Evaluation of a nutrition education module as a component of the career orientation of foreign missionaries

RESEARCH ARTICLE Evaluation of a Nutrition Education Module as a Component of the Career Orientation of Foreign Missionaries PATRICIA

C.

HART,t BETTY B. ALFORD, AND MARY ANNE GORMAN 2

Department of Nutrition and Food Sciences, Texas Woman's University, Denton, Texas 76204; lPresent address: Department of Human Nutrition and Hospitality Management, University of Alabama, Tuscaloosa, Alabama 35487-0158; 2Present address: Department of Nutrition and Dietetics, P.O. Box 32869, Texas Christian University, Denton, Texas 76129 moters would not only improve their own nutrition practices, but would also be in a better position to help others in need. Health promotion through nutrition education must be based on sound information . However, numerous studies have shown that Americans in general have a limited knowledge of nutrition (1-12). Because one of the main objectives of nutrition education research for many years has been to increase the nutrition knowledge of participants, a large body of data has evolved surrounding pre- and post-testing to assess knowledge gains. The majority of these studies have shown that nutrition education intervention results in increased nutrition knowledge (6, 7, 9-11 , 13-17). Nutrition educators have also evaluated the relationships between changes in nutrition knowledge and changes in attitudes and behavior as a result of program interventions. Various investigations (6, 13-15), including a review of adult nutrition education studies by Looker (17), have revealed that although nutrition knowledge is usually increased by nutrition education, changes in attitude and behavior have not been as prevalent. Other research has shown that nutrition knowledge is positively related to attitudes toward nutrition (18-21). Schwartz (19, 20, 22) has maintained that knowledge change precedes attitude change and change in behavior. Sims (21) and Rosander (23) have proposed, however, that instead of the traditional knowledge-to-attitude-tobehavior process, attitude change may precede changes in both knowledge and behavior. A few investigators (2427) have defined attitude as either flexibility- or rigidityto-change. In a broader definition of attitudes in nutrition education research, Foley et al. (28) classified attitudes as 1) preferences, likes or dislikes, and feelings ; 2) food behavior; 3) flexibility versus rigidity; 4) agreement; and 5) complexity of meanings. Research is needed to explore all of these definitions (27) . A meta-analysis or secondary analysis was done by

ABSTRACT The purpose of this study was to evaluate the effect of a nutrition education module, emphasizing both cognitive and affective concepts, on the nutrition knowledge, flexibility of attitude toward nutrition and attitude about nutrition education of missionaries during their orientation period. The experimental (n = 22) and control (n = 19) groups completed pre- and post-test questionnaires that were developed for this study. Missionaries in the experimental group demonstrated significant increases in both nutrition knowledge and more positive attitudes about nutrition education after participation in the module. The control group, however, had no significant increase in knowledge at post-testing and, in general, had significantly more negative attitudes about nutrition education. No Significant changes in flexibility were detected for the control group and only for one statement in the experimental group. Significant positive correlations resulted at post-testing between nutrition knowledge and attitude, as well as knowledge and flexibility for the experimental group and between flexibility and attitude for both the experimental and control groups. Results from this study suggest that a change in nutrition knowledge precedes a change in attitude in the knowledge-attitude-behavior pathway as revealed by an analysis of covariance. This sequence supports the principles of adult learning and the theory of holistic education upon which the program of missionary orientation is based. (JNE 22:81-88, 1990)

INTRODUCTION Hunger and malnutrition, along with diseases associated with overnutrition, contribute to the majority of health problems in both third world and industrialized countries. If nutrition knowledge and positive attitudes about nutrition could be increased during missionary training, then perhaps these thousands of potential nutrition proPlease address correspondence to Patricia C. Hart, Ph.D. , R.D. , Department of Human Nutrition and Hospitality Management, University of Alabama, Tuscaloosa, AL 35487-0158. 0022-3182/90/2202-0081$02.00/0 © 1990 SOCIETY FOR NUTRITION EDUCATION 81

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Hart et al. I MISSIONARY NUTRITION EDUCATION

Table 1.

