontong toko program . lebih mungkin untuk melaporkan
peningkatan konsumsi buah-buahan nd sayuran.
Organisasi change nd pengembangan Kebijakan
Worksite karakteristiks
Komunitas
Media (Nasional - KampanyeSosial) pemasaran Grocery toko
Kesadaran toko kampanye Partisipasi di kelontong toko kampanye

Skamice: Sorensen, G, M.. K. Hunt, N. Cohen, et al. 1998. Tempat kerja dan keluarga
pendidikan untuk perubahandiet: The Treatwell 5-a- ProgramDay. Kesehatan Pendidikan
Penelitian 13:577-591. Digunakan dengan izin.
.........
...
..........
.
.
.
.
.
.

over masyarakat praktek yang mempengaruhi kehidupanmereka. Proses untuk

membangun- ing kolektif efikasi agak seperti kelompok tujuan-
prosespengaturan: kelompok inembers mengidentifikasi masalah yang
menjadi perhatian, menetapkan kecil tujuan untuk mengatasi kekhawatiran,
dan, ketika hasil nyata hasil yangini, datang untuk percaya that mereka
memiliki kemampuan untuk mengubah sosial dan politik lingkungan di mana
mereka tinggal. Ini mengarah mereka untuk percaya bahwa mereka dapat
mengatasi bahkan yang lebih sulit masalah dan karenanya untuk
menetapkan lebih yang tujuanambisius. lainnya Proses juga digunakan. Namun,
mereka semua bekerja, penyangatan individu rasa
sebagian, dengan en
keberhasilan bahwa mereka dapat membawa yang nyata perubahan
dalam hidupmereka. Ada bukti bahwa keterampilan dalam advokasi dan
com munity membangun kenaikan gaji baik pribadi dan kolektif efficacy, yang dapat
mengakibatkan kolektif tindakan yang mungkin dalam gilirannya chage
masyarakat praktek dan kebijakann.
Pemberdayaan Apa itu pemberdayaan? Pemberdayaan, sebuah istilah yang
digunakand longgar dan hsebagai msebuah definisiy, mirip dengan proses
group pemberdayaan of kognitif teorisosial. Banyak melihatnya sebagai
sebagian besar merupakan pribadi proses di mana individu mengembangkan
dan penggunaan diperlukan pengetahuan, kompetensi, atau confidence
untuk membuat sendiri keputusan (agak seperti diri-khasiat). Beberapa bisa
bahkan merujuk ke belajar membaca makanan label sebagai pemberdayaan.
Namun, pemberdayaan umumnya digambarkan sebagai “suatu sosial proses
melalui mana individu, masyarakat, dan organisasi memperoleh mas tery
atas hidupmereka, dalam konteks perubahan mereka sosial dan politik
lingkungan untuk meningkatkan kualitas hidup” (Wallerstein 1992). Th di, itu adalah
sosial proses mengenali dan meningkatkan masyarakat kemampuan
sebagai group untuk meet mereka sendiri kebutuhan nd untuk memobilisasi
yang diperlukan sumber daya

CHAPTER 6 Foundation di Theory dan Penelitian: Mempromosikan lingkungan Support

untuk Acti
129
untuk mengontrol lebih lingkunganmereka. Ini adalah tentang politik dan
kekuasaansosial, bukan hanya kekuatanpribadi.
tive sarapan Program di lain, dan tidak ada-masak masak untuk mereka yang tidak
diizinkan untuk memasak di hotelmereka. Ketika mereka mengembangkan lebih
kolektif khasiat dan menjadi lebih berdaya, mereka mengambil yang lebih kontrol dari
tdia proyek dan kesehatan pendidikan staf menurun peranmereka, sErving terutama
sebagai narasumber.
Pendidikan Sosial Aksi Konsep pemberdayaan pendidikan pada awalnya
dikembangkan oleh Paolo Freiere Brasil sebagai “pedagogy yang tertindas,” or
pendidikan untuk kesadarankritis, yang melibatkan mengembangkan pemahaman
tentang akar penyebab masalah. pusat Metode untuk pemberdayaan adalah
conscientizacion, atau kelompok kesadaran-penggalangan (Friere 1970, 1973).
pemberdayaan Pendidikan adalah proses dimana kelompok anggota de velop
identitas dan sosial dukungan untuk satu sama lain, menentukan masalah dalam
hidupmereka, merefleksikan akar penyebab masalahini, dan mengembangkan
rencana sosial atau aksipolitik. Dengan demikian pendidikan bagi perubahansosial. Ini
menekankan pentingnya sosial konteks di untukod- dan gizi terkait praktek dan pergeseran
pandang sudut jauh dari korban menyalahkan dan menuju sistem menyalahkan.
Namun, sosial konteks tidak harus dilihat sebagai struktural penghalang untuk yang
baik kesehatan yang perlu diubah oleh kesehatan promosi intervensi dengan cara
dinding perlu diruntuhkan, namun sebagai sesuatu yang harus dipahami dan diubah oleh
orang-orang dan com munities melalui proses pemberdayaan (Travers 1997a).
Parent Pusat lain gizi pendidikan program untuk sosial perubahan yang terlibat rendah
pendapatan wanita yang bertemu mingguan informal sambil minum kopi di sebuah
Induk Cen ter (Travers 1997b). Masalah menjadi yangbersama perhatian mereka
sedang memberi makan mereka keluarga pada berpenghasilanrendah. gizi Pendidik
mengajukan pertanyaan-pertanyaan yang menyebabkan group dialog dandiskusi, dari
yang muncul the kelompok's persepsi bahwa makanan biaya lebih
rendah-lingkunganpendapatan. Hal ini menyebabkan mereka untuk membuat studi
terstruktur perbandingan dari harga makanan di mereka lokal toko-toko dan harga di
toko-toko dari yang sama rantai di berpenghasilan lingkunganmenengah.

Strategi untuk Memperkuat Pemberdayaan Gizi pendidik dapat memfasilitasi

pendidikan prosesini, ketika ap propriate, atau memberikan bantuanteknis. Lebih
khusus, di ini con sciousness- prosesmembesarkan, pendidik pose masalah kepada
para pesertakelompok, yang memanfaatkan mereka sendiri pengetahuan dan
pengalaman mencoba untuk memahami mereka kehidupan dalam kaitannya
dengan masalah. Anggotakelompok, melalui dialog, datang ke pemahaman
kolektif akar penyebab masalah dan mulai melihat bagaimana mereka dapat
membuat perubahan dalam situasimereka. They menjadi diberdayakan untuk
mengubah mereka realitas melalui perubahan sosial atau kondisi politik
kehidupanmereka. Seperti em powerment proses dapat membawa tidak hanya
pribadi, empowerment tetapi juga pemberdayaan di o tingkatrganizational, di mana
pengaruh organisasi dalam yang lebih luas masyarakat ditingkatkan, dan di
tingkatmasyarakat, di mana individu dan organisasi bekerja sama untuk membawa
diinginkan hasil di masyarakat (Israel et al. 1994). Sebagai kata power dalam jangka
eMPOwerment menunjukkan, proses akhirnya merupakanbout changed kekuasaan
hubungan antara individu dalam kelompok dan antara kelompok-kelompok dan
struktursosial. seperti itu Pendekatan telah menganjurkan untuk gizi pendidikan
(Kent 1988; Rody 1988; Travers Arnold et al1997;. 2001).
Role of nutrisi pendidiktor. The nutrition pendidik memberikan teknis bantuan pada
tugasini. Ketika mereka temuan menunjukkan bahwa harga di dalam-kota tokosecara
konsisten higheh daripada di tengah- lingkungan pendapatan, wanita menyadari
bahwa kesulitan mereka dalam mendapatkan yang cukup gizi adalah sebagian hasil
dari ketidakadilansosial. Mereka datang ke keputusan untuk menulis ke toko untuk
mengungkapkan mereka keprihatinan tentang ketidakadilan di pricing dan kualitas. Hal ini
mengakibatkan rantai toko menurunkan harga dalam rendah- lingkunganpendapatan.
gizi Pendidik difasilitasi proses dengan mendapatkan kata pengolah dan menulis
surat dengan mereka. ini Success menyebabkan rasa memberdayakan ment. ini
Kegiatan juga led mereka untuk mengakui bahwa mereka kesejahteraan tunjangan
tidak cukup untuk memenuhi kebutuhanmereka. Dampak dari ini informasi pada
mereka secara pribadi adalah bantuan dari diri-menyalahkan karena mereka menyadari
bahwa mereka ketidakmampuan untuk membeli cukup makanan yang untuk mereka keluarga
bukan karena mereka pribadi kekurangan tetapi karena kebijakanpemerintah. tua
Tindakan orang. Hal ini kemudian led mereka untuk memutuskan untuk mengambil
tindakan terhadap perubahan. Mereka menulis surat kepada politik pemimpin dan
bekerja dengan masyarakat kelompoklainnya, mengakibatkan beberapa peningkatan
tunjangankesejahteraan. Akhirnya, ketika beberapa waktu kemudian ada upaya untuk
menutup Induk Pusat menjadicause anggaran cuts, perempuan menyelenggarakan
pawai di kota balai dan mendapat perhatianmedia, yang mencegah penutupan.

Proyek Fokus pada Pemberdayaan Beberapa contoh dari the makanannd

gizi fIELD menggambarkan pendekatanini.

Senior Citizens Proyek Tenderloin Senior Organizing Project (TSOP) yang

terlibat yang lebih tua iklanuLTS yang tinggal terisolasi hidup di hotel tempat tinggal
di kejahatan-sarat tetangga hood (Minkler 1997). kesehatan Pendidik menggunakan
kombinasi pendidik tional dan mengorganisir approaches untuk membantu warga untuk
mengidentifikasi issues penting bagi mereka, memahami akar csuatu penggunaan
ini isu-isu dalam politik dan struktur sosial masyarakat, dan mengembangkan sosial
dukungan dan merasakan dari masyarakat melalui kelompok diskusi dan tugas. hotel
Penduduk menyadari kebutuhanuntuk bekerja dengan hotel dan masyarakat kelompok
pada masalahbersama, seperti kejahatan. Ketika mereka mencapai sukses pada
masalahini, termasuk meyakinkan walikota untuk menempatkan beatlebih patroli
petugas di lingkungan, mereka mengambil isu pangan ketersediaanmiskin. Mereka
mendirikan Mini-pasar di tiga hotel, sebuah Koperasi
Sekolah-Berdasarkan Intervensi Dalam yang lebih formal pengaturan dari
sekolah, pemberdayaan proses yang digunakan dalam kurikulum pengembangan
proyek (da Cunha, Contento, & Morin 2000). Dalam prosesini, nutrisi pendidik
pertama kali bertemu dengan ersmengajar, school personilmakanan, dan
administrator di beberapa tinggi-kemiskinan sekolah untuk kenaikan gaji pertanyaan about
masalah poatau gizi di kalangan mahasiswa. The anggota SCHool staf yang
bersangkutan. Tdia schools dinominasikan groupkecil, terdiri dari guru, school food
tenagalayanan, dan orang tua, untuk bertemu dengan gizi pendidik untuk mengatasi
masalahmereka. Mereka kembalisebuahlized bahwa mereka perlu untuk mengetahui
lebihbout masalah, sehingga mereka merancang dan melakukan yang komprehensif
kebutuhan penilaian di kalangan mahasiswa dan keluargamereka. Dari ini kebutuhan
penilaian y kemudian merancang gizi pendidikan kurikulum untuk mengatasi
kebutuhan diidentifikasi dan membantu satu sama lain dalam implemen tasi dari
kurikulum. ini Kelompok bertemu mingguan setelah sekolah pada mereka sendiri
waktu selama tujuh bulan. gizi Pendidik menggunakan sadar ness-menaikkan dan
pemberdayaan proses seluruh, membantu kelompok,

130
PART I Menghubungkan Penelitian, Teori, dan Praktek: Yayasan

melalui dialog dan interpretasi berdasarkan mereka pengalaman dan

pengetahuansendiri, untuk membuat keputusansendiri. gizi Pendidik bertindak
sebagai fasilitator dan memberikan teknis bantuan melakukan dalam kebutuhan
penilaian dan mengembangkan kurikulum tetapi tidak mengarahkan pilihan konten.
BERAS

Pemuda Empowerment Pemberdayaan pemuda adalah dasar dari sebuah proyek di

mana SMA siswa dioperasikan pertanian berdiri di rendah-berpenghasilan masyarakat
(Hughes, Blalock, & Strieter 2005). The pemuda membuat perubahan di mereka
komunitas dengan menciptakan akses ke terjangkau, lokal berkembang makanan
dan mendukung lokal fariners dan petani. Pada yang saatsama, para pemuda belajar
penting keterampilan dalam bisnis, keuangan, dan bekerja sama dalam matang dan
tive cara-caraproduksi, mempersiapkan mereka untuk tenagakerja.

Summary Dalam semua makanan-yang berkaitan kasus saja dijelaskan, kita dapat
melihat bahwa spesifik isu-isu perhatian diidentifikasi oleh orang-orang dalam
komunitas daripada stafintervensi, bahwa proses tujuan untuk membawa sosial
change melalui pemberdayaan didividuals dan kelompok, thdi tdia peran gizi pendidikadalah
untuk memfasilitasi dan advokat daripada menjadi ahli yang menyediakan semua
informatipada, dan membentuk col laborations dapat meningkatkan effectiveness tindakan.
Ini should juga harus dicatat bahwa kolektif keberhasilan dan pemberdayaan pendekatan
bekerja pada lon waktu kerangkag, sering melibatkan bulan dan tahun, tetapi lingkungan
perubahan yang ditimbulkan lebih cenderung menjadi panjang-abadi.
Aschool makanan chef menunjukkan yang baru makan siang resep dan memberikan kesempatan
bagi anak-anak dengan selera.

Membanguning Koalisi dan Collabojatah Dalam organisasi-level intervensi,

bekerja di collaboration dengan keputusan para pengambil dan kebijakan pembuat
sangat penting. Hal ini bahkan lebih benar di masyarakat level. Disini, gizi pendidik
dalam banyak kasus mengembangkan kemitraan dan berpartisipasi dalam koalisi dengan
lain kelompok-kelompok yang memiliki yang sama tujuan untuk membawa masyarakat
perubahan yang mendukung perilaku tujuan dari pendidikan programgizi. gizi
Pendidik berpartisipasi dalam berbagai koalisi. Berikut adalah beberapa contoh untuk
menggambarkan jenis kolaborasi di mana individu gizi pendidik atau program dapat
berpartisipasi.
komunitas anggota. Berbagi kami Kekuatan adalah sebuah nasional organisasi dengan
kehadiran di banyak komunitas yang bertujuan untuk menginspirasi dan mengatur
individu dan bisnis untuk berbagi mereka kekuatan untuk membantu mengakhiri
kelaparan. gizi pendidikan Programnasional, Operasi Frontline, memobilisasi
kokirelawan, ahligizi, dan keuangan perencana untuk nutrisimengajar, memasak
sehat,nd makanan penganggaran kelasuntuk individu berisiko hun ger. Head Start
memberikan pendidikan dan makanan rendah- prasekolah anak-anakpendapatan.
Operasi Frontline mengajarkan nya enam-minggu kurikulum Head Start program
orangtua, memberikan contoh kemitraan antara pemerintah program dan
masyarakat program untuk meningkatkan reach dan effectiveness dari kedua
organizations (Jones 2005). The Program telah menghasilkan peningkatan
pengetahuan dan keterampilanorangtua.

Komunitas Koalisi dan Kemitraan: Contoh Bangunan Menyusui-yang

Ramah Komunitas Contoh di Serikat Amerika dari kolaborasi mengenai very
tertentu perilaku adalah program dimana WIC ahli gizi bekerja dengan lainnya
makanan bantuan program dan berbagai masyarakat mitra untuk membangun
menyusui-friendly masyarakat (Singleton et al. 2005). Tdia tujuannya adalah untuk
meningkatkan kesadaranmasyarakat, acceptance, dan masyarakat sup port untuk
menyusui. Program dalam satu negara termasuk publik forum dengan 145 kunci
masyarakat pemangku kepentingan untuk mengembangkan cetak biru untuk
tindakan untuk membantu masyarakat, keluarga, sekolah dan anak- pusatperawatan,
kesehatan caulang sistem, pembuatkebijakan, sebuahnd tempat kerja dalam mereka
upaya untuk membuat menyusui norma untuk pemberian makananbayi. ini
Kemitraan juga memprakarsai kesadaran masyarakat kampanye dan kegiatan untuk
advokasi untuk perubahan dalam perawatan sistemkesehatan, industriasuransi,
komunitasbisnis, dan pendidikan sistem untuk mendorong menyusui, dan advokasi untuk
perubahan dalam ketersediaan sumber daya untuk organisasi dan
keluargamasyarakat.
Bekerja di Koalisi: Manfaat dan Biaya The upaya tertentu kelompok untuk
membawa sosial perubahan yang sangat ditingkatkan dengan membangun koalisi
dengan lain kelompok-kelompok yang memiliki yang tujuansama. Coalitions d
kolaborasi dapat memobilisasi material sumber dayadan masyarakat 'knowledge,
keterampilan, dan antusiasme untuk mencapai yang diinginkan tujuan dengan cara
yang tidak mungkin bagi kecil kelompok-kelompok saja. Ada biaya juga, namun.
kolaboratif Upaya yang kompleks, dan perankepemimpinan, desi pembuatansion,
dukungansosial, dan sosial jaringan kekhawatiran adalah isu-isu yang harus diatasi
secara memuaskan untuk semua berkolaborasi kelompok terlibat; ini bekerja mungkin
memerlukan waktu dan usaha. Bahkan ketika koalisi mem bers puas dan aktif terlibat,
ini tidak menjamin bahwa koalisi akan efektif dalam mencapai disepakati-upon gol.
Kepemimpinan dan manajemen juga harus efektif.

sukses Kemitraans Faktor yang mungkin untuk meningkatkan sukses collaboration

meliputi berikutini: a bersama dan disepakati-pada visi dan misi, dicapai dengan
konsensus melalui dialogterbuka, negotiation, dan pemecahanmasalah; yang unik tujuan
yang bermakna kepada anggota; tugas-tugas yang jelas dan memberdayakan; rasa
produktivitas dan efisiensi; sebuah terampil convener dan fasilitator of tim membangun
dan resolusikonflik; luas-berbasis Keterlibatan dalam pengambilankeputusan; terbuka,
sering komunikasi yang, dengan komunikasi umpan balik loop; menjadinefits bahwa
penghasilan bagi anggota untuk par
Mengurai dengan Low-pendapatan Audiens lain Contoh adalah kemitraan antara dua
organisasi-Share kami Kekuatan dan Head Start-untuk meningkatkan diet
penerbangan-pendapatan com

CHApter 6 Foundation di Teori dan Penelitian: Mempromosikan Lingkungan

Mendukung untuk Actipada
31
ticipation; hubungan yang didasarkan pada trust, keterbukaan, dan rasahormat; po
berbagiwer; dan memadai sumber daya yang (Rosenthal 1998).
kesehatan dan sosial/ekonomi peningkatan serta belajar tentang sehat makan, fisik
aktivitas, ekonomi pemberdayaan, keuangan literasi, dan pengembangan kecil usaha.
Program Evaluasi yang terlibat survei, pedometer, food bukuharian, dan berat
pengukuranbadan. awal Hasil menunjukkan bahwa HARAPAN Lingkaran peserta
penurunan tubuh massa indeks (IMT) dibandingkan dengan perbandingan perempuan
dan secara signifikan meningkatkan mereka buah dan sayuran asupan dan
aktivitasfisik. Mereka juga memulai kecil usaha (Benedict & Campbell 2009).
Nutrisi PendidikanNetworks gizi pendidikan jaringan telah juga datang ke dalam
keberadaan di banyak negara di bagian AmerikaSerikat, dengan pendanaan dari USDA
dan lain sumbers. ini Jaringan adalah kemitraan dan koalisi antara Tambahan Bantuan
ProgramNutrisi, yang Cooperative Extension Service, swasta sukarela organisasi
seperti American Cancer Society atau American Heart Association, toko, universitas,
dan lain-lain dengan tujuan membina kolaborasi antara pangan bantuan program dan
mengembangkan dan menyampaikan konsisten nutrisi pesan di jaringan
kemitraan untuk rendah-pendapatan, Tambahan nutrisi Bantuan Program
(SNAP) penonton. ini Kemitraan memiliki penggunaand berbagai of channels
untuk menjangkau ini audiens--langsung dan tidak langsung nu trition pendidikan serta
sosial pemasaran //Wwwcsreskamida (http:...gov/nea/makanan/isne/fsne.html).
gizi pendidikan Jaringan sering bekerja dengan physicisebuahns,
departemenkesehatan, sekolah, dan masyarakat-berbasis organisasi untuk mempromosikan
sehat makan dan fisik aktivitas kebiasaan di sekolah-berusia anak anak dan orang
tuamereka. Mereka telah juga memulai berbagai kegiatan untuk mempromosikan
inisiatif kebijakan dan kepada memberdayakan orang-orang menjadi pendukung untuk
sehat makanan dan aktivitas lingkungan di mereka sekolah dan
hubunganCommuni. Mereka sering bekerja untuk mengubah organizational kebijakan
d fisik lingkungan untuk bantuan rendah-berpenghasilan keluarga makan
dietsehat, lebih aktif, dan berpartisipasi dalam USDA bantuan programgizi. Sebuahn
contoh adalah California Nutrition Network, yang mensponsori luas rsebuahge gizi
pendidikan kegiatan (California Department of Public Health 2007).
Petani Pasar Banyak masyarakat sekarang telah memulai petani pasar di mana lokal
petani dapat membawa mereka produk dan lainnya pertanian produk ke kota di
pasar dibentuk oleh masyarakat. Tambahan Nutrisi Bantuan Program Elektronik
Manfaat transfer (EBT) kartu sering diterima di pasarini, membuat segar lokal yang
makanan tersedia untuk rendah- Resi penyok pendapatan masyarakat.
Communituy-Level Intervention Banyak masyarakat-tingkat intervensi telah
dilakukan selama bertahun-tahun, termasuk awal -berskala proyekproyek seperti
Stanford, Minne sota dan Pawtucket jantung kesehatan program (Shea & Basch 1990a,
1990b). Komunitas-based intervensi adalah mereka yang masyarakat sangat banyak
terlibat dalam desain, implementasi, dan evaluasi o f program melalui kemitraan dan
koalisi. Thadalah memungkinkan untuk intervensi harus didasarkan pada aset
masyarakat serta mendalam pemahaman yang anggota dari masyarakat
memiliki sekitar mereka diri. Banyak baru-baru ini intervensi telah membahas masalah
obesitas (Economos & Irish-Hauser 2007; Demattia & Denney 2008). Berikut
adalah beberapa contoh.
Fisik Lokalitas Efek Ada bukti bahwa lingkungan berdampak pada obesitas dan
kesehatan (Harrington & Eliot 2009; Dengel et al 2009.). Dalam tetangga hoods
banyak ritel makanan toko-toko seperti supermarket dan tokokelontong, dan restoran
dan cepat makanan geraisaji. Ada hubungan antara akses ke supermarket dan sehat
makanan asupans, seperti peningkatan buah dan sayuran intake, terutama karena
supermarket cenderung offer greater berbagai foods pada rendah cost. Nutrisi
interven tion dalam toko menggunakan titik-dari Informasipilihan, peningkatan
ketersediaan, meningkat variasi, harga, nd promosi strategi harus resulted moderat
perbaikan dalam sehat makan perilaku seperti buah dan sayur konsumsi (Glanz et al-.
2007).
Istilah makanan gurun memiliki datang untuk menggambarkan wilayah dalam
perkotaan pusat-pusat maupun di pedesaan daerah di mana rendah-berpenghasilan
orang tidak memiliki akses ke buah-buahan, sayuran, dan sehatlainnya, sehat
makanan dengan terjangkau biaya (Smengan & Morton 2009). Para peneliti
menggunakan geographic infor masi sistem (GIS) untuk memetakan lokasi
supermarket di geografis wilayah untuk mengidentifikasi guruntersebut. gizi Pendidik
telah bekerja di coali tion dengan orang lain untuk chsebuahnge kebijakan sehingga
mendorong supermarket untuk mencari di gurunini.
yang dibangun Lingkungan dan walkability dari lingkungan memiliki juga been terbukti
berhubungan dengan kondisikesehatan. Walkability di cludes gagasan jalan-jalan
yangaman, menarik trotoar dengan tempat-tempat antar est, dan koneksi ke
tempat-tempat orang perlu untuk pergi. lebih tinggi Lingkungan walkability,
misalnya, dikaitkan dengan lebih berjalan, menurunkan BMI, dan menurunkan darah
tekanan (Rohere, Pierce, & Dennison Rundle et al2004;. 2 Li et al008;. 2009).
Sekalilagi, dalam koalisi dengan oranglain, gizi pendidik tor telah bekerja untuk
meningkatkan ketersediaan yang aman dan menarik tempat bagi orang untuk
berjalan.
Shape Up Somerville (SUS): Makan Cerdas, Bermain Keras SUS adalah
sebuah komunitas-berbasis partisipatif penelitian proyek yang Illus- trates ekologi
pendekatansosial. Ini ditujukan kekhawatiran about obesitas dengan mengatasi anaks
'sebelum sekolah, selama sekolah, setelah sekolah, rumah, dan lingkunganmasyarakat. Hal ini
dijelaskan dalam Nutrisi Pendidikan dalam Aksi 6-2.

HOPE (Health Opportunities, Partnerships, Empowerinent) Works HOPE Works

was a community-based participatory research project that recognized the importance
of positive psychology and hope to make health and life changes. It involved low-income,
ethnically diverse rural women. The model used the idea of “talking circles" in Native
Ameri can communities. Community women were trained to organize and facilitate
HOPE circles of 8 to 12 women from their social networks. These circles met twice a
month for 6 months, where they set goals for
Investment in Community-Level Actions A number of foundations have
invested grant funding to improve com munity empowerment and changes in policy
and environment to sup port healthy eating and physical activity. Among them is the
Robert Wood Johnson Foundation's (RWJF) Active Living and Healthy Eating (Sallis et
al. 2009) and Bridging the Gap (Chaloupka & Johnston 2007) initiatives, which support
research to identify promising policy and en vironmental strategies for increasing physical
activity, promoting healthy eating, and preventing obesity (http://www.rwjf.org).
The W. E. Kellogg Foundation's national Food & Fitness Initiative within its Food and
Community Program has inves ted locally in several communities around the United
States in collaborative efforts dedicated
132 PART I Linking Research, Theory, and Practice: The
Foundations
.
.
.
.
.
.

