Development and Formative Evaluation of a Nutrition Education Curriculum Aimed at Reducing Fat Intake in Taiwan Elementary Students

Taiwan, like many other Pacific Rim Asian countries, has experienced great economic growth in the past 4 decades, accompanied by a 150% increase in daily availability of calories to 2970 kcal and a 578% increase in fat to 137 gm. Nutrition education is not provided in schools. Consequently, a 15-week fat-intake reduction curriculum for fifth graders was designed and implemented as part of required after-school enrichment classes. The nutrition conceptual framework was based on use of a traffic light analogy (where foods are placed into red, yellow, and green labeled categories) and emphasized analyzing food advertisements and valuing traditional low-fat Chinese foods. The education/behavior change framework was Social Cognitive Theory (SCT).A pre-post intervention, comparison group design was used with random assignment of classes within two randomly selected schools to conditions (n = 8 classes, 256 students). Student and teacher satisfaction with the curriculum was high. Individual activities of SCT such as self-monitoring, goal setting, and problem solving were well accepted in this culture but not group discussions or team activities. The mean pre-post difference scores for the intervention group were significantly greater (p < .05) than for the comparison group on the overall knowledge and skills and attitudes scales and most attitude subscales. Intervention effects were not significant for food choice intentions and frequency of intake of specific lower fat foods but were for the overall total score. Results suggest that Taiwan's required after-school program may be a promising avenue for chronic disease prevention.