Improving the Nutritional Quality of the Home Food Environment using Self-Directed Home Kitchen Makeovers
Carol Byrd-Bredbenner, PhD, RD, FADA
Professor of Nutrition/Extension Specialist
Rutgers University
Jaclyn Maurer Abbot, PhD, RD
Research Associate Nutritional Sciences
Rutgers University
ABSTRACT
Eating meals at home may make it easier for families to eat together and reap the nutritional benefits of family meals. However, there are many obstacles to eating meals at home. The purpose of this paper is to describe a pilot test of a 5-step self-directed, action-oriented intervention program designed to help mothers of young children (n=20) plan, prepare, and serve healthy family meals within their lifestyle constraints. Paired t-tests results indicated that between the pretest and posttest, mothers significantly (p<0.0001) improved their kitchen organization, food storage area, and mealtime planning, preparation, and shopping. Mothers in the Happy, Healthy, Food Involved and Healthy, Free of Food Price, Taste, Convenience, and Advertising Effects cluster segments made more changes in response to the activities in each folio, while those in the Stressed, Emotional Eating, Time Conscious group made the least. Differences in psychographic segments of a population (i.e., groups defined by factors that influence eating choices) may help explain why differences occur in response to interventions among individuals who belong to a seemingly homogenous demographically-defined group and may lead to interventions with characteristics more likely to improve dietary intake and overall health, thereby contributing to the cost-effectiveness of programs.
Key Words: Healthy Meals, Mothers, Kitchen, Makeover, Meal Planning, Meal Preparation, Home Food Environment, Nutrition Education
INTRODUCTION
In 1965, Americans spent an average of 44 minutes preparing meals and 21 minutes cleaning up. Three decades later, just 26 to 38 minutes, depending on the extent of convenience food use, were spent preparing meals and clean-up took only 4 minutes (Cutler, Glaeser, and Shapiro 2003; Robinson and Godbey 1997; Beck 2007). In 1987, 43 percent of all home cooked meals contained at least one item that was made from scratch, while 10 years later this rate decreased to 38 percent (Harnack, Jeffery, and Boutelle 2000). American food behaviors also have shifted to include more foods prepared outside of the home. Each day, more than 90 percent of Americans consume food that was prepared away from home (NPD 2005), with a quarter or more of the daily intake of calories, protein, fat, carbohydrate, fiber, and key vitamins and minerals provided by this food (Wilson et al. 1997; Guthrie, Lin, and Frazao 2002). Statistics such as these highlight the quick and easy trends associated with the current meal preparation habits of Americans.
The desire for convenience is a primary consideration when choosing food (Byrd-Bredbenner and Maurer Abbot 2008; Sloan 2005) and appears to be an important factor driving Americans outside of their kitchens to find meals. Convenience and good nutrition are not necessarily mutually exclusive. The wide array of nutrient-dense, easy-to-prepare foods in today’s supermarkets makes it possible to prepare nutritious, delicious meals quickly even with limited food preparation skills (Maurer and Byrd-Bredbenner 2007). In addition to cost savings, preparing meals at home makes it easier to control the ingredients used and thus the nutritional quality of meals. Eating meals at home also may make it easier for families to eat together and reap the nutritional benefits of family meals. For instance, meals with at least one parent present are associated with higher intakes of fruits, vegetables, grains, calcium, fiber, folate, iron, and vitamins B6, B12, C, and E and lower intakes of soft drinks and saturated fat among family members (Boutelle et al. 2001; Field et al. 2003; Videon and Manning 2003; Larson et al. 2006; Neumark-Sztainer et al. 2003).
In recent years, few interventions have focused on helping families improve their self-management abilities to make regular family meals a reality. Thus, the purpose of this paper is to describe the results of a pilot program designed to improve the self-management abilities of mothers of young children with regard to planning, preparing, and serving healthy family meals within their lifestyle preferences and constraints.
METHODS
This multiphase project involved 201 mothers from New Jersey who had one or more children aged 12 years old or younger; were food secure (Life Sciences Research Office and Andersen 1990); and were married or living with a domestic partner. Neither the participant nor her spouse was employed in a health-related profession. Participants were the family food gatekeepers (i.e., they were responsible for household meal planning, grocery shopping, and meal preparation) and their families ate dinner at home at least three times per week.
Phases 1 and 2 of this project provided baseline data that described key factors influencing food choices (i.e., psychographics; see Table 1 of this article’s companion paper [Maurer Abbot and Byrd-Bredbenner 2009]). Cluster analysis of the factors influencing food choices data revealed mothers grouped into 4 segments: Happy, Healthy, Food Involved Mothers;Working, Convenience Driven Mothers; Healthy, Free of Food Price, Taste, Convenience, and Advertising Effects Mothers; and Stressed, Emotional Eating, Time Conscious Mothers(Byrd-Bredbenner, Abbot, and Cussler 2008). Phases 3 and 4 provided the formative research needed to guide the development of the intervention program. This article’s companion paper (Maurer Abbot and Byrd-Bredbenner 2009) summarizes the results of Phases 1 and 2 and details Phases 3 and 4 findings. This article reports the findings from Phase 5, the pilot test of the intervention developed in Phase 4. This study was approved by the Institutional Review Board at Rutgers University. Study participants gave informed consent.