Demographic characteristics of the sample. Group

Variable

+

Control (N = 19)

34 ± 1.5

35 ± 1.5

Age in years

(Mean

Sex

MaleS Females

7 15

7 12

Marital status

Married Single

21 1

18 1

Total no. of children in each age range

0-2 yrs. 3-5 yrs . 6-12 yrs. 13-19 yrs.

9 7 17 2

Asia and the South Pacific Latin America Africa Europe and the Middle East

6 6 10 0

Country of assignment

Johnson and Johnson (29) on the research findings in 303 articles that dealt with nutrition education. Results showed that, in general, nutrition education has led to a marked increase in knowledge about nutrition, some increase in positive attitudes toward eating nutritiously, and constructive changes in patterns of food consumption . However, there is still little evidence as to whether or how nutrition knowledge, attitudes, and behavior are related. Specific objectives of this investigation were 1) to determine the nutrition knowledge, flexibility of attitude toward nutrition, and attitude toward learning about nutrition , teaching nutrition in the mission field and the need for nutritionists overseas, by missionaries before and after the nutrition education module presented during their orientation period (experimental group) and of missionaries who did not participate in the module (control group); 2) to determine if there is a link between nutrition knowledge, flexibility of attitude toward nutrition and attitude about nutrition education; and 3) to explore the nature of the relationships among nutrition knowledge, flexibility of attitude, and attitude about nutrition education.

METHODS Experimental design. The participants in this study were selected from pre-assembled orientation groups of career missionaries in training (30) . Two separate orientation groups were selected as control and experimental groups. Participants were selected by a non-randomized control group pre-test, post-test design that relies on pre-assembled groups (31). The demographics of the sample are shown in Table L The control group did not participate in the nutrition educ;ltion module, while the experimental group was required to attend. All condi-

SO)

Experimental (N = 22)

3

8

14

0

6

3 7 3

tions in orientation and teaching learning environment were kept as similar as possible for both groups , except for the nutrition education module. Both groups were pre- and post-tested for nutrition knowledge, flexibility of attitude toward nutrition, and attitude toward learning about nutrition, teaching nutrition in the field and the need for nutritionists overseas . Description of the module. The education philosophy of missionary training is based on the principles of adult learning and the theory of holistic education (32-35). The principles of adult learning set forth by Knowles (32) are geared toward learner-centered and self-directed learning. The theory of holistic education proposed by Rinke (33-35) focuses on the whole teaching/learning situation, and varies the strategy to meet the needs of the learner, the teacher, and the situation, in an effort to attain the educational outcomes desired. Since nutrition was a completely new content area for most of the missionaries, class lecture and discussion were used in the module to convey the basic concepts (32,35). Four formal classes were held dealing with basic nutrition and nutrition through the life-span. In addition, case studies, individual research, computer programs, slides and video tapes were used to convey both cognitive and affective concepts. The cognitive concepts of the nutrition module were based on the seven "Basic Concepts of Nutrition" as proposed by Leverton (37). These concepts were selected because of their usefulness in developing countries as well as being applicable to industrialized areas . The two affective concepts emphasized throughout the module were " Nutrition education in the mission field is important" and "Missionaries could serve as nutrition education promoters." All educational materials paralleled the affective and cognitive concepts. Four classes of one hour each were taught, using a variety of media directed toward the needs of the par-

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ticipants. The two affective concepts presented above were embedded in the content. Nutrition was integrated into the aspects of the missionary orientation such as agriculture, gardening, well digging, sanitation and health care. Each missionary was responsible for completing a personal learning contract (36) .

score was five , where high scores reflected greater flexibility or a more open attitude toward nutrition. The original scale assigned low scores for flexible attitudes and high scores for inflexible attitudes. The alpha reliability coefficient of the F ATNS administered to missionary participants was 0.79.