NUTRITION EDUCATION IN ACTION 6-2

Shape Up Somerville (SUS)—Eat Smart, Play Hard: A
Social Ecological Approach
.
.
.
.
.
.
.
.

Evaluasi
.
.
.
.
.
.
.
.

Environmental factors at the community level may contribute to the

development and maintenance of obesity. Children, in particular, have very
little control over their food choices and options for physical activity.
School-based programs have been developed, but school time accounts for less
than 50% of children's waking hours. Shape Up Somerville was developed
to change the environment to prevent obesity in elementary school children.
Three matched, culturally diverse communities were assigned to
intervention and control conditions. About 1,200 children in public schools
in the intervention community participated in the classroom curriculum and
pre and post evaluations.
.
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Hasil
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Program
..
.....
..........

This three-year program was directed at children in grades 1 through 3 and

was designed to bring about energy balance by increasing physical activity
options and availability of healthful foods within children's before-, during-,
and after-school, home, and community environments. It used a
multifaceted collaborative community participatory research (CBPR)
approach. The community was involved in all phases: designing,
implementing, and evaluating the intervention, and identifying how the data
would be used to improve the health of the community. The intervention
involved not only children, parents, and teachers but also food service
providers, city departments, policy makers, health care providers,
restaurants, and the media.
. Students: The intervention resulted in a significant decrease in
the BMI z-scores in children (P=.001). School environment: More fruits,
vegetables, and whole-grain and low-fat milk products were available;
menus and à la carte items were brought into closer compliance with
guidelines; attitudes of students, parents and guardians, school faculty, and
food service staff improved; and policies related to food in schools were
adopted.
• Restaurants: About one third of restaurants actively recruited
became SUS-approved restaurants, agreeing to serve smaller portions and
offer healthier options. SUS approval was marketed to the community.
....
....
.
..
....

Components of the SUS program

....

Rumah
..
...

Before School
· Breakfast program

· Walk to school campaign

..
• Parent outreach and education

• Family events
• Child's "Health Report Card"
....
9
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.
.
.
.
.
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During School

• School health office

School food service

• SUS classroom curriculum
--- 30-minute nutrition and physical activity lesson each week – 10-minute daily
"Cool Moves"

Enhanced recess
• School Wellness policy development
.
.

Community
• SUS community advisory Council
· Ethnic-minority group collaborations
City employee wellness campaign Farmers' market initiative SUS “approved"
restaurants Annual 5K family fitness fair Media--columns and ads
City ordinances on walkability/bikeability
.
.
.
.
.
.
.
.
.

After School
SUS after-school curriculum Walk from school campaign
Sources: Economos, C. D., R. R. Hyatt, J. P. Goldberg, et al. 2007. A community
intervention reduces BMI z-score in children: Shape Up Somerville first year
results. Obesity 15:1325-1336; Economos, C. D., S. C. Folta, J. P. Goldberg, et
al. 2009. A community-based restaurant initiative to increase availability of
healthy menus options in Somerville, Massachusetts: Shape Up Somerville.
Prevention of Chronic Disease 6(3).
http://www.cdd.gov/pcd/issues/2009/jul/o8_0165.htm; and Goldberg, J. P., J. J. Collins,
S. C. Folta, et al. 2009. Retooling food service for early elementary school in
Somerville, Massachusetts: The Shape Up Somerville experience.
Prevention of Chronic Disease 6(3):A103.
.
.
.
.

CHAPTER 6 Foundation in Theory and Research: Promoting

Environmental Supports for Action
B3

to changing the policies, practices, and systems that prevent communi ties from
being healthy. The foundation aims to create vibrant com munities that
provide equitable access to affordable, healthy, locally grown food and safe and
inviting places for physical activity and play (http://www.kkf.org/faf).
Organizational-Level Policy Activities Organizational policies
regarding school, worksite, and community food environments influence
people's food choices and eating patterns. Thus, an important venue for nutrition
education is to work with policy makers to develop or modify existing policies to make
them more supportive of healthy eating and active living.
I POLICY AND SYSTEMS CHANGE ACTIVITIES Policy activities
are extremely important to help make the healthful choices the easy ones. They enable
changes in systems and social struc tures to facilitate the enactment of healthful
food and physical activity behaviors. Policy complements education and
environmental change (Rothschild 1999).
School Policies School Food Environment Many food-related environmental issues that
influence youth food intake in schools need to be addressed by institutional policy action
rather than, or in addition to, classroom education because the school food
environment is challenging:

• Food used in school fundraising. Short of funds, many schools

sell food products to raise money; these products are usually high-fat or high-sugar
items such as candy, chips, or sweetened
beverages.
• Food is often used in the classroom as a reward or incentive. Again,
most often such foods tend to be high-fat and high-sugar, largely because
these are liked by students. Food advertising. In schools, advertising of food occurs
directly on vending machines, book covers, wall boards, hallway decorations, sports
scoreboards, and in student publications and yearbooks, and indirectly through
coupons to fast food outlets given for aca
demic achievement.
• Contracts for beverage sales. In schools, contracts, usually for soft
drinks, have been common in exchange for signing bonuses and a percentage of the profits.
Beverage contracts present a nutri tion education challenge because the schools must urge
students to consume these beverages to guarantee contracted minimum purchases, yet
nutrition guidelines would advocate for healthier options on a regular basis.
Relationship Among Education, Environmental Change, Policy, and Systems
Education, as we have seen, involves a combination of theory-based strategies to
increase awareness, enhance motivation, and facilitate the voluntary adoption or
maintenance of behaviors that are conducive to health. Some researchers note that it
does not provide, on its own, direct or immediate reward or punishment (Rothschild
1999). Sometimes, the anticipated outcomes nutrition educators bring to the public's attention
are far into the future, such as “If you drink milk now, you are less likely to develop
osteoporosis when you are old.”
Environmental change attempts to make the environment favorable for the new
behavior. Changing the environment can promote voluntary changes in behavior by
offering audiences the benefits people want and reducing the barriers they are
concerned about, accompanied, in social marketing, by effective communications or
persuasion to enhance moti vation. Environmental changes reduce barriers by
providing the products or services that would make enacting the behavior easier, for
example, by increasing the availability of fruits and vegetables in grocery stores in the
audience's community and making them more accessible through pricing incentives or
the use of coupons. In this case, the anticipated outcomes or rewards are more
immediate.
Policy complements these approaches and can also have an im portant and positive
role here. Policies and regulations can ensure the performance of a desirable behavior
when it would be difficult to carry out because of social pressure to conform to a different stan
dard. For example, food policies or nutrition standards for all foods available in
school could make it easier for students to eat more fruits and vegetables or
drink fewer sweetened beverages, even though less healthy options might be more
appealing to students and financially desirable to schools. Nutrition educators need to
participate in relevant food policy decisions. This may require them to serve as
advocates for healthy policies to policy makers and even lawmakers at the local or
national level.
Systems changes, often linked to policy change, can be made to be more supportive of
healthful action. A system is a group of independent but interrelated and interacting
elements-individuals, institutions, and infrastructure—that form a unified whole.
Examples include the school system, the transportation system, and the parks and
recreation system. Thus the individuals, institutions, and infrastructure that make up the
food system are involved in the interconnected activities of produc ing, processing,
distributing, retailing, preparing, and consuming food. Systems are not static but
constantly changing and evolving. Public policy, organizational policy, and other actions
can bring about changes in systems. System change complements other venues
for facilitating healthful action.
In response to these challenges, the Institute of Medicine developed recommendations
for nutritional standards for foods and beverages available in the school environment
outside the USDA school meals pro gram (Institute of Medicine 2007). These include
making only healthful foods and drinks available in all venues during the school
day.
Local Wellness Policies Over the years, nutrition educators have advocated that
schools form school nutrition advisory councils or health councils made up of teachers,
administrators, parents, students, and intervention staff to assess the over all school
food environment, consider and discuss issues, and advance school-level policy that
promotes a healthful food environment so as to make the healthful choice the easy
choice (Kubik, Lytle, & Story 2001; Lytle et al. 2004). In the United States, such an
approach has become reality. The Child Nutrition and WIC Reauthorization Act of 2004
required each local educational agency participating in a program authorized by the
National School Lunch Act or the Child Nutrition Act to establish a local school wellness
policy. The policy at a minimum has to include the following (Child Nutrition and WIC
Reauthorization Act 2004):

Goals for nutrition education, physical activity, and other school

based activities that are designed to promote student wellness
• Nutrition guidelines selected by the local school for all foods
available on campus during the school day, with the objectives of promoting student
health and reducing childhood obesity

134 PART I Linking Research, Theory, and Practice: The

Foundations
"employee advisory board” at each site and through delivery of the intervention
by peers. The employee advisory board chooses the intervention components to be
implemented in the individual worksite setting, disseminates program messages and
information throughout the worksite, and encourages long-term incorporation of the
program into the worksite (Sorensen et al. 1990; Sorensen
et al. 1992; Cousineau et al. 2008). The more that employees are involved, the
greater a re the number of activities implemented (Hunt et al. 2000). Worksite
management must put in place policies to permit and encourage employees to take work time
to participate in these health promotion activities (Williams et al. 2007).

Local school wellness policies have improved the nutritional value of school lunches

Guidelines for reimbursable school meals that are no less re strictive than
regulations and guidance of the USDA for program
requirements and nutrition standards
• A plan for measuring implementation of the local wellness
policy The law requires the following participants to be involved in the well ness policy
process: parents, students, representatives of the school food authority, the school board,
school administrators, and the public. A nutrition educator is not specifically required to
be part of the team, but can offer his or her services as a member of the public or as a
parent.
Although all schools or school districts have such policies in place, the
comprehensiveness of the policies differ and the degree to which they are
implemented in schools also differ. In a survey of schools across the United States,
changes in food service operations included the use of nutrition guidelines for à la carte
foods, beverages, fundraisers, par ties, and vending (Longley & Sneed 2009). Other
research also shows some progress (U.S. Department of Agriculture 2005; Story,
Nanney, & Schwartz 2009), but much still needs to be done and nutrition educators can
help with the process in collaboration with the schools.
Community- and City-Level Food Policy Activities Many community
organizations focus on food policy. For example, the food policy council is
composed of stakeholders from various segments of a state or local food system. Councils
can be officially sanctioned through a government action such as an executive order or can
be grassroots efforts. The primary goal of many food policy councils is to examine the
operation of a local food system and provide ideas or recommendations for how it can be
improved. Nutrition educators are often members of such councils to broaden the scope of
the councils, in which members may be more concerned with emergency food as
sistance or agriculture policy in the most traditional sense (see http://
www.statefoodpolicy.org).
Various food security coalitions and farin and food projects also work to analyze and
develop policy initiatives to link local farmers and communities so as to rebuild and restore
regional food and agriculture systems to enhance the economic livelihoods of family
farms and rural communities and at the same time provide healthy and affordable food
for the community (e.g., see http://www.foodsecurity.org).
Cities have also become involved in food and physical fitness policy. Some cities such as
New York City have initiated regulations that require chain fast food restaurants to post calorie
counts of food items on the menu board itself. Cities can also enact regulations so that
mobile carts get perinits to sell fresh fruits and vegetables in city streets, becoining green
carts. Another example is a recommendation of the president of Manhattan borough,
New York City, that one fifth of foods used in government-related venues come from
local “food sheds,” a term that is analogous to watersheds (Stringer 2009).

National-Level Public Policy The main vehicle for national public policy in relation to
food is through advocacy action in relation to proposed or existing legislation.
These activities are described in Chapter 18.
Workplace Policies Many interventions in the worksite have tested a comprehensive, multi
level approach to creating an environment supportive of healthy eating by
addressing organizational issues as well as the physical and social environments
(Sorensen et al. 1998; Beresford et al. 2001). Health profes sionals are very
important for educating decision makers and manage ment about the
importance of food and health issues and convincing them to take action. They also can
initiate programs and provide services and technical support. However, they need to
work in collaboration with both employees and management to develop policies and
procedures so as to implement and institutionalize programs
A review of such studies finds that a number of organizational factors are related to
program effectiveness (Sorensen et al. 2002):
STRATEGIES TO IMPROVE ENVIRONMENTAL AND POLICY SUPPORTS
FOR ACTION OR BEHAVIOR CHANGE

Management commitment and supervisory support are essen tial. Policies need to be modified
and this requires management
support.
• Worker involvement in planning and implementation is just as
important. This can be done through such mechanisms as an
Based on the considerations just discussed, nutrition educators can use many different kinds
of activities to address environmental determinants of health actions or behavior change. In
most of these activities, nutrition educators need to work in collaboration with others, such as
food or service providers and decision makers. This usually involves educating decision
makers or policy makers in organizations and communities about the importance of
food and nutrition issues, and then building coalitions with them to develop and
implement plans to enhance the

CHAPTER 6 Foundation in Theory and Research: Promoting

Environmental Supports for Action
135

opportunities for individuals to engage in identified health-promoting actions. It

also means collaborating with program participants and other like-minded
community groups to work toward developing or revising public policies,
or even legislation, to support the behaviors or issues that are of concern to the
program.
Figure 6-2 shows how nutrition education can be directed at various levels of
influence using the logic model: the individual and household level; the
interpersonal level; the institutional, organizational, and com munity level;
and the social structures, policies, and systems level. The educational
activities at both the individual and interpersonal levels
Inputs
Outputs
Outputs

Resources
Activities
Participants
Short-Term
Medium-Term
Long-Term

Individuals

Take action:
Learning and motivation:
Improved health:
Individual Level Theory-based Identified educational audiences such as programs
children, youth, using direct
adults, diverse in-person and cultural groups indirect methods (e.g., materials)
• Awareness
• Motivation

• Values
• Skills
• Incorporate
skills
• Take action
• Change
behaviors
• Decreased risk
factors for health conditions

Social marketing directed at identified program behaviors/issues

Interpersonal Level
Financial
resources
Social support, social networks
Identified audiences such as families and social networks
People (staff
and volunteers)
Partners
Time

Materials
Gain awareness:
commit to change:
Solve community problems:

Needs/issues
identification process
Institution, Organization, and
Commun ity Levels Strategies to Community groups develop partner- and
leaders, local ships, and together agencies, build community institutions, capacity,
collective organizations in efficacy, and the partnerships empowerment; and reduce
environmental barriers for action by identified audiences
• Understanding
of issues
• Involvement of
partners, community groups
• Partners adopt
plans to address program behaviors/
issues
· Community
actions improve targeted behaviors/ issues

Identify and define issues

Policymakers Work toward needed change
Social Structures, Systems, and Policy Efforts to create/ Policymakers revise
social systems and public policies related to core behaviors/issues
Revise/adopt policies and practices related to targeted behaviors/issues

FIGURE 6-2 A nutrition education logic model framework addressing multiple levels of
intervention. Source: Based on Helen Chipman (national coordinator),
Supplemental Nutrition Assistance Program Education (SNAP-Ed), NIFA/USDA,
and Land Grant University System Partnership. 2006, January. Community Nutrition
Education (CNE) Logic Model, Version 2: Overview.
http://www.nifa.usda.gov/nea/food/fsne/logic.html. Used with permission.

136
PART I Linking Research, Theory, and Practice: The Foundations
address personal mediators of action or behavior change, such as be- liefs, attitudes, affect, and skills,
with immediate-, intermediate-, and extended outcomes for individuals. The activities at the other
are directed at environmental determinants of behavior change and are
levels
also designed to affect individuals, but in this case by making the healthy action
also the easy action through changes in policy, systems, and social structures.
to subsidize more healthful, but higher-priced foods such as fruits and vegetables or lower-fat
alternatives (sold at, say, 15% lower than oth erwise) in such a way as to be revenue neutral to
the organization in which the food sales occur. Attractive presentation of the foods and
promotional activities can further increase the choice of these foods. Again, nutrition educators
need to work with food providers to bring about such changes.

Nutrition Education Activities Directed at the Interpersonal Level Social

Networks and Social Support Enhancing Existing Social Networks To
enhance social support for the key food- and nutrition-related be havior or behaviors
that have been identified as of concern to the pro gram (e.g., increasing
breastfeeding rates, increasing the consumption of fruits and vegetables), existing social
networks can be called upon and expanded. For example, parent associations in
schools, employee associations at workplaces, and groups that meet regularly in communi ties
and organizations may be interested in nutrition issues. Nutrition education programs can
work with these groups to make them more supportive of the targeted behaviors or practices.
Community-Level Activities Building Community Capacity: Facilitating
Collective Efficacy and Empowerment Collective Efficacy The processes of
enhancing collective efficacy and empowerment are somewhat similar. In the
process of enhancing collective efficacy, group members, with the technical
assistance of the nutrition educator, iden tify the issue of concern to them in the social
and political environments. They can start out by setting small goals that will help to address the
concern. When these are accomplished, the group members can pose even more difficult
problems and set more ambitious goals. Such an approach can be effective with many
age groups, particularly youth.
Empowerment strategies generally involve some sort of conscious ness-raising process,
whereby the educator poses problems to the group participants and asks them to draw
on their own knowledge and ex periences to try to understand their lives in relation to
the problem. Group members, through dialogue, come to a collective understanding of
the root causes of the problems and begin to see how they can make changes in their situation.
They then set goals for actions that they will take to transform their reality through
making changes in the social or political condition of their lives. In these settings, the
role of the nutri tion educator is to facilitate the process at the beginning, if needed, until
the group has developed its own agendas and procedures and no longer needs the nutrition
educator. Another possibility is that a group has already initiated community action and
needs the nutrition educator as a resource person.
Developing New Social Network Linkages Programs frequently create social support for
program participants by initiating a social support group through which new social network linkages
are built. For example, a group can be developed for those in a workplace who are
interested in weight control or weight acceptance. Support groups can be developed at a
health center for those with HIV/ AIDS, or cooking classes and behavioral change sessions
can be created for participants in a program.

Organizational-Level Activities Changing the Food Environment Foods

offered at nutrition education program sites, such as schools, workplaces, communities,
soup kitchens, or food banks, can be modi fied to make them more supportive of the
healthful behaviors identified as important by nutrition educators or by participants. In
schools, this means making changes in the school meal offerings, vending
machines, à la carte offerings, and food items sold in school stores.
Bringing about changes at such sites may require the use of both mo tivational- and
action-phase activities, this time directed at the providers of food as the audience so that
they are motivated to make changes in the foods offered. Professional development
workshops and incentives are important here. Changes in the food offered may require
changes in organizational policy and union rules so that food service staff can make the changes,
which will require negotiations and advocacy. Making such food changes possible
may also require changes in physical facilities at sites such as schools or other
locations so that foods can actually be cooked or prepared on site. All of these
actions require coalition building with groups that have authority in the relevant
areas.

Pricing and Promotional Activities Changes in the pricing of food items

can be helpful in supporting health ful eating. As we have seen, large price changes
are effective in increas ing the sales of healthy items in organizations but are not financially
sustainable over the long term. A more sustainable strategy is to raise prices slightly (5% to 10%)
on more popular, high-fat, high-sugar foods
Playgrounds in a community encourage physical activity.

CHAPTER 6 Foundation in Theory and Research: Promoting Environmental Supports

for Action
37

Fruits & Vegetables Available Here

Se Vende Frutas & Vegetales Aqui

Move to
Muévete a Fruits & Vegetables Frutas
Vegetales
Your Heart
Tu Corazón and Your Waistline
y tu Cintura te lo Will Thank You
Agradecerán
NYC
CARE
CUÍDATE
The new torx Cty Department of heats and Mental Hygiene
Depxterio de Salud y Salud Mental de
Ciutad de Rosa York

FIGURE 6-3 New York City Department of Health and Mental Hygiene: Diet. Source: Courtesy of the New
York City Department of Health and Mental Hygiene.

Burn Calories, Not Electricity

Community-Based Programs Developing community-based interventions requires that nutrition
educators work in collaboration or partnership with various sectors within the community,
perhaps community centers, health centers, food banks, churches, community gardens,
schools, restaurants, and so forth. The role of the nutrition educator can vary considerably, from being a
member of the team and only providing technical expertise in the food, nutrition, and activity
areas, to providing more of a coordinating or organizing role. This means that the nutrition educator must have a
deep understanding of the community and respect for a diversity of

Inforinational Environment Information provided in public forums serves several purposes. It can
provide motivational (why-to) or instrumental (how-to) information on an important issue. However, the information
can also help to establish social and community norms that are supportive of dietary change. For
example, numerous posters about breastfeeding or eating fruits and vegetables can encourage
people to see these behaviors as the social norm. They can also serve as cues to action. In addition
to posters in schools, at work, or in community centers, billboards in the commu nity can help
establish norms and serve as cues to action. Promotions through other media, such as radio and
magazines, can be supportive of the behavior change that is targeted by the intervention. Studies have shown
that posters could increase stair use in blue- and white-collar worksites, shopping centers, and other
locations (Kerr et al. 2000, 2001; Kwak et al. 2007).
The New York City Department of Health has provided posters for use in multiple settings. Two are
shown in Figure 6-3 and Figure 6-4: one

Take the Stairs!

Walking up the stairs just 2 minutes a day helps prevent wakati gans, it also help, the
an aronne si. learn more at woonvertit
e n una

FIGURE 6-4 New York City Department of Health and Mental Hygiene: Exercise. Source:
Courtesy of the New York City Department of Health and Mental Hygiene.

138
PART I Linking Research, Theory, and Practice: The Foundations
about policies and issues as they come up and participate, where pos sible and
appropriate, to have a voice in how these policies will be developed and implemented. Some of
these national policy activities are described in Chapter 18 of this book.
poster is for use in small neighborhood grocery stores. As you can see, the graphic
provides why-to, or motivational, information: "Move to Fruits & Vegetables. Your Heart and
Your Waistline Will Thank You,” and how-to, or instrumental, information: “Fruits &
Vegetables Available Here.” The second poster is about taking the stairs rather than taking
the elevator and can be used in any building. It links a “green” message with a health
message: “Burn Calories, Not Electricity. Take the Stairs.”
Information on the number of calories on menu items in fast food res taurants has
become available in some communities. This can signal to people that this is an
important feature to consider and may have some impact on food choices (Bassett et
al. 2008; Harnack et al. 2008).
SUMMARY
Environmental interventions and policy and system change activities seek to enhance
opportunities for people to engage in healthful food and activity behaviors. Addressing
environmental determinants of people's health-rela ted action takes many different approaches
and involves a variety of venues. Nutrition educators inform, educate, and form part nerships with
others—food and service providers, decision makers with authority and power, and policy
makers—to address the environmental determinants that mediate the behaviors or practices
targeted by nutri tion programs. Thus, nutrition educators work with schools, Head Start
programs, workplaces, and communities to make healthful foods avail able and
accessible and to develop policies and system changes that encourage and reinforce
healthful eating practices, as follows:
Policy and System Changes Organizational Food Policy Nutrition
educators can assist organizations to develop appropriate poli cies with respect to
foods offered on site. Thus, in schools, they can work with local wellness councils made
up of teachers, school food service staff, administrators, community members, and
students. They can pro vide technical assistance to these councils to review and help
evaluate the effectiveness of policies to encourage healthful food environments that address the
following issues: food used in school fundraising or in the classroom as a reward or incentive,
food advertising in schools, and beverage sales in schools. The Centers for
Disease Control and Prevention (CDC) has developed a monitoring tool that schools
can use to assess the school health environment and evaluate how they are doing (Centers for
Disease Control and Prevention 2004a, 2004b). Within workplaces and other settings, vendors
are usually for-profit operations. However, even here food policies can be developed so
that healthful foods are more available and accessible.
Schoolwide Policies and System Change Activities In schools, schoolwide
food-related policies about beverage availability, vending machines, and school stores, as
well as school cafeteria policies, should
provide students the opportunity to have easy access
to healthful food choices and to see healthful food practices modeled.

Worksite Interventions In workplaces, healthful alternatives should be made

available in the cafeteria and in vending machines and should be promoted.

Community and National Policy Many community organizations and national

organizations focus on food policy. Nutrition educators can work within them to advocate
for, create, or revise policies that are supportive of the behaviors or issues that are
important for nutritional health. Here, nutrition educators can provide technical
assistance as well as influence. Nutrition educators also can bring their
knowledge and skills to food assistance programs and public health agencies.
Nutrition educators need to stay informed
Making the Healthful Choice the Easy Choice In all settings, the
healthful choice should be an easy choice. Active participation of community
members and worksite employees as well as leaders must be incorporated into any
interventions. Indeed, commu nity empowerment and collective efficacy are high
priorities. Adopting these comprehensive approaches enhances the likelihood of
improving the effectiveness of nutrition education interventions for individual and
environmental change.

