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How to cite this article:

Sosa-Cárdenas MR, Puch-Ku EBS, Rosado-Alcocer L. Efecto de la educación sobre hábitos alimentarios en estudiantes de Licenciatura en Enfermería. Rev Enferm Inst Mex Seguro Soc. 2015;23(2):99-107.

Effect of education of feeding habits in nursing students

María Rebeca Sosa-Cárdenas,¹ Eloísa Beatriz del Socorro Puch-Ku,¹ Ligia Rosado-Alcocer¹

¹Facultad de Enfermería, Universidad Autónoma de Yucatán, Yucatán, México

Correspondence: María Rebeca Sosa Cárdenas

Email: rebeca.sosa@uady.mx

Received: July 4^th 2014

Judged: January 16^th 2015

Accepted: February 27^th 2015

Abstract

Introduction: Adopting the General Self-Care Deficit Theory of Dr. Orem eating habits can be purchased based on adequate guidance: educational support.

Objective: To determine the effect of educational support in feeding habits of students in the second semester of the Bachelor of Nursing, Mérida Unit, Faculty of Nursing at the abattoir.

Methods: Quasi-experimental, longitudinal study on 43 students. A survey was applied with a Cronbach’s alpha of .757 habits that measured for the selection, preparation and consumption of food. The data collection was carried out before the implementation of the support program (pretest) and the second measurement (post- test) the same month. Statistical test of Wilcoxon rank assigned with a confidence level of 95 % and the p value ≤ 0.05 was calculated.

Results: Regarding the Wilcoxon statistical test in paragraph selection of foods, the Z obtained in the pre and posttest was 3358 with p = .001. In food preparation section, the Z obtained in the pre and posttest was 3976 with p = .000 and food consumption section, Z obtained in the pre and posttest was -566 with a p = .571. Of the three scores a statistically significant result given by a p value of .000 was obtained.

Conclusions: The educational support improved eating habits of students in the Bachelor of Nursing FEUADY.

Keywords: Feeding behavior; Self care

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Introduction

The period of university studies is usually the time when students first take responsibility for their food. Entering college coincides with a stage of life characterized by the autonomy to decide meals and schedules, multiple physical changes, and psychosocial challenges. Therefore, it is a critical period for education on the development of dietary habits, which are very important for a healthy life in the future.¹

Montero Bravo et al. claim that the diet of college students is inappropriate, with high fat and low dietary fiber. The dietary habits of adolescents and young adults are affected by the fast food market, which results in overweight and obesity, which are increasingly seen among youth.²

The increase in poor health conditions, changes in behavioral patterns, mainly due to the incorporation of harmful lifestyle and dietary habits, are the result of college students’ adjustments to school life, in which various factors intervene like ignorance of nutrition, diversity of academic activities, and staying for longer hours at school. This situation is one of the main elements for considering university students as a population at risk of overweight, obesity, and chronic diseases such as hypertension, diabetes mellitus and dyslipidemias.³

Some of the major problems associated with eating habits and lifestyle, both in industrialized countries and those in development, are related to excess weight, obesity and dyslipidemia. These conditions have increased significantly in recent decades and morbidity rates have become a global public health problem. In most of the countries of Latin America and the Caribbean there has been an epidemiological transition characterized by an increase in morbidity and mortality associated with chronic noncommunicable diseases (NCDs), such as obesity, diabetes, hypertension and cardiovascular disease, most which is directly or indirectly related to poor eating habits and sedentariness.¹ Nunez et al., in regard to knowledge, self-perception, and the personal situation of nursing students from the Universidad Michoacana de San Nicolas de Hidalgo, found that 18 % of this population were overweight with a range of 25 to 26.9 kg/m², while 28 % of students presented obesity with a body mass index (BMI) higher than 27 kg/m². With these results, the authors suggest the implementation of educational programs as one strategy to reduce the prevalence rates of overweight and obesity mentioned above.⁵

Troncoso Pantoja conducted a qualitative study in Colombia to interpret the perception of college students of food in the stage of college education. Among the main factors related to unhealthy eating is the lack of time during the period of professional training, subject to the quality of food consumed, the selection and purchase of food, and setting meal times. In conclusion, students identify the importance of maintaining a healthy diet, but at the same time students being in professional training is seen as a constraint to fulfilling this objective.⁶