Instruments. Data were collected for the study by means of two structured questionnaires. The instruments included an information sheet, a nutrition knowledge test, two scales of nutrition attitude (flexibility of attitude toward nutrition and attitude about nutrition education), and several open-ended questions about nutrition education in the mission field. The pre-test questionnaire contained the information sheet, which requested demographic data, plus the knowledge test and attitude scales, while the post-test contained the same knowledge test and attitude scales with the added open-ended questions .

Attitude about nutrition education scale (AANES). In order to measure attitudes of missionaries about nutrition education in the mission field , another Likert-type scale, the AANES, was developed for this study. The same fivechoice range from strongly disagree to strongly agree noted above was used. The two attitude concepts defined on an a priori basis that were to be measured were "Nutrition education on the mission field is important" and "Missionaries could serve as nutrition education promoters." A pool of test items pertaining to each concept was constructed. About one-half of the statements were worded to elicit "agree" responses and the other half worded to elicit "disagree" responses, in order to avoid stereotyped answers (41). The disagree responses were reversed for statistical analysis. The informal criteria for formulating attitude scales compiled by Edwards (42) were used in editing the statements. In order to determine favorableness or unfavorableness of each item and to establish content validity, a group of nutrition experts including educators and dietitians was asked to place the questions into three categories : attitudes favorable to nutrition, attitudes unfavorable to nutrition, and neutral attitudes or attitudes the experts considered unsuited to the purpose of the test. Any item placed in the neutral category by two or more experts was eliminated. Such expert judging, which aided in establishing content validity, is generally employed with attitude scales and was proposed by Carruth and Anderson (24). The attitude statements remaining after expert judgement were pilot-tested with 43 graduate students enrolled in a seminary missiology class. The total possible score for each item was five, reflecting a very positive attitude, while lower scores reflected a less positive attitude. Items that received the same answer from 90% or more of the pilot group were eliminated, due to the inability of the statement to discriminate among people with different degrees of favorableness of attitude. A total of 26 attitude statements were selected for the AANES. Items pertaining to the two attitude concepts were alternated. Data for the 26 remaining attitude statements from the pilot test were analyzed. Internal consistency reliability was established by using the Cronbach alpha coefficient (40). The alpha reliability coefficient of the AANES pilot test was 0.93.

Nutrition knowledge test (NKT). The nutrition knowledge test chosen for this study was the NKT developed at Michigan State University (38, 39) to test the nutrition knowledge of secondary teachers. The NKT was designed as a test for general knowledge of potential nutrition educators. The framework for the test was the "Basic Concepts of Nutrition" (37), which paralleled the cognitive concepts of the nutrition module. The original 40-question instrument was developed with established concurrent validity and a Kuder-Richardson 20 reliability coefficient of 0.93. The instrument was refined through item analysis resulting in 33 distinct questions in the NKT for this study. The Cronbach alpha coefficient may be used to estimate the internal reliability of test items that are scored dichotomously (correct or incorrect) with results exactly the same as using the Kuder-Richardson 20 formula (40). The alpha reliability coefficient of the NKT administered in this study was 0.75. Flexibility of attitude toward nutrition scale (FATNS). This scale was developed by Boren and coworkers (27), based on an original scale developed by Carruth and Anderson (24) and implemented by Carruth et al. (25). The I8-item scale was constructed to measure attitudes independent of knowledge and the degree of flexibility-rigidity in changing nutritional practices. Both content and criterion-related validity were established for the original I8-item scale, with an alpha reliability coefficient of 0.84 (27) . One item related to over-consumption, which was not relevant to this study, was eliminated from the original scale. Responses to statements were measured by a Likert-type scale. The scale varied from strongly disagree, disagree, neither agree or disagree, agree, to strongly agree. Each value was assigned a number for scoring. For analysis, all statements were scored as positive ones. For this study the total possible

Collection of data. Pre-tests for both the control and experimental groups were administered in the first week of each of the seven-week orientation sessions. Post-tests for both groups were given during the last week. Ques-

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Hart et al. / MISSIONARY NUTRITION EDUCATION

Table 2. Comparison of responses from experimental (N = 22) and control (N Test (NKT) prior to and following the nutrition education module".