CHAPTER 6 Foundation in Theory and Research: Promoting Environmental

Supports for Action
39
Questions and Activities
1. Think about one or two dietary changes you have tried to
make.
What factors in the environment have been helpful in supporting your
change, and what factors have not been helpful? List five of each. Based on
this chapter, what do you think that nutrition educators could have done to be
helpful to you? What would the ideal healthful food and activity environment look
like to you-at work or school or in the community? What role do you think nutrition
educators should play in promoting an
environment that is supportive of healthful eating? 3. What is the social ecological
approach to nutrition education?
Describe the levels of influence in this approach and the role of
nutrition educators in each. 4. Define the following terms and describe how they relate
to nutri
tion education. Give examples: a. Social networks b. Social support
C. Collaboration 5. What is community capacity? How can it be strengthened?
What
is the role of nutrition educators in the process? 6. “Local wellness
policies” are required in the United States. What
are these? How are nutrition educators involved? 7. If you were asked to
name five things that schools could do to
support healthy eating and active living, what would they be?
What is the evidence for your recommendations? 8. If you were asked to name
three things that worksites could do
to support healthy eating and active living, what would they be?
What is the evidence for your recommendations? 9. Describe
"community-based participatory research." How might
nutrition educators be involved? 10. What do we mean by policy in relation to diet
and physical activ
ity? How are education, environmental change, and policy related?
What is the role of nutrition educators in policy making? 11. What skills do you think
 nutrition educators should have to be
able to work in collaboration with others to bring about environ ments and policy
that are supportive of health? What role would
you like to see yourself play in these activities?
Benedict, S., and M. K. Campbell. 2009. HOPE Works: A successful community based
project to address obesity, hope, and economic determinants of health among low income,
rural, ethnically diverse women. Paper presented at the International
Society for Behavioral Nutrition and Physical Activity Annual Meeting, Portugal.
Beresford, S. A., B. Thompson, 2. Feng, A. Christianson, D. McLerran, and D. L.
Patrick. 2001. Seattle 5 a Day worksite program to increase fruit and vegetable
consumption. Preventive Medicine 32(3):230-238. Berge J. M., M. Wall, K.W. Bauer,
and D. Neumark-Sztainer. 2009. Parenting
characteristics in the home environment and adolescent overweight: a latent
class analysis. Obesity Oct 8 (Epub ahead of print). Berkman, L. F., and T. Kaca.
2000. Social integration, social networks. social
support, and health. In Social Epidemiology, edited by L. F. Berkman and I.
Kawachi. New York: Oxford Press. Burgess-Champoux, T. L., N. Larson, D. Neumark-Sztainer, P. J.
Hannan, and M.
cerita. 2009. Are family meal patterns associated with overall diet quality during the transition from
early to middle adolescence? Journal of Nutrition Education
and Behavior 41(2):79-86. California Department of Public Health. 2007. Network for a Healthy
California.
http://www.dhs.ca.gov/ps/cdic/cpns/network. Center for Food and Justice. 2010. About the
national Farm to School program. http://
www.farmtoschool.org/about.htm. Centers for Disease Control and Prevention. 2004a.
School Health Index: A self
assessment and planning guide. Elementary school version. Atlanta, GA: Author.
- 2004b. School Health Index: A self-assessment and planning guide. Middle
school/high school version. Atlanta, GA: Author. Chaloupka, F. J., and L. D.
Johnston. 2007. Bridging the Gap: Research informning
practice and policy for healthy youth behavior. American Journal of Preventive
Medicine 33(4 Suppl):S147-5161. Child Nutrition and WIC Reauthorization Act. 2004,
June 30. Local wellness policy.
Section 204 of Public Law 108-265. Enacted by the 108th Congress of the United
States of America. Cohen, D. A. 2008. Obesity and the built environment: Changes in
environmental
cues cause energy imbalances. International Journal of Obesity 32:S137-S142. Contento, I.
R., S. S. Williams, J. L. Michela, and A. B. Franklin. 2006.
Understanding the food choice process of adolescents in the context of family
and friends. Journal of Adolescent Health 38(5):575-582. Council of Economic Advisors.
2000. Teens and their parents in the 21st century:
An examination of trends in teen behavior and the role of parental involvement.
Washington, DC: Author. Cousineau, T., B. Houle, J. Bromberg, K. C. Fernandez,
and W. C. Kling. 2008. A pilot
study of an online workplace nutrition program. Journal of Nutrition Education
and Behavior 40:160-167. Cullen, K. W., T. Baranowski, E. Owens, T. Marsh, L.
Rittenberry, and C. de Moor.
2003. Availability, accessibility, and preferences for fruit, 100% fruit juice, and vegetables
influence children's dietary behavior. Health Education and Behavior
30(5):615-626. Cullen, K. W., and I. Zakeri. 2004. Fruits, vegetables, milk, and
sweetened beverages
consumption and access to a la carte/snack bar meals at school. American
Journal of Public Health 94(3):453-467. da Cunha, Z., 1. R. Contento, and K. Morin. 2000.
A case study of a curriculum
development process in nutrition education using empowerment as
organizational policy. Ecology of Food and Nutrition 39:417-435. Davis, E. M., K. W. Cullen,
K. B. Watson, M. Konarik, and J. Radcliffe. 2009. A Fresh
Fruit and vegetable Program improves high school students' consumption of
fresh produce. Journal of the American Dietetic Association 109(7):1227-1231.
DeMattia, L., and S. L. Denney. 2008. Childhood obesity prevention: Successful
community-based efforts. Annals of the American Academy of Political and Social
Science 615:83-99. Dengel, D. R., M. O. Hearst, J. H. Harmon, A. Forsythe, and L. A.
Lytle. 2009. Does
the built environment relate to the metabolic syndrome in adolescents? Health Place
15(4):946-951.
References Abratt, R., and S. D. Goodey. 1990. Unplanned buying and in-store
stimuli in
supermarkets. Managerial Decisions and Economics 11:111-121. American Academy
of Pediatrics Committee on Environmental Health. 2009. The
built environment: Designing communities to promote physical activity in
children. Pediatrics 126(6):1591-1598. Ammerman, A. S., C. H. Lindquist, K. N. Lohr, and J. Hersey. 2002. The
efficacy of
behavioral interventions to modify dietary fat and fruit and vegetable intake: A
review of the evidence. Preventive Medicine 35(1):25-41. Arnold, C. G., P. Ladipo, C.
H. Nguyen, P. Nkinda-Chaiban, and C. M. Olson. 2001.
New concepts for nutrition education in an era of welfare reform. Journal of
Nutrition Education 33(6):341-346. Bandura, A. 1997. Self efficacy: The exercise of
control. New York: WH Freeman.
- . 2001. Social cognitive theory: An agentic perspective. Annual Review of
Psychology 51:1-26. Bassett, M. T., T. Dumanovsky, C. Huang, et al. 2008.
Purchasing behavior and
calorie information at fast-food chains in New York City, 2007. American Journal of Public
Health 98(8):1457-1459.

140
PART I Linking Research, Theory, and Practice: The
Foundations
Economos, C. D., and S. Irish-Hauser. 2007. Community interventions: A brief
overview and their application to the obesity epidemic. Journal of Law and
Medical Ethics 35(1):131-137. Edmundson, E., G. S. Parcel, H. A. Feldman, et al.
1996. The effects of the Child and
Adolescent Trial for Cardiovascular Health upon psychosocial determinants of
diet and physical activity behavior. Preventive Medicine 25(4):442-454. Engbers, L. H.,
M. N. van Poppel, A. Paw, M. J. Chin, and W. van Mechelen. 2005.
Worksite health promotion programs with environmental changes: A systematic
review. American Journal of Preventive Medicine 29(1):61-70. Feuenekes, G.I. J., C. De Graff. S.
Meyboom, and W. A. Van Staveren. 1998. Food
choice and fat intake of adolescents and adults: Association of intakes within
social networks. 26:645-656 French, S. A., R. W. Jeffery, M. Story, et al. 2001. Pricing and
promotion effects on
low-fat vending snack purchases: The CHIPS Study. American Journal of Public
Health 91(1):112-117. French, S. A., and G. Stables. 2003. Environmental interventions to
promote
vegetable and fruit consumption among youth in school settings. Preventive
Medicine 37(6 Pt 1):593-610. French, S. A., M. Story, R. W. Jeffery, P. Snyder, M. Eisenberg, A.
Sidebottom, and D.
Murray. 1997. Pricing strategy to promote fruit and vegetable purchase in high
school cafeterias. Journal of the American Dietetic Association 97(9):1008-1010.
French, S. A., and H. Wechsler. 2004. School-based research and initiatives: Fruit
and vegetable environment, policy, and pricing workshop. Preventive Medicine
39 (Suppl 2):S101-S107. Friere, P. 1970. Pedagogy of the oppressed. New York:
Continuum.
- 1973. Education for critical consciousness. New York: Continuum.
Fulkerson, J. A., S. A. French, M. Story, H. Nelson, and P. J. Hannan. 2004.
Promotions to increase lower-fat food choices among students in secondary schools:
Description and outcomes of TACOS (Trying Alternative Cafeteria
Options in Schools). Public Health Nutrition 7(5):665-674. Fulkerson, J. A., D.
Neumark-Sztainer, P.J. Hannan, and M. cerita. 2008. Family
meal frequency and weight status among adolescents: Cross-sectional and 5-year
longitudinal associations. Obesity (Silver Spring) 16(11):2529-2534. Furst, T.,
M. Connors, C. A. Bisogni, J. Sobal, and L. W. Falk. 1996. Food choice: A
conceptual model of the process. Appetite 26(3):247-265. Gillespie, A. H.,
and G. W. Gillespie, 2007. Family food decision-making: An
ecological systems framework. Journal of Family and Consumer Sciences 99(2):
22-28. Gillespie, A. H., and W. L. Johnson-Askew. 2009. Changing family food and eating
practices: The family food decision-making system. Annual Review of Behavioral
Medicine Nov 3 (Epub ahead of print). Glanz, K., J. F. Sallis, B. E. Saelens, and L. D.
Frank. 2005. Healthy nutrition
environments: Concepts and measures. American Journal of Health Promotion 19(5):330-333,
ii. ----. 2007. Nutrition Environment Measures Survey in stores (NEMS-S):
Development and evaluation. American Journal of Preventive Medicine
32(4):282-289. Goodman, R. M., et al. 1999. Identifying and defining the dimensions
of community
capacity to provide a basis for measurement. Health Education and Behavior
25:258-278. Gottlieb, B. H. 1985. Social networks and social support: An overview of
research,
practice, and policy implications. Health Education Quarterly 12(1):5--22. Green, L. W.,
and M. W. Kreuter. 2004. Health promotion planning: An educational
and ecological approach. 4th ed. New York: McGraw-Hill Humanities/Social
Sciences/Languages. Hannan, P., S. A. French, M. Story, and J. A. Fulkerson. 2002.
A pricing strategy
to promote sales of lower fat foods in high school cafeterias: Acceptability and
sensitivity analysis. American Journal of Health Promotion 17(1):1-6, ii. Harnack, L.
J., S. A. French, J. M. Oakes, M. T. Story, R. W. Jeffery, and S. A. Rydell.
2008. Effects of calorie labeling and value size pricing on fast food meal choices:
Results from an experimental trial. International Journal of Behavior Nutrition
and Piysical Activity 5:63. Harrington, D. W., and S. J. Eliot. 2009. Weighing the
importance of neighborhood:
A multilevel exploration of the determinants of overweight and obesity. Social
Science and Medicine 68(4):593-600. Harrington, K. F., F. A. Franklin, S.
L. Davies, R. M. Shewchuk, and M. B. Binns.
2005. Implementation of a family intervention to increase fruit and vegetable
intake: The Hi5 + experience. Heaith Promotion Practice 6(2):180-189. He, M., C.
Callaghan, A. Evans, and G. Mandich. 2009. Healthy eating champions
award for elementary schools. Canadian Journal of Dietetic Practice and Research
70(2):101-104. Hearn, D. M., T. Baranowski, J. Baranowski, et al. 1998. Environmental
influences
on dietary behavior among children: Availability and accessibility of fruits and
vegetables enable consumption. Journal of Health Education 29:26-32. Hoelscher, D. M.,
P. Mitchell, J. Elder, A. Clesi, and P. Snyder. 2003. How the CATCH
Eat Smart program helps implement the USDA regulations in school cafeterias.
Health Education and Behavior 30:434-446. Hughes, L. J., L. Blalock, and L.
Strieter. 2005. Youth-oriented farm stands as a
vehicle for improving food security in targeted low-income communities. Journal
of Nutrition Education and Behavior 37(Suppl 1):S36. Hunt, M. K., R. Lederman, S.
Potter, A. Stoddard, and G. Sorensen. 2000. Results
of employee involvement in planning and implementing the Treatwell 5-a-Day
work-site study. Health Education and Behavior 27(2):223--231. Institute of Medicine.
2007. Nutrition standards for foods in schools: Leading the way
towards healthier youth. Washington, DC: National Academies Press. Israel, B., B.
Checkoway, A. Schulz, and M. Zimmerman. 1994. Health education
and community empowerment: Conceptualizing and measuring perceptions of individual,
organizational, and community control. Health Education Quarterly
21(2):149-170. Israel, B. A, and K. A. Rounds. 1987. Social networks and
social support: A synthesis
for health educators. Health Education and Promotion 2:311-351. Jones, A. S.
2005. Start by eating right: Promoting healthy eating in young children
through partnerships between Share Our Strength and Head Start and other community
agencies. In National nutrition education conference. Washington,
DC: U.S. Department of Agriculture, Food and Nutrition Service. Jordan, A. B.
2008. Overweight and obesity in America's children: Causes,
consequences, solutions. Annals of the American Academy of Political and Social
Science 615:225-243. Kent, G. 1988. Nutrition education as an instrument of
empowerment. Journal of
Nutrition Education 20:193-195. Kerr, J., F. Evans, and D. Carroll. 2000. Posters
can prompt less active individuals to
use the stairs. Journal of Epidemiology and Community Health 54:942-943. Kerr, J.,
F. Evans, and D. Carroll. 2001. Six-month observational study of promoted
stair climbing. Preventive Medicine 33:422-427. Kistin, N., M. S. Abramson, and N.
Dublin. 1994. Effect of peer counselors on
breastfeeding initiation, exclusivity, and duration among low-income urban
women. Journal of Human Lactation 10:11-16. Kremers. S. P. J., G-J. de Bruijn, T. L.
S. Visscher, W. van Mechelen, N. K. de
Vries, and J. Brug. 2006. Environmental influences on energy-balance-related behaviors: A
dual-process view. International Journal of Behavioral Nutrition and
Physical Activity 3:9. Kubik, M. Y., L. A. Lytle, and M. cerita. 2001. A practical,
theory-based approach to
establishing school nutrition advisory councils. Journal of the American Dietetic
Association 101(2):223-228. Kwak, L., S. P. J. Kremers, M. A. van Baak, and J. Brug.
2007. A poster-based
intervention to promote stair use in blue- and white collar worksites. Preventive
Medicine 45(2-3):177-181. Li, F., P. Harmer, B. J. Cardinal, and N. Vongjaturapat. 2009.
Built environment and
changes in blood pressure in middle aged and older adults. Preventive Medicine
48(3):237-241.
 Sosial Media dan Pendidikan Gizi
Dr. Heni Hendriyani, SKM MPH

 Social media can be a quick, low-cost, direct way for nutrition educators to broaden the
scope of their targeted programs
 Social media features were categorized based on the function, purpose or activity for which
it was used and by specific platforms.
 The three main functions of social media in the interventions were
1) to facilitate communications and relationships among peers;
2) to support self-tracking and gamification; and
3) to share content among research staff and participants.
 One of the more common uses of social media was to facilitate communication, relationship
building, and social support among peers. Blogs were used to disseminate information and
allow commentary by community members.
 More extensive interactions including support seeking, relationship building, problem
solving, and behavior sharing were supported through online discussion forums.
 Smaller group interactions were offered through private groups, messaging, and chats using
Facebook, WhatsApp, Twitter and homegrown apps.
 In some cases, interactions were open-ended to allow participants to organically discuss
topics of interest which in one case was monitored by a professional. However, three
interventions supplied topics and structured activities with assigned partners for discussion.
 Social media was also used to support sharing of tracking activities and gamification. Public
and selective sharing of goal setting, diet logging, and physical activities were included in
five interventions. Two included assessments or coaching from peers. Diet and exercise
related games and challenges were included with one application enabling public results
posting. Homegrown applications or existing social media platforms such as Twitter and
Fitbit were used for these activities. Lastly, social media was used to share content among
study staff and participants. This included educational information, messages, reminders,
polls, and health related event information. Three studies supported multimedia content

1
 sharing including podcasts , photograph diary testimonials from peers, health-related images
selected by study staff from Pinterest sent through Twitter, and video messages from peer
coaches.
 Despite the growing recognition of social media’s potential to help young individuals
improve health, few systematic reviews specifically examined this question.
 Study results show that use of social media in public health interventions for improving
nutrition among adolescents and young adults is limited but promising.
 Of sixteen studies reviewed, eleven had significant nutrition outcomes suggesting social
media may be valuable for delivering interventions for adolescents and young adults. The
majority used high-quality study designs and showed clinical outcomes improvements,
increases in healthy dietary behaviors, or reductions in unhealthy habits.
 Many studies were conducted in racially and ethnically diverse populations. Studies serving
low income populations and broader income levels showed significant nutrition outcomes.
All this suggests that interventions that incorporate digital technologies and, in particular,
social media have a high potential of reaching diverse groups of adolescents and young
adults.
 However, together with these encouraging results, this review highlighted a number of
limitations in the current research. First, while this review focused specifically on
interventions that incorporate social media, it is important to note that the majority of
reviewed interventions were complex, and included multiple features together with and often
primary to social media. Many interventions included nutrition and behavior change features
to help individuals better understand their dietary habits, make informed choices, and learn
healthy eating skills. These included diet and activity tracking and feedback and educational
content delivered using automated messages or online media. Several incorporated practical
nutritional content, such as recipes and meal planning, helping to translate education into
practical changes in diets.
 Finally, several included tailoring, such as personalized guidance on interpreting and
modifying nutritional choices. Because these interventions were evaluated holistically,
separating the impact of social media from the impact of other features remains a challenge.
Further research is needed to compare the impact of social media with the impact of other
interventions for healthy nutrition among adolescents and young adults, and to examine the

2
 relative contribution of social media to the impact of complex interventions. Second, social
media use in the included studies was conservative and engagement with social media was
limited. Many interventions relied on traditional discussion boards and blogs to facilitate
communication and disseminate information.
 Others developed homegrown websites but incorporated similarly traditional discussion
boards. While feasibility and usage of features were not uniformly reported, those studies
that included data on user engagement showed mixed to low usage and decline in use
overtime for these simpler forms of social media. These findings suggest that future
interventions for healthy nutrition should consider leveraging newer and more innovative
social media platforms that have new affordances and can inspire new health behaviors.
These findings are further supported by studies that were screened, but did not qualify for
the review.
 Many were not evaluated for clinical effectiveness but included innovative social media. For
example, studies found adolescents and the general public are using social media platforms
to document and share meal photos, learn recipes, and showcase food preparation. Though
subject to reporting bias, taking photographs is perceived as faster and simpler than keeping
standard food diaries.
 In other such studies, researchers are using social media posts to learn about food choice
influences, to incorporate photosharing of meals, and to allow users to collectively reflect on
the food environment. Though not targeted towards young people, others have explored
social collaborative learning for collectively identifying healthy diet through food image
tagging and improving nutritional knowledge through crowdsourcing. Another area that has
received considerable attention outside the clinical domain is gamification. Studies in this
review using online games saw limited long-term engagement. However, behavioral
challenges and reminders led to sustained engagement and diet logging in one study.
 Others have used games to introduce heuristics for healthy eating. Although these
technologies are innovative in design, evaluation is needed to determine the effectiveness in
improving nutrition.
 Third, while some studies in this review did examine the efficacy of social media as a novel
mechanism for delivery of behavioral interventions, many used social media to add social
support component to a more traditional behavioral intervention. In many cases, the

3
 interventions required that the participants socialize with other users of the same
intervention, rather than leverage their existing social connections and networks.
 Review shows that while both of these approaches appear to have a positive impact on
behaviors, adding social components to behavioral interventions does not always lead to
high user engagement. This is consistent with findings of previous studies of social media
usage patterns that suggest that individuals are more likely to use social media sites to
maintain existing social networks, rather than to develop new relationships.
 Consequently, Nutrition is a popular topic—there are umpteen websites, social media pages
and books dedicated to food and eating, culinary skills, and the science of nutrition. Near-
universal access to the internet, sophisticated search engines plus widespread adoption of
social media now underpins the public’s access to information about food and health, and
the public are increasingly turning to the internet for information.
 However, the internet has no filters on quality or accuracy of information, enabling myths
and pseudoscience to proliferate rapidly. People declaring themselves as ‘subject experts’
who lack formal training, reputable credentials or adherence to a professional code of
conduct have a voice.
 Blogs, social media and ‘expert’ websites can be written by anyone, regardless of their
expertise. They can effectively influence their online followers and nutrition
professionals need to acknowledge and compete in this space to be heard. The
emergence of technology that supports interaction and engagement with users, including the
Web 2.0, with its emphasis on social networking and user-generated content, has aided
nutrition and health information accessibility.
 User-generated content refers to “media content created or produced by the general public
rather than paid professionals, and is primarily distributed on the internet. People are
increasingly accessing information from user-generated sources such as social media. In the
United States, 80% of people reported seeking advice about their health online in 2011
and 70% reported social media as one of their sources of news.
 Accessing food and nutrition information through social media is popular with the
public, with it being the second most accessed area of science news, behind health and
medicine. Food, nutrition and health appear to be subject areas where people wish to

4
 share their personal experiences, beliefs and opinions, which are often either purported
or interpreted as facts, rapidly propagating trends and fads.
 The challenge for the public is to be able to accurately differentiate between ‘fact or
fad’ from the sheer volume of information available; the challenge for nutrition
professionals is to deliver targeted messages in a manner to which the public will
engage with them.
 The shift from qualified nutrition experts disseminating the nutrition information they deem
to be appropriate to the public taking charge of the information they learn has resulted in a
paradigm shift in how nutrition is communicated.
 Reliance and trust of evidence-based information presented by government and health care
professionals with nutrition expertise has been reduced. Internet users seeking health or
medical information commonly favour commentary from people’s personal experiences on
social media and blogs.
 Celebrities and non-credentialed experts are frequently preferred as sources of credible
nutrition information, ranging from movie and sports stars, to the new “health celebrities”,
famous for their health and nutritional recommendations. People not only look up to
celebrities, but may be vulnerable to information provided by them, including
misinformation. As there are no restrictions as to whom provides online nutrition
information, it produces a confusing world where consumers have to synthesise the ‘truth’ or
indeed what meets their needs.
 The resulting rise of user generated content online combined with the public’s increased
autonomy over their learning, makes understanding people’s behaviour around accessing
nutrition information paramount. Tertiary qualifications in nutrition do not necessarily
translate to ‘expertise’ in the eyes of the general public or make them receptive to receiving
nutrition information.
 Massive Open Online Courses (MOOCs) are an emerging free and open access source of
education, enrolling millions of learners, and provide a platform for academics to reach
global lay audiences. A key aspect for MOOC learning is their discussion forums; allowing
learners to converse, debate and share information with their peer group. These discussion
forums can provide opportunities for observational research involving thousands of people

5
 engaging in natural dialogue, and these people can be viewed as representative of people
actively seeking information online.
 Real-World Data (RWD), including information from discussion forums and social media,
are increasingly recognised as useful in research to better understand the participant
perspective. Online discussion forums provide rich RWD on participants’ interactions and
engagement with the course content and with each other.
 Observing people’s behaviour in sharing and reporting nutrition information provides a
naturalistic window where we can further understand the characteristics of those seeking
nutrition information and from where that information is being acquired. This is important to
understand whether nutrition professionals are to be able to effectively deliver nutrition
information using online formats.
 While the internet and social media have been shown to be growing sources of nutrition
information, less is known about who the providers of this information are. There are also
gaps in understanding regarding who the public prefer to access online, and how they use the
information they find. In order to provide timely nutrition advice that resonates with the
public, nutrition professionals need to acknowledge and understand the rapidly
evolving information-seeking landscape if experts are to compete in this fast-moving
space.

Referensi

Lauren N Tobey , Melinda M Manore , Social media and nutrition education: the food hero
experience Mar-Apr 2014;46(2):128-33. doi: 10.1016/j.jneb.2013.09.013. Epub 2013 Nov 9.