Sample
The sample for the pilot test was comprised of a subgroup (n=20) of the 201 mothers who participated in the earlier phases of the study. All participants were blind to the study funding source.
Intervention Implementation
The intervention is described in detail elsewhere (Maurer Abbot and Byrd-Bredbenner 2009). In brief, it consisted of three Factivity (facts + activity) folios that were self-directed and action-oriented. Using concepts from the Social Cognitive Theory as a guiding framework, the intervention aimed to expand mothers’ knowledge of and self-management abilities related to planning, preparing, and serving nutritious, delicious family meals in a hurry and building confidence in their ability to achieve this goal. Factivity Folio A focused on kitchen organization. Factivity Folio B covered food storage practices. Factivity Folio C addressed healthy meal planning, preparation, and grocery shopping and included a meal planning grid used to create menu plans. The meal planning grid combined the menu with a shopping plan listing all items needed and arranged by food form to increase shopping efficiency and improve organization of home storage of purchased foods.
The intervention was pilot tested in five steps. During the Step 1, each participant was mailed a disposable camera to take ‘before’ photographs of food storage areas (i.e., refrigerator, freezer, pantries, cabinets, and other dry food storage areas), kitchen counters, and areas where pots, dishes, and other kitchen-related equipment were stored. In addition, each completed the pretest questionnaire. After receiving a participant’s ‘before’ camera and pretest, Step 2 began with researchers sending the first of the three folios and an ‘after’ camera.
Participants were given approximately one week per folio to complete the activities in the folio. The time needed to complete the activities depended on each participant’s current kitchen organization and food practices. However, participants were required to devote at least four hours to the activities in a folio. The four hours could be anytime during the week and could be broken into sessions lasting at least one hour. Participants were instructed to select times when they would be able to devote their full attention to the activities. After completing a folio, mothers took relevant ‘after’ photographs (e.g., de-cluttered kitchen counters, organized pots and pans cabinet) and completed the post-folio questionnaire. Step 3 commenced when a mother completed the post-Folio A questionnaire and researchers sent Folio B. Likewise, Step 4 began when the post-Folio B questionnaire was completed and researchers sent Folio C and a meal planning/cooking guide (QuickFlip, Faughey 1999).
At the end of the intervention (Step 5), mothers returned their ‘after’ cameras and copies of the activity sheets associated with each folio. They also completed the posttest questionnaire and participated in the exit interview.
To monitor progress and adherence to the program, a registered dietitian emailed and/or phoned each participant at least twice during each week of the intervention. During these contacts, the dietitian checked to see if mothers had questions about the folio. Participants also were able to contact the registered dietitian at any time during the intervention.
Instruments
The pretest and posttest questionnaires, administered online, assessed current behaviors related to each folio: level of overall kitchen organization (Folio A scale), food storage organization (Folio B scale), and meal planning, food shopping, and meal preparation practices (Folio C scale). These scales included 5-point Likert type, 5-point semantic differential, and dichotomous items. Folio A scale included 14 items and scores could range from 14 to 70. The Folio B scale contained 20 items with a possible score range of 20 to 85. Folio C scale had 18 items and a possible score range of 18 to 81. The posttest questionnaire included an additional seven 5-point Likert items that assessed participants’ perceptions of the effects of the changes they made after using the folios.
After completing each folio, mothers completed a brief (10 minute) online post-folio questionnaire comprised of 5-point semantic differential items that evaluated changes in participants’ kitchen or food-related activities, knowledge, abilities, and confidence. In addition, characteristics of the folio (readability, attractiveness, interestingness, length, completeness, relevance, and usefulness) were assessed using 5-point semantic differential items.
After completing the posttest questionnaire, each mother participated in a 20-minute telephone exit interview conducted by a trained researcher. The interview explored the participant’s experience with the intervention and outcomes (e.g., was her kitchen more organized now? has mealtime planning and grocery shopping improved?) and elicited suggestions for improving the folios.
Data Analysis
Themes and trends in qualitative data were identified, using standard methods (Miles and Huberman 1994), by researchers trained in qualitative content analysis. Paired t-tests compared changes between the intervention pretest and posttest. Analysis of covariance (ANCOVA), with pretest score as the covariate, was used to explore posttest questionnaire differences among cluster segments. Photographs (before and after) were qualitatively reviewed by researchers to better explore how the intervention materials affected the organization of kitchen and food storage areas.