Group Experimental (N = 22) Control (N = 19)

19) groups to the Nutrition Knowledge

Percent Correct Mean ± SO Scores on NKT Pre- Test

Percent Correct Mean ± SO Scores on NKT Post-Test

Percent Correct Adjusted Mean'" Scores on NKT

54.0 ± 14.4 51.2 ± 11.4

65.3 ± 14.6 53.3 ± 12.8

64.454.2b

"Values within a column with different letter superscripts are significantly different at the p ~ 0.01 level. ""Percent correct post-test scores in this column are adjusted based on percent correct pre-test scores.

tionnaires for pre- and post-tests were given to all participants in both groups, but the completion of the questionnaire was not required. Analysis of data. Data were analyzed using the computerized Statistical Package for the Social Sciences Series X (SPSSX). Pearson correlation coefficients were computed to determine the strength of the relationship between flexibility, attitude, and nutrition knowledge scores. Differences in flexibility, attitude, and scores on the nutrition knowledge tests in the experimental and control groups prior to treatment were assessed by computing 2-sample independent t-tests. This test was also utilized to assess differences in flexibility, attitude, and scores on nutrition knowledge tests between experimental and control groups following treatment. Paired t-tests were computed to assess the Significance of scores (flexibility, attitude, and percentage correct) within the experimental and control groups prior to and following treatment. Multiple regression was performed to determine if either nutrition knowledge and/or flexibility could significantly predict attitude. Predictors of attitude were determined prior to treatment and following treatment, within the experimental and control groups. The coefficient of determination, r2, was calculated to determine the proportion of variability in attitude accounted for by knowledge and flexibility. Analysis of covariance was utilized to determine differences in post-test scores of the experimental and control groups adjusted on the basis of pre-test scores.

RESULTS Of the 31 missionaries in the control group, all completed pre-tests and 19 completed post-tests. Time pressure and lack of interest accounted for the 30% case loss. Of the 28 missionaries in the experimental group, 26 completed pre-tests and 22 completed post-tests. Participants who completed both pre- and post-tests were treated in the statistical analysis. Table 1 summarizes demographic data, which was similar for both groups with the exception of the number and ages of children.

Table 2 shows the comparison of responses from the experimental group (n == 22) and control group (n == 19) to the NKT prior to and following the nutrition education module. Mean scores were reported as percent correct of the total number of 33 questions. No significant difference was found between the mean pre-test scores in nutrition knowledge for the control and experimental groups. Upon post-testing, the experimental group showed significantly higher (p :5 0.01) mean knowledge scores than did the control group. When the change in knowledge scores from pre-test to post-test was analyzed for the experimental and control groups, no significant difference (p :5 0.01) was found between pre-test and post-test knowledge scores. In addition, the comparison of change in knowledge scores from pre-test to post-test between the experimental and control groups was significan tl y differen t (p :5 0.01). Responses of experimental (N == 22) and control (N == 19) groups to the FATNS prior to and following the nutrition education module were compared. Negative statements were reversed for scoring so that high scores reflected flexibility or a more open attitude toward nutrition, and low scores reflected rigidity or a more closed attitude toward nutrition. There were no significant differences found between the pre-test mean scores of the control and experimental groups for any of the statements. Also upon post-testing, no significant differences were found between the post-test mean scores of the control or experimental groups. However, for flexibility statement number one, regarding the willingness to taste foods similar in appearance to disliked items, the experimental group mean post-test score was Significantly higher (p :5 0.05) than the mean pre-test score. There were no other significant changes in pre-test to post-test mean scores for any other statement for either group. When a comparison was made of experimental and control group changes in flexibility scores, there were no significant findings. Comparisons of attitude responses of the experimental (N == 22) and control (N == 19) groups to the AANES prior to and following the nutrition education module were made. Again, negative statements were reversed for scoring so that high scores reflected more positive attitudes about nutrition education and low scores a more