Tugas:

Mencari jenis-jenis pendidikan gizi dengan sosial media di internet minimal 3 macam kegiatan

6
 Sosial Media Dan Pendidikan Gizi
Dr Heni Hendriyani, SKM MPH

∙ Media sosial dapat menjadi cepat, murah, cara langsung untuk pendidik nutrisi untuk
memperluas lingkup program yang ditargetkan mereka
∙ fitur media sosial yang dikategorikan berdasarkan fungsi, tujuan atau aktivitas yang digunakan
dan oleh platform tertentu.
∙ Tiga fungsi utama media sosial di intervensi adalah
1) untuk memudahkan komunikasi dan hubungan antara rekan-rekan;
2) untuk mendukung self-tracking dan gamification; dan
3) untuk berbagi konten di antara staf penelitian dan peserta.
∙ Salah satu penggunaan yang lebih umum dari media sosial adalah untuk memfasilitasi
komunikasi, membangun hubungan, dan dukungan sosial di antara rekan-rekan. Blog
digunakan untuk menyebarkan informasi dan memungkinkan komentar oleh anggota
komunitas.
∙ interaksi lebih luas termasuk dukungan pencarian, membangun hubungan, pemecahan
masalah, dan berbagi perilaku didukung melalui forum diskusi online. ∙ interaksi kelompok
kecil yang ditawarkan melalui kelompok swasta, pesan, dan chatting menggunakan Facebook,
WhatsApp, Twitter dan aplikasi homegrown.
∙ Dalam beberapa kasus, interaksi yang terbuka untuk memungkinkan peserta untuk organik
mendiskusikan topik yang menarik yang dalam satu kasus dipantau oleh seorang profesional.
Namun, tiga intervensi diberikan topik dan kegiatan terstruktur dengan mitra yang ditugaskan
untuk diskusi.
∙ MediaSosial juga digunakan untuk mendukung berbagi melacak aktivitas dan gamification.
Berbagi secara publik dan selektif tentang penetapan tujuan, pencatatan diet, dan aktivitas fisik
dimasukkan dalam lima intervensi. Dua termasuk penilaian atau pembinaan dari rekan-rekan.
Permainan dan tantangan terkait diet dan olahraga disertakan dengan satu aplikasi yang
memungkinkan pengeposan hasil publik. Aplikasi buatan sendiri atau platform media sosial
yang ada seperti Twitter dan Fitbit digunakan untuk kegiatan ini. Terakhir, media sosial
digunakan untuk berbagi konten antara staf studi dan peserta. Ini termasuk informasi pendidikan,
pesan, pengingat, jajak pendapat, dan informasi acara terkait kesehatan. Tiga studi mendukung
konten multimedia

1
berbagi termasuk podcast , foto testimonial buku harian dari rekan-rekan, gambar terkait
kesehatan yang dipilih oleh staf studi dari Pinterest yang dikirim melalui Twitter, dan pesan
video dari pelatih sebaya.
∙ Meskipun semakin dikenalnya potensi media sosial untuk membantu individu muda
meningkatkan kesehatan, beberapa ulasan yang sistematis secara khusus meneliti
pertanyaan ini. ∙ Studi Hasil penelitian menunjukkan bahwa penggunaan media sosial di
intervensi kesehatan masyarakat untuk meningkatkan gizi di kalangan remaja dan dewasa
muda terbatas tapi menjanjikan.
∙ Of enam belas studi ditinjau, sebelas memiliki hasil gizi yang signifikan menunjukkan media
sosial mungkin berharga untuk memberikan intervensi untuk remaja dan dewasa muda.
Mayoritas menggunakan desain penelitian berkualitas tinggi dan menunjukkan
peningkatan hasil klinis, peningkatan perilaku diet sehat, atau pengurangan kebiasaan
tidak sehat.
∙ Banyak penelitian dilakukan pada ras dan etnis populasi yang beragam. Studi yang melayani
populasi berpenghasilan rendah dan tingkat pendapatan yang lebih luas menunjukkan hasil
gizi yang signifikan. Semua ini menunjukkan bahwa intervensi yang menggabungkan
teknologi digital dan, khususnya, media sosial memiliki potensi tinggi untuk menjangkau
beragam kelompok remaja dan dewasa muda.
∙ Namun, bersama-sama dengan hasil yang menggembirakan, ulasan ini menyoroti sejumlah
keterbatasan dalam penelitian saat ini. Pertama, sementara tinjauan ini berfokus secara
khusus pada intervensi yang menggabungkan media sosial, penting untuk dicatat bahwa
sebagian besar intervensi yang ditinjau bersifat kompleks, dan mencakup banyak fitur
bersama-sama dan sering kali utama untuk media sosial. Banyak intervensi termasuk fitur
nutrisi dan perubahan perilaku untuk membantu individu lebih memahami kebiasaan diet
mereka, membuat pilihan berdasarkan informasi, dan mempelajari keterampilan makan yang
sehat. Ini termasuk diet dan pelacakan aktivitas dan umpan balik dan konten pendidikan yang
 disampaikan menggunakan pesan otomatis atau media online. Beberapa memasukkan
kandungan nutrisi praktis, seperti resep dan perencanaan makan, membantu menerjemahkan
pendidikan ke dalam perubahan praktis dalam diet.
∙ Akhirnya, beberapa termasuk menjahit, seperti bimbingan pribadi di menafsirkan dan
memodifikasi pilihan gizi. Karena intervensi ini dievaluasi secara holistik, memisahkan
dampak media sosial dari dampak fitur lain tetap menjadi tantangan. Penelitian lebih lanjut
diperlukan untuk membandingkan dampak media sosial dengan dampak intervensi lain
untuk gizi sehat di kalangan remaja dan dewasa muda, dan untuk menguji

2
kontribusi relatif media sosial terhadap dampak intervensi kompleks. Kedua, penggunaan
media sosial dalam studi yang disertakan bersifat konservatif dan keterlibatan dengan
media sosial terbatas. Banyak intervensi mengandalkan papan diskusi tradisional dan blog
untuk memfasilitasi komunikasi dan menyebarkan informasi.
∙ Lainnya dikembangkan homegrown website tetapi dimasukkan papan diskusi sama
tradisional. Meskipun kelayakan dan penggunaan fitur tidak dilaporkan secara seragam,
studi yang menyertakan data tentang keterlibatan pengguna menunjukkan penggunaan
yang beragam hingga penggunaan yang rendah dan penurunan penggunaan dari waktu ke
waktu untuk bentuk media sosial yang lebih sederhana ini. Temuan ini menunjukkan
bahwa intervensi masa depan untuk nutrisi sehat harus mempertimbangkan untuk
memanfaatkan platform media sosial yang lebih baru dan lebih inovatif yang memiliki
kemampuan baru dan dapat menginspirasi perilaku kesehatan baru. Temuan ini lebih
lanjut didukung oleh penelitian yang disaring, tetapi tidak memenuhi syarat untuk
ditinjau.
∙ Banyak yang tidak dievaluasi untuk efektivitas klinis tetapi termasuk media sosial yang inovatif.
Misalnya, penelitian menemukan remaja dan masyarakat umum menggunakan platform
media sosial untuk mendokumentasikan dan berbagi foto makanan, mempelajari resep, dan
memamerkan persiapan makanan. Meskipun tunduk pada bias pelaporan, mengambil foto
dianggap lebih cepat dan lebih sederhana daripada menyimpan buku harian makanan standar.
∙ Dalam studi lain seperti, peneliti menggunakan posting media sosial untuk belajar tentang
pengaruh makanan pilihan, untuk menggabungkan photosharing makanan, dan untuk
memungkinkan pengguna untuk secara kolektif mencerminkan pada lingkungan makanan.
 Meskipun tidak ditujukan untuk kaum muda, yang lain telah mengeksplorasi pembelajaran
kolaboratif sosial untuk secara kolektif mengidentifikasi diet sehat melalui penandaan citra
makanan dan meningkatkan pengetahuan gizi melalui crowdsourcing. Area lain yang
mendapat banyak perhatian di luar domain klinis adalah gamifikasi. Studi dalam ulasan ini
menggunakan game online melihat keterlibatan jangka panjang yang terbatas. Namun,
tantangan dan pengingat perilaku menyebabkan keterlibatan berkelanjutan dan pencatatan
diet dalam satu penelitian.
∙ lain telah digunakan games untuk memperkenalkan heuristik untuk makan sehat. Meskipun
teknologi ini inovatif dalam desain, evaluasi diperlukan untuk menentukan efektivitas dalam
perbaikan gizi.
∙ Ketiga, sementara beberapa penelitian di ulasan ini melakukan meneliti khasiat media sosial
sebagai mekanisme baru untuk pengiriman intervensi perilaku, banyak digunakan media sosial
untuk menambahkan komponen dukungan sosial dengan intervensi perilaku yang lebih
tradisional. Dalam banyak kasus,

3
intervensi mengharuskan peserta bersosialisasi dengan pengguna lain dari intervensi yang
sama, daripada memanfaatkan koneksi dan jaringan sosial yang ada. ∙ Ulasan menunjukkan
bahwa sementara kedua pendekatan ini tampaknya memiliki dampak positif pada perilaku,
menambahkan komponen sosial untuk intervensi perilaku tidak selalu menyebabkan keterlibatan
pengguna yang tinggi. Hal ini sesuai dengan temuan penelitian sebelumnya tentang pola
penggunaan media sosial yang menunjukkan bahwa individu lebih cenderung
menggunakan situs media sosial untuk mempertahankan jaringan sosial yang ada,
daripada mengembangkan hubungan baru. ∙ Akibatnya, Nutrisi adalah populer topik-ada
website sekian, sosial halaman media dan buku yang didedikasikan untuk makanan dan makan,
keterampilan kuliner, dan ilmu gizi. Hampir akses universal ke internet, mesin pencari canggih
ditambah adopsi luas media sosial sekarang mendukung akses publik ke informasi tentang
makanan dan kesehatan, dan masyarakat semakin beralih ke internet untuk informasi.
∙ Namun, internet tidak memiliki filter pada kualitas atau keakuratan informasi,
memungkinkan mitos dan pseudosains berkembang biak dengan cepat. Orang-orang yang
menyatakan diri mereka sebagai 'ahli mata pelajaran' yang tidak memiliki pelatihan
formal, kredensial yang bereputasi baik, atau kepatuhan terhadap kode etik profesional
 memiliki suara.
∙ Blog, media sosial dan situs 'ahli' dapat ditulis oleh siapa saja, terlepas dari keahlian
mereka. Mereka dapat secara efektif mempengaruhi pengikut online mereka dan
profesional nutrisi perlu mengakui dan bersaing di ruang ini untuk didengar.
Munculnya teknologi yang mendukung interaksi dan keterlibatan dengan pengguna,
termasuk Web 2.0, dengan penekanannya pada jejaring sosial dan konten buatan pengguna,
telah membantu aksesibilitas informasi nutrisi dan kesehatan.
∙ konten yang dibuat pengguna mengacu pada “isi media yang dibuat atau diproduksi oleh
masyarakat umum daripada profesional yang dibayar, dan terutama didistribusikan di
internet. Orang semakin mengakses informasi dari sumber yang dibuat pengguna seperti
media sosial. Di Amerika Serikat, 80% orang melaporkan mencari nasihat tentang
kesehatan mereka secara online pada tahun 2011 dan 70% melaporkan media sosial
sebagai salah satu sumber berita mereka.
∙ Mengakses makanan dan informasi gizi melalui media sosial populer dengan
masyarakat, dengan itu menjadi daerah kedua yang paling diakses berita ilmu
pengetahuan, belakang kesehatan dan obat-obatan. Makanan, gizi dan kesehatan
tampaknya bidang studi di mana orang ingin

4
berbagi pengalaman pribadi mereka, keyakinan dan opini, yang sering baik diakui
atau ditafsirkan sebagai fakta, cepat menyebarkan tren danmode.
∙ Tantangan bagi masyarakat adalah untuk dapat secara akurat membedakan antara
'fakta atau keisengan' dari banyaknya informasi yang tersedia; tantangan bagi
para profesional nutrisi adalah menyampaikan pesan yang ditargetkan dengan cara
yang akan melibatkan publik dengan mereka.
∙ Pergeseran dari ahli gizi yang berkualitas menyebarluaskan informasi nutrisi yang mereka
anggap sesuai dengan biaya pengambilan publik dari informasi yang mereka pelajari telah
mengakibatkan pergeseran paradigma dalam cara gizi dikomunikasikan.
∙ Reliance dan kepercayaan dari informasi berbasis bukti yang diajukan oleh pemerintah dan
perawatan kesehatan profesional dengan keahlian gizi telah berkurang. Pengguna internet
yang mencari informasi kesehatan atau medis biasanya menyukai komentar dari
 pengalaman pribadi orang di media sosial dan blog.
∙ Selebriti dan ahli non-credentialed sering disukai sebagai sumber informasi gizi yang kredibel,
mulai dari film dan bintang olahraga, ke yang baru “selebriti kesehatan”, terkenal untuk
kesehatan mereka dan rekomendasi gizi. Orang tidak hanya mengagumi selebritas, tetapi
juga rentan terhadap informasi yang diberikan oleh mereka, termasuk informasi yang salah.
Karena tidak ada batasan tentang siapa yang memberikan informasi nutrisi online, ini
menghasilkan dunia yang membingungkan di mana konsumen harus mensintesis 'kebenaran'
atau memang apa yang memenuhi kebutuhan mereka.
∙ kenaikan yang dihasilkan dari konten yang dibuat pengguna secara online dikombinasikan
dengan peningkatan otonomi masyarakat atas pembelajaran mereka, membuat perilaku
pemahaman masyarakat sekitar mengakses informasi nutrisi penting. Kualifikasi tersier
dalam nutrisi tidak selalu berarti 'keahlian' di mata masyarakat umum atau membuat mereka
mau menerima informasi nutrisi.
∙ besar-besaran Terbuka Online Di (MOOCs) adalah muncul bebas dan open source akses
pendidikan, mendaftarkan jutaan pelajar, dan menyediakan platform untuk akademisi untuk
menjangkau audiens awam global. Aspek kunci untuk pembelajaran MOOC adalah forum
diskusi mereka; memungkinkan peserta didik untuk berbicara, berdebat dan berbagi informasi
dengan kelompok sebaya mereka. Forum diskusi ini dapat memberikan kesempatan untuk
penelitian observasional yang melibatkan ribuan orang

5
terlibat dalam dialog alami, dan orang-orang ini dapat dipandang sebagai perwakilan dari
orang-orang yang secara aktif mencari informasi secara online.
∙ Real-World Data (RWD), termasuk informasi dari forum diskusi dan media sosial, semakin
diakui sebagai berguna dalam penelitian untuk lebih memahami perspektif peserta. Forum
diskusi online menyediakan RWD yang kaya tentang interaksi dan keterlibatan peserta
dengan konten kursus dan satu sama lain.
∙ Mengamati perilaku masyarakat dalam berbagi dan melaporkan informasi nutrisi menyediakan
jendela naturalistik di mana kita dapat lebih memahami karakteristik mereka informasi
nutrisi mencari dan dari mana informasi yang diakuisisi. Hal ini penting untuk memahami
apakah ahli gizi mampu menyampaikan informasi gizi secara efektif menggunakan format
 online.
∙ Sementara internet dan media sosial telah terbukti sumber informasi gizi tumbuh, sedikit yang
diketahui tentang siapa penyedia informasi ini. Ada juga kesenjangan dalam pemahaman
tentang siapa yang lebih disukai publik untuk mengakses online, dan bagaimana mereka
menggunakan informasi yang mereka temukan. Untuk memberikan saran nutrisi tepat
waktu yang sesuai dengan publik, profesional nutrisi perlu mengakui dan memahami
lanskap pencarian informasi yang berkembang pesat jika para ahli ingin bersaing di
ruang yang bergerak cepat ini.

Referensi

Lauren N Tobey , Melinda M Manore , Sosial media dan pendidikan gizi: pengalaman
pahlawan makanan Mar-Apr 2014;46(2):128-33. doi: 10.1016/j.jneb.2013.09.013. Epub
2013 Nov 9.

Tugas:

Mencari jenis pendidikan gizi dengan media sosial di internet minimal 3 macam kegiatan

6
MATERIAL CETAK
Prinsip dasar mendesain Material Cetak 1
DESAIN

▪ tampilkan hanya satu pesan setiap ilustrasi

▪ batasi jumlah konsep dan halaman
▪ buat interaktif
▪ biarkan ruang kosong .. white space
▪ susun pesan sesuai urutan
▪ gunakan ilustrasi untuk membantu menerangkan text

2
LAY OUT
▪ gunakan gaya yg layak : tak
banyah shadow, gambar lengkap,
line drawing
▪ gunakan ilustrasi sederhana
▪ gunakan images yg sudah
dikenal (ssai situasi sasaran)
▪ ilustrasi realis, tak abstrak
▪ ilustrasi proporsional (ukurannya)
▪ jika menggunakan simbol pretest
dulu
▪ gunakan warna yg pantas

3
TEXT
▪ gunakan kalimat aktif dan
pendekatan positif
▪ gunakan bahasa dan
perbendaharaan kata yg
sama
▪ ulangi pesan dasar
sekurangnya dua kali
▪ pilih jenis & ukuran huruf
shg mudah dibaca
▪ gunakan huruf besar &
kecil. Huruf besar semua
sulit baca
4
AN EFFECTIVE
POSTER OR
BILLBOARD
▪ dramatisasi single idea
▪ menarik perhatian dari
jarak 10 meter
▪ gunakan gambar sebagai
pembawa pesan
▪ memorable
▪ tunjukkan manfaat
▪ Pertahankan nada yg sama
pada semua pendekatan

5
6
7
8
9
10
11
12
13
X SENADA…………

14
15
A USEFUL LEAFLET
❑ Usahakan informasi yg tak terlupakan
❑ Gunakan gambar untuk bercerita, tak hanya dengan
kata-kata
❑ Tunjukkan perilaku kunci
❑ Gunakan gambar yg menarik
❑ Singkat
❑ Desain mudah digunakan
❑ urutan logis
❑ sesuaikan gambar/grafis dan bahasa sesuai target
audience

16
17
18
19
20
SOFTWARE
▪ Power point – cukup baik
▪ Canva dll
▪ Publisher
▪ Corel - Adobe

21
TUGAS
▪ Tiap kelas bentuk 12 kelompok:
1. 1. Untuk Kelompok Ibu Hamil dan
2. Untuk Kelompok Ibu Menyusui
3. 2. Untuk Kelompok Umur 1-3 tahun dan
4. Untuk Kelompok Umur 4-6 tahun
5. Untuk Kelompok Umur 7-9 Tahun dan
6. Anak Usia Sekolah 10-12 tahun
7. 4. Untuk Kelompok Umur 13-15 tahun
8. 5. Untuk Kelompok Umur 16-18 tahun
9. 6. Untuk Kelompok Umur 19-29 tahun
10. 7. Untuk Kelompok Umur 30-49 tahun
11. 8. Untuk Kelompok Umur 50-64 tahun
12. 9. Untuk Kelompok Umur >65 tahun

▪ Pedoman umum gizi seimbang

22
TUGAS
▪ Membuat
▪ brosur/leaflet
▪ Poster
▪ PPT – 30 menit

▪ Pembagian tugas ..semua praktik membuat

▪ PPT -

23
 Poltekkes Kemenkes Semarang

Facilitating Why and

How to Take Action
 Poltekkes Kemenkes Semarang

Memfasilitasi Mengapa dan

Bagaimana dalam Mengambil
Tindakan
 Analyses of the results of health campaigns revealed
that information alone
was not sufficient to lead to the desired behavior

Poltekkes Kemenkes Semarang 3

 Analisis hasil kampanye
kesehatan mengungkapkan bahwa
informasi saja tidak cukup untuk
mengarah pada perilaku yang
diinginkan

Poltekkes Kemenkes Semarang 4

Elements Contributing to Nutrition
Education Effectiveness

• A focus on behaviors/practices
• Determinants of behavior
• Use of theory
• Multiple levels and sufficient duration
• Strategies

Poltekkes Kemenkes Semarang 5

Elemen yang Berkontribusi pada
Kefektifan Pendidikan Gizi

Fokus pada Determinan Menggunakan

perilaku/praktik perilaku teori

Multilevel dan Beberapa

cukup waktu strategi

Poltekkes Kemenkes Semarang 6

A focus on behaviors/practices
• Focusing on Specific Behaviors, Actions, or
Practices Improves Effectiveness
• Food and Nutrition-Related Behaviors Can Be
Part of Broader Goals
• Critical Thinking Skills and Autonomy Are Still
Important

Popular author John C. Maxwell (2000) puts it this way:

“People change when they hurt enough that they
have to, learn enough that they want to, and receive
enough that they are able to.”

Poltekkes Kemenkes Semarang 7

Fokus pada perilaku/praktik

Fokus pada
Perilaku terkait
perilaku,
makanan dan gizi Keterampilan
tindakan, atau
dapat menjadi berpikir kritis dan
praktik yang
bagian dari otonomi masih
spesifik dapat
tujuan yang lebih penting
meningkatkan
luas
efektivitas

Penulis populer John C. Maxwell (2000) mengatakannya seperti ini:

"Orang berubah ketika mereka cukup terluka sehingga mereka harus,
belajar cukup yang mereka mau, dan menerima cukup yang mereka
mampu."

Poltekkes Kemenkes Semarang 8

Addressing the determinants of
action and behavior change

Poltekkes Kemenkes Semarang 9

Mengatasi faktor penentu tindakan
dan perubahan perilaku

Perilaku dan Pemilihan

Pendidikan Gizi Makanan terkait Diet

Poltekkes Kemenkes Semarang 10

Why Theory Is Important?
• Provides mental map of why a behavior or
behavior change occurs.
• Specifies the kinds of information that need to be
gathered before designing an intervention
• Provides nutrition educators guidance on exactly
how to design the various intervention
components
• Provides guidance on exactly what to evaluate to
measure the impact of the intervention, and how to
design accurate measuring instruments.
• Theory is generated from research in nutrition
education and related fields,
Poltekkes Kemenkes Semarang 11
Mengapa Teori Penting?

Menyediakan peta Menentukan jenis Memberikan panduan

mental mengapa suatu informasi yang perlu pendidik gizi tentang
perilaku atau perubahan dikumpulkan sebelum bagaimana merancang
perilaku terjadi. merancang intervensi berbagai komponen
intervensi

Memberikan panduan
tentang apa yang harus Teori dihasilkan dari
dievaluasi untuk mengukur penelitian di bidang
dampak intervensi, dan
bagaimana merancang pendidikan gizi dan
instrumen pengukuran yang bidang terkait,
akurat.

Poltekkes Kemenkes Semarang 12

ADDRESSING MULTIPLE
INFLUENCES ON
BEHAVIOR

Poltekkes Kemenkes Semarang 13

MENGATASI BEBERAPA
PENGARUH TERHADAP
PERILAKU

Poltekkes Kemenkes Semarang 14

A SOCIAL-ECOLOGICAL APPROACH

Poltekkes Kemenkes Semarang 15

A SOCIAL-ECOLOGICAL APPROACH

Poltekkes Kemenkes Semarang 16

PENDEKATAN SOSIAL-EKOLOGIS
Struktur tingkat sosial, kebijakan, dan
sistem: Berfokus pada kebijakan dan
struktur yang mengatur tindakan
kesehatan
Settings
Tingkat institusi/ Tingkat komunitas
organisasi
• Tempat kerja,
• Sekolah, Berfokus pada jaringan
• Pelayanan kesehatan sosial, norma, dan harapan
komunitas, toko kelontong
Peraturan
Kebiajkan Berfokus pada jaringan
sosial, norma, dan harapan
Struktur informal Tingkat interpersonal: Berfokus
komunitas, toko kelontong
pada keluarga, teman, teman
sebaya, interaksi dengan
profesional kesehatan, peran
sosial, dan jaringan sosial

Individual level:
Berfokus pada
psikobiologis🡪 pengala
man dengan makanan,
preferensi makanan,
menikmati makanan,
Nutrition
kepercayaan, sikap,
nilai, pengetahuan, education
sosial dan budaya
norma, atau
pengalaman hidup

Poltekkes Kemenkes Semarang 17

DESIGNING STRATEGIES FOR NE

Poltekkes Kemenkes Semarang 18

MERANCANG STRATEGI UNTUK
NE

Poltekkes Kemenkes Semarang 19

Factors influencing nutritional well-being
and the role of nutrition education.

Poltekkes Kemenkes Semarang 20

Faktor-faktor yang mempengaruhi
kesejahteraan gizi dan peran pendidikan gizi.

Poltekkes Kemenkes Semarang 21

Poltekkes Kemenkes Semarang 22
A logic model of theory-based NE

Poltekkes Kemenkes Semarang 23

Model logika NE . berbasis teori

Poltekkes Kemenkes Semarang 24

The example

Poltekkes Kemenkes Semarang 25

Contoh: Cooking with Kids

Poltekkes Kemenkes Semarang 26

Evaluation
In a pilot evaluation,
• more than 80% of the students reported liking the
foods cooked in the classroom,
• 75% chose the foods in the cafeteria, and
• 60% ate half or more of the lunch.
• About 50% of the parents reported that they used
Cooking with Kids recipes at home, and
• 65% said their children now ate more fruits and
vegetables at home.

Poltekkes Kemenkes Semarang 27

Evaluasi
Lebih dari 80% siswa melaporkan menyukai makanan
yang dimasak di kelas,

75% memilih makanan di kafetaria

In a pilot
evaluation 60% makan setengah atau lebih dari makan siang.

Sekitar 50% orang tua melaporkan bahwa mereka

menggunakan resep memasak dengan anak di rumah

65% mengatakan anak-anak mereka sekarang makan

lebih banyak buah dan sayuran di rumah.

Poltekkes Kemenkes Semarang 28

Thank you

Poltekkes Kemenkes Semarang 29

Identifying health
issues or needs and
intended audience

Poltekkes Kemenkes Semarang 30

Mengidentifikasi
masalah atau
kebutuhan kesehatan
dan audiens yang
dituju

Poltekkes Kemenkes Semarang 31

Design
Flowchart of steps in
designing theory-based
nutrition education.

Poltekkes Kemenkes Semarang 32

Desain
Flowchart langkah-langkah
merancang pendidikan gizi
berbasis teori.

Poltekkes Kemenkes Semarang 33

Poltekkes Kemenkes Semarang 34
 Pendidikan Gizi Pada Anak Sekolah
Dr. Heni Hendriyani, SKM MPH

Pendahuluan
Kesehatan sangat penting untuk pembangunan, tanpa kesehatan suatu negara dan
penduduknya tidak dapat berfungsi dengan baik. Gizi yang baik adalah salah satu pilar
pembangunan, dan bukan hanya karena makanan adalah kebutuhan paling dasar manusia. Tanpa
gizi yang tepat, kesehatan tidak mungkin. Jumlah dan jenis makanan yang dimakan orang, serta
kualitas dan keamanan gizinya, berdampak langsung pada kesehatan dan kesejahteraan manusia,
dan karenanya pada kemampuan mereka untuk bertindak guna meningkatkan kehidupan mereka
sendiri. Pendidikan juga penting untuk perkembanga untuk menciptakan pilihan dan peluang bagi
orang-orang, mengurangi beban ganda kemiskinan dan penyakit, dan memberikan suara yang lebih
kuat kepada individu-individu dalam masyarakat. Pendidikan menciptakan tenaga kerja yang
dinamis dan warga negara yang berpengetahuan luas yang mampu bersaing dan bekerja sama
secara global - membuka pintu menuju kemakmuran ekonomi dan sosial.

Mengapa pendidikan gizi penting?

Mengingat pentingnya peran gizi, kesehatan dan pendidikan bagi masyarakat yang aktif,
seperti dijelaskan di atas, intervensi yang menangani faktor-faktor ini tidak hanya mendesak tetapi
juga juga memiliki potensi untuk memberikan kontribusi besar bagi perekonomian suatu negara
secara keseluruhan dan perkembangan sosial. Pendidikan gizi adalah intervensi semacam itu.
Pendidikan gizi memberi pengetahuan, keterampilan dan motivasi untuk membuat pilihan
pola makan dan gaya hidup yang bijaksana, membangun dasar yang kuat untuk hidup sehat
dan aktif. Ada dua jenis utama masalah gizi kronis yang ditemukan di keduanya ujung spektrum
gizi buruk: hal-hal yang disebabkan oleh kurangnya asupan dan kualitas yang baik dan makanan
yang aman, dan yang disebabkan oleh asupan makanan yang berlebihan atau tidak seimbang atau
tertentu jenis makanan. Keduanya dapat dicegah atau dikurangi dengan pola makan yang memadai
atau tepat. Apakah persediaan makanan langka atau berlimpah, penting bagi orang-orang untuk
mengetahui caranya terbaik untuk menggunakan sumber daya mereka untuk mengakses berbagai
makanan yang aman dan berkualitas baik; untuk memastikan kesehatan gizi. Agar pangan terjamin

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dan cukup bergizi, rumah tangga membutuhkan sumber daya yang cukup untuk memproduksi dan
/ atau membeli makanan yang memadai. Selain itu, mereka membutuhkan pemahaman tentang apa
yang merupakan diet yang tepat untuk kesehatan, juga keterampilan dan motivasi untuk membuat
pilihan yang tepat tentang perawatan keluarga dan praktik pemberian makan. Pendidikan pangan
dan gizi dengan demikian memainkan peran penting dalam mempromosikan ketahanan pangan
sangat penting bagi rumah tangga miskin untuk mengoptimalkan penggunaan makanan dan praktik
lokal pola makan yang sehat. Pendidikan gizi yang efektif juga penting untuk memerangi
peningkatan penyakit tidak menular terkait makanan yang terlihat di banyak negara.