RESULTS
The demographic characteristics of the subsample of participants in Phase 5 did not differ significantly from the full sample of 201 mothers. The characteristics of the full sample are described in more detail in this article’s companion paper (Maurer Abbot and Byrd-Bredbenner 2009) and elsewhere (Byrd-Bredbenner and Maurer Abbot 2008).
Comparison of Pretest and Posttest Scores
Paired t-test results indicated that between the pretest and posttest, mothers significantly (p<0.0001) improved their kitchen organization (Folio A scale), food storage areas (Folio B scale), and mealtime planning, preparation and shopping (Folio C scale). An examination of changes by segment revealed that, with few exceptions, mothers in each segment significantly improved in all areas between the pretest and posttest (see Table 1).
ANCOVA, with pretest scores as the covariate, revealed significant differences between cluster segments at posttest on the Folio A and C scales. Specifically, those in the Stressed, Emotional Eating, Time Conscious segment (n=5) scored significantly lower on the Folio A scale at posttest than those in the Healthy, Free of Food Price, Taste, Convenience, and Advertising Effects (n=5) and Happy, Healthy, Food Involved (n=5) segments (p=0.036). Likewise, ANCOVA indicated that Stressed, Emotional Eating, Time Conscious mothers scored significantly lower on the Folio C scale at posttest than Happy, Healthy, Food Involved (n=5) mothers (p=0.011).
Changes Implemented During Intervention
An examination of the activities mothers engaged in related to each folio revealed that regardless of the work zone selected, before making the changes associated with Folio A, mothers commonly reported that zone counters were cluttered, zone equipment was not easy to find or reach, items stored in the zone were not all directly related to the zone or used infrequently (Table 2). Most (70%) indicated that the amount of change needed ranged from some to total overhaul. The primary changes mothers reported making related to Folio A were re-organization, removal of infrequently used equipment, and de-cluttering. The major barriers to accomplishing greater organization were space availability, time, and cost. These barriers were overcome by finding ways to better utilize space (e.g., eliminating or relocating infrequently used equipment, creating new space with space-saving items like bins and tiered shelves), setting aside work time (e.g., when kids were at school or napping), and re-purposing items such as shoeboxes, large jars, and plastic zip-closure bags that could be used to improve organization. Supplies used tended to be inexpensive space-saving items, re-purposed items, and personal energy (e.g., “myself and a large trash can”). To sustain the changes made, mothers got their families involved in making the changes, planned to remind family members of the new organization, and stated they would set an example themselves. An examination of the segments revealed that Healthy, Free of Food Price, Taste, Convenience, and Advertising Effects mothers reported making the most improvements in kitchen organization and Stressed, Emotional Eating, Time Conscious mothers made the least.
Regardless of the food storage area selected, before beginning Folio B, the majority of mothers reported that they had food on hand that was not fresh and/or safe to eat (Table 2). When asked whether foods stored in different areas could be located quickly, most mothers indicated that frozen foods were hardest to find quickly and half reported pantry foods (i.e., dried, canned) could not be located quickly. Most (55%) felt that their food storage areas needed at least some re-organization and another 25% reported these areas needed a total overhaul. The main changes mothers reported making related to Folio B were organizing frozen foods, organizing pantry foods by type or category (e.g., placing baking items together), discarding food items that were old or unlikely to be eaten, and placing foods in bins/containers for easy identification (e.g., flour and grains in plastic bins). The most commonly named barriers were time, space, and personal motivation. To overcome these obstacles, mothers reported finding time when children were occupied (e.g., during naptime), being creative with their organization, not overstocking food, and “deciding to make it a priority.” One mother reported that the positive feeling of having an organized kitchen was incentive enough to find the time needed to achieve this. Supplies used included food storage containers, markers, and labels. When planning to maintain the organizational changes, mothers reported they would teach their families to keep the food storage area organized by using verbal reminders, having them assist in the kitchen, and labeling shelves and cabinets. An examination of the segments revealed that Happy, Healthy, Food Involved mothers reported making the most improvements in food storage area organization and Stressed, Emotional Eating, Time Conscious moms made the least.
