Happy family eating: an evaluation of an online interactive course aiming to improve healthy family eating behaviours found particular benefits for those most in need.
Obesity (Care and treatment)
Family (Health aspects)
|Publication:||Name: Community Practitioner Publisher: Ten Alps Publishing Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 Ten Alps Publishing ISSN: 1462-2815|
|Issue:||Date: July, 2010 Source Volume: 83 Source Issue: 7|
|Geographic:||Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom|
With the current high levels of obesity and evidence which
indicates that simply supplying healthy eating information can not
facilitate significant behaviour change, (1) new methods of changing
eating patterns need to be explored. It is considered particularly
important to engage with parents of young children, since they have
responsibility for establishing the eating habits of the next
There are many influences on families that lead to unhealthy lifestyles (4) and so, in order to make positive changes to eating behaviours, the interventions must fit easily and enjoyably into everyday family life and avoid being onerous in terms of time and content.
The Healthy Happy Family Eating course, developed by the parenting website Netmums, aims to improve the diets and the enjoyment of family eating for a large number of families using simple emailed challenges in conjunction with appropriate web-based content and a dedicated discussion forum. The course conveys specific nutritional messages in ways that are easy and interesting to incorporate into family life. It intended to increase the confidence of participants in providing healthy diets for their families and in their meal planning skills.
Netmums is a UK-based parenting website with over 1.2 million unique visitors each month. Its mission is to provide information and support to parents in the UK, empowering them to bring up happier, healthier families with confidence. It has had previous successes in changing self-reported behaviour in other areas important to parents--the Making Mums Happy (5) and Relationship (6) courses. Both of these involved a combination of email messaging and a dedicated course forum to offer a supportive course environment.
The majority of Netmums members are parents with children aged under 10 years. Analysis by Hitwise (a well regarded internet traffic monitor) has found that a greater proportion of users of the website come from lower socio-economic groups than might be expected--32% from D/E social group, which represents only 20% of the overall online population. The geographical spread of Netmums members across the UK is generally representative of the population, with slightly higher proportion in South-East England.
Netmums and family eating
Netmums has a large, popular section on family food and healthy eating including easy recipes, fussy eating advice and budget eating information. Recent additions to the food section include articles offering support for those wanting to lose weight, advice on weaning and information on reducing saturated fat intake.
In addition, Netmums has campaigned for better family food since 2003, and has successfully demonstrated the views of parents in terms of issues such as front-of-pack labelling, food additives and school meals.
* Daily emailed challenges and ideas
* Web-based content supporting and supplementing the course emails
* A dedicated discussion forum viewable and available to course members
* Free access to a registered dietitian via the online forum.
The emails are sent to course participants every weekday over the four weeks.
The email content, which was written in conjunction with a registered dietitian, is a fundamental part of the course and written in an encouraging, informal style. Links are included to relevant information within the food section and to the discussion forum.
The email challenges vary from providing nutritional messages to fun food-related activities. All are based around the six course principles to:
* Enjoy good food
* Get the balance right
* Get organised and get cooking
* Swap bad food for good
* Eat breakfast
* Keep hydrated.
Participants are asked to rate seven statements in pre- and post-course quizzes to determine how the course has impacted on their family eating. The statements rated by participants are:
* 'We have happy mealtimes in our house'
* 'I am well organised when it comes to family eating and mealtimes'
* 'I am inspired to try new recipes and food ideas'
* 'I am concerned that we aren't eating a healthy diet'
* 'I am happy to cook'
* 'I often choose unhealthy options because they are more convenient'
* 'I feel confident about using food labels'.
The quizzes are an integral part of the course experience, providing participants with an opportunity to focus on how they feel about different aspects of eating and feeding the family. The participants' answers to the two quizzes also form the basis for the project evaluation.
The number of Netmums members who signed up for the initial course run and completed quiz 1 at the start of the course was 1857. Of these, 528 participants (28.4%) finished the course and completed quiz 2. The data collected from the 528 participants who completed both quizzes was used for further quantitative analysis.