Mengapa pendidikan gizi penting di negara berkembang

Mengingat banyaknya permasalahan ekonomi dan lingkungan hidup yang berkembang,
pendidikan gizi mungkin tampaknya menjadi kepentingan kedua di sana. Kenyataan di negara-
negara ini justru menunjukkan sebaliknya, karena berbagai alasan:
• Tingkat kekurangan gizi yang tinggi (Vitamin A, yodium, zat besi anemia defisiensi dan
sebagainya) membutuhkan intervensi segera.
• Penyakit kronis yang berhubungan dengan diet, termasuk kelebihan berat badan dan obesitas,
meningkat negara berkembang serta di negara maju. Negara berkembang akan melakukannya
merasa sangat sulit untuk memikul beban ganda akibat penyakit kekurangan gizi dan kelebihan
serta ketidakseimbangan makanan.
• Pembangunan ekonomi dan manusia membutuhkan orang yang sehat.
• Tingkat pertumbuhan penduduk yang tinggi mempengaruhi seluruh sistem pangan suatu negara,
termasuk penduduknya perlu mempelajari dan menyesuaikan dengan perkembangan baru dalam
sistem.
• Terjadi migrasi yang lebih besar dari masyarakat pedesaan ke lingkungan perkotaan, di mana
orang bergantung sepenuhnya pada pasokan makanan komersial. Karena itu, pendatang baru perlu
keterampilan baru untuk memilih makanan bergizi.
• Perkembangan ekonomi dan globalisasi memperkenalkan makanan baru dan mengubah
kebiasaan makan dan pola gaya hidup, membuat pengetahuan dan keterampilan tradisional tidak
mencukupi dan tidak pantas. Pengetahuan baru dan keterampilan baru dibutuhkan untuk memilih
pola makan yang sehat sesuai dengan kebutuhan gizi. Gambar sering kali dapat menjelaskan
masalah yang kompleks lebih baik daripada banyak kata. Grafik di bawah ini, gambar dari foto1

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yang diambil di Namibia, secara mencolok menggambarkan mengapa pendidikan gizi penting di
negara berkembang.

Mengapa memberi pendidikan gizi melalui sekolah?

Sekolah adalah zona perkembangan alami untuk pendidikan gizi. Mereka adalah salah
satunya konteks sosial utama tempat gaya hidup dikembangkan. Anak-anak yang bersekolah usia
mengembangkan perilaku melalui interaksi dengan murid lain, guru, orang tua, saudara kandung
dan kelompok sebaya. Mereka dipengaruhi oleh rumah mereka, komunitas mereka, massa media
dan sekolah. Dengan demikian sekolah merupakan bagian dari jaringan pengaruh yang mana
bentuk pola makan dan sikap. Sekolah juga merupakan tempat yang ideal untuk mempromosikan
makan sehat, karena banyak alasan lain:
• Mereka menjangkau sebagian besar anak, selama beberapa tahun, secara teratur.
• Mereka memiliki mandat untuk membimbing kaum muda menuju kedewasaan. Mengingat
perannya yang vital gizi dalam hidup terpenuhi sehat, pendidikan gizi adalah bagian dari tanggung
jawab ini.
• Mereka memiliki personel yang memenuhi syarat untuk mengajar dan membimbing.
• Mereka menjangkau anak-anak pada usia kritis ketika kebiasaan dan sikap makan sedang
berkembang mapan.
• Mereka memberikan kesempatan untuk mempraktikkan pola makan sehat dan keamanan pangan
di sekolah melalui program memberi makan, dan melalui penjualan makanan di tempat mereka.
• Mereka dapat menetapkan kebijakan dan praktik sekolah - misalnya, fasilitas sanitasi, aturan
tentang mencuci tangan - yang dapat meningkatkan kesehatan dan gizi.
• Mereka menyebarkan pengaruhnya dengan melibatkan keluarga dalam pendidikan gizi anak-
anak mereka.
• Dapat menjadi saluran partisipasi masyarakat, misalnya melalui proyek taman sekolah atau
kantin sekolah, atau melalui komite lintas sektoral setempat.
• Mereka dapat memberikan intervensi gizi yang hemat biaya (selain pendidikan). Sekolah dasar
merupakan sarana yang sangat cocok untuk pendidikan gizi.
Mereka menangkap anak-anak yang lebih muda, saat kebiasaan mereka masih dibentuk.
Mereka mencapai proporsi yang lebih besar dari populasi - khususnya anak perempuan, yang
cenderung meninggalkan sekolah lebih awal. Apalagi gizi pelajarannya sederhana, menarik, penuh

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warna dan mudah dipelajari dengan demonstrasi, ilustrasi, contoh dan tindakan praktis -
pendekatan yang alami untuk pendidikan dasar.

Classroom
curriculum

School Links with

environment family and
community

Gambar 1. Kurikulum tripartit pendidikan gizi berbasis sekolah

Pendekatan kelas juga akan dikondisikan oleh fakta bahwa pendidikan gizi, seperti
pendidikan kesehatan, berkaitan dengan perilaku dan sikap serta dengan pemahaman. Ini
membutuhkan lebih banyak keterlibatan diri daripada dengan mata pelajaran lain. Anak-anak perlu
mengalami, mengamati, bereksperimen, berdiskusi, mendengar orang lain - di atas segalanya,
untuk secara aktif terlibat dalam menafsirkan pengalaman dan membuat pilihan. Demikianlah
konsep promosi kesehatan, dan hakikat pembelajaran gizi itu sendiri, keduanya menentukan apa
yang harus dipelajari, bagaimana itu dipelajari dan di mana. Untuk sekolah, ini mungkin berarti
banyak jenis adaptasi:
• membangun hubungan kerja yang baik dengan keluarga dan masyarakat;
• lebih terlibat dengan lingkungan lokal mereka dan praktik makanannya;
• membentuk konten kelas sesuai dengan situasi lokal;
• mengatur kunjungan lapangan, acara dan proyek;
• mengembangkan kebijakan sekolah;
• mengadaptasi pendekatan dan materi kelas.
Untuk otoritas pendidikan dan kementerian, mereformasi kurikulum pendidikan gizi akan
berarti pendekatan multisektoral dan multi-level yang luas di beberapa bidang, termasuk:
• pengembangan kurikulum;
• pelatihan guru;

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• produksi material;
• bantuan dan dukungan lain untuk sekolah.
Kurikulum sekolah umumnya penuh sesak dan didominasi oleh ujian. Gizi apa pendidikan
di sana (dan terkadang hampir tidak ada) seringkali terbatas dan tertutup hanya sebentar dalam
silabus ekonomi rumah tangga. Namun, ruang harus dibuat untuk gizi pendidikan dalam dirinya
sendiri. Makan sehat adalah inti dari masyarakat yang sehat, dan pendidikan gizi berbasis sekolah
dapat memberikan kontribusi penting bagi pola makan sehat.

Kesimpulan
Pendidikan gizi yang baik - terutama jika disampaikan dengan cara yang disarankan
Panduan ini - membantu anak-anak menjadi "melek gizi". Anak-anak yang dididik dengan cara ini
akan datang mengetahui, misalnya, bagaimana mencapai pola makan yang baik dengan sarana
terbatas, makanan apa yang bergizi berharga, di mana menemukannya, bagaimana menyiapkan
makanan dengan aman dan membuatnya menarik, dan bagaimana caranya hindari bahaya
makanan. Dengan kata lain, bagaimana membuat makanan- dan gaya hidup-pilihan yang baik dan
kembangkan kebiasaan makan yang baik untuk diri sendiri dan orang lain (misalnya, orang tua
atau orang sakit). Jika mereka berada dalam komunitas pertanian, mereka akan memiliki ide-ide
bagus (lama dan baru) tentang apa yang akan ditanam dan bagaimana cara mengolahnya,
memanennya dan mengawetkannya.
Di daerah perkotaan mereka akan tahu di mana harus berbelanja, gerai makanan mana yang
tidak higienis dan bagaimana cara memberi a dianggap sebagai reaksi terhadap iklan yang
memikat. Semua akan tahu pentingnya kebersihan air yang aman untuk minum dan mencuci. Saat
mereka menjadi orang tua, mereka akan sadar akan resiko gizi yang ditimbulkan oleh kehamilan
wanita dan bayi, tahu tentang menyusui dan makanan pendamping, dan jadilah mampu
membangun kebiasaan makan dan kebersihan yang baik pada anak mereka sendiri. Orang dewasa
yang buta gizi akan tahu di mana mendapatkan jawaban atas pertanyaan tentang makanan dan diet,
akan menghormati budaya diet tetapi tahu bagaimana memvariasikan dan memperluasnya, akan
menantang mitos makanan berbahaya, dan akan memiliki latar belakang pendidikan untuk
dipahami kebijakan komunitas, campur tangan dalam perdebatan dan promosikan tindakan untuk
kesehatan.

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Referensi
FAO 2005 Nutrition Education in Primary Schools ISBN 92-5-105454-1

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 Pendidikan Gizi di Tempat Kerja
Dr. Heni Hendriyani, SKM MPH

Pendahuluan
Menciptakan Lingkungan Gizi Tempat Kerja yang Sehat membahas pentingnya makan
sehat dalam konteks tempat kerja dengan menghadirkan hubungan antara gizi, produktivitas, dan
pencegahan penyakit kronis(berkembang diusia kerja) di antara karyawan. Kebiasaan makan saat
ini berkontribusi pada peningkatan tingkat kesehatan terkait gizi kondisi seperti penyakit jantung,
stroke, diabetes tipe 2, beberapa jenis kanker, obesitas dan depresi. Ini adalah waktu untuk
mengatasi kebiasaan makan yang buruk di Ontarians. Pendidikan gizi di tempat kerja sangat
penting mengingat:
1. Sebagian besar orang dewasa yang bekerja menghabiskan setidaknya 60% dari jam bangun
mereka di tempat kerja dan makan setidaknya satu kali makan selama hari kerja, tempat kerja
adalah tempat yang ideal untuk mempromosikan pola makan yang sehat.
2. Gizi yang memadai penting untuk kesehatan dan vitalitas karyawan secara keseluruhan.
Mempromosikan makan sehat di tempat kerja dapat membantu mencegah biaya tempat kerja
yang berkaitan dengan ketidakhadiran, penurunan produktivitas, peningkatan premi asuransi,
biaya medis, biaya obat resep, serta tingkat cedera, kecacatan, dan pensiun dini yang lebih
tinggi.
3. Tempat kerja sebaiknya menciptakan Lingkungan Gizi Tempat Kerja yang Sehat dengan
menyediakan lingkungan dan kondisi yang mendorong kesehatan yang baik dan mendukung
pola makan yang sehat.

Ada sembilan elemen penting untuk Lingkungan Gizi Tempat Kerja yang Sehat. Sembilan
elemen penting tersebut adalah:

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1. Komitmen organisasi untuk budaya makan sehat yang positif
2. Lingkungan makan sosial yang mendukung
3. Lingkungan makan fisik yang mendukung.
4. Akses ke makanan sehat, harga terjangkau, dan sesuai budaya.
5. Pendidikan gizi yang kredibel dan dukungan sosial bagi karyawan dan keluarganya
6. Pendidikan gizi untuk pengambil keputusan utama dan perantara disediakan oleh Ahli Gizi
Terdaftar.
7. Akses ke layanan dari Ahli Gizi Terdaftar
8. Praktik makanan yang aman dan akomodasi kebutuhan diet khusus.(karyawan yang sakit,bisa
diberikan makanan khusus)
Kebijakan gizi yang mendorong pola makan sehat Untuk mencapai sembilan elemen
esensial, tindakan yang disarankan telah diusulkan untuk pemangku kepentingan termasuk:
pengusaha, operator layanan makanan, distributor makanan, anggota serikat, perusahaan asuransi
tunjangan kelompok, pemerintah provinsi dan kesehatan masyarakat. Sangat direkomendasikan
agar semua tempat kerja menerapkan Standar Gizi untuk Tempat Kerja yang menekankan
makanan dan minuman dengan "Nilai Gizi Maksimum". Standar Gizi untuk Tempat Kerja dapat
digunakan untuk menilai makanan dan minuman yang ditawarkan dan dijual di tempat kerja untuk
menentukan apakah mereka mengikuti rekomendasi makanan sehat.
Para pemangku kepentingan termasuk pengusaha, operator layanan makanan, distributor
makanan, anggota serikat, perusahaan asuransi tunjangan kelompok dan pemerintah provinsi
untuk mengakui bahwa lingkungan gizi saat ini di tempat kerja adalah masalah kesehatan
masyarakat yang signifikan yang perlu ditangani dan menyadari bahwa tempat kerja memainkan
peran penting dalam menciptakan dan memelihara budaya yang mendorong dan mencontohkan
praktik tempat kerja yang wajar dan sehat. Ajakan Bertindak menawarkan kerangka kerja yang
didasarkan pada sembilan elemen penting, yang dapat digunakan oleh pemangku kepentingan
utama untuk menciptakan, menerapkan, dan mendukung Lingkungan Gizi Tempat Kerja yang
Sehat di dalam yurisdiksi mereka sendiri dengan menggunakan model kesehatan tempat kerja yang
komprehensif
Makan sehat dikaitkan dengan risiko yang lebih rendah untuk mengembangkan penyakit
kronis terkait gizi. Pola makan sehat ditentukan seiring waktu karena orang-orang dari segala usia
mengalami fluktuasi nafsu makan dan asupan makanan dan minuman karena berbagai alasan. Ini

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adalah pola keseluruhan makanan yang dimakan dari waktu ke waktu dan bukan satu makanan
atau makanan apa pun yang menentukan apakah perilaku makan itu sehat. Mempromosikan makan
sehat di tempat kerja mempertimbangkan hal ini dan mengambil pendekatan makan yang positif,
hormat, dan suportif. Gizi yang memadai penting untuk kesehatan dan vitalitas karyawan secara
keseluruhan. Karyawan yang memiliki manfaat kesehatan yang optimal lebih cenderung berada di
tempat kerja dan berkinerja baik. Produktivitas dan konsentrasi dapat dioptimalkan di tempat kerja
dengan menyediakan waktu yang cukup untuk makan dan akses ke makanan sehat di tempat kerja.
Pola makan yang sehat dikaitkan dengan kejadian yang lebih rendah dari kondisi kronis terkait
gizi seperti penyakit jantung, stroke, obesitas, diabetes tipe 2, beberapa jenis kanker dan depresi.
Mempromosikan makan sehat di tempat kerja dapat berkontribusi pada pengurangan
1) biaya di tempat kerja terkait ketidakhadiran,
2) tingkat cedera dan kecacatan,
3) premi asuransi, biaya obat resep, biaya medis dan kompensasi pekerja,
4) pensiun dini
5) tabrakan mobil, biasanya terkait dengan perkembangan kondisi kesehatan terkait gizi.
Membuat perubahan di tempat kerja yang mendukung pola makan sehat dapat
meningkatkan produktivitas dan membantu individu yang memiliki penyakit kronis untuk
mengelola kondisi mereka.
Konsumsi sayuran (khususnya sayuran hijau tua dan oranye), buah utuh dan biji-bijian
tidak mencukupi. Hal ini dapat berkontribusi pada perkembangan tekanan darah tinggi, kolesterol
tinggi, sindrom metabolik, penyakit jantung, stroke, diabetes tipe 2, jenis kanker tertentu, obesitas,
penyakit ginjal dan osteoporosis. Konsekuensi negatif dan implikasi jangka panjang dari praktik
makan yang tidak sehat tidak dapat dilebih-lebihkan. Meningkatnya prevalensi penyakit kronis
akan berdampak pada angkatan kerja, karena adanya kondisi kesehatan kronis dikaitkan dengan
berkurangnya partisipasi dalam angkatan kerja. Selain itu, praktik makan yang tidak sehat akan
terus membebani sistem perawatan kesehatan. Sebagai contoh pada tahun 2007, penyakit kronis
bertanggung jawab atas 79% dari semua kematian di Ontario. Dari kematian ini, 80% disebabkan
oleh penyakit kronis yang berhubungan dengan gizi seperti penyakit kardiovaskular, kanker dan
diabetes tipe 2. Penyakit yang dapat dicegah ini menurunkan kualitas hidup kita , ekonomi dan
masyarakat.

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Referensi

Ontario Society of Nutrition Professionals in Public Health Workplace Nutrition Advisory Group. 2012.
Call to Action: Creating a Healthy Workplace Nutrition Environment.

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 Pendidikan Gizi di Masyarakat
Dr. Heni Hendriyani, SKM MPH

Pendahuluan

Kebiasaan makan mempengaruhi kekuatan fisik dan perkembangan kondisi penyakit

tertentu. Di era ilmiah, banyak bukti yang mendukung peran diet dalam timbulnya banyak penyakit
kronis. Abad ke-21 terbuka untuk nutrigenomik dan kemungkinan untuk merancang strategi
pemberian makan yang optimal dan nutrisi yang sesuai dengan kebutuhan individu berdasarkan
faktor penentu genetik. Bukti ilmiah telah menempatkan gizi masyarakat di antara strategi garis
depan dalam promosi kesehatan dan sebagai bidang wajib untuk dimasukkan dalam setiap rencana
kesehatan. Konsep dan kerangka kerja Gizi masyarakat didefinisikan sebagai kelompok kegiatan
yang terkait dengan Gizi Terapan dalam konteks Kesehatan Masyarakat, yang tujuan utamanya
adalah menyesuaikan pola pangan individu dan populasi sesuai dengan pengetahuan ilmiah terkini,
di wilayah tertentu dengan tujuan akhir promosi kesehatan. Gambar 1 mendeskripsikan elemen
kunci yang menarik terkait dengan aksi gizi masyarakat. Unsur-unsur ini harus dibahas dengan
tujuan khusus dalam rencana dan kebijakan kesehatan di tingkat regional dan nasional.

Gambar 1. Action areas under the scope of community nutrition.

COMMUNITY-LEVEL ACTIVITIES

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A community refers to both a physical locality where a group of people live and to a group of
people who share common interests. Nutrition educators work in almost every community, so
community projects abound.

Community Capacity Building

Community capacity may be described as the characteristics of communities that affect their ability
to identify, mobilize, and address social and public health problems (Goodman et al. 1999). It is
similar to the idea of social capital, where the structure of social relationships facilitates
coordination and cooperation for mutual benefit. Nutrition educators can participate in the process
by working in coalition with others to enhance collective efficacy and empowerment to increase
community capacity.

Collective Efficacy

Collective efficacy is the belief of groups and community members that they have the
capacity to take collective action to create change in their environment. Bandura (2001) notes that
because human functioning is rooted in social systems, personal agency operates within a broad
network of social structures that individuals, in turn, also help to create. Thus, personal agency and
social structures operate interdependently. According to Bandura (2001), personal agency is not
about self-centered individualism; rather, studies show that a high sense of efficacy tends to
promote a prosocial orientation, involving cooperativeness and an
interest in each other’s welfare. Collective efficacy can be enhanced by “equipping people with
a firm belief that they can produce valued effects by their collective action and providing
them with the means to do so” (Bandura 1997). This is a group enablement process. Group
efficacy becomes more than the sum of the personal efficacies of group members because there is
an interaction among members and a coordination of their skills, competencies, and activities. In
parallel to personal self-efficacy, the strength of individuals’ belief in their collective efficacy
determines the goals they are willing to set, how much effort they put into the group’s endeavors,
how much they are willing to persist in the face of difficulties, their morale and resilience, and
their level of performance.

Building Collective Efficacy Through Group Goal Setting

2
Collective efficacy involves the power to produce change in the social or political environment.
Social cognitive theory suggests that to build collective efficacy, individuals need to learn how to
exert influence

Community-Level Interventions

Numerous community-level interventions have been conducted over the years, including
early large-scale projects such as the Stanford, Minnesota and Pawtucket heart health programs
(Shea & Basch 1990a, 1990b). Community-based interventions are those in which the community
is very much involved in the design, implementation, and evaluation of the program through
partnerships and coalitions. This allows for the intervention to be based on the assets of the
community as well as the deep understanding members of the community have about themselves.
Many recent interventions have addressed the issue of obesity (Economos & Irish-Hauser 2007;
DeMattia & Denney 2008). Here are a couple of examples.

Shape Up Somerville (SUS): Eat Smart, Play Hard SUS was a community-based
participatory research project that illustrates the social ecological approach. It addressed the
concerns about childhood obesity by addressing children’s before school, during school, after
school, home, and community environments.

HOPE (Health Opportunities, Partnerships, Empowerment) Works

HOPE Works was a community-based participatory research project that recognized the
importance of positive psychology and hope to make health and life changes. It involved low-
income, ethnically diverse rural women. The model used the idea of “talking circles” in Native
American communities. Community women were trained to organize and facilitate HOPE circles
of 8 to 12 women from their social networks. These circles met twice a month for 6 months, where
they set goals for health and social/economic improvement and learned about healthy eating,
physical activity, economic empowerment, financial literacy, and
developing small businesses. The program evaluation involved surveys, pedometers, food diaries,
and weight measurements. Preliminary results showed that HOPE Circle participants decreased
their body mass index (BMI) compared to comparison women and significantly increased their
fruit and vegetable intake and physical activity. They also started small businesses (Benedict &
Campbell 2009).

3
Farmers’ Markets

Many communities now have initiated farmers’ markets where local growers can bring their
produce and other farm products into cities at markets set up by the community. Supplemental
Nutrition Assistance Program Electronic Benefit Transfer (EBT) cards often are accepted at these
markets, making fresh local foods available to low-income residents in communities.

Physical Locality Effects

There is evidence that neighborhoods have an impact on obesity and health (Harrington &
Eliot 2009; Dengel et al. 2009). Within neighborhoods are many retail food stores such as
supermarkets and grocery stores, and restaurants and fast food outlets. There is an association
between access to supermarkets and healthier food intakes, such as increased fruit and vegetable
intakes, mostly because supermarkets tend to offer a greater variety of foods at a lower cost.
Nutrition interventions within grocery stores using point-of-choice information, increased
availability, increased variety, pricing, and promotional strategies have resulted in moderate
improvements in healthy eating behavior such as fruit and vegetable consumption (Glanz et al.
2007). The term food deserts has come to describe areas within urban centers as well as in rural
areas where low-income people do not have access to fruits, vegetables, and other wholesome,
healthful foods at affordable costs (Smith & Morton 2009).

Researchers are using geographic information systems (GISs) to map locations of

supermarkets in geographic areas to identify such deserts. Nutrition educators have worked in
coalition with others to change policies so as to encourage supermarkets to locate in these deserts.
The built environment and walkability of neighborhoods have also been shown to be associated
with health conditions. Walkability includes the notion of safe streets, attractive sidewalks with
places of interest, and connections to places people need to go. Higher neighborhood walkability,
for example, is associated with more walking, lower BMI, and lower blood pressure (Rohere,
Pierce, & Dennison 2004; Rundle et al. 2008; Li et al. 2009). Again, in coalition with others,
nutrition educators have worked to increase availability of safe and attractive places for people to
walk.

Investment in Community-Level Actions

4
 A number of foundations have invested grant funding to improve community
empowerment and changes in policy and environment to support healthy eating and physical
activity. Among them is the Robert Wood Johnson Foundation’s (RWJF) Active Living and
Healthy Eating (Sallis et al. 2009) and Bridging the Gap (Chaloupka & Johnston 2007) initiatives,
which support research to identify promising policy and environmental strategies for increasing
physical activity, promoting healthy eating, and preventing obesity (http://www.rwjf.org). The W.
F. Kellogg Foundation’s national Food & Fitness Initiative within its Food and Community
Program has invested locally in several communities around the United States in collaborative
efforts dedicated

2. Penyuluhan Gizi di Fasilitas Kesehatan

Tim interprofesional perlu memeriksa bagaimana memasukkan RD secara sistematis ke
dalam pendidikan mereka. Prinsip panduan untuk masa depan Upaya masa depan untuk mengubah
cara kita mengintegrasikan nutrisi dan aktivitas fisik ke dalam pendidikan dan pelatihan
profesional perawatan kesehatan perlu mengikuti serangkaian prinsip panduan yang ditetapkan
dengan jelas yang dibangun di atas pendekatan multidisiplin.

Prinsip-prinsip yang disajikan di bawah ini berlaku untuk semua profesional perawatan
kesehatan dan dengan demikian merupakan tema lintas sektoral untuk pelatihan profesional
perawatan kesehatan:

1) Profesional perawatan kesehatan harus menerapkan praktik nutrisi yang direkomendasikan dan
mempromosikan panduan diet saat ini yang dikeluarkan oleh agen federal dan masyarakat
profesional untuk pencegahan dan pengobatan penyakit. Praktik dan prinsip harus berbasis bukti,
mencerminkan keadaan sains saat ini, dan diterapkan sesuai dengan praktik terbaik.

2) Dasar-dasar NCP, pendekatan sistematis yang saat ini digunakan sebagian besar oleh ahli diet /
ahli gizi untuk menyediakan perawatan gizi berkualitas tinggi yang mencakup penilaian gizi,
diagnosis, intervensi berdasarkan akar penyebab, dan pemantauan / evaluasi (71) harus disesuaikan
yang sesuai untuk penyedia layanan kesehatan lainnya. Proses ini harus menentukan peran khusus,
seperti siapa yang merujuk dan kapan, interaksi antara profesi, dan bagaimana tim multidisiplin
bekerja sama untuk hasil kesehatan terbaik bagi pasien mereka. Pendidikan nutrisi interprofesional

5
sangat penting untuk menanamkan pendekatan tim dalam pengajaran, pelatihan, dan pembelajaran
serta perawatan pasien.