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negative attitude. The experimental group scored significantly higher in the pre-test (p ::s: 0.05) than did the control group for statement number nine, regarding the importance of teaching children and nutrition practices. The experimental group had three times as many children under two years of age as did the control group and. may have had nutrition emphasized by a pediatrician or other regular visit with health professionals. Upon post-testing, the experimental group showed mean scores that were significantly higher (five at p ::s: 0.01 and four at p ::s: 0.001) than the control group for 13 of the 26 attitude statements. When changes in the mean attitude scores from pre-test to post-test were examined for the experimental and control groups, there were significant differences for both groups. In the experimental group, significantly higher (three at p ::s: 0.05, four at p ::s: 0.01 and one at p ::s: 0.001) mean attitude scores were found for eight of the attitude statements. For the control group, there were three statements that showed a significant change in mean score from pre-test to post-test; however, these scores were significantly lower than pre-test attitude scores (one at p ::s: 0.05 and two at p ::s: 0.01) at post-testing. When a comparison was made between the experimental and control groups' changes in mean attitudes scores from pre-test to posttest, there were significant differences (five at p ::s: 0.05 and one at p ::s: 0.001) for six statements. These differences reflect an increase in positive attitudes about nutrition education in the experimental group, as opposed to a decrease in positive attitudes for the control group. Analysis of covariance was performed in order to determine possible differences in post-test scores adjusted on the basis of pre-test values. Adjusted post-test scores of the experimental group were significantly higher (indicating a more positive attitude toward nutrition education) than adjusted post-test scores of the control group (p::S: 0.05) in 14 of the 26 attitude toward nutrition statements analyzed. No significant differences were observed when comparing adjusted post-test scores in the experimental and control groups for any of the 17 flexibility of attitude statements analyzed. Adjusted posttest nutrition knowledge scores of the experimental group were significantly higher (p < 0.05) than adjusted posttest nutrition knowledge scores in the control group. Correlations were calculated among the pre- and posttest scores for the NKT, FATNS, and AANES for both the experimental and control groups. As Table 3 demonstrates, a significant positive relationship was found between total post-test mean scores for nutrition knowledge and attitudes about nutrition education, between nutrition knowledge and flexibility of attitude toward nutrition, and between flexibility of attitude toward nutrition and attitudes about nutrition education. At posttesting, the control group showed a significant positive correlation between total mean scores for flexibility of

85

Table 3. Relationships among total mean scores for the NKT, FATNS, and AANES for the experimental and control groups prior to and following the nutritional educational module.

Pearson Correlation Coefficient Experimental Group (N = 22) Pre-Test NKT (a) AANES (c) NKT FATNS (b) FATNS AANES Post-Test NKT AANES NKT FATNS FATNS AANES

0.44'

Control Group (N = 19)

0.30

0.25

-0.06

0.31

0.30

0.53'*

0.38

0.51"

0.26

0.52"

0.62**

a. NKT = Nutrition Knowledge Test b. FATNS = Flexibility of Attitude Toward Nutrition Scale c. AANES = Attitude About Nutrition Education Scale 'Significant at the p s 0.05 level "Significant at the ps 0.01 level

attitude toward nutrition and attitudes about nutrition education. In order to further investigate the relationships between knowledge, flexibility and attitudes, regression analysis was conducted to determine the extent to which knowledge and flexibility scores contributed to the prediction of attitude scores for the experimental and control groups. Post-test analysis showed that, for the control group, the flexibility score was the only significant predictor of attitude score. Knowledge score was neither a significant predictor of attitude score nor of flexibility score. In the experimental group, post-test analysis showed that only the knowledge score was a significant predictor of both the attitude and flexibility scores. Flexibility score was not a significant predictor of attitude score when both knowledge and flexibility were entered into the prediction equation.

