Efficacy of an online nutrition education intervention and its impact on nutrition knowledge, attitude, practice and nutritional status among students of Universiti Malaysia Sabah
Nutrition education is imperative because healthy eating and physical activity are known modifiable risk factors for non-communicable diseases (NCDs), especially among young adults or university students who are prone to unhealthy eating habits and sedentary lifestyles. Lack of nutrition knowledge a...
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| Format: | Thesis |
| Language: | English English |
| Published: |
2023
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| Subjects: | |
| Online Access: | https://eprints.ums.edu.my/id/eprint/41215/1/24%20PAGES.pdf https://eprints.ums.edu.my/id/eprint/41215/2/FULLTEXT.pdf |
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| Summary: | Nutrition education is imperative because healthy eating and physical activity are known modifiable risk factors for non-communicable diseases (NCDs), especially among young adults or university students who are prone to unhealthy eating habits and sedentary lifestyles. Lack of nutrition knowledge and motivation could lead to unhealthy eating habits and a sedentary lifestyle, increasing the risk of developing NCDs such as obesity, hypertension, and high cholesterol levels. This warrants nutrition intervention but information on the efficacy and impact of online nutrition education intervention in a university setting in Malaysia is limited. The main purpose of this study is to determine the efficacy of an online nutrition education intervention and its impact on nutrition knowledge, attitude, practice, and nutrition status parameters among students of Universiti Malaysia Sabah. The online nutrition education intervention was pilot tested on 32 university students to ascertain the feasibility of the larger study. This study was a 10-week online nutrition education intervention of randomized pre- and post-design and a control group. The modules used in the intervention were sourced from Malaysia Government nutrition-related publications such as The Malaysian Dietary Guidelines 2020, Recommended Nutrient Intakes for Malaysia, Clinical Practice Guidelines on Obesity and Pengurusan Fit & Trim. Selected contents of these modules were adapted into materials that were delivered online (PowerPoint, video, and infographic). The intervention was delivered using Microsoft Team (E-learning platform), WhatsApp and Facebook. A total of 177 university students participated in this study. Participants were grouped into the normal weight (n=81) or overweight/obese group (n=96) according to their body mass index. This study conducted non-blinded simple randomization to assign participants to either a control or intervention group. The normal weight participants (n=81) were randomly assigned to either the Intervention Knowledge (IK) group (n=46) to receive nutrition education intervention or the Control Knowledge (CK) group (n=35) that did not receive nutrition education intervention. The overweight/obese participants (n=96) were assigned to either the Intervention Weight Loss (IWL) group (n=50) to receive nutrition education intervention or the Control Weight Loss (CWL) group (n=46) that did not receive the nutrition education intervention. Information such as height, weight, waist circumference, body fat composition, and clinical parameters (blood pressure, fasting blood glucose, lipid profile, iron profile) were obtained using standard methods. Participants’ self-reported dietary intakes were obtained through three-day food diary. Nutrition knowledge, attitude, and practice (KAP) were obtained through a questionnaire. Physical activity level was determined from the International Physical Activity Questionnaire (IPAQ). Step counts were measured using pedometers. Participants’ anthropometric data (height, body weight, body mass index, waist circumference, body fat and visceral fat), clinical parameters (blood pressure, fasting blood glucose, lipid profile and iron profile), dietary intake (three-day food diary), physical activity (IPAQ and three-day step counts) and nutrition knowledge, attitude, and practice (KAP) were obtained at pre and post-intervention. Statistical analysis was conducted using IBM SPSS 28. Results showed that IWL had lower post-intervention vigorous physical activity (510.0 ± 827.2 Met-Minute/Week <2807.3 ± 3554.5 Met-Minute/Week, p=0.024) compared to CWL. IWL showed significantly higher post-intervention than pre-intervention values for diastolic blood pressure (p=0.036, mean diff: 7.2 mmHg), 3-day step counts (p=0.016, Mean diff =1961.1) and nutrition knowledge (p=0.007, mean diff=1.8). IWL showed significantly lower post-intervention than pre-intervention values for energy intake (p<0.001, Mean Diff= -443.2 Kcal), fat intake (p<.001, Mean Diff= -21.2 g), carbohydrate intake (p=0.001, Mean Diff= -58.2 g), dietary fibre intake (p=0.001, Mean Diff= -4 g), cholesterol intake (p=0.044, Mean Diff= -49.6 g), sugar intake (p<0.001, Mean Diff= -39.4 g), EI: BMR (p<0.001, Mean Diff= -0.3), HDL-cholesterol (p <.001, Mean Diff=-0.3 mmol/L), iron (p=0.009, Mean Diff=-5.1 umol/L), vigorous physical activity (p=0.013, mean diff= -596.0 Met-Minute/Week) and IPAQ score (p=0.031, mean diff= -1062.0 Met- Minute/Week). IK showed post-intervention values that were significantly higher than that of CK for a majority of parameters such as body weight (50.1 ± 5.4 kg > 47.3 ± 3.9 kg, p=0.043), hours being sedentary (7.1 ± 6.2 Hour/day > 1.1 ± 2.5 Hour/day, p=0.007), nutrition knowledge (35.8 ± 3.3 > 25.4 ± 11.0, p=0.002), nutrition attitude (41.2 ± 4.8 > 39.8 ± 4.3, p=0.009), energy intake (1475.7 ± 481.6 kcal > 1224.5 ± 425.2 kcal, p=0.008), fat intake (50.5 ± 21.3 g > 46.6 ± 21.8 g, p=0.008), carbohydrate intake (185.0 ± 65.2 g > 143.3 ± 52.6 g, p=0.023), dietary fibre intake (8.4 ± 3.1 mg > 4.8 ± 3.5 mg, p=0.001), sodium intake (2255.4 ± 957.9 mg > 1792.1 ± 561.5 mg, p=0.016), potassium intake (1288.3 ± 440.4 mg > 1161.8 ± 570.4 mg, p=0.019) and EI: BMR (1.3 ± 0.4 > 1.1 ± 0.4, p=0.008). IK showed values that were significantly higher at post-intervention than at pre-intervention for systolic blood pressure (p=0.018, Mean Diff=5.9 mmHg), diastolic blood pressure (p=0.002, Mean Diff=5.7 mmHg), dietary fibre intake (p=0.030, Mean Diff= 2.2 g), 3-day step count (p=0.002, Mean Diff=2080.9), nutrition knowledge (p=0.006, mean diff=1.7), nutrition attitude (p=0.016, mean diff=2.8). However, IK showed lower nutrition practice (p=0.008, mean diff= -6.5) post-intervention. In conclusion, the online nutrition education intervention resulted in lower dietary intake (energy intake) and improvement in nutrition knowledge among the overweight intervention group (IWL), improvement in nutrition knowledge and attitude among the normal weight intervention group (IK) as well as increased step counts in both of these groups. |
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