Before starting Folio C activities, most mothers did not plan a menu weekly or even three days in advance. However, most felt that the food they had on hand would allow them to serve meals that were delicious, nutritious, and quick to prepare (Table 2). Half of the mothers reported their shopping lists were organized for efficient shopping, but most did not base lists on menus and frequently forgot necessary items when grocery shopping. At the start of Folio C activities, mothers planned to prepare approximately five family meals that week and estimated they would spend 30 to 40 minutes preparing each meal. Short-cut ingredients they reported substituting to boost nutrient content of meals included brown rice, reduced fat dairy products, whole wheat bread and pasta, and canned, precut, or frozen fruits and vegetables. Short-cut ingredients they substituted to save time and effort were many of the same items used to boost nutrient content as well as pre-shredded cheese, fresh salad bar items at the supermarket, pre-seasoned fresh chicken strips, bagged salad greens, and ready-to-eat pizza crust. Mothers reported that pre-planning meals, hungry children, their personal commitment to preparing healthy meals for their families, inner strength (“I took a deep breath and used the mantra, if it is to be, it is up to me”), and their desire to set an example for their children (“remembering it’s up to me”) would motivate them to follow through with their meal plans. To get and keep their family practicing healthy eating behaviors, mothers commonly named these strategies: making healthier snack items available and accessible, serving more fruits and vegetables, and getting the family involved with meal planning and preparation. An examination of the segments revealed that both Healthy, Free of Food Price, Taste, Convenience, and Advertising Effects and Happy, Healthy, Food Involved mothers reported making the most improvements in healthy meal planning, preparation, and grocery shopping and Stressed, Emotional Eating, Time Conscious made the least.
Perceived Effects of Changes Resulting from Folio Use
Mothers agreed or strongly agreed that their use of the folios had resulted in positive changes in their kitchen organization and mealtime planning (Table 3). They also agreed that meal preparation was now less stressful and healthier. Working, Convenience Driven Mothers indicated use of short-cut foods had increased whereas Stressed, Emotional Eating, Time Conscious mothers tended to be neutral about whether their use of short-cut foods had increased. Qualitative exit interview responses were similar across segments and supported quantitative findings. After completing the intervention activities, all mothers reported that their kitchens were more organized except one who stated that as a result of participating in the intervention “I found out I was already neurotically organized.” Reported organizational efforts included de-cluttering (cleaning off) kitchen counters, organizing cabinets (e.g., putting like items together, adding tiered shelving), and creating a message center in the kitchen.
Three-quarters reported they felt better prepared to improve the healthfulness of the foods they purchased and prepared after completing the activities in the folios. Some of the specific changes mothers reported making included buying lower fat foods, selecting brown rice over white rice, “ensuring I get fruits and vegetables with every meal,” “planning meals,”and using more short-cut foods (the extra cost of “some partially prepared foods…is offset by the time it saves me”; “short cuts… to help speed up food prep while keeping the meal healthy”). The most commonly mentioned short-cut foods mothers started selecting were pre-cut and pre-washed fresh produce (e.g., shredded lettuce, pre-washed salad greens) and canned and frozen fruits and vegetables (“if I make a salad I add canned mandarin oranges or use canned potatoes and bake them, it saves time”).
Most mothers (85%) reported that their mealtime planning and food shopping had improved as a result of using the folios. Mothers stated, “now I actually plan meals” and “I am more diligent with menus; information was helpful to me to plan a whole meal; kids love having a weekly menu.” Mothers particularly liked the menu planning grid: “I now plan out my week’s menu, I don’t always write it down, but I have it in my head, so I am prepared; the menu grid got me on the right path,” and “being more organized makes making meals easier, I really like the meal planner– it relieves stress.”
All but one mother felt the stated goal of the self-directed home kitchen makeover program (i.e., to help moms serve nutritious, delicious meals in a hurry so they can concentrate on building healthier families) was met. Mothers commented that participation “made me realize that you don’t need to order fast food; you can make healthy meals quickly that your family will like,” made “my kitchen … much easier to work [in] and now my kids help out,” “helped me with meal planning, getting organized, gave me new ideas and now I can prepare foods quickly,” and helped me get “my kids involved and they are learning what healthy food choices are and my stress level has decreased.” The one mother who did not feel the goal was met stated the program needed “more hands-on details and directions to get people to change; overall I felt they [the folios] were very philosophical and less directive.”
Assessment of Folio Characteristics
ANOVA revealed that mothers rated the three folios similarly on all characteristics. Overall, mothers rated all the folios as easy to read, attractive, and interesting (mean ratings were 4.4+0.8 Standard Deviation [SD], 4.2+0.8SD, and 4.0+0.9SD, respectively) and indicated the length was ‘just right.’ They also favorably rated the information provided by the folios as complete, relevant, and useful (mean ratings were 4.1+1.0SD, 3.9+1.0SD, and 3.9+1.0SD, respectively). They felt the folios helped them make improvements (3.7+1.2SD) and increased their knowledge (3.3+1.1SD) and confidence (3.7+1.1SD). They felt that other mothers likely would feel more knowledgeable (4.0+0.9SD) and confident (3.9+0.9SD) after reading the folios.
An examination of folio ratings by cluster segments revealed interesting trends. Mothers in the Working, Convenience Driven segment tended to rate the characteristics of all three folios lower than other segments. In contrast, mothers in the Happy, Healthy, Food Involvedsegment tended to rate Folio A higher than other segments whereas those in the Healthy, Free of Food Price, Taste, Convenience, and Advertising Effects segment tended to rate Folio B higher than others. Folio C ratings tended to be higher for those in these segments: Healthy, Free of Food Price, Taste, Convenience, and Advertising Effects and Happy, Healthy, Food Involved Mothers.