3) Penting untuk mengenali dan mempromosikan peran unik RD dalam tim perawatan kesehatan,
bermitra dengan dokter dalam penilaian nutrisi, rekomendasi terapeutik, dan tindak lanjut bersama
pasien sebagai landasan NCP. Meskipun sangat mendukung pendekatan multidisiplin, peran unik
dan esensial ahli gizi dalam proses perawatan perlu digarisbawahi. RD juga memainkan peran
kunci dalam mengajar dan memberikan pelatihan bagi profesional perawatan kesehatan lainnya.

4) Pendidikan gizi di sekolah kedokteran / profesional perlu disampaikan dalam konteks

pendekatan yang paling mutakhir untuk desain dan penyampaian kurikulum dengan menggunakan
pendekatan terpadu dan longitudinal daripada berfokus pada kursus tunggal atau disiplin yang
terpisah. Pendekatan ini mengalihkan fokus dari menghafal dan menuju integrasi yang lebih
bermakna dari konstruksi baru dengan pengetahuan yang ada (90).

5) Pengalaman pendidikan gizi harus melibatkan upaya kolaboratif dari berbagai pemangku
kepentingan dan pendekatan paling inovatif untuk pengajaran yang efektif, seperti pembelajaran
berbasis masalah, pembelajaran berbasis kasus, metodologi perilaku seperti wawancara motivasi,
simulasi, bermain peran, dan modalitas lainnya ( 99). Sumber daya untuk menyediakan kandungan
nutrisi dalam konteks pendekatan ini harus tersedia sepenuhnya untuk tim pengajar.

6) Penting untuk memahami penerapan penelitian berbasis bukti dalam pengembangan pedoman
diet dan gizi untuk kesehatan masyarakat dan untuk dapat menerapkan pengetahuan tersebut ke
arah hasil pasien yang lebih baik. Pengalaman pendidikan harus mencakup penjelasan menyeluruh
tentang bagaimana pedoman berbasis bukti diturunkan serta pelatihan interaktif tentang evaluasi
temuan penelitian di masa depan dan penerapannya pada praktik klinis.

7) Harus ada penekanan yang lebih besar pada penelitian pendidikan yang mengidentifikasi dan
memvalidasi strategi untuk memberikan pendidikan gizi kepada pelajar profesional perawatan
kesehatan dan dokter praktik. Pendekatan pendidikan gizi baru yang diterapkan di masa depan
akan membutuhkan penilaian obyektif untuk kemanjuran dan keefektifan. Akan ada kebutuhan
untuk mempelajari pendekatan pendidikan di seluruh ranah profesional medis / perawatan
kesehatan, terutama yang berkaitan dengan penggabungan nutrisi ke dalam kurikulum pelatihan
profesional perawatan medis / kesehatan yang baru berkembang. Profesional perawatan kesehatan

6
harus memperhatikan masalah kesehatan populasi yang mempengaruhi kelompok yang berbeda.
Melekat pada hal ini adalah memiliki pemahaman tentang faktor penentu sosial kesehatan untuk
menjadi manajer perubahan yang efektif (100).

Rekomendasi penelitian Berdasarkan kenyataan bahwa kurikulum pendidikan gizi untuk

para profesional perawatan kesehatan belum terintegrasi dengan baik dalam program pendidikan
dan pelatihan, maka perlu dilakukan penelitian untuk mengidentifikasi model pendidikan dan
pelatihan terbaik dan pengaruhnya terhadap praktik profesional perawatan kesehatan, manfaat
selanjutnya pada hasil pasien, dan dampak pada kesehatan masyarakat dan biaya terkait. Investasi
yang cukup besar dalam penelitian diperlukan untuk mengembangkan dan melaksanakan program
pendidikan gizi yang paling efektif di seluruh kontinum pendidikan dan pelatihan profesional
perawatan kesehatan dan medis. Ini diklasifikasikan sebagai rekomendasi lintas sektoral untuk
semua profesional perawatan kesehatan serta yang secara khusus relevan dengan sekolah
kedokteran, program residensi dan fellowship, dan profesional perawatan kesehatan lainnya (Tabel
4). Kepemilikan tantangan / solusi Institut NIH memberikan kepemimpinan yang kuat untuk model
pendidikan nutrisi biomedis yang baru dan ditingkatkan yang akan menjadi bagian integral dari
pelatihan profesional perawatan medis dan kesehatan lainnya. Dengan bimbingan dan dukungan
mereka, kami mengembangkan strategi baru yang inovatif yang dibangun di atas inisiatif
sebelumnya seperti NAA dan membawa komponen perawatan kesehatan penting ini ke tingkat
keunggulan berikutnya.

Untuk memastikan bahwa upaya dan kemajuan ini akan berkelanjutan, diperlukan
kolaborasi berbagai pemangku kepentingan. Pemangku kepentingan utama meliputi: lembaga
pendidikan tinggi, masyarakat profesional, dewan kredensial, praktisi profesional perawatan
kesehatan, spesialis pendidikan, pembuat kebijakan, konsumen perawatan kesehatan, profesional
perawatan kesehatan masyarakat, dan industri perawatan kesehatan secara keseluruhan (baik
penyedia maupun perusahaan asuransi ). Upaya untuk mencapai dukungan untuk inisiatif ini akan
ditingkatkan dengan pembentukan kompetensi inti, yang memberikan kerangka kerja terorganisir
untuk menginformasikan pemangku kepentingan dan membawa mereka ke dalam diskusi (101).
Demikian pula, kolaborasi antara pendidik dan dokter akan meningkatkan baik pengembangan
pendekatan pendidikan baru serta studi penelitian penting yang diperlukan untuk memberikan
bukti ilmiah tentang keefektifannya (102). Diharapkan bahwa kelompok seperti NHLBI dan ASN

7
akan bekerja sama untuk menciptakan kompetensi gizi umum dan pedoman kurikulum yang
diadopsi di berbagai disiplin ilmu untuk meningkatkan pendidikan dan pelatihan profesional
perawatan kesehatan untuk perbaikan kesehatan penduduk.

Cross-cutting research recommendations

· Identify and evaluate new approaches or strategies for educating health care professionals about
nutrition and healthy lifestyle behaviors
· Conduct research on how interprofessional nutrition education with multidisciplinary teams
contributes to more coordinated care and better performance and patient outcomes
· Evaluate newer models of instruction (eg, competency-based curricula, interprofessional team-
based education, information technology– empowered learning, patient and population centered)
on health care professionals’ skills and competencies
· Evaluate the efficacy of the 2 types of training (integrative and traditional approaches) or their
combinations on nutrition learning and assess patient outcomes of the traditional and
nontraditional (integrative/innovative) models
· By using new technologies (electronic medical records, electronic monitoring devices for food
intake and physical activity), test whether health care professional training improves compliance
with diet and healthy lifestyle modification among patients
· Conduct studies that evaluate the nutrition content of board examinations
· Evaluate the current curricula of medical schools, residency and fellowship programs, and
continuing education programs (eg, for other health care professionals such as nurses, dentists,
and pharmacists) to assess their nutrition content
· Update and evaluate the effectiveness of the Nutrition Academic Award Curriculum Guide for
the Health Professions through coordinated nutrition education, research, and training activities
for health care professionals, including those for medical students, residents and fellows, nurses,
pharmacists, dentists, physician assistants, and other clinicians and health care professionals to
encourage interprofessional training and collaboration
· Evaluate the updated competency-based curricula in nutrition for all health care professionals
· Identify “best practices” related to nutrition education and patient care in medical schools,
residency and fellowship programs, and in other health care professional programs (eg, nursing,
dental, dietetics, pharmacy)
· Test new approaches for incorporating nutrition in the training of residents, fellows, and other

8
health care professionals (eg, use of new technology and training modules)
· Determine how one can build capacity to increase nutrition knowledge and practice by
considering continuing professional education by dietitians and nutrition researchers to update
nurses, nurse practitioners, and other health care providers

Referensi

1. Contento, I R. 2011. Nutrition education : linking research, theory, and practice 2nd ed.
Jones and Bartlett Publishers, LLC Massachusset.
2. J Aranceta 2003. Community nutrition. European Journal of Clinical Nutrition
volume 57, pagesS79–S81(2003)
3. Smart Choices: A Community Nutrition Education Program
https://snaped.fns.usda.gov/library/materials/smart-choices-community-nutrition-
education-program accessed 15 feb 2021 Developer Louisiana State University
Agricultural Center. Year 2005
4. Penny M Kris-Etherton, Sharon R Akabas, Connie W Bales, Bruce Bistrian, Lynne Braun,
Marilyn S Edwards, Celia Laur, Carine M Lenders, Matthew D Levy, Carole A Palmer,
Charlotte A Pratt, Sumantra Ray, Cheryl L Rock, Edward Saltzman, Douglas L Seidner,
and Linda Van Horn. 2004. The need to advance nutrition education in the training of
health care professionals and recommended research to evaluate implementation and
effectiveness1–4 Am J Clin Nutr 2014;99(suppl):1153S–66S. American Society for
Nutrition

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9
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ver
seCul
tur
alGr
oups
c.Soci
oeconomi
csBackgr
ound
d.Gat
ekeeper
s:Deci
cion Maker
s and
Pol
i
cyMaker
s
e.Gov
ernment
2.Manakah y
ang mempengar
uhior
ang unt
uk
memi
l
ihsuat
umakananmenur
utsoci
alpr
efer
ence
?
a.col
or,
shapeoff
ood
b.f
oodsmel
l
,tast
eandgar
nish
c.Packagi
ngandshapeoff
ood
 d.Tast
e,av
aibi
l
ityandconv
eni
ence
e.t
ypeoff
oodandf
oodl
abel

9. Audi
Gal
uhAzhar
i Mat
eri:Nut
ri
ti
onEducat
ion
P1337431220010 1.Memuncul kanataumemi mpin,dandapatdil
ihat
sebagaipr oses yang ti
dak hanya member i
kan
pengetahuan,inf
ormasi,dan keter
ampi l
an t
etapi
j
ugamendor ongperkembangan,pert
umbuhan,dan
perubahan,merupakanpengert
iandari…
a.Educationalst
rategi
es
b.Desi
gned
c.Faci
l
itat
e
d.Vol
unt
ary
e.St
rat
egi
es
2.
Berikutmerupakant ant
angan-t
ant
angandal
am
Educati
ngPeople,kecuali
…

a.Bi
ologi
cal
Inf
luences

b.Cul
tur
alandSoci
alPr
efer
ences

c.Fami
l
yandPsy
chol
ogi
cal
Fact
ors

d.SenseofEmpower
ment

e.Cl
i
mat
echange

10. Put
riAul
i
aAzi
zzah
Mat
eri
:FoodBasedDi
etar
yGui
del
i
nes
P1337431220011

ang t
1.Susunan y idak t
epatdar
imakanan
ber
agam, sei
mbang, dan sehat akan
ber
var
iasi
ter
gant
ungpada.
..
a.Kebut
uhani
ndi
vi
du
b.Gay
ahi
dup
c.Kont
eksbuday
a
d.Makanany
angt
ersedi
a
e.Makanandi
etsehat
2.Hal
-hal y
ang har
us di
per
hat
ikan dal
am
mengembangkan pendi
dikan gi
zi bagi
 masy
arakatadal
ah…
a.Dapatdi
ter
imasecar
abuday
a
b.Car
a pengol
ahan dan per
siapan
makanan
c.Var
iasi
kel
ompok
d.Teknol
ogi
e.Zatgi
zidanz
atnon-
giz
i

11. AmandaAul
i
aRahma
Mat
eri
:FoodBasedDi
etar
yGui
del
i
nes
P1337431220012
1. Ser
angkai
an pengal
aman bel
ajar y
ang
di
desai
n unt
uk memf
asi
l
itasi adopsi
per
il
aku makan dan gi
zisecar
a sukar
ela
y
ang kondusi
f unt
uk kesehat
an dan
kesej
aht
eraanmer
upakandef
ini
sidar
i?
A.PedomanGi
zi
B.Pendi
dikanGi
zi
C.KandunganGi
zi
D.Ahl
iGi
zi
E.Penel
i
tianGi
zi

2.Susunany
angt
epatdar
imakananber
aneka
r
agam,sei
mbangdansehatakanber
var
iasi
t
ergant
ung pada kont
eks di
bawah i
ni,
kecual
i
?
A.Makanan y
ang t
ersedi
a secar
a adat
i
sti
adat
B.Kebut
uhani
ndi
vi
du
C.Kont
eksbuday
a
D.Kebut
uhanpol
i
tik
E.Makanany
angt
ersedi
asecar
alokal

12. Fat
imahAzzahr
a Mat
eri:FoodBasedDi
etar
yGui
del
ines
 P1337431220013 1.Pedomangi
ziper
tamakal
idi
publ
i
kasi
kandi
....padat
ahun....
a.Amer
ikaSer
ikat
,1917
b.Amer
ikaSer
ikat
,1916
c.I
nggr
is,
1917
d.I
nggr
is,
1916
e.I
nggr
is,
1915
2.FAO dan WHO mempr
omosi
kan Food
Based Di
etar
y Gui
del
i
nes dal
am
I
nter
nat
ionalConf
erenceonNut
ri
ti
onpada
t
ahun....
a.1989
b.1990
c.1991
d.1992
e.1993

13. Sal
sabi
l
aRaf
iqaSahda MATERI
:FOODBASEDDI
ETARYGUI
DLI
NES
P1337431220014
1.PGBM har
usf
leksi
belunt
ukdi
gunakanol
eh
or
ang-
orang dengan gay
a hi
dup y
ang
ber
beda ser
ta or
ang-
orang dar
iber
bagai
usi
a dan kondi
sif
isi
ologi
syang ber
beda.
Per
nyat
aani
nisesuaidengansal
ahsat
uhal
y
ang har
us di
per
hat
ikan dal
am
mengembangkanPGBM y
ait
u..
.
a.Mudahdi
pahami
b.Dapatdi
ter
imasecar
abuday
a
c.Kepr
akt
isan
d.Keef
ekt
if
an
e.Pol
amakan
14. Ver
osaLi
l
ianasar
i MATERI:FoodBasedDi
etar
yGui
del
i
nes
P1337431220015 1.Pedoman Gi
ziper
tama di
publ
i
kasi
kan di
Amer
ikaSer
ikatpadat
ahun….
a.1917
b.1918
c.1919
d.1920
e.1921
2. I
nfor
masiy
angdi
ber
ikanol
ehPedoman
Gi
ziy
ait
u,kecual
i
….
a.Jeni
smakanan
b.Pol
amakanan
c.Kel
ompokmakanan
d.Juml
ahmakanan
e.Ni
l
aiGi
zimakanan

15. Si
tiKhumai
roh Mat
eriFoodBasedDi
etar
yGui
del
ines
P1337431220016
Dal
am per
ti
mbanganpenggunaanPGBM halapa
saj
ayanghar
usdi
per
ti kecual
mbangkan, i
?
a.Fungsibi
ologi
sdanef
ekkesehat
anmasi
ng-
masi
ngkandunganmakanan
b.Car
apengol
ahandanper
siapanmakanan
c.Car
a t
ubuh dal
am mener
ima asupan
makanany
angdi
ber
ikan
d.Pedomangi
ziy
angdi
susunmakanan
e.Kombi
nasi
zatgi
zi

16. Vi
tar
aDy
ahAy
uwar
a Mat
erif
oodbaseddi
etar
ygui
del
ines
Si
ndy 1.7Pedomangi
zimer
upakanpedomany
ang
P1337431220017 di
gunakanol
eh,
kecual
i:
a.par
apr
ofessi
onal
gizi
dankesehat
an
b.pembuatkebi
j
akan
 c.pendi
dik
d.di
str
ibut
ormakanan
e.pet
ani

17. Jul
i
aSal
maAgust
ina Mat
erif
oodbaseddi
etar
ygui
del
ines
P1337431220018 Tuj
uandi
ber
ikanny
apedomangi
zi:
A.Menambahwawasan
B.Meni
ngkat
kankesehat
andankesej
aht
eraan
C.Membant
uIbudananak
D.Mengedukasi
masy
arakat
E.Member
ipenger
ti
anpadamasy
arakat

18. Ani
saMunzi aKumala Materi=Foodbaseddiet
arygui
del
ines
P13337431220020
Susunan yang tepat dar
i makanan ber
aneka
r
agam,
sei
mbang dan sehat akan ber
var
iasi
t
ergant
ungpadakebut
uhani
ndi
vi
duy
angmel
i
put
i
…kecual
i
A.Usi
a
B.Jeni
skel
ami
n
C.Buday
a
D.Akt
ivi
tasf
isi
k
E.Gay
ahi
dup

19. Pr
asast
iNur
mal
i
ta Mat
eriDet
ermi
nant
sofFoodChoi
ceandDi
etar
y
Pasy
a Change:I
mpl
icat
ionsf
orNut
ri
ti
onEducat
ion
P1337431220023 1.Manusi adi l
ahirkandengankecender ungan
biol
ogis y ang t idak t erpel
ajar unt uk
meny ukair asa mani s dan menol ak r asa
asam danpahi t.Kesukaanterhadapgar am
tampakny a ber kembang beber apa bul an
setel
ah l ahir
, mer upakan makna dar i
kecenderungan per i
laku secara bi ologis
yang di t entukan mel al
ui pr edisposi si
peril
aku,yaitu..
.
A.Rasa/ kesenangan
 B.Mani s,asam, asin,danpahi t
C.Mekani smer asal apar/keny ang
D.Sensor i
k
E.Kesukaan/ ketidaksukaan
2.Di bawah i ni mer upakan per kumpulan
kompetensipendi di kangiziunt ukspesiali
s
pendi
dikangizi,kecual i.
..
A.Kandunganmakanandangi zi
B.Per i
lakumakan
C.Teor iper
ilakudanpendi dikan
D.Met odepenel i
tiandanev aluasipr
ogram
E.Riway atpeny aki t

20. MawaddahZi
yadat
un Mat
eriDet
ermi
nant
sofFoodChoi
ceandDi
etar
y
Ni
’
mah Change:I
mpl
icat
ionsf
orNut
ri
ti
onEducat
ion
P1337431220024 1.Ber
ikuti
nipr
edi
sposi
siper
il
akuy
angsecar
a
bi
ologi
s t
idak mempengar
uhi pi
l
ihan
makanan
danper
il
akudi
etadal
ah.
..
A.Mekani
smer
asal
apar
/kekeny
angan
B.Mani
s,asam,
asi
n,danpahi
t
C.Per
sepsi
ter
hadappi
l
ihanmakanan
D.Rasa/
kesenangan
E.Sensor
ik-r
asakeny
angt
ert
ent
u

2.Per
asaan seseor
ang set
elah makan,dapat
memi
l
iki dampak y
ang kuat pada pr
efer
ensi
makanan.Ji
ka makan di
i
kut
iol
eh ef
ek negat
if
,
seper
tir
asa mual
,maka past
i akan muncul
keengganan y
ang t
erkondi
si. Hal t
ersebut
mer
upakan pengal
aman makan y
ang t
erkai
t
dengan…
A.Pengkondi
sianbi
ologi
s
B.Pengkondi
sianaf
ekt
if
C.Pengkondi
siansosi
al
D.Pengkondi
sianf
isi
ologi
s
 E.Pengkondi
sianasosi
ati
f

21. Sal
sabi
l
aAl
i
fya Mat
eriDet
ermi
nant
sofFoodChoi
ceandDi
etar
y
Ummay
a Change:I
mpl
icat
ionsf
orNut
ri
ti
onEducat
ion
P1337431220025 1.Di
bawah i
niy
ang bukan t
ermasuk f
akt
or
i
ntr
aper
sonaly
ang mempengar
uhipi
l
ihan
makanandanper
il
akudi
etadal
ah….
A.Key
aki
nan
B.Si
kap
C.Nor
masosi
al
D.Kel
uar
gadanj
ejar
ingsosi
al
E.mot
ivasi
danni
l
ai

2.Di
bawahi
niy
angt
ermasukpengkondi
sian
sosi
alpadapengal
amandenganmakanan
y
ait
u..
.
A.Kondi
sikeny
ang
B.Kondi
si:
pref
erensi
makanan
C.Pr
akt
ikasuhanak
D.Kebi
j
akanpubl
i
k
E.Penget
ahuandankemampuan

22. Sal
i
naRahmani Mat
eriDet
ermi
nant
sofFoodChoi
ceandDi
etar
y
Mahar
dika Change:I
mpl
icat
ionsf
orNut
ri
ti
onEducat
ion
P1337431220026 1.Yangt
ermasukdal
am f
akt
ori
nter
per
sonal
dal
am pengar
uh pi
l
ihan makanan dan
per
il
akudi
etdi
bawahi
niadal
ah…
A.I
klan
B.Per
sepsi
C.Pendi
dikan
D.Har
ga
E.Hubungansosi
al
23. Si
ndi
Amanda Mat
eri:Det
ermi
nant
sofFoodChoi
ceandDi
etar
y
Rahmadani 1.Fakt
or i
ntr
a dan i
nter
per
sonal y
ang
P1337431220028 mempengar
uhi pi
l
ihan makanan dan
per
il
aku di
et secar
a bi
ologi
s di
tent
ukan
pr
edi
sposi
si, di
bawah i
ni y
ang t
idak
t
ermasukper
il
akut
ersebutadal
ah….
A.Rasa/
kesenangan
B.Mani
s,asam,
asi
n,danpahi
t
C.Mekani
smer
asal
apar
/kekeny
angan
D.Sensor
ik-r
asakeny
angt
ert
ent
u
E.Mer
asal
emasdanmudahl
apar

24. AgnesSi
ntaMel
i
a Mat
eriDet
ermi
nant
sofFoodChoi
ceandDi
etar
y
P1337431220029 Change:I
mpl
icat
ionsf
orNut
ri
ti
onEducat
ion
Ber
ikuti
niy
ang t
ermasuk f
akt
orsensor
i-
afekt
if
,
kecual
i
….
a.kondi
sikeny
ang
b.pr
efer
ensi
ter
hadapmakanan
c.sumberday
a
d.pr
akt
ikasuhanak
e.t
ahut
ent
angkeamananpangan

25. Sar
ti
kaYul
i
anaZaki
ah Mat
eriDet
ermi
nant
sofFoodChoi
ceandDi
etar
y
P1337431220031 Change:I
mpl
icat
ionsf
orNut
ri
ti
onEducat
ion
Tanggapan t
erhadap dua seny
awa pahi
tyang
di
sebut PTC dan PROP mer
upakan per
ist
iwa
t
erkai
tpr
edi
sposi
siper
il
aku….
a.I
mpul
srasakeny
angdanl
apar
b.Rasaat
aukesenanganseseor
ang
c.mekani
smer
asakeny
angat
aul
apar
d.I
nder
aper
asat
erhadapr
asamani
s,asam,
asi
n,
danpahi
t
e.Ket
idaksukaanpadasesuat
u
26. Nast
ainaAwi
m Naf
ian Mat
eriDet
ermi
nant
sofFoodChoi
ceandDi
etar
y
P1337431220032 Change:I
mpl
icat
ionsf
orNut
ri
ti
onEducat
ion
1.Bagai
mana pengal
aman seseor
ang dengan
makanan dapat mempengar
uhi pi
l
ihan
makanandanper
il
akudi
et?
A.Per
bedaani
ndi
vi
dunont
est
ersdansuper
t
est
ersdal
am memi
l
ihmakanan.
B.Per
asaan seseor
ang set
elah makan
memi
l
iki dampak pada pr
efer
ensi
makanan.
C.Var
iasi makanan y
ang t
ersedi
a
mempengar
uhi
ukur
anmakanan.
D.Per
sepsi seseor
ang t
ent
ang makanan
y
ang bai
k at
au bur
uk ber
dampak pada
pemi
l
ihanmakanan.
E.Rasa makanan ber
pengar
uh pada
kesukaan dan ket
idaksukaan t
erhadap
makanan.
2.Ber
ikuti
niy
angmer
upakandet
ermi
nansosi
al
dan l
i
ngkungan y
ang dapatmempengar
uhi
pi
l
ihanmakanandanpi
l
ihandi
etadal
ah.
..
A.kebi
j
akanpubl
i
k,pr
efer
ensimakanan,dan
nor
masosi
al
B.kel
uar
ga,
pendi
dikan,
dansumberday
a
C.hubungan sosi
al, pr
akt
ik buday
a, dan
ket
ersedi
aanmakanan
D.kebi
j
akan publ
i
k,hubungan sosi
al,dan
mot
ivasi
E.nor
masosi
al,pr
akt
ikbuday
a,danst
rukt
ur
sosi
al

27. Febi
l
aDi
anPr
aset
ya Mat
eriDet
ermi
nant
sofFoodChoi
ceandDi
etar
y
P1337431220033 Change:I
mpl
icat
ionsf
orNut
ri
ti
onEducat
ion
 1.Pol
amakant
erbent
ukdar
iindi
vi
du,or
angl
ain,
danj
ugal
i
ngkungandansosi
al.padast
rukt
ur
sosi
al, t
erdapat beber
apa f
akt
or y
ang
membuat pol
a makan i
ndi
vi
du t
ersebut
t
erbent
uk.Sal
ahsat
uny
aadal
ah
A.pr
esepsi
ataut
anggapant
ent
angsesuat
u
B.Har
ga y
ang t
idak cukup uang unt
uk
membel
imakanan
C.mal
umembawabekalkar asahi
enamer gh
cl
ass sehi
ngga l
ebi
h suka membel
i
makanancepatsaj
i
D.mewar
isi
dar
ili
ngkungant
empatt
inggal
E.pendapatdal
am menent
ukanmakanan

2.I
buAsedanghami
l8bul
an,i
ati
nggaldidesa.
set
iap kal
idi
a makan,sel
alu di
pil
ah-
pil
ah ol
eh
mer
tuany
a,kar
enaadabeber
apamakanany
ang
t
idakbol
ehdi
konsumsiol
ehwani
tay
angsedang
hami
l
. hal t
ersebut mer
upakan f
akt
or y
ang
mempengar
uhi
pemi
l
ihanmakananadal
ah?
A.Kel
uar
ga
B.j
ejar
ingsosi
al
C.si
kap
D.i
nfor
masi
E.nor
mabuday
a