Several authors have noted that the university population is a particularly vulnerable group from the nutritional point of view, as it is characterized by often skipping meals, "nibbling" between meals, having a preference for fast food, and consuming alcohol frequently. Studies show that college students’ diet is inappropriate, with high fat content and low dietary fiber. Other causes are that this age group is subject to rigid schedules and extracurricular activities. On the other hand, some studies suggest that sleep restriction alters the levels of different hormones. These hormonal changes may contribute to energy imbalance and therefore overweight, obesity, and chronic diseases associated with nutrition. Moreover, late-night weekends can cause disorders in times of food consumption, such as a good breakfast or skipping any meal times during the day; this, coupled with long hours of classes, influences both poor nutrition, and lower academic performance.³

Unfortunately, the myths about the changes that entering college exert on physical health have been largely corroborated by scientific research. Hoffman, Policastro, Quick and Lee showed in 2006 that most freshmen at a university in the United States gained weight during this period. Also, Huang et al. found in 2003 that the college students not only gain weight but start diets low in fiber and high in saturated fat; this coupled with dietary modifications are almost always accompanied by a significant decrease in physical activity and exercise. Different researchers corroborate such findings using a variety of methodologies.⁴

This justifies the need to insist on training on dietary guidance, in order to have the tools to improve these habits and thus guarantee society quality healthcare by professionals who, besides being aware, are examples of proper eating habits and attitudes. Such behavior could be the cause of early biophysiological changes such as overweight, obesity, diabetes mellitus, hypertension and dyslipidemia. In Mexico this orientation is governed by Norma Oficial Mexicana NOM-043-SSA2-2005 Basic health services: Promotion and education for healthy eating. This law includes content related to nutrition and food throughout life, as well as information on the prevention of overweight, obesity, and the diseases associated with poor nutrition through diet and physical activity.⁷

During college, students experience various changes in eating habits that lead to needs for self-care that must be resolved or compensated for, for the balance of health and the preservation of wellness. To do so, students must be motivated and educated to perform self-care under the guidance of nursing professionals and understand how to achieve the education and management of food habits and avoid later repercussions for academic performance.³

The general theory of self-care deficit (SCDT) of Dr. Dorothea Orem approves the design of the form of education and that the person is encouraged to actively participate in self-care decisions for their health; also it identifies when nursing assistance (Figure 1) is required.

The existence of a self-care deficit is the fact that legitimizes the need for nursing systems of educational support that are suitable for situations where the person is capable of performing measures or can learn but requires guidance, support, teaching, and an environment conducive to their development.

The requirements of self-care would be defined by physical, psychological and social changes, so that the actions of self-care developed will be bound to promote and maintain health, and to improve or alleviate the negative effects of the changes during the college period.⁸

Of particular importance, and a starting point for the execution of this protocol, are the results in terms of eating habits evidenced by studies conducted since 2003 at the Facultad de Enfermería de la Universidad Autónoma de Yucatán (FEUADY) about lifestyles and health profile in new students. This research protocol raises the need to implement an educational support program that includes teaching healthy eating habits to improve dietary health behaviors.⁹

Therefore the objective is to determine the effect of educational support in the eating habits of students in the second semester of the Bachelor’s degree in nursing at the Merida Unit, at the Facultad de Enfermería de la Universidad Autónoma de Yucatán, Mexico.

For this, the design and implementation of an educational support program was based on the philosophy of Dorothea E. Orem’s self-care model, where the general criteria of dietary guidance are established that can suit the needs and possibilities of the students, thereby preventing the onset of chronic noncommunicable diseases (NCD). It focuses particularly on everything that may affect food consumption and dietary practices, such as eating habits, their selection and preparation, their safety and environmental conditions.

Methods

A quasi-experimental study was conducted with a total of 52 students in the second semester of the August to December 2012 graduating class of the Bachelor’s of Nursing at FEUADY.