Qualitative exit interview data regarding folio characteristics supported the online surveys. When asked what they most liked about the folios, mothers stated they “were colorful, well organized,” “easy to read,” “easy to follow,” and organized in a “logical order”; contained“great ideas; had the “right balance of pictures and text”; “liked the set up—it was attention grabbing” and “the bulleted lists”; and contained “content [that] made me think.” The most requested improvement mothers suggested was adding “more photos of organization items” and adding makeover recipes.
When asked whether other moms would find the folios useful, 90% of the participants said yes (“absolutely,” “definitely”). The reasons given were “these topics are what moms talk most about,” “many moms have disorganized kitchens,” “some need the organizational information and others need the nutrition information,” “ideas are always useful and while many of the ideas were common sense, reading them helps motivate you to take action,” “they make moms think and plan ahead, be more organized and know what is on hand in the kitchens,” and “moms are very busy and these … help remind them of the importance of family meals and put the focus on meal time.”
Before and After Photographs
Photographs from 13 mothers were of sufficient visual quality to allow a qualitative comparison of the before and after photographs. The quality of before and/or after photographs of the other seven mothers was too poor for evaluation. Changes in the organization of kitchen work areas and food storage areas between the start and end of the study were striking and supported the mothers’ self reports.
DISCUSSION AND CONCLUSIONS
Overall, the intervention had positive effects on mothers’ kitchen organization, food storage area organization, meal planning, preparation, and grocery shopping. Dividing the target population into cluster segments revealed that despite what appeared to be a homogenous demographically-defined group (i.e., mothers of young children), these women differed in their reactions to the intervention. These differences may indicate that demographically defining a target audience does not sufficiently describe an audience or their interests, motivations, and responses to an intervention (Mintz et al. 1997). Averaging findings across demographically-defined groups may mask changes in subgroups and underestimate overall effectiveness of interventions. For example, Working, Convenience Driven mothers rated all folios lower than other cluster segments, suggesting that their characteristics (described in Phase 1 of this study, Byrd-Bredbenner, Abbot, and Cussler 2008) may affect their interest in fully engaging in nutrition education efforts such as the one reported in this paper. It is also important to note that Phase 1 revealed that Working, Convenience Driven mothers tended to have poorer diets and higher BMIs than mothers in other segments, which likely indicates the mothers have a greater need for nutrition education. Despite their somewhat lower ratings of the folios, the positive feelings Working, Convenience Driven mothers have about convenience foods likely contributed to their reports that the folios had helped them use short-cut foods to improve the healthful qualities of the meals they serve. Not only could these foods increase their time scheduling flexibility (Beck 2007), they felt they could now better identify and incorporate healthier choices of these time saving foods.
Although interventions often result in changes, the reasons why interventions lead to (or do not lead to) desired changes are frequently unknown or not easily explored (i.e. different intervention formats and populations make comparisons difficult) (Ammerman et al. 2002; Delichatsios et al. 2001; Kahn et al. 2002). A comparison of the findings from the pilot test with the characteristics of the cluster segments that were elucidated in Phase 1 of this study did show changes and appear to provide some insight into why the segments differed in their response to the folios. For instance, mothers in the Happy, Healthy, Food Involved segment tended to score significantly higher on the factors influencing food choices (see Table 1 in this paper’s companion paper, Maurer Abbot and Byrd-Bredbenner 2009) than those in other segments. In addition, they tended to rate their families’ nutritional status significantly higher than other segments did and felt their families’ ate healthier diets than other families they know. In fact, they did have more nutritious diets and lower BMIs than mothers in other segments. Thus, because Happy, Healthy, Food Involved mothers felt they were already serving nutritious family meals before the intervention, they likely were limited in the extent to which they could improve further. Or, they were so strongly committed to the belief that they were serving nutritious meals prior to the intervention, it was difficult to reconcile these beliefs with the possibility that further improvements could be made or even necessary. Nonetheless, these mothers did report making improvements in healthy meal planning, preparation, and grocery shopping. Their optimistic outlook, strong value placed on health, and high food involvement levels may have served as internal motivators that helped them make further improvements despite already serving healthy meals.