28. El
okDwi
Rahmadani Mat
eriFaci
li
tat
ingwhyandhowt
otakeact
ion
P1337431220034 1.
Ber
ikut y
ang t
ermasuk f
akt
or l
i
ngkungan
ekonomi dal
am menent
ukan t
indakan dan
per
ubahanper
il
aku,
kecual
i
….
a.Har
ga
b.Key
aki
nan
c.Wakt
u
 d.Sumberday
a
e.Pendi
dikan
2.
Pendekat
ansosi
alt
ingkati
nter
per
sonalber
fokus
kepada….
.
a.Pengal
amanhi
dup
b.I
nter
aksi
denganpr
ofesi
onal
kesehat
an
c.Pr
efer
ensi
makanan
d.Keper
cay
aan
e.Si
kapni
l
ai

29. At
hifSy
afi
qRi
dho Mat
eriFaci
li
tat
ingwhyandhowt
otakeact
ion
P1337431220036 1.
Sal
ah sat
u f
akt
or penent
u t
indakan dan
per
ubahan pr
il
aku y
ait
u f
akt
or i
ntr
aper
sonal
,
di
bawahi
nikecual
i
a.si
kap
b.kel
uar
gadanj
ejar
ingsosi
al
c.key
aki
nan
d.pr
esepsi
e.mot
ivasi
danni
l
ai
2.
Ket
ersedi
aan makanan t
ermasuk dal
am
det
ermi
nansosi
al/
li
ngkungan…
a.f
isi
k/y
angt
erbent
uk
b.sosi
albuday
a
c.ekonomi
d.i
nfor
masi
e.kel
uar
ga

30.
. Si
tiReni
eaOct
avi
a Mat
eri:Faci
li
tat
ingwhyandhowt
omakeact
ion
P1337431220038
1.Fakt
ory
ang mempengar
uhikesej
aht
eraan
gi
zi t
erhadap i
nfeksi at
au obat
-obat
an
adal
ah.
.
a.dampaksosi
al
b.f
akt
orbi
ologi
s
 c.bi
ologi
danpengal
amanmakan
d.f
akt
or-
fakt
orf
isi
k
e.f
akt
orl
i
ngkungan

2. Unsur
-unsury
ang ber
kont
ri
busipada
ef
ekt
ivi
tas
pendi
dikangi.Kecual
zi i
a.f
okuspadaper
il
aku/
prakt
ek
b.det
ermi
nanper
il
aku
c.menggunakant
eor
i
d.mul
ti
lev
eldancukupwakt
u
e.ket
erampi
l
anber
piki
rkr
it
is

31 Nur
ussi
l
miKaaf
fah Mat
eri:Fal
ici
tat
ingwhyandhowt
omakeact
ion:
P1337431220042 1.Beber
apa f
ungsi dar
iteor
i pada
keef
ekt
if
anpendi
dikangi
zi
,kecual
i
a.Meny
edi
akan pet
a ment
al
mengapasuat
uper
il
akuat
au
per
ubahanper
il
akut
erj
adi
b.Member
ikanpanduanpendi
dik
gi
zi t
ent
ang bagai
mana
mer
ancang ber
bagai
komponeni
nter
vensi
c.Member
ikanpanduant
ent
ang
apa y
ang har
us di
eval
uasi
unt
uk mengukur dampak
i
nter
vensi
, dan bagai
mana
mer
ancang i
nst
rumen
pengukur
any
angakur
at
d.Ter
ori di
hasi
l
kan dar
i
penel
i
tian di bi
dang
pendi
dikan gi
zi dan bi
dang
t
erkai
t
 e.Menent
ukan j
eni
s i
nfor
masi
y
ang per
lu di
kumpul
kan
sebel
um mer
ancangi
nter
vensi
2.Dal
am mengat
asi f
akt
or penent
u
t
indakan dan per
ubahan per
il
aku,
t
erdapat f
akt
or det
ermi
nan
sosi
al/
li
ngkungan,
kecual
i
a.Li
ngkungan f
isi
k/y
ang
t
erbent
uk
b.Li
ngkungansosi
albuday
a
c.Li
ngkunganekonomi
d.Li
ngkungani
nfor
masi
e.Li
ngkunganseki
tar

32 Adel
i
aTr
iPr
amudi
ta Mat
eri:Fal
ici
tat
ingwhyandhowt
omakeact
ion
P1337431220043
1.Ber
ikut i
ni l
angkah l
angkah mer
ancang
pendi
dikangi
ziber
basi
steor
iyangbenar,
y
ait
u…
a.Mer
encanakanev
aluasi-Mendesai
n
Akt
ivi
tas -Memi
l
ih Teor
i-Memi
l
ih
Kebi
asaan - Mengkonsenkan
t
erhadapsuat
uisu
b.Mendesai
nakt
ivi
tas-Memi
l
ihTeor
i-
Mengkonsenkan suat
u i
su -
Mer
encanakan ev
aluasi - Memi
l
ih
Kebi
asaan
c.Mengkonsenkant
erhadapsuat
uisu-
Memi
l
ihKebi
asaan-Mengi
dent
if
ikasi
Det
ermi
nan -Memi
l
ih Teor
i-St
ate
Obj
ect
ive - Mendesai
n akt
ivi
tas -
Mer
encanakanev
aluasi
 d.Memi
l
iht
eor
i-Mendesai
nakt
ivi
tas-
Mer
encanakan ev
aluasi -
Mengkonsenkant
erhadapsuat
uisu-
Memi
l
ihKebi
asaan-St
ateObj
ect
ive
e.St
ateObj
ect
ive-Memi
l
ihLandasan
Teor
i - Mendesai
n akt
ivi
tas -
Mer
encanakanev
aluasi

2.Or
angber
ubahket
ikamer
ekacukupt
erl
uka,
adal
ahpenggal
ankat
adar
itokohsi
apaa?
a.JohnKot
elawal
a
b.MrGeor
geLam
c.Adam Af
lai
nsss
d.JohnC.Maxwel
l
e.Cel
l
osMax
wel
lK

3.Ber
ikuti
niel
emen y
ang ber
kont
ri
busidal
am
keef
ekt
if
anPendi
dikanGi
ziadal
ah.
..
a.MenggunakanTeor
i
b.I
nter
vensi
Masal
ah
c.Cukupdengansat
ust
rat
egi
d.Fokuspadasuat
ukej
adi
andi
masal
ampau
e.Menggunakanmusy
awar
ahmuf
akat

33 Shof
iaSaf
areni Mat
eri:Fal
ici
tat
ingwhyandhowt
omakeact
ion
P1337431220044
1.Fakt
ory
angmempengar
uhikesej
aht
eraangi
zi
t
erhadapi
nfeksi
?
a.Fakt
orl
i
ngkungan
b.f
akt
orf
isi
k
c.bi
ologi
danpengal
amanmakan
d.f
akt
orbi
ologi
s
e.dampaksosi
al
 2.El
ementy
ang ber
kont
ri
busipada keef
ekt
if
an
pendi
dikangi
zi
,adal
ah?
a.Foodbev
eragei
ndust
ry
b.Foodsy
stem
c.Mul
ti
plel
evel
sandsuf
fi
cientdur
ati
on
d.Foodassi
stancepr
ogr
ams
e.Heal
thcar
epr
ogr
ams

34 Nashi
dat
ulMunt
amah Mat
eri:Faci
li
tat
ingwhyandhowt
otakeact
ion
P1337431220045 1.Ber
ikutel
ement
s cont
ri
but
ing t
o nut
ri
ti
on
educat
ionef
fect
iv kecual
eness, i
..
A.Af
ocusonbehav
ior
s
B.Useoft
heor
y
C.St
rat
egi
s
D.Det
ermi
nant
sofbehav
ior
E.Mot
ivat
ional

35 Anggr
aheni
Tri Mat
eri:Faci
li
ti
ngwhyandhowt
otakeact
ion
Wul
andar
i Det
ermi
nanper
il
akut
ermasukdal
am el
emeny
ang
P1337431220046 ber
kont
ri
busi
padakeef
ekt
if
anpendi
dikangi
zi
.Apa
saj
ael
emeny
angl
ainny
a?
a.Beber
apa st
rat
egi
, mul
ti
lev
el dan
kekur
anganwakt
u,f
okuspadaper
il
aku
b.Ti
dak menggunakan t
eor
i, beber
apa
st
rat
egi
,mut
il
evel
dancukupwakt
u
c.Menggunakan t
eor
i,sat
u st
rat
egi
,fokus
padakepr
ibadi
an
d.Fokus pada pr
akt
ik,menggunakan t
eor
i,
mul
ti
lev
eldancukupwakt
u
e.Mengunakanpr
akt
ek,f
okuspadaper
il
aku,
beber
apast
rat
egi
36 AZZAHRARFROSYADI
Pendi
dikan gi
zihar
us di
rancang sesuaidengan
P1337431220048
dasar
-dasary
angadasal
ahsat
uny
aber
basi
steor
i
gunamember
ipanduant
ent
angapay
anghar
us
di
l
akukan dan di
eval
uasi
.Ber
ikutadal
ah ur
utan
f
lowchar
tber
basi
steor
i

a. st
ate obj
ect
ives-
choose i
ssues-
choose
behav
ior
s-i
dent
if
y medi
ator
s-sel
ectt
heor
y-desi
gn
act
ivi
ti
es-
planev
aluat
ion

b. choose i
ssues-
choose behav
ior
s-i
dent
if
y
medi
ator
s-sel
ect t
heor
y-st
ate obj
ect
ive-
desi
gn
act
ivi
ti
es-
planev
aluat
ion

c. choose i
ssues-
choose behav
ior
s-i
dent
if
y
medi
ator
s-sel
ect t
heor
y-desi
gn act
ivi
ti
es-
plan
ev
aluat
ion-
stat
eobj
ect
ives

d.choosei
ssues-
choosebehav
ior
s-sel
ectt
heor
y-
desi
gnact
ivi
ti
es-
ident
if
ymedi
ator
s-pl
anev
aluat
ion

e. choose i
ssues-
choose behav
ior
s-i
dent
if
y
medi
ator
s-seect t
heor
y-desi
gn act
ivi
ti
es-
plan
ev
aluat
ion-
stat
eobj
ect
s-pl
anev
aluat
ion

37 MuhammadAmanat Mat
eri:Medi
aCet
ak
‘
Abdul
l
ah 1.Unsurdal
am desi
gnmedi
acet
akant
aral
ain
P1337431220049 :
a.gambari
nter
akt
if
b.ber
ikani
nfor
masi
hoax
c.gambart
idakmendi
dik
d.j
anganber
iruangkosong
e.war
nagel
ap
2.Unsurdal
am pembuat
anl
eaf
let
,ant
aral
ain:
a.t
idakmengandungedukasi
b.gambart
idakmenar
ik
 c.t
unj
ukkankat
akunci
d.kat
akunci
yangsukardi
pahami
e.gunakani
nfor
masi
yangpal
su

38. El
l
isaNurAr
if
in
P1337431220050 apay
gbukanmer
upakanf
akt
orpeny
ebabpr
il
aku
behav
iorcauses?
a.f
akt
orpr
edi
sposi
si
b.f
akt
orpemungki
n
c.f
akt
orpendor
ong
d.f
akt
orl
ingkungan

39. Rohmat
ulFadhi
l
ah Mat
eri:PengembanganMedi
aCet
ake-
Medi
a
P1337431220051 Ber
ikuti
nimer
upakankesal
ahandal
am membuat
post
er,
kecual
i
…
a.Menggunakanbany
akshadow
b.I
lust
rasi
abst
rakdanr
umi
t
c.Gambarseadany
a
d.Membi
arkanr
uangkosong/whi
tespace
e.Semuakat
adi
tul
i
sdal
am hur
ufbesar

40. Ul
faNoer
chol
i
za Mat
eri:PengembanganMedi
aCet
ake-
Medi
a
P1337431220052 Poi
npent
ingdal
am pembuat
anpost
erat
aupapan
r
ekl
amey
angef
ekt
ifadal
ah….
a.Menunj
ukkanmanf
aat
b.Mengul
angi
pesandasar
c.Membi
arkanr
uangkosong
d.Meny
usunpesansesuai
urut
an
e.Menggunakangay
ayangl
ayak

41. Nadi
aAy
uPuspi
tasar
i Mat
eri:PengembanganMedi
aCet
ake-
Medi
a
P1337431220054
 1.Di
bawah i
nimer
upakan sy
arat
-sy
aratdar
i
post
erat
au r
ekl
ame y
ang ef
ekt
if
.Namun
di
ant
ara sy
aratt
ersebutada sy
araty
ang
sangatpent
ingy
ait
u….
.
a.menar
ikper
hat
iandar
ijar
ak10met
er
b.gunakangambarsebagaipembawa
pesan
c. memor
abl
e
d.t
unj
ukkanmanf
aat
e.Per
tahankan nada y
g sama pada
semuapendekat
an

2.Post
erat
aur
ekl
ameakanber
manf
aatbagi
audi
ence apabi
l
a didal
am post
er at
au
r
ekl
amememi
l
iki
,kecual
i
…..
a.Usahakan i
nfor
masi y
g t
ak
t
erl
upakan
b.Gunakangambarunt
ukber
cer
it
a,t
ak
hany
adengankat
a-kat
a
c.Gunakangambary
gmenar
ik
d.Desai
n sul
i
t di
gunakan dan
di
temukan
e.Sesuai
kangambar
/gr
afi
sdanbahasa
sesuai
tar
getaudi
ence

42. I
snaeni
Rahma Mat
eri:PengembanganMedi
aCet
akE-
Medi
a
P1337431220055 Ber
ikut mer
upakan beber
apa hal y
ang har
us
di
per
hat
ikandal
am menul
i
steksdisebuahpost
er,
kecual
i….
.
a.Ul
angi
pesandasarsekur
angny
aduakal
i
 b.Pi
l
ihj
eni
sdanukur
anhur
ufsehi
nggamudah
di
baca
c.Gunakanbahasadanper
bendahar
aankat
a
y
angsama
d.Gunakan kal
i
mat akt
if dan pendekat
an
posi
ti
f
e.Gunakanwar
nay
angpant
as

43. Ar
ini
Kinant
iSy
ayi
dina Mat
eri:PengembanganMedi
aCet
akE-Medi
a
P1337431220056 1.ket
ika membuat E - Medi
a per
lu
memper
hat
ikan beber
apa hal t
ermasuk
sal
ahsat
uny
aadal
ahLayOut
,LayOuty
ang
disar
ankan sal
ah sat
uny
ayai
tui
l
ust
rasi
y
angr
eal
i
s,dibawahi
niy
angmer
ujukpada
i
l
ust
rasi
yangr
eal
i
syai
tu.
.
a.i
l
ust
rasimenggambar
kanobj
eky
ang
al
ami
ah dan ser
asi dengan
kei
ndahanwar
na
b.i
l
ust
rasi menggambar
kan adany
a
sebuahper
bedaanbent
ukpadaobj
ek
asl
idanhasi
lkar
yany
a
c.i
l
ust
rasidi
buatber
tuj
uanagarmudah
di
per
hat
ikan dengan penggunaan
war
nawar
nay
angmencol
ok
d.i
l
ust
rasidi
buatmeny
erupaidengan
keser
asi
an bent
uk dengan keasl
i
an
obj
eky
angdi
gunakan
e.i
l
ust
rasi di
buat semi
ri
p mungki
n
dengan kar
tun ani
masi y
ang
ber
tuj
uan unt
uk l
ebi
h menar
ik
per
hat
ianket
ikadi
l
ihat

2.Mahasi
swagi
ziakanmengadakan
 peny
uluhandengant
ema“
IsiPi
ri
ng
TepatI
nvest
asiSehat
”yang akan
di
l
aksanakan didesa -X dengan
beber
apa masy
arakatdiant
arany
a
memi
l
ikil
atarbel
akang kesehat
an
mat
a y
ang bur
uk, pada kej
adi
an
t
ersebut sebai
kny
a ket
ika akan
membuatmedi
a cet
ak E -Medi
a
har
us memper
hat
ikan hal-haldi
bawahi
nikecual
i….
a.I
lust
rasi di buat bent
uk
abst
rakagarl
ebi
h mudah di
pahami
b.gunakan i
l
ust
rasi y
ang
seder
hana
c.gunakan i
mages y
ang sudah
di
kenal
(sesuai
dengansi
tuasi
sasar
an)
d.gunakan gambary
ang j
elas
sebagai
pembawapesan
e.pi
l
ihj
eni
s dan ukur
an hur
uf
sehi
nggamudahdi
baca

44. I
ntanNur
’ai
ni Soalpengembanganmedi
acet
ake-
medi
a
P1337431220057 Di
bawah i
niy
ang mer
upakan sy
aratdar
idesai
n
sebuahmat
eri
alcet
akadal
ah…
a.Gunakani
l
ust
rasi
seder
hana
b.Bat
asi
juml
ahkonsepdanhal
aman
c.Gunakanhur
ufbesardankeci
l
d.Gunakanwar
nay
angpant
as
e.I
lust
rasi
real
i
sti
s
NOTE:
Kasi
hket
erangansoal
mat
eri
apa.

Regul
erB

No. I
dent
it
as Soal

1. Ter
ranaWi
l
lma Mat
eriNut
ri
ti
onEducat
ion
P1337431220058 Kebi
j
akanper
tani
andansi
stem panganber
kai
tan
dengankual
i
tasmakanansebagaiukur
annut
ri
si
y
ang bai
k.Ber
ikuti
niy
ang mer
upakan pi
l
ihan
kebi
j
akandal
am si
stem pasardanper
dagangan
adal
ah…
A.Kebi
j
akan per
dagangan, i
nfr
ast
rukt
ur,
i
nvest
asi
,kebi
j
akanagr
ibi
sni
s
B.Kebi
j
akanpenel
i
tianper
tani
an,
subsi
dii
nput
,
i
nvest
asi
peny
uluhan,
aksest
anahdanai
r
C.Per
atur
an pel
abel
an, per
atur
an i
kl
an,
kebi
j
akanf
ort
if
ikasi
D.Kebi
j
akan penel
i
tian, subsi
di konsumen,
t
ransf
ert
unai
E.Kebi
j
akan f
ort
if
ikasi
,kebi
j
akan agr
ibi
sni
s,
subsi
dii
nput

Di
bawahi
niy
angmer
upakankesi
mpul
ant
ent
ang
nut
ri
ti
oneducat
iondar
isi
sil
i
ngkungani
nfor
masi
adal
ah…
A.Pendi
dikan gi
zi j
uga per
lu unt
uk
meni
ngkat
kan ket
erampi
l
an ber
piki
rkr
it
is
masy
arakat
 B.Or
ang-
orang t
erpapar i
kl
an makanan
sel
ama3j
am set
iapmi
nggudi
bandi
ngan
denganmengi
kut
ipendi
dikangi
zi
.
C.Masy
arakat membut
uhkan i
nfor
masi
ber
basi
sil
mu penget
ahuan y
ang akur
at
t
ent
ang makanan dan hubungan ant
ara
makanan,
gizi
dankesehat
an.
D.Or
ang-
orang mengi
kut
i pendi
dikan gi
zi
sel
ama3j
am set
iapmi
nggudi
bandi
ngan
dengant
erpapari
kl
anmakanan.
E.Masy
arakatmembut
uhkani
nfor
masit
anpa
ber
basi
s i
l
mu penget
ahuan y
ang t
idak
akur
at t
ent
ang makanan dan hubungan
ant
aramakanan,
gizi
dankesehat
an.

2. Zi
aNazi
haNurFay
za Mat
eriNut
ri
ti
onEducat
ion
P1337431220061 Di
bawah i
niy
ang mer
upakan 3 kehar
usan y
ang
di
l
akukanol
ehpendi
diknut
ri
si,
yai
tu.
..
A.Set
ti
ng,
Scope,
Audi
ence
B.Desi
gned,
Vol
unt
ary
,Faci
l
itat
e
C.Technol
ogy
,Cul
tur
al,
Sosi
al
D.I
ndi
vi
dual
,I
nst
it
uti
onal
,Communi
ty
E.Tast
e,av
ail
abi
l
ity
,conv
eni
ence

3. Put
riSar
ahNur Mat
eriNut
ri
ti
onEducat
ion
Al
j
annah Ber
ikut y
ang bukan t
ermasuk t
ant
angan at
au
P1337431220063 chal
l
engesebagai
tenagapendi
dikanadal
ah…
a.bi
ologi
cal
inf
luences
b.cul
tur
alandsoci
alpr
efer
ences
c.f
ami
l
yandpsy
chol
ogi
cal
fact
ors
d.senseofempower
ment
e.mat
eri
alr
esour
cesandequi
pmentcont
ext
4. AnekeSal
sabi
l
aShoof
i Mat
eriNut
ri
ti
onEducat
ion
Har
tri ber
ikut y
ang t
ermasuk scope of nut
ri
ti
on
P1337431220066 educat
ion,
kecual
i….
a.wi
der
angeofcont
ent
b.f
oodsaf
etyandf
oodsy
stems
c.l
i
fest
agegr
oups
d.soci
alj
ust
iceandsust
ainabi
l
ity
e.phy
sical
act
ivi
tyandnut
ri
ti
on

5. At
hif
aUl
yaYasf
anni Mat
eriNut
ri
ti
onEducat
ion
P1337431220068 Yang t
idak t
ermasuk dal
am t
ant
angan
mengedukasi
seseor
angy
ait
u?
A.Pengar
uhbi
ologi
s
B.Pr
efer
ensi
buday
adansosi
al
C.Fakt
orkemi
ski
nan
D.Fakt
orkel
uar
gadanpsi
kol
ogi
s
E.Sumberday
amat
eri
al&kont
eksl
i
ngkungan

Yang t
idak t
ermasuk pendapat menur
ut Rol
ls
(
2000)t
erkai
tsensor
ikhususkekeny
anganadal
ah
?
A.Or
ang makan l
ebi
h bany
akdar
imakanan
t
ert
ent
udal
am per
iodewakt
uyangsi
ngkat
menj
adi
kur
angmeny
ukai
rasany
a
B.Or
ang makan l
ebi
h bany
akdar
imakanan
t
ert
ent
udal
am per
iodewakt
uyangpendek
menj
adi
kur
angmeny
ukai
rasany
a
C.Fenomenaor
angkeny
angt
apimasi
hbi
sa
makanmakananpenut
up
D.Fenomenaor
angkeny
angt
apit
idakbi
sa/
t
idaksanggupmakanmakananpenut
up
E.Di
ety
angber
var
iasij
ugat
erny
atamembuat
 or
angmakanl
ebi
hbany
ak

6. Lut
hfi
aDeaSav
ira Mat
eriNut
ri
ti
onEducat
ion
P1337431220069 Pendi
dikan gi
zidi
def
ini
skan sebagaiber
ikuti
ni,
kecual
i
...
A.Kombi
nasi
dar
ist
rat
egi
pendi
dikan
B.Pendi
dikan gi
zi di
ser
tai dukungan
l
i
ngkungan
C.Di
rancang unt
uk memf
asi
l
itasi adopsi
sukar
ela pemi
l
ihan makanan dan per
il
aku
t
erkai
tmakanandannut
ri
sil
ainny
aunt
uk
kesehat
andankesej
aht
eraan
D.Pendi
dikan gi
zi di
sampai
kan mel
alui
beber
apat
empat
E.Pendi
dikangi
zit
idakwaj
i
b di
pahamiol
eh
masy
arakat

7. Nor
ahi
maNabi
l
a Mat
eriNut
ri
ti
onEducat
ion
Nur
unnaj
ah Pendi
dikangi
zimencakupbeber
apahal
,kecual
i
…
P1337431220070 A.Ber
bagai
kont
en
B.Kemananpangandansi
stem pangan
C.Pol
akonsumsi
makananber
lebi
han
D.Keadi
l
ansosi
aldankeber
lanj
utan
E.Akt
ivi
tasf
isi
kdannut
ri
si

8. Ani
sFi
tr
ia Mat
eri:Nut
ri
ti
onEducat
ion
P1337431220071 Buday
a moder
n menekankan kemudahan at
au
kecepat
an dal
am meny
iapkan at
au memper
oleh
makanan,sesuaidengangay
ahi
dupy
angsi
buk
saati
ni
membuatpendi
dikan t
ent
ang makanan,nut
ri
si,
danper
ubahanpol
amakanmenj
adi
a.sul
i
t
 b.agaksul
i
t
c.mudah
d.agakmudah
e.sangatmudah
Or
ang y
ang makan (
pemakan) membut
uhkan
pemi
ki
rankr
it
isdanket
erampi
l
an…
a.af
ekt
if
b.subj
ekt
if
c.obj
ekt
if
d.l
ogi
s
e.kr
it
is

9. Amel
i
aSal
sabi
l
a Mat
eri
:Nut
ri
ti
onEducat
ion
Wi
bowo di
manay
angmeny
edi
akanNE?
P1337431220072 a.komuni
tas
b.komuni
tasdanor
gani
sasi
adv
okasi
c.sekol
ah
d.t
empatker
ja
e.semuabenar

10 Renat
aOl
gaZanet
i Mat
eri:FoodBasedDi
etar
yGui
del
ines
P1337431220073 Di
bawahi
niy
ang bukant
ermasukt
ujuandal
am
pember
iani
nfor
masi
gizi
adal
ah….
a.Meni
ngkat
kankesehat
andankesej
aht
eraan
masy
arakat
b.Mengur
angi
resi
kot
erj
adi
nyaPTM
c.Mengur
angir
esi
kot
erj
adi
nyast
unt
ingpada
anak
d.Menambah wawasan kepada masy
arakat
t
ent
angf
akt
akesehat
an
e.Menambahangkakemat
ian