DISCUSSION AND CONCLUSIONS The results of this study indicate that the nutrition education module was effective in significantly increasing the nutrition knowledge and positive attitudes about nutrition of the missionaries in the experimental group, but was not as effective in influencing the flexibility of attitude toward nutrition. The significant gain in knowledge of the experimental group reflects an emphasis 011 cognitive concepts throughout the module. Similar results

86

Hart et al. / MISSIONARY NUTRITION EDUCATION

have been found in the literature for the majority of nutrition education interventions reported (6, 7, 9-11, 13, 16, 19, 21, 43). Because of the high pre-test scores on the FATNS for both the control and experimental groups, a possible ceiling effect may have prevented the scale from adequately detecting changes in flexibility from pre-test to post-test. One other recent study by Brush et al. (10), which used a test based on this scale (27), reported a similar ceiling effect and no changes in flexibility of attitude were detected. In addition, it may be that individuals who have committed themselves to missionary service could already have more flexible attitudes toward nutrition. These questions remain to be explored. Since the study of the different definitions of attitudes, such as flexibility, is relatively new, the need for further refining of instruments to measure flexibility of attitude is apparent (28). Missionaries who participated in the nutrition education module and learned about nutrition through the cognitive and affective concepts that were emphasized significantly increased their positive attitudes about nutrition education. They felt a) that it was important to learn even more about nutrition after completion of the module and b) that they could use this knowledge in the mission field. They also felt that more nutritionists and dietitians belonged in the mission field. Missionaries in the control group who did not participate in the module had significantly less positive attitudes toward learning more about nutrition, teaching nutrition in the mission field, and the need for nutritionists overseas. These results seem to confirm one of the principles of adult learning as defined by Knowles (32), which states that adult learners need to know why they need to learn something before they have an interest in learning it. When adult learners have no previous experience with a content area and do not understand the relevance of a content area to their life tasks or problems, or feel no internal need to learn that content, they must be instructed as to what the content is, how it is organized, what special terminology is used, and what the resources are for learning it, before they are either able to learn more about that area or even want to learn more about it (32). The results also support the theory of holistic education (33-35), which recognizes the importance of varying the teaching-learning approach depending on the needs of the learner, the educator and the situation. The increase in positive attitudes about nutrition due to nutrition intervention has also been reported (9, 12, 19-23). The significant positive correlations found for the experimental group after participating in the nutrition module indicate that as nutrition knowledge increased so did more positive attitudes about nutrition. Similar positive correlations have been reported (8, 9, 11, 1821, 23, 44). Further significant positive correlations in the experimental group at post-testing revealed that as nutrition knowledge increased, flexibility of attitude to-

ward nutrition also increased. Flexibility of attitudes toward nutrition education was also positively correlated with attitudes about nutrition education. The control group also showed a significant positive relationship between flexibility and attitude at post-testing. Although no previous studies in the literature were found which correlated these two variables, it is logical to assume that attitudes defined as flexible/rigid or open/ closed would be related to other attitudes defined as preferences, likes or dislikes, or feelings (28). However, the very low positive correlation between knowledge and attitude and between knowledge and flexibility at posttesting for the control group, in contrast to the significant strong positive correlation for these variables in the experimental group, show the effect of the module. The results of the regression analysis parallel the correlation results. Although this study was not designed to test causality in the relationships among nutrition knowledge, flexibility of attitudes, and attitudes about nutrition education, it seems probably that the data support the model proposed by Schwartz (19, 20, 22) that a change in nutrition knowledge precedes a change in attitudes about nutrition. St. Pierre (44) also hypothesizes that knowledge is the most proximate outcome of nutrition education intervention, with a change in attitudes and behavior following an increase in knowledge. Further investigations are needed in order to determine the interrelationships of these variables. As Brush et al. (10) have suggested, there may be pathways that are more complex than the linear pathways proposed to date. The findings in this study, where both nutrition knowledge and attitudes about nutrition were significantly increased as a result of participation in the nutrition education module, underscore the need for nutrition interventions that emphasize both cognitive and affective concepts, and are based on the principles of adult learning (32, 46) and the theory of holistic education (3~5). 0