Healthy, Free of Food Price, Taste, Convenience, and Advertising Effects mothers tended to rate Folio B higher than others and, indeed, reported making the most improvements in food storage organization. An examination of the factors that influence eating choices (i.e., psychographics), from Phase 1 revealed that they shared many similarities with Happy, Healthy, Food Involved mothers. However, of all segments, Healthy, Free of Food Price, Taste, Convenience, and Advertising Effects mothers were the least price conscious (Byrd-Bredbenner, Abbot, and Cussler 2008). Folio B stressed streamlining food storage (e.g., discarding foods that were old, not likely to be eaten, and/or had low nutrient density) and incorporating devices that could enhance overall organization (e.g., tiered shelf inserts; drawer organizers). Although Folio B offered alternative solutions to discarding foods not likely to be eaten (e.g., donate to a food drive) or that were low nutrient density (e.g., “If tossing the food will strain your food budget, resolve not to buy it again”), or purchasing organizational items (e.g., use shoe boxes to organize items or create shelf risers), mothers who were more price conscious than Healthy, Free of Food Price, Taste, Convenience, and Advertising Effects mothers may have found it more difficult to make the changes promoted by Folio B.
The finding that Stressed, Emotional Eating, Time Conscious mothers made the least improvements in kitchen organization, food storage area organization, and healthy meal planning, preparation, and grocery shopping is, perhaps, not surprising given their characteristics and priorities. That is, of all segments, Stressed, Emotional Eating, Time Conscious mothers had the lowest ‘life and stress are under control’ score (Byrd-Bredbenner, Abbot, and Cussler 2008). The high degree of stress they reported may have interfered with the time and emotional energy available to devote to intervention activities. However, their slightly positive view about whether meal preparation was less stressful after the intervention may be an important change for these women given the extent of stress in their lives overall. Their neutral view about whether their use of short-cut foods had increased may be because they used convenience foods more often than most other segments prior to the intervention.
Although this study is limited by a specifically defined sample of mothers of young children who live in one geographic region (i.e., New Jersey) and were predominately white and of moderate socioeconomic status, it is among the first studies to explore how groups defined by factors that influence eating choices (i.e., psychographics), rather than demographic characteristics, affect audience response to a nutrition education intervention. Data from this study and others (Burnett and Leigh 1986; Candel 2001; Dutta-Bergman 2003; Endresen and Wintz 1988; Ling et al. 2007; Wansink 2003) indicate that segmenting populations into psychographically defined groups is important and of practical value (i.e., may increase the likelihood of identifying consumers most likely to change behaviors and promote the development of targeted educational efforts leading to positive behavioral changes). Utilizing psychographically segmented groups in nutrition education may help transform these educational efforts from broad labors affecting change in only a few to more focused works promoting positive changes in specifically defined populations with the greatest needs and/or interest in learning (Mintz et al. 1997; Slater 1995; Wansink 2003; Albrecht and Bryant 1996).
An important next step is to clarify and confirm the findings of the pilot-test by conducting a full-scale community-wide assessment of this intervention. In addition, future research is needed to psychographically segment other target audiences and examine the response of each segment to interventions. Not only can segmentation help nutrition professionals more sharply focus their interventions, psychographic segmentation may help explain why differences occur in responses to interventions among individuals who belong to a seemingly homogenous demographically-defined group and lead to interventions with characteristics more likely to improve dietary intake, nutritional status, and overall health thereby contributing to the cost-effectiveness of programs (Snyder 2007; Wansink and Lee 2004)
Table 1. Mean Pretest and Posttest Folio Scale Scores of Mothers of Young Children by Cluster Segment (n=20)
| Folio* |
Total Group |
Cluster Segment |
|||
|
Mean+SD# |
Stressed, Emotional Eating, Time Conscious Mothers (n=5) Mean+SD# |
Mean+SD# |
Working, Convenience Driven Mean+SD# |
Happy, Healthy, Food Involved Mothers (n=5) Mean+SD# |
|
| Folio Scale A | |||||
|
Pretest |
55.25+4.73 |
54.80+4.32 |
54.80+5.17 |
54.60+5.86 |
56.80+4.76 |
|
Posttest |
63.75+5.32†a |
59.80+3.27 |
67.00+5.10e |
61.20+6.14‡ |
67.00+2.45j |
| Folio Scale B | |||||
|
Pretest |
56.40+8.26 |
60.80+12.34 |
55.40+5.94 |
57.00+7.07 |
52.40+6.35 |
|
Posttest |
76.00+7.35b |
73.60+3.58‡ |
79.40+7.23f |
71.20+9.91h |
79.80+4.97k |
| Folio Scale C | |||||
|
Pretest |
58.90+6.22 |
56.60+5.55 |
57.80+3.70 |
59.40+7.30 |
61.80+8.17 |
|
Posttest |
68.15+3.31c |
65.40+3.21d |
68.20+2.05g |
68.00+3.94i |
71.00+1.58l |
*Possible range of scores: Folio A – 14 to 70; Folio B – 20 to 85; Folio C – 18 to 81.
#SD=Standard Deviation
†Superscripts indicate that posttest score is significantly different from pretest score: a p<0.0001; b p<0.0001; c p<0.0001; d p<0.03; e p<0.02; f p<0.006; g p<0.007; h p<0.05; i p<0.03; j p<0.004; k p<0.003; l p<0.05
‡Approached significance; p=0.08.