11. Ar
ri
faJul
i
aWar
dani Mat
eri:FoodBasedDi
etar
yGui
del
ines
P1337431220074 Sy
arat
-sy
aratdal
am mengembangkanPGBM :
 a.Makananat
aukel
ompokmakanany
angdi
anj
urkanhar
ust
erj
angkau
b.PGBM har
us memper
ti
mbangkan kondi
si
sosi
al,ekonomi
,per
tani
an,danl
i
ngkungan
y
ang mempengar
uhimakanan dan pol
a
makan
c.PGBM har
usf
leksi
belunt
ukdigunakanol
eh
or
ang-
orangdar
iber
bagaiusi
adankondi
si
f
isi
ologi
syangber
beda
d.PGBM sehar
usny
a mer
ekomendasi
kan
per
ubahan r
adi
kaldal
am pr
akt
ek makan
saati
ni
e.Ter
minol
ogi y
ang di
gunakan har
us
seder
hana dan har
us mengacu pada
makanan,sedapatmungki
nbukanpadazat
gi
zi

12. Sor
ayaKhoi
runni
sa FOODBASEDDI
ETARYGUI
DELI
NE
P1337431220075 1.Yangbukanf
il
osof
ikunci
edukasi
okuspadat
a.f otaldi
et
b.menggunakan nut
ri
ti
on based
appr
oach
c.t
idakadabai
kdanbur
uk
d.pendekat
any
angposi
ti
f
e.menggunakanf
oodbased

2.Pedomangi
zimer
upakanpedomany
ang
di
gunakanol
eh….
a.par
apr
ofesi
onal
giz
idankesehat
an
b.semuamasy
arakaty
angsehat
c.masy
arakatdengankel
ebi
hanber
at
badan
 d.par
aibucer
das
e.masy
arakat dengan kekur
angan
ber
atbadan

3. pedoman gi
zimember
ikan beber
apa
i
nfor
masi
,yangbukanmer
upakansal
ahsat
u
dar
iinf
ormasi
ter
sebutadal
ah….
a.t
ent
angj
eni
smakanan
b.t
ent
angj
uml
ahmakanan
c.pol
amakan
d.kebi
asaanmakan
e.j
eni
sdanj
uml
ahmakanan

13. Mi
thaAddi
niNaf
isah Mat
eri=Foodbaseddi
etar
ygui
del
ines
P1337431220077
Di
bawah i
ni y
ang t
ermasuk mempengar
uhi
per
geser
andal
am pol
amakan
a.Ur
bani
sasiy
angcepat
b.Kont
eksbuday
a
c.Adati
sti
adat
d.Usi
a
e.Jeni
skel
ami
n

14. Ber
li
anSi
faAzZahr
a Mat
eri=Foodbaseddi
etar
ygui
del
ines
P1337431220079 Dibawah i
nibukan t
ermasuk kecender
ungan
per
il
akuseseor
angy
angdapat memepengar
uhi
pemi
l
ihanmakananadal
ah
A.Jeni
skel
ami
n
B.Akt
ivi
tasf
isi
k
C.Usi
a
 D.Buday
a
E.Gay
ahi
dup

15. Ri
i
fai
Addi
tChandr
a Mat
eri:FoodBasedDi
etar
yGui
del
ines
P1337431220080 1.Kapandandi
manapedomangi
ziper
tama
kal
idi
publ
i
kasi
kan?
a.Padat
ahun1920di
Amer
ikaSer
ikat
b.Padat
ahun1917di
Inggr
is
c.Padat
ahun1917di
Amer
ikaSer
ikat
d.Padat
ahun1920di
Inggr
is
e.Padat
ahun1918di
Inggr
is

16. Al
fi
naTr
iAt
ma MATERI:
FOODBASEDDI
ETARYGUI
DELI
NES
Sal
sabi
l
a 1.Di
bawah i
ni mer
upakan f
il
osof
i kunci
P1337431220081 edukasi
,kecual
i…
a.Di
fokuskan t
otal di
et dar
ipada
i
ndi
vi
dual
foods.
b.Menggunakan nut
ri
ti
on based
appr
oacht
idakpadaf
oodbased
c.Ti
dakadamakanany
angbai
kat
au
bur
uk
d.Kuncidi
ety
angbai
kadal
ah bal
ance,
v
ari
ety
,andmoder
ati
on
e.Pendekat
an posi
ti
funt
uk makanan
har
usl
ebi
hdi
tekankan
2.Pedomangi
ziadal
ahpedomany
angdi
gunakan
ol
ehsebagai
ber
ikut
,kecual
i…
a.par
apr
ofesi
onal
giz
idankesehat
an
b.pembuatkebi
j
akan
c.pendi
dik
d.pr
odusenmakanan
e.masy
arakat
3.Pedoman gi
ziadal
ah pedoman y
ang ber
laku
unt
uk…
 a.par
apr
ofesi
onal
giz
idankesehat
an
b.pembuatkebi
j
akan
c.masy
arakat
d.pendi
dik
e.pr
odusenmakanan

17. Ri
zkaEnggarDwi Mat
eri:FoodBasedDi
etar
yGui
del
ines
Pawest
ri Manakahdi
bawahi
niy
angt
ermasukPedomanGi
zi
P1337431220082 Ber
basi
s Makanan (
PGBM) dengan ar
tiDapat
di
ter
imasecar
aBuday
a,kecual
i...
a.PGBM sehar
usny
ati
dakmer
ekomendasi
kan
per
ubahan r
adi
kaldal
am pr
akt
ek makan
saati
ni
b.Pi
l
ihanmakanandanwar
nay
angdi
gunakan
dal
am i
l
ust
rasi
har
ussesuai
buday
a
c.PGBM har
usposi
ti
fdanhar
usmendor
ong
unt
ukmeni
kmat
imakanany
angt
epat
d.Pedoman har
us peka t
erhadap
per
ti
mbangan buday
aagamadan l
ainny
a,
t
erut
amadar
ikel
ompokmay
ori
tas
e.Pr
esent
asi har
us menggunakan bahasa
at
audi
aleky
angsesuai

18. Ar
nesCant
ikaD Mat
eri:FoodBasedDi
etar
yGui
del
ines
P1337431220083 I
nvest
asigi
zipent
ingdanmer
upakanal
atef
ekt
if
,
kecual
i
….
a.memer
angi
kel
apar
an
b.f
oodi
nsecur
it
y
c.masal
ahgi
zikesehat
an
d.per
bai
kankual
i
tasmenumasy
arakat
e.masal
ahgi
zimel
uas

19. Er
li
yahNov
itaDi
niar
ti Mat
eri:Det
ermi
nan Per
ubahan Makanan dan
 P1337431220086 I
mpl
ikasipadaPendi
dikanGi
zi
Secar
a bi
ologi
s, kecender
ungan per
il
aku
seseor
ang y
ang memepengar
uhi pemi
l
ihan
makananant
aral
ain,
kecual
i
...
a.Mekani
smel
aparkeny
ang
b.Mani
s,asam,
asi
n,pahi
t
c. buday
a
d.r
asa/
kesenangan
e.f
akt
or sensor
ik t
erhadap r
asa keny
ang
t
ert
ent
u

20. NandaPut
riQi
sti
na Mat
eri:
Det
ermi
nan Per
ubahan Makanan dan
P1337431220087 I
mpl
i
kasipadaPendi
dikanGi
zi
Ber
ikuty
angbukanmer
upakanpr
osespendi
dikan
gi
ziadal
ah….
a.Fakt
orpr
efer
ensi
dansensor
iaf
ekt
if
b.Per
sepsiSi
kapKey
aki
nanAr
tiNor
maSosi
al
Ef
ikasi
dir
i
c.Ket
ersedi
aan pangan dan Pengar
uh
l
i
ngkungan
d.Per
ubahan dal
am pi
l
ihan makanan dan
Pr
akt
ekdi
et
e.Teor
iper
il
akudanpendi
dikan

21. Regi
naDar
inSy
afa Mat
eri:Det
ermi
nan Per
ubahan Makanan dan
P1337431220089 I
mpl
i
kasipadaPendi
dikanGi
zi
Yangbukanmer
upakanper
kumpul
ankompet
ensi
pendi
dikan gi
ziunt
uk spesi
ali
s pendi
dikan gi
zi
adal
ah…
a.Kandunganmakanandangi
zi
b.Per
il
akumakan
c.Teor
iper
il
akudanpendi
dikan
d.Met
odepenel
i
tiandanev
aluasi
progr
am
e.Li
ngkungansosi
albuday
a
22. Hani
fahNur
’Ai
ni Mat
eri:Det
ermi
nan per
ubahan makanan dan
P1337431220090 i
mpl
ikasipadapendi
dikangi
zi
Apay
angdi
maksuddenganper
sepsipadaf
akt
or
i
ntr
aper
sonaly
ang ber
pengar
uh pada pemi
l
ihan
makanandanper
il
akudi
et…
a.Pendapatseseor
angt
erhadapmakanan
b.Key
aki
nanseseor
angt
erhadapmakanan
c.Gambar
ant
erhadapmakanan
d.Rasai
ngi
ntahut
erhadapsuat
umakanan
e.Pengar
uhdar
ior
angseki
tar

Det
ermi
nan t
erkai
tseseor
ang t
erdi
ridar
ifakt
or
i
ntr
aper
sonal dan f
akt
or i
nter
per
sonal
. Yang
t
ermasukdal
am f
akt
ori
ntr
aper
sonal
,kecual
i
…
a.Pendi
dikan
b.Key
aki
nan
c.Nor
masosi
al
d.Mot
ivasi
danni
l
ai
e.Penget
ahuandankemampuan

23. RahmaApr
il
iaBudi
art
i Mat
eri:Det
ermi
nan per
ubahan makanan dan
P1337431220091 i
mpl
ikasipadapendi
dikangi
zi
Yang t
ermasuk dal
am Fakt
or sensor
i-
afekt
if
pengkondi
sianasosi
ati
fsecar
afi
siol
ogi
s,kecual
i
..
a.I
ngi
n t
ahu dan i
ngi
n bel
ajar mengenai
keamananmakanan
b.Rasa/kesenangan
c.Kesukaanpadamakanan
d.Kondi
siKeny
ang
e.Pr
efer
ensi
Makanan
Det
ermi
nan t
erkai
tseseor
ang t
erdi
ridar
ifakt
or
i
ntr
aper
sonal dan f
akt
or i
nter
per
sonal
. Yang
 t
ermasukdal
am f
akt
ori
nter
per
sonal
adal
ah.
..
A.Pr
esepsi
B.Si
kap
C.Key
aki
nan
D.Wakt
u
E.Kel
uar
gadanj
ejar
ingsosi
al

Qor
iSusi
All
i
fah Mat
eri:Det
ermi
nan Per
ubahan Makanan dan
24. P1337431220093 I
mpl
i
kasipadaPendi
dikanGi
zi
Ber
ikut y
ang mer
upakan det
ermi
nan t
erkai
t
seseor
ansecar
abi
ologi
sdi
tent
ukanpr
edi
sposi
si
per
il
akuadal
ah…
A.Si
kap
B.Rasa/kesenangan
C.Key
aki
nan
D.Wakt
u
E.Kel
uar
gadanj
ari
ngan

Ber
ikutmer
upakan kompet
ensipendi
dikan gi
zi
unt
uk spesi
ali
s pendi
dikan gi
zi ant
ara l
ain,
kecual
i
…
A.Kandunganmakanandangi
zi
B.Per
il
akumakan
C.Teor
iper
il
akudanpendi
dikan
D.Met
odepenel
i
tiandanev
aluasi
E.Var
iasi
makananseseor
ang

25. Mur
ytaWahy
uNi
ngr
um Mat
eri:Det
ermi
nan Per
ubahan Makanan dan
P1337431220094 I
mpl
i
kasipadaPendi
dikanGi
zi

Halt
abuseper
tii
buhami
lyangt
idakbol
ehmakan
i
kan mer
upakan sal
ah sat
u unsur f
akt
or
i
ntr
aper
sonal
yai
tu…
A.Maknapr
ibadi
 B.Per
sepsi
C.Nor
mabuday
a
D.Key
aki
nan
E.Penget
ahuandankemampuan

Det
ermi
nan sosi
alat
au l
i
ngkungan t
erdi
riat
as
l
i
ngkunganf
isi
k/y
angt
erbent
uk,
li
ngkungansosi
al
buday
a, l
i
ngkungan ekonomi
, dan l
i
ngkungan
i
nfor
masi
.Yangt
ermasukdal
am l
i
ngkungansosi
al
buday
aadal kecual
ah, i…
A.Kebi
j
akanpubl
i
k
B.Pr
akt
ikbuday
a
C.Ket
ersedi
aanmakanan
D.St
rukt
ursosi
al
E.Hubungansosi
al

26. Fi
ranaLai
l
iNasr
iyat
ul Mat
eri:Det
ermi
nan Per
ubahan Makanan dan
Akhadi
yah I
mpl
i
kasipadaPendi
dikanGi
zi
P1337431220095
Di
bawahi
nif
akt
orl
i
ngkungansosi
albuday
ayang
mempengar
uhipi
l
ihanmakanandanper
il
akudi
et
kecual
i
...
..
.
a.Hubungansosi
al
b.Pr
akt
ikbuday
a
c.Pendi
dikanpubl
i
k
d.St
rukt
ursosi
al
e.Kebi
j
akanpubl
i
k
Di
bawahi
niy
angbukant
ermasukkedal
am f
akt
or
i
ntr
aper
sonal y
ang mempengar
uhi pi
l
ihan
makanandanper
il
akudi
etadal
ah.
..
.
a.Per
sepsi
b.Si
kap
c.Mot
ivasi
danni
l
ai
 d.Kel
uar
gadanj
ejar
ingsosi
al
e.penget
ahuandankemampuan

27.
. Put
riAsr
ianaK Mat
eri:Det
ermi
nan Per
ubahan Makanan dan
P1337431220096 I
mpl
i
kasipadaPendi
dikanGi
zi

Ber
ikut adal
ah f
akt
or i
nter
per
sonal y
ang
mempengar
uhipi
l
ihanmakanandanper
il
akudi
et
kecual
i.
..

a. Per
sepsi

b. Key
aki
nan

c. Si
kap

d. Nor
maSosi
al

e. Pr
omot
if

28. Hashi
fahHanaNoorA Mat
eri:Faci
li
tat
ingWhyandHowt
oTakeAct
ion
P1337431220097 Sal
ah sat
u out
comes pada modell
ogi
ka NE
ber
basi
steor
iyai
tu…
a.Ket
rampi
l
anmengat
urdi
risendi
ri
b.Ri
sikopeny
aki
tber
kur
ang
c.Rencanaaksi
d.Ri
sikodankekhawat
ir
an
e.Si
kapdanpr
efer
ensi
yangbai
k

29. Ter
esi
aJesi
caPut
ri Mat
eri
:Faci
li
tat
ingWhyandhowt
otakeact
ion
P1337431220098
Sal
ahsat
ucar
amengat
asif
akt
orpenent
uti
ndakan
dan per
ubahan per
il
aku adal
ah dengan f
akt
or
i
ntr
aper
sonal
. cont
oh f
akt
or i
ntr
aper
sonal
 kecual
i
….

a.per
sepsi
b.si
kap
c.nor
masosi
al
d.penget
ahuandankemampuan
e.hubungansosi
al

30. Vi
naAnj
ani
a Mat
eri
:Faci
li
tat
ingWhyandhowt
otakeact
ion
P1337431220099 Fakt
or-
fakt
ory
ang mempengar
uhikesej
aht
eraan
gi
zidan per
an pendi
dikan gi
zisal
ah sat
uny
a
adal
ahf
akt
orbi
ologi
s,ber
ikuti
niy
angt
ermasuk
f
akt
orbi
ologi
sadal
ah….
a.usi
a,j
eni
skel
ami
n,danber
atbadan
b.genat
ik,
gay
ahi
dup,
danj
eni
skel
ami
n
c.usi
a,j
eni
skel
ami
n,dangenet
ik
d.usi
a,r
iway
atpendi
dikan,
dangenet
ik
e.genet
ik,
jeni
skel
ami
n,danpol
amakan

31. Shaf
inaPut
riMul
i
a Mat
eri
:Faci
li
tat
ingWhyandhowt
otakeact
ion
P1337431220100 Di
bawahi
niy
angmer
upakanel
emenkeef
ekt
if
an
pendi
dikangi
zi
,kecual
i
…
A.Fokuspadaper
il
aku
B.Fokuspadakeadaani
ndi
vi
du
C.Mul
ti
lev
el
D.Menggunakant
eor
i
E.Menggunakanbeber
apast
rat
egi

32. Shaf
aNur
syaf
i’
ah Mat
eri:Faci
li
tat
ingWhyandhowt
otakeact
ion
P1337431220101 Pendekat
an sosi
al ekol
ogi
s pada t
ingkat
I
nter
per
sonal
lebi
hber
f kecual
okuskepada, i
…..
..
a.Kel
uar
ga
b.Jar
ingansosi
al
c.Pengal
amanhi
dup
d.Temansebay
a
 e.Per
ansosi
al

33. Sy
indi
Rizki
Cahy
ani Mat
eri:Faci
li
tat
ingwhyandhowt
otakeact
ion
P13374731220102 Adabeber
apaf
akt
ory
ang dapatmempengar
uhi
t
indakan dan per
il
aku seseor
ang.Di
bawah i
ni
mer
upakanf
akt
ori
nter
per
sonal
kecual
i
,.
..
a.Nor
masosi
al
b.Kel
uar
gadanj
ejar
ingsosi
al
c.Nor
mabuday
a
d.Kebi
j
akanpubl
i
k
e.Pr
esepsi

34. Ai
syahKhoi
runni
sa Mat
eri:Faci
li
tat
ingwhyandhowt
otakeact
ion
P1337431220103 Dal
am mengi
dent
if
ikasi suat
u masal
ah at
au
kebut
uhan kesehat
an halper
tama y
ang har
us
di
l
akukan adal
ah memi
l
ih at
au menent
ukan
per
masal
ahan apa y
ang hendak di
i
dent
if
ikasi
.
Set
elah menent
ukan masal
ahny
a apa,kemudi
an
l
angkahsel
anj
utny
aadal
ah…
A.memi
l
iht
eor
iyangakandi
gunakan
B.mendesi
gn akt
ivi
tas/
kegi
atan apa y
ang
akandi
l
akukan
C.memi
l
ih per
il
aku at
au beber
apa t
arget
per
il
aku
D.mengi
dent
if
ikasi
det
ermi
nan
E.mel
akukanev
aluasi
rencana

Dibawahi
niy
ang mer
upakanbagi ii
andar nput
model
l kaNut
ogi ri
ti
onEducat
ionadal
ah…
A.pr
ice
B.peopl
e
C.pr
oduct
D.pl
ace
 E.pol
i
tic

El
emen y
ang ber
kont
ri
busi pada keef
ekt
if
an
pendi
dikan gi
zisal
ah sat
uny ah mul
a adal ti
ple
l
evel
s and suf
fi
cient dur
ati
on,y
ang di
maksud
denganel
ement
ersebutadal
ah…
A.seber
apal
amawakt
uyangdi
but
uhkandan
adakai
tanny
adenganbi
aya
B.f
okuspadaper
il
akui
ndi
vi
du
C.menggunakan ber
bagaimacam t
eor
i,mi
s
t
eor
ipsi
kol
og,
kogni
ti
f,pl
anbehav
ior
D.f
okus pada pr
akt
ik y
ang dapat
meni
ngkat
kanef
ekt
ivi
tas
E.mampuber
piki
rkr
it
isdengandur
asiy
ang
t
idakl
ama

35. Andhi
niPr
ast
iwi
P.H Mat
eri:Faci
li
tat
ingWhyandHowToTakeAct
ion
P1337431220104 Langkah-
langkan mer
ancang pendi
dikan gi
zi
ber
basi
steor
i(i
nput
)yangbenaradal
ah.
..
A.Sel
ectt
heor
y
B.Pl
anev
aluat
ion
C.Desi
gnact
ivi
ti
es
D.Choosei
ssue
E.St
ateobj
ect
ives

36. Fi
nal
i
ani
syaFebr
iani Mat
eri:Faci
li
tat
ingwhyandhowt
otakeact
ion
P1337431220106 Membuat menu one di
sh meal y
ang dapat
memenuhi kel
engkapan gi
zi sesuai dengan
pedoman i
si pi
ri
ngku sehi
ngga memudahkan
aksesmasy
arakatdal
am memenuhimakansesuai
i
sipi
ri
ngkumer
upakansal
ahsat
ucont
ohEl
emen
keef
ekt
if
anpendi
dikangi
zipada.
.
a.Det
ermi
nanper
il
aku
b.Beber
apast
rat
egi
 c.Fokuspadaper
il
aku/
prakt
ik
d.Mengguanakant
eor
i
e.Mul
ti
lev
eldancukupwakt
u

37. Cahy
aFaj
ri
ati Mat
eri:Pengembanganmedi
acet
ak
P1337431220107 Dal
am mendesai
n mat
eri
alcet
ak sal
ah sat
uny
a
post
er,har
us memi
l
ikiper
bedaan dengan y
ang
l
ain.makadar
iit
uci
ripost
ery
angef
ekt
if
,kecual
i
…
a.menar
ikper
hat
iandar
ijar
ak10met
er
b.memor
abl
e
c.Desai
nmudahdi
gunakan
d.menggunakan gambarsebagaipembawa
pesan
e.dr
amat
isasi
singl
eidea

38. Sr
iPopy Mat
eri:PengembanganMedi
aCet
ak
P1337431220108 Dal
am membuatmat
eri
alcet
akhalhaly
anghar
us
di
per
hat
ikansaatmembuatdesai
nlay
outkecual
i…
a.t
idak bany
ak shadow,memor
abl
e,whi
te
space
b.menggunakan i
l
ust
rasiseder
hana,war
na
y
angpant
as,
dant
idakbany
akshadow
c.menggunakan gay
ayang l
ayak,i
l
ust
rasi
r
eal
i
sdant
idakabst
rak
d.menggunakan gay
ayang l
ayak,i
l
ust
rasi
seder
hana,
il
ust
rasi
yangpr
oposi
onal
e.t
idak bany
ak menggunakan shadow,
gambarl
engkap,
il
ust
rasi
seder
hana

39. Nur
mit
aNi
l
as Mat
eri:PengembanganMedi
aCet
akE-
Medi
a
Must
ikawat
i 1.Met
ode pr
omosikesehat
an di
gol
ongkan
P1337431220109 ber
dasar
kant
ekni
kkomuni
kasi
…..
 (
1)Pendekat
ani
ndi
vi
du
(
2)Met
odepeny
uluhanl
angsung
(
3)Pendekat
anmassa
(
4)Met
odepeny
uluhant
idakl
angsung
a.1,
2,dan3
b.1dan3
c.2dan4
d.4saj
a
e.semuasal
ah/benar
2.Apamedi
aint
erper
sonaly
angpal
i
ngef
ekt
if
dal
am r
angkakomuni
kasi
adv
okasi
……
a.Fl
i
pchar
d,bookl
et,
sli
deat
auv
ideocasset
te
b.penger
assuar
adanpower
poi
nt
c.Memo
d.Papant
uli
s
e.Sal
ahsemua

40. MuhammadRi
zqi Mat
eri
:PengembanganMedi
aCet
ak
Nugr
aha Textpadamedi
acet us…kecual
akhar i
?
P1337431220110 a.menggunakankal
i
matakt
ifdanposi
ti
f
b.menggunakan bahasa dan
pembendahar
aankat
ayangsama
c.menggunakanunsurr
adi
kal
d.ul
angipesandasarsekur
ang-
kur
angny
adua
kal
i
e.pi
l
ihj
eni
sdan ukur
anhur
ufy
angmudah
di
baca

41. Dhi
yaRahmaSy
afhi
ra Mat
eri:PengembanganMedi
aCet
ak
P1337431220112 Yang har
us di
per
hat
ikan saatmembuatdesai
n
medi
acet
akagart
erl
i
hatmenar
iky
ait
u,kecual
i
….
f
. Bany
akshadow
 g.Gambarl
engkap
h.Menggunakani
l
ust
rasi
seder
hana
i
. Menggunakanwar
nay
angpant
as
j
.Il
ust
rasi
propor
sional
(Ukur
anny
a)

42. Gay
uhRi
dhoWi
cakso Mat
eri:PengembanganMedi
aCet
ak
P1337431220113 Ber
ikuti
nibukan mer
upakan post
erdan
Bi
l
lboar
dyangef
ekt
if
…
A.Menar
ikper
hat
iandar
ijar
ak10met
er
B.Gambarsebagai
pembawapesan
C.Memor
abl
e
D.Menunj
ukanmanf
aat
E.Seder
hana

43. Chi
kaPut
riPr
ashant
i Mat
eri:PengembanganMedi
aCet
ak
P1337431220114 Ber
ikuti
niy
angt
ermasukmedi
acet
akadal
ah…
A.BukudanModul
B.Sl
i
de
C.Tul
i
sanber
ger
ak
D.Fi
l
m
E.Ber
it
atv

NOTE:
Kasi
hket
erangansoal
mat
eri
apa.
Al
i
hJenj
ang

No. I
dent
it
as Soal

1. Khol
i
dah Mat
eri:PengembanganMedi
aCet
ak
P1337431221051 Dal
am membuat medi
a cet
ak har
us
memper
hat
ikankai
dahpenggunaant
exty
angbai
k.
Ber
ikuti
nikai
dah penggunaan t
exty
ang bai
k,
kecual
i
…
 a.Gunakankal
i
maty
angakt
ifdanpendekat
an
posi
ti
f
b.Gunakanbahasadanper
bendahar
aany
ang
sama
c.Mengul
angipesandasarsekur
angny
adua
kal
i
d.Pi
l
ihj
eni
sdanukur
anhur
ufsehi
nggamudah
di
baca
e.Gunakanhur
ufbesarat
aukeci
l

2. Ni
syaMagf
ir
a Mat
eri:PengembanganMedi
aCet
ak
P1337431221092 Sal
ahsat
uci
ridesai
nyangbai
kadal
ah…
a.menampi
l
kanbany
akpesanpadaset
iap
i
l
ust
rasi
b.t
idakmembat
asi
juml
ahkonsepdanhal
aman
c.t
idakadar
uangkosong(
whi
tespace)
d.menggunakani
l
ust
rasi
unt
ukmembant
u
mener
angkant
ext
e.pesany
angadadal
am desai
nti
dakber
urut
an