ACKNOWLEDGMENT This article was adapted from the unpublished doctoral dissertation of P. C. Hart entitled, "Evaluation of a Nutrition Education Module as a Component of the Career Orientation of Southern Baptist Foreign MiSSionaries," Department of Nutrition and Food Sciences, Texas Woman's University, Denton, Texas 76204.

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for effectiveness, an synthesis of research. Journal of Nutrition Education 17(suppl. ), 1985. The Missionary Learning Center (MLC) of the Foreign Mission Board of the Southern Baptist Convention approved the participation of missionaries in its orientation program. Isaac, S. and M.B. Michael. Handbook of research and evaluations. San Diego: EDITS Publishers, 1981. Knowles, M.S. The adult learner: A neglected species, 3rd ed. Houston: Gulf Publishing Co., 1984, pp. 51-85. Rinke, W.J. Holistic education: Toward a functional approach to adult education. Lifelong learning: Th e adult years 5(no. 8):12-14, 1982. Rinke , W.J. Holistic education: An answer? Training and Development Journal 39(no. 8):67-68, 1985. Rinke, W.J. Holistic education : a new paradigm for nutrition education. Journal of Nutrition Education 18:151-155, 1986. Knowles, M.S. Using learning contracts. San Francisco: JosseyBass Publishers, 1986, pp. 3-8, 40-42. Leverton, RM. Basic nutrition concepts. Journal of Home Economics 59:346-348, 1967. Lackey, C.J., K.M. Kolasa, K.P. Penner and B.C. Mutch. Development of the NKT-A general nutrition knowledge test for teachers. Journal of Nutrition Education 13:100-101, 1981. Penner, K.P. and K.M . Kolasa. Secondary teachers' nutrition knowledge, attitudes, and practices. Journal of Nutrition Education 15:141-145, 1983. Ebel, RL. and D.A . Frisbie. Essentials of educational measurement, 4th ed. Englewood Cliffs, New Jersey: Prentice-Hall, Inc., 1986, pp. 76-78. Likert, R. The method of constructing an attitude scale. In Readings in attitude theory and measurement, Mark Fishbein (ed.). New York: John Wiley & Sons, Inc., 1967, pp. 90-96. Edwards, A.L. Techniques of attitude scale construction. New York: Appleton-Century-Crofts, Inc. , 1957, pp. 13-14. Looker, A.C. and B. Shannon. Threat vs. benefit appeals: Effectiveness in adult nutrition education. Journal of Nutrition Education 16:173-176, 1984. Byrd-Bredbenner, C. The interrelationships of nutrition knowledge, attitudes toward nutrition, dietary behavior, and commitment to the concern for nutrition education. Unpublished doctoral dissertation, The Pennsylvania State University, 1980. St. Pierre, R G. Specifying outcomes in nutrition education evaluation. Journal of Nutrition Education 14:49-51, 1982. Bigge, M.L. Learning theories for teachers, 4th ed. New York: Harper & Row, Publishers, 1982, U8 pp.