Table 2. Assessment of Kitchen and Mealtime Characteristics of Mothers of Young Children Before Implementing Folio Activities (n=20)
| Folio and Assessments |
% Responding Yes |
| Folio A: Zone Assessment | |
| Zone appliances were nearby |
90 |
| Zone counters were | |
|
100 |
|
25 |
| Zone equipment | |
|
85 |
|
50 |
|
65 |
| Stored items in zone were | |
|
25 |
|
35 |
| Folio B: Foods On Hand Assessment | |
| All foods on hand were fresh and safe to eat |
30 |
| Refrigerated foods could be located quickly |
80 |
| Frozen foods could be located quickly |
20 |
| Pantry (dried, canned) foods could be located quickly |
50 |
| Frequently used foods were stored at eye-level |
70 |
| Folio C: Mealtime Planning, Preparation, and Shopping Assessment | |
| Foods on hand would yield a meal that is | |
|
70
|
|
85 |
|
65 |
| Menus for family meals were planned |
20 |
| Food shopping was planned with family meal menus in mind |
40 |
| Grocery shopping list was organized for efficient shopping |
50 |
| Frequently forgot to buy needed food items |
65 |
Table 3. Mothers’ of Young Children Perceived Effects of Changes Resulting from Folio Use by Segment (n=20)*
| Change |
Mean+SD† |
| Meal ingredients now are easier find |
4.35+0.75 |
|
3.80+0.84 |
|
4.60+0.55 |
|
4.20+0.84 |
|
4.80+0.45 |
| Kitchen is now more organized which makes meal preparation, serving, and clean-up more efficient |
4.55+0.61 |
|
4.60+0.55 |
|
4.80+0.45 |
|
4.20+0.84 |
|
4.60+0.55 |
| Now better able to plan meals ahead of time |
4.40+0.75 |
|
4.00+1.00 |
|
4.40+0.55 |
|
4.60+0.55 |
|
4.60+0.89 |
| Now prepare a shopping list based on weekly menu before shopping |
4.50+0.76 |
|
4.40+0.89 |
|
4.60+0.55 |
|
4.40+0.89 |
|
4.60+0.89 |
| Time spent preparing meals has become less stressful |
3.85+1.14 |
|
3.40+0.89 |
|
4.20+0.45 |
|
3.80+1.30 |
|
4.00+1.73 |
| Meals prepared now are healthier than previously |
3.60+1.05 |
|
3.40+0.55 |
|
4.00+0.71 |
|
4.20+0.84 |
|
2.80+1.48 |
| Meals prepared now include more short-cut foods than previously |
3.50+1.10 |
|
3.00+1.00 |
|
3.60+0.55 |
|
4.00+1.23 |
|
3.40+1.52 |
*Rated on a scale of 1 to 5 (5 being highest)
#Sample size for each segment is 5.
†SD=Standard Deviation
Funding Source:
Canned Food Alliance
References
Albrecht, TL, and C Bryant. 1996. Advances in segmentation modeling for health communication and social marketing campaigns. Journal of Health Communications 1:65-80.
Ammerman, AS, CH Lindquist, KN Lohr, and J Hersey. 2002. Efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Preventive Medicine 35:25-41.
Beck, ME. 2007. Dinner preparation in the modern United States. British Food Journal109:531-547.
Boutelle, KN, LA Lytle, DM Murray, AS Birnbaum, and M Story. 2001. Perceptions of the family mealtime environment and adolescent mealtime behavior: Do adults and adolescents agree? . Journal of Nutrition Education 33:128-133.
Burnett, JJ, and JH Leigh. 1986. Distinguishing characteristics of blood donor segments defined in terms of donation frequency. Journal of Health Care Marketing 6:38-48.
Byrd-Bredbenner, C, J Abbot, and E Cussler. 2008. Psychographic segmentation of mothers of young children using food decision influencers. Nutrition Research 28:506-516.
Byrd-Bredbenner, C, and J Maurer Abbot. 2008. Food choice influencers of mothers of young children: Implications for nutrition educators. Topics In Clinical Nutrition 25:198-215.
Candel, MJ. 2001. Consumers’ convenience orientation towards meal preparation: Conceptualization and measurement. Appetite 36:15-28.
Cutler, D.M., E.L. Glaeser, and J.M. Shapiro. 2003. Why have Americans become more obese? Journal of Economic Perspectives 17:93-118.
Delichatsios, HK, MK Hunt, R Lobb, K Emmons, and MW Gillman. 2001. EatSmart: efficacy of a multifaceted preventive nutrition intervention in clinical practice. Preventive Medicine 33 (2 Pt 1):91-98.
Dutta-Bergman, MJ. 2003. A descriptive narrative of healthy eating: A social marketing approach using psychographics in conjunction with interpersonal, community, mass media and new media activities. Health Marketing Quarterly 20:81-101.
