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Chapter 15
Designing Community Nutrition Interventions
Lecture Launcher
How many of you have ever tried to change a behavior, and were successful? Unsuccessful? Why do you
think you were successful/unsuccessful?
Chapter Outline
I.
Introduction
A. There are two important aspects of designing interventions.
B. The first is that you must have information about your target population and why they do what
they do in terms of behavior.
C. The second is that you need an arsenal of tools for influencing behavior.
II. Choose an Intervention Strategy
 The first step in designing an intervention is to review the program’s goals and objectives, which
specify the program outcomes.
 Next you need to design a rough outline of what the intervention might look like.
 The intervention strategy is the approach for achieving the program’s goals and objectives and it
addresses the question of how the program will be implemented to meet the target population’s
nutritional needs.
A. The intervention strategy can be directed towards:
1. Individuals
2. Communities
3. Systems
B. The intervention strategy can also encompass one or more levels of intervention:
1. Level I: building awareness
a. These focus on increasing awareness of a problem.
b. They are helpful for changing attitudes and beliefs and increasing knowledge of risk
factors but they seldom result in actual behavior changes.
c. Examples include health fairs, screenings, Internet web sites, and newsletters.
2. Level II: changing lifestyles
a. These are designed to help individuals make lifestyle changes.
b. They can be successful when they call for small changes over time and when they use a
combination of education and behavior modification.
c. Level II interventions reach individuals through one-on-one counseling and small group
meetings.
d. They involve a program of assessing current behaviors, setting goals for behavior change,
developing skills needed to change behavior, providing support for change, and
evaluating progress.
e. Examples include fitness programs in schools and health promotion programs for city
employees.
IM for Community Nutrition in Action 4e, by Melanie Burns of Eastern Illinois University
3.
Level III: creating supporting environments for change
a. These work toward creating environments that support the behavior changes made by
individuals.
b. They include worksite health promotion and cafeteria programs.
c. Supportive environments can be created through policies that support gleaning, point-ofpurchase labeling, and tax incentives for companies with health promotion programs.
C. Study the Target Population
 When designing an intervention, study the target population’s eating patterns and their
beliefs, values, and attitudes about foods and health.
 Conduct library research, review existing programs that deal with the target population,
network with colleagues who work with the group, and post queries about the target
population on Internet listservs.
 The target population’s food-related behavior is important and many factors influence food
intake and nutritional status.
1.
2.
3.
4.
5.
Food Supply and Food Availability. Below are some of the many factors that influence food
intake and nutritional status.
a. Food choices are influenced by the types and amounts of foods available in the food
supply.
b. Food availability is affected by the food distribution system, types of imported foods,
facilities for food processing and production, and the regulatory environment.
Income and Food Prices. Income and food prices are two economic factors that affect food
consumption; households with higher incomes have more money to spend on food and
choose whatever foods they want, regardless of price.
Sociocultural Factors
a. Food choices are strongly influenced by social groups, and primary social groups include
families, friends, and work groups with the family exerting the most influence.
b. Culture influences food behaviors and even dictates how foods are stored, processed,
consumed, disposed of, and even which foods are considered edible.
c. Religious beliefs affect food choices and some religions, such as Islam, Hinduism,
Judaism, and Seventh-Day Adventism, specify the foods that may be eaten and how they
should be prepared.
Food Preferences, Cognitions, and Attitudes. Food preferences, cognitions, and attitudes
also influence food habits.
a. Preferences for certain tastes and foods appear to develop quite early in humans.
b. Food choices are affected by our cognitions, or what we think.
c. Attitudes are believed to influence behavior indirectly.
Health Beliefs and Practices. Beliefs about foods, diet, and health, such as the traditional
Chinese beliefs of yin and yang, influence food