RESUME: Evaluation d'un module d'education nutritionnelle en tant que composante de I'orientation vocationnelle des missionnaires . L' objectif de cette etude etait d' evaluer r effet d' un module d'education nutritionnelle qui valorise les concepts cognitifs et les concepts affectifs, sur les connaissances nutritionneIIes ainsi que la flexibilite des attitudes des missionnaires envers la nutrition et J' education nutritionneIIe lors de leur orientation. Le groupe de contr6le (n = 19) et Ie groupe experimental (n = 22) ont complete des questionnaires pre et post-experimentaux con<;!us pour cette etude. Les missionnaires du groupe experimental ont demontre un changement positif significatif dans leurs connaissances ainsi que dans leur attitude envers feducation nutritionneIIe apres avoir participe au module. Le groupe de contr6le, cependant, n'a demontre aucun changement significatif des connaissances et en general possedait des attitudes plus negatives envers I'education nutritionneIIe lors de revaluation post-experimentale. De plus, aucun changement dans la flexibilite des attitudes n'a ete revele au sein de ce groupe tandis que chez Ie groupe experimental, un tel changement n'a ete demontre que pour run des enonces. Une correlation

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positive significative entre les connaissances nutritionnelles et l' attitude s' est averee au sein du groupe experimental lors de l'evaluation. Une correlation positive a egalement ete revelee entre la flexibilite et l'attitude chez les deux groupes. Les resultats de cette etude suggerent qu'un changement des connaissances nutritionnelles precede un changement de l'attitude dans l'axe attitude-comportement d'apres I'analyse de la covariance. Cette sequence supporte les principes de I' apprentissage chez les adultes et la theorie de "I' education holistique" sur laquelle est base Ie programme d'orientation des missionnaires. (JNE 22:81-88, 1990) Translated by the National Institute of Nutrition (Canada)

RESUMEN: EI proposito de este estudio fue el de evaluar el efecto de un m6dulo educativo en nutrici6n, enfatizando los conceptos cognoscitivos y afectivos, sobre el conocimiento de nutrici6n, la flexibilidad de la actitud hacia nutrici6n y la actitud acerca de I educaci6n nutricional de misioneros durante su periodo de orientaci6n. Los grupos, experimental (n = 22) y

de control (n = 19), completaron examenes iniciales y finales los cuales fueron desarollados para este estudio. Los misioneros del grupo experimental demonstraron incrementos significantes en su conocimiento de nutrici6n y en las actitudes positivas acerca de educaci6n nutricionalluego de su participaci6n en el m6dulo. Sin embargo, el grupo de control, que no particip6 en el m6dulo, no present6 estos incrementos significantes en su conocimiento al presentar su exam en final y, en general, tuvo un incremento significante de actitudes negativas acerca de educaci6n nutricional. En este grupo tampoco fue detectado ningun cambio significativo en flexibilidad y en el grupo experimental solo hubo cambio en uno de los puntos evaluados. En el exam en final, el grupo experimental present6 como resultado correlaciones positivas significantes entre conocimiento de nutrici6n y actitud al igual que entre el conocimiento y flexibilidad y entre flexibilidad y actitud 10 hicieron ambos grupos. Resultados de este estudio sugieren que el cambio en conocimiento de nutrici6n precede al cambio en actitud en la relaci6n conocimiento-actitud-conducta. Esta sequencia sostiene los principios de aprendizaje de adultos y la teoria de educaci6n "holistic" sobre los cuales esta basado el programa de orientaci6n misionera. (JNE 22:81-88; 1990) Translated by the authors

SATELLITE SYMPOSIUM OFFERED ON DIET AND HEALTH A satellite symposium on "Diet and Health: Combating Misinformation" will be broadcast on Friday, May 11. Produced by the University of California, Davis, the professional development program is aimed at dietitians, home economists, educators and other health-care professionals. The four-hour symposium will air on C-Band from 9 a.m. to 1 p.m. Pacific Daylight Time and will be available for preregistered receive (downlink) sites across the nation. At a later date, videotapes of the program will also be available to sites without satellite receive equipment. The symposium will focus on misinformation about obesity and weight control, dietary fiber and fat, nutrient supplements and why people are vulnerable to nutrition and health misinformation and quackery and what can be done about it. Participants will be able to phone in questions for each speaker, using a toll-free number. Inquiries about the program and registration fees for single or multi-receive sites should be directed to Karen Berke, Agricultural Communications, University of California, Davis, CA 95616 or phone (916) 757-8949.