The collection instrument was a survey with four sections. The first included some of the basic determinants of Dr. Orem’s SCDT: age, marital status, religion, national origin, gender, and socioeconomic status. The second corresponds to the selection of food, which included eight items with a maximum score of 24 points. The third section is on how food is prepared, consisting of 14 items with a maximum score of 42. Finally, in the fourth section habitual food consumption was determined with 20 items with a maximum score of 60. For answers from the second to the fourth section, the Likert scale was used: always, almost always, sometimes, never. This instrument was piloted with 39 students in the same semester, undergraduate and faculty but from another unit, and validated by two nutritionists and a nurse with experience in the research study variables related to eating habits (criterion validity). To establish the reliability of the instrument, the split-halves statistical test was done, whose correlation in the first 21 questions was 0.643 and in the other 21 was 0.685. Also, to measure the internal consistency within reagents Cronbach's alpha coefficient test was performed, the result was 0.757. The data collection was performed in two stages: the first measurement is performed before the implementation of the educational support program (pre-test) to identify the eating habits of students and the second measurement (post-test) a month after implementation.

After authorization from the FEUADY Committee for Research and Bioethics, application was made to the director of the host institution for permission to roll out the project. Participants were asked for informed consent upon reading, explanation, and corresponding signature.

The design of the educational support program was made based on the competency model and included a total of eight hours divided into four sessions of two hours each. The topics addressed include the following: "Don’t worry about your heart, stay active" to identify cardiometabolic risk factors for health; "Criteria for effective dietary guidance based on Norma Oficial Mexicana NOM-043-SSA2-2005: selection, preparation, and consumption of food, for analysis thereof; "Design your menu", to develop an individualized healthy eating plan and "Small changes, big differences", to identify self-care actions necessary for the development of healthy eating habits. Each section included theoretical elements and skill development, motivational elements, and supporting material such as slides, handouts, food replicas, menu designs, moments of physical activation, and more.

The data collected were processed and analyzed using SPSS statistical software, version 19. The categorical variables (religion, gender, marital status, place of origin, and socioeconomic status) were analyzed using descriptive statistics and were presented in frequencies and percentages, while for the continuous variable (age) measures of central tendency and dispersion were obtained. To determine the effect of educational support in the eating habits of the population under study, a series of responses were obtained on an ordinal scale (0 = never, 1 = sometimes, 2 = almost always and 3 = always) at two different times, the first before the intervention of educational support program and the second, a month after the intervention. For this, the Wilcoxon signed-rank statistical test was calculated with a confidence level of 95 % and p < 0.05, giving significant results.

Results

According to the established exclusion and elimination criteria, 43 students came from an original population of 52 (six repeating students and three who did not complete the educational support program). The description of sociodemographic variables (basic conditioning factors) and the scores pre- and post- educational support program "Habits for food selection, preparation, and consumption: Small changes, big differences" are presented, followed by analysis based on the Wilcoxon signed-rank statistical test.

The analysis of the basic conditioning factors (age, sex, and place of origin) is shown in Figure 2. The most common age was to 20 years with 19 students (42 %); as for sex, 35 students (81 %) are women; and as for place of origin, 25 students (59 %) were from Merida (Figure 2).

With regard to the variable of religion, 32 students (75 %) were Catholic, 7 (16 %) were Protestant, and 4 (9 %) professed another religion.

Regarding socioeconomic status, the minimum wage in Yucatan was taken as reference, and the average prevalence was observed (between $9000 and $5000 pesos per month) in 47 % of students (Figure 3).

As for students’ food selection habits, the higher score corresponded to the post test, i.e. it was higher after the implementation of the educational support program. Notable among the results is the item regarding reading labels, in which only 14 % of the students used to read them, which increased to 75 % after the implementation of the educational support program. As for the Wilcoxon statistical test of this section, the Z obtained in the pre- and post-test was -3.358 with p = 0.001, which is considered statistically significant after the implementation of educational support program "Healthy Eating Habits: Small changes, big differences" (Table I).

As for student’s habits of preparing food, the higher score also corresponded to the post-test, i.e., it rose after program implementation. Notable among the results is the item relating to scrubbing and washing fruits and vegetables, whose percentage (75 %) remained the same before and after the implementation of the educational support program. As for the Wilcoxon statistical test in the food preparation section, Z obtained in the pre and posttest was -3.976 with p = 0.000, so it was considered statistically significant after the implementation of the educational support program (Table II).