Endresen, KW, and JC Wintz. 1988. Healthstyles: A new psychographic segmentation system for health care marketers. Journal of Medical Practice Management 3:273-277.
Faughey, E. 1999. Quick Flip to Delicious Dinners. Boulder, CO: Nutrition Connections.
Field, AE, MW Gillman, B Rosner, HR Rockett, and GA Colditz. 2003. Association between fruit and vegetable intake and change in body mass index among a large sample of children and adolescents in the United States. International Journal of Obesity and Related Metabolic Disorders 27:821-826.
Guthrie, JF, BH Lin, and E Frazao. 2002. Role of food prepared away from home in the American diet, 1977-78 versus 1994-96: changes and consequences. Journal of Nutrition Education and Behavior 34:140-150.
Harnack, LJ, RW Jeffery, and KN Boutelle. 2000. Temporal trends in energy intake in the United States: An ecologic perspective. American Journal of Clinical Nutrition 71:1478-84.
Kahn, EB, LT Ramsey, RC Brownson, GW Heath, EH Howze, KE Powell, EJ Stone, MW Rajab, and P Corso. 2002. The effectiveness of interventions to increase physical activity. A systematic review. American Journal of Preventive Medicine 22 (4 Suppl):73-107.
Larson, N, M Story, M Wall, and D Neumark-Sztainer. 2006. Calcium and dairy intakes of adolescents are associated with their home environment, taste preferences, personal health beliefs, and meal patterns. Journal of the American Dietetic Association 106:1816-1824.
Life Sciences Research Office, and SA Andersen. 1990. Core indicators of nutritional state for difficult to sample populations. Journal of Nutrition 120:1557S-1600S.
Ling, PM, TB Neilands, TT Nguyen, and CP Kaplan. 2007. Psychographic segments based on attitudes about smoking and lifestyle among Vietnamese-American adolescents. Journal of Adolescent Health 41:51-60.
Maurer Abbot, J, and C Byrd-Bredbenner. 2009. Development of a self-directed home kitchen makeover for mothers of young children. Forum for Family and Consumer Issues 14 (1: Spring).
Maurer, J, and C Byrd-Bredbenner. 2007. The state of the American diet. The nutrition facts: What, why, when, and where are we eating in America? And, how can we cope? . Topics In Clinical Nutrition 22:202-234.
Miles, MB, and AM Huberman. 1994. Qualitative Data Analysis. 2nd ed. Thousand Oaks, CA: Sage Publications.
Mintz, JH, N Layne, R Ladouceur, J Hazel, and M Desrosiers. 1997. Social advertising and tobacco demand reduction in Canada. In Social marketing. Theoretical and practical perspectives, edited by M. Goldberg, M. Fishbein and S. Middlestadt. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers.
Neumark-Sztainer, D, P Hannan, M Story, J Croll, and C Perry. 2003. Family meal patterns: Associations with sociodemographic characteristics and improved dietary intake among adolescents. Journal of the American Dietetic Association 103:317-322.
NPD. 2005. NPD reports Americans eat differently 20 years later. The NPD group releases findings from its 20th annual report on eating patterns in America.
Robinson, JP, and G Godbey. 1997. Time for Life: The surprising ways Americans use their time. University Park, PA: Pennsylvania State University Press.
Slater, MD. 1995. Choosing audience segmentation strategies and methods for health communications. In Design health messages. Approaches from communication theory and public health practice, edited by E. Maibach and R. Parrott. Thousand Oaks, CA: Sage Publications.
Sloan, E. 2005. Demographic directions: Mixing up the market. Food Technology 59:34-45.
Snyder, LB. 2007. Health communication campaigns and their impact on behavior. Journal of Nutrition Education and Behavior 39:S32-S40.
Videon, TM, and CK Manning. 2003. Influences on adolescent eating patterns: The importance of family meals. Journal of Adolescent Health 32:365-373.
Wansink, B. 2003. Profiling nutritional gatekeepers: three methods for differentiating influential cooks. Food Quality and Preferences 14:289-297.
Wansink, B, and K Lee. 2004. Cooking habits provide a key to 5 a day success. Journal of the American Dietetic Association 104:1648-1649.
Wilson, JW, CW Enns, JD Goldman, KS Tippett, SJ Mickle, LE Cleveland, and PS Chahil. 1997. Data Tables: Combining results from USDA’s 1994 and 1995 Continuing Survey of Food Intakes by Individuals and 1994 and 1995 Diet and Health Knowledge Survey, Table Set 5. Washington, DC: United States Department of Agriculture.
Cite this article
Carol Byrd-Bredbenner and Jaclyn Maurer Abbot. 2009. Improving the Nutritional Quality of the Home Food Environment using Self-Directed Home Kitchen Makeovers. The Forum for Family and Consumer Issues, 14 (1).