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The Development of interventions to improve the diet of girls and young women from populations at risk of low birthweight

Project Code: N14003

31/07/2005

European Institute of Health & Medical Sciences, University of Surrey
Lawrence, J ;
School of Pharmacy and Life Sciences, Robert Gordon University, St Andrew Street, Aberdeen, AB25 1HG
Wrieden, W;
Centre for Public Health Nutrition Research, Division of Clinical & Population Sciences & Education, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY
Barton, K;
European Institute of Health & Medical Sciences, University of Surrey
Kelly, M; Chinouya, M;
Food, Consumer Behaviour and Health Research Centre; University of Surrey
Shepherd, R; Raats, M;
University of Stirling
Devlin, E; Macaskill, S

1.1 Aims and Objectives

The overall aim of the project was to develop, implement and evaluate, transferable community-based interventions to improve the diet of girls and young women from populations at risk of low birth weight.

The individual objectives were:
• To investigate factors which may inhibit sensible dietary choices in girls and young women.
• To develop a range of interventions suitable for improving the diet of girls and young women from low income and ethnic minority groups.
• To pilot the interventions in a range of different settings
• To evaluate the impact of the interventions on dietary intake, understanding, motivation, beliefs and attitudes towards dietary improvement.
• To interpret the intervention evaluation data.
• To evaluate the sustainability of the interventions in each of the settings.
• To make recommendations on suitable interventions to improve the diet of girls and young women.

1.2 Approach

The process of establishing the intervention used a community development approach taking account of the perceived needs of the groups and resources (money, time, skills). Focus groups were held with the target communities to investigate the views of the women and girls.

Focus groups were held with:
• Six Caucasian women attending a mother and toddlers group at a community centre in a low-income area of Dundee.
• Four 12-13 year old Caucasian girls attending a youth group in a low-income area of Dundee.
• Eight young Caucasian women from a low income area of Dundee, aged 14-18 years who were all regular attendees of a drop-in youth café.
• Five Pakistani/Bangladeshi women, able to communicate largely in English with some help from the translator, attending a women’s group in Dundee.
• Six Pakistani/Bangladeshi women, talking through the translator, attending a literacy group in Dundee.
• Three 10-14 year old girls, either born in the UK to Zimbabwean parents or arrived in the UK from Zimbabwe within the past 5 years. These girls knew each other but lived in different locations in outer London.
• Three young Zimbabwean women, living in Surrey
• Six 24-34 year old Zimbabwean women, friends of student nurses at Surrey University.
• Ten Somali teenage girls living in Southall in the vicinity of a community centre.

The development of the programme was informed by results from the focus groups. Information gained from the focus groups was also used to adapt questionnaires to evaluate the programme. Using this information the original CookWell manual was amended to take account of the needs and current cooking practices of each community enabling facilitators to follow a standardised but flexible, programme with each group of participants. CookWell II was then run in locations in Dundee and Luton, for a period of approximately 2 months in each community. Four communities (with 6-8 participants in each intervention group) were recruited and the programme was delivered with a delayed intervention for thecontrol group.

These communities included:
• Pakistani/Bangladeshi (Urdu/Punjabi speakers) young mothers, attending community literacy group at Grey Lodge Settlement – a large community centre in Dundee.
• Caucasian girls who were regular attendees at a drop-in youth café at Kirkton Community Centre, Dundee.
• Somali mothers attending classes at Dallow Learning Community Centre in Luton.
• Zimbabwean women, mostly care workers and students living in Luton.

In all cases, researchers with the assistance of local community workers recruited people to take part.

The primary outcome measures were:
• fruit and vegetable consumption
• perceived cooking skills
• understanding of healthy eating/food preparation
• motivation/behaviour towards healthy eating
• beliefs about healthy eating

Evaluation used pre- and post-assessments of food intakes, cooking skills, nutrition knowledge, attitudes, household food budgets, and expenditure in intervention and delayed intervention groups. A ‘delayed intervention’ group was necessary in each community to provide a control for comparison with the group who had taken part in the CookWell classes but also to give all study participants an opportunity to take part in the intervention. Quantitative evaluations using food diaries and questionnaires were carried out in intervention and delayed intervention (control) subjects at baseline (T1) and immediately after the intervention (T2). Qualitative interviews were also carried out at T2 in a sample of intervention subjects, a small sample of control subjects and the group leaders.

1.3 Key findings

Initial focus groups suggested that a cooking intervention would be welcomed by many of the girls and young women interviewed.

Of the 41 subjects initially recruited, 41 completed the T1 assessments (24 intervention and 17 controls). At T2 a total of 36 (20 intervention and 16 controls) completed some or all of the assessments.

The quantitative results were difficult to interpret due to small numbers; however, the results of dietary evaluations suggest an increase in fruit and vegetables and fibre consumption in two of the ethnic groups. The feasibility of carrying out food intake and behavioural measurements in these groups of women was established and tools piloted. Further work needs to be done to continue the investigation of foods consumed within ethnic groups and to develop nutritional composition tables that reflect the diversity of food intake in these group.

Over 50% of the respondents reported spending between £10 and £20 per person on food and drink not including alcohol per week. This was consistent between T1 and T2 and between the intervention group and the control group, although some variation was seen between the different communities.

Qualitative results showed that the respondents had learned new skills from the course, or at least had existing skills they had learned at school in Home Economics reinforced. The Caucasian girls in Dundee mentioned preparing and cooking a variety of new dishes, including: carrot cake, spaghetti bolognese, stovies, tuna pasta bake and biryani. They also indicated learning how to prepare fresh vegetables.

“How to chop an onion properly.”
“Yeh, cut the vegetable, cut them all nicely.”
“We already know that from HE at school.”

The average cost of implementing the 7-week CookWell course was £160 per person. Information from the research was used to produce a revised edition of CookWell (Appendix 21) suitable for use with ethnic and regional groups.

1.4 Technical evaluation and interpretation

The value of this study lies in the richness of the qualitative data, the revision and increased applicability of the original CookWell pack and the practical guidance that can be passed on to field workers. Appendix 21 contains proposals for an updated tutor’s manual for a CookWell programme that could be used in a wider range of communities. Tools for evaluating the project have been piloted and with further revision could be used by other workers.

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