The results showed that there was a statistically significant increase in the mean scores for all seven statements after the course. Calculation of the effect size showed that participation in the programme had a significant large and positive effect on participants' views of the subjects tested in the statements.
The analysis found that parents reported most improvement in:
* Organisation and planning of family eating and meal times
* Inspiration for new recipes and new food ideas
* Amount of concern parents felt about feeding their families unhealthy diets.
Many parents were empowered by the new knowledge from the course, while others found the course reassuring because the content acted as a reminder for them.
Least improvement was shown in the participants' happiness to cook, though this statement had the highest mean average score of all the statements in quiz 1, so there was less scope for improvement.
Lower starting knowledge: benefits
A key aim of many public healthy eating campaigns is to provide particular support to those who find healthy eating especially challenging. Due to this, further analysis of the results was undertaken to see how participants who found healthy eating more difficult at the start of the course benefitted, in relation to those that ordinarily found it less difficult.
The respondents were divided into two subpopulations:
* Lower scoring group, who scored at or below the overall mean score at the start of the programme
* Higher scoring group, who scored above the overall mean score at the beginning of the programme.
A paired t-test analysis was then carried out for each subpopulation, and the low scoring group showed a much greater increase in scores on all questions after the programme than the higher scoring group. This suggests that the programme had greater benefits for respondents who were most challenged by feeding their family healthy food options.
The results indicate that an email and web-based format for nutrition education based around simple, engaging dietary challenges, with no direct person-to-person contact, can have a positive impact on improving eating behaviour and enjoyment of family eating within participating families. The course appeared to be particularly helpful in increasing the level of confidence among participants.
The combination of frequent emails, supporting website content and a discussion forum enabled healthy eating messages to reach and influence many more families than would have been possible using traditional face-to-face methods within the same timeframe and at the same cost.
Further research is needed to understand the demographics of those who choose to participate in this type of educational package. Participants of the course were self-selecting and required a degree of self-motivation in order to complete the course, and we need to consider how to encourage more groups of parents to engage with future programmes. Emphasis should be placed on encouraging parents who have a lower starting knowledge and would have most to gain from the information and support that the course offers. Promotion for future courses, is therefore planned through cooperative working with health visitors, primary care trusts, GPs and Sure Start children's centres.
The Netmums Healthy Happy Family Eating programme was funded jointly by the Food Standards Agency Saturated Fat and Energy Intake programme and Department of Health Change4Life initiative.
(1) NHS Information Centre. Statistics on obesity, physical activity and diet: England, February 2009. London: HMSO, 2009.
(2) Savage JE, Fisher JO, Birch LL. Parental influence on eating behaviour. Journal of Law Medicine and Ethics, 2007; 35(1): 23-34.
(3) Caraher M, Lang T, Dixon P, Carr-Hill R. The state of cooking in England: the relationship of cooking skills to food choice. British Food Journal, 1999; 101(8): 590-609.
(4) Withall J, Jago R, Cross J. Families' and health professionals' perceptions of influences on diet, activity and obesity in a low-income community. Health & Place, 2009;15(4): 1078-85.
(5) Netmums. Making Mums Happy programme. Available at: www.netmums.com/homelife/Making_Mums_ Happy_Programme.372 (accessed 10 June 2010).
(6) Netmums. (2008) Better Together Relationship course 3. Available at: www.netmums.com/support/ Better_Together_Relationship_Course_3.2823 (accessed 10 June 2010).
(7) Bennett GG, Glasgow RE. The delivery of public health interventions via the internet: actualising their potential. Annual Review of Public Health, 2009; 30: 273-92.
(8) Hasson H, Brown C, Hasson D. Factors associated with high use of a workplace web-based stress management program in a randomized controlled intervention study. Health Education Research, 2010; doi:10.1093/her/cyq005 (11 February 2010).
Community paediatric dietitian, Manchester
Freelance dietitian, Bracknell
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