The third section corresponded to food consumption. It is worth mentioning that is the section in which the fewest changes occurred. As in the two preceding paragraphs, the higher score was in the post-test, i.e., it was higher after program implementation. Notable among the results was the item relating to the consumption of red meat: it was found that before the educational intervention 19 % of students always consumed red meat, and post-intervention only 9 % always did. As for the Wilcoxon statistical test of the food consumption section, Z obtained in the pre- and post-test was -566 with p = 0.571, which is considered not statistically significant after the implementation of the educational support program (Table III).

As regards the sum of the final scores of the three sections of "Habits for food selection, preparation, and consumption" after the two measurements (pre and post-test and application of the Wilcoxon signed-rank test) a result was obtained of Z equal to -3.759 with a value of p = 0.000, which is statistically significant, so the hypothesis is accepted that "educational support improves eating habits of students in the second semester (August-December 2012 graduating class) of the Bachelor’s in Nursing, Merida Unit, FEUADY."

Discussion

Knowledge about nutrition and its relation to health is the best way to get changes in eating habits and instill healthy and lasting ways to prevent nutrition-related diseases.¹⁴ According to Orem, health education is necessary to acquire knowledge, skills, and motivation, so self-care actions will be designed to promote and maintain health, and to improve or alleviate the negative effects of the changes during the college period.⁸

As for the timing of selection of food Rodriguez et al., in their study on "Food habits, physical activity, and socioeconomic status in Chilean college students" show the bad eating habits of college students. One of the problems cited is the lack of reading nutrition labeling before the moment of food choice; on average, 28 % of students surveyed said that they never read the nutrition labeling and only 21 % always read the labels. This allowed them to conclude that the vast majority of students only sometimes or never read the labels of the caloric content of the products they consume daily.¹¹ This contrasts with the results of research conducted with the FEUADY students, as before only 14 % used to read the labels, and after implementation of the program the percentage increased to 75 %.

Regarding food preparation, students who participated in the study mentioned that they wash their hands before eating food, use boiled water to prepare them, and wash with water and scrub vegetables and fruits before eating; they also kept containers used for preparation clean and covered. This shows that in regard to food preparation students have the right information and act as expected.

According to what Vidal et al. reported in their article "Changing certain attitudes towards food in nursing students after completing the course in nutrition and dietetics" 33.8 % consume meat 1 or 2 times a week, a percentage which was reduced to 28.6 % after taking the class.¹⁰ In this investigation it was found that before the educational intervention 19 % (8) of the FEUADY students always ate red meat and post-intervention only 9 % always did (4). As can be seen in both studies there was a decrease in consumption of this product.

According to the results obtained in this research, improving eating habits is gradual, and with educational support offered to students a starting line is drawn to achieve it. It is proposed to follow up to evaluate the achievements in the field of eating habits throughout their professional training. These results are consistent with what Arauz et al. mentioned in their study "Changing eating practices in non-insulin-dependent diabetics: effects of a multidisciplinary educational intervention," arguing that changing eating habits is a gradual process and requires time to integrate the information received into practice.¹²

Saad et al. in their study "Changes in eating habits of nursing students at the Universidad El Bosque during academic training, Bogotá, 2007" say it is important to promote good eating habits in college students through strategies for information, communication, and education to maintain a healthy lifestyle to prevent diseases that may affect development.¹³

This coincides with the survey results, because improvement was seen by using strategies for the development of skills in addition to the cognitive. During the educational support program, students did research and individually managed to propose their own eating plan based on what they learned.

Conclusions

Educational support significantly improved the eating habits of students in the second semester of the Bachelor’s in Nursing, Merida Unit, FEUADY. According to the statistical data obtained, it was observed that at the three moments studied, selection, preparation, and consumption of food in relation to the eating habits of students, the section on consumption showed the least change in the post-test.

Although no limitations to fulfilling the objective of the study were found, and in keeping with the line of improving eating habits, it is proposed that the results be used in future research to give continuity to this study. It would be opportune to manage to follow up with students participating in more advanced semesters to measure the impact of the educational support program and determine the progress achieved in relation to food during their time in college to promote the culture of self-care. Similarly this research could be reproduced with students of different graduating classes to contrast measurement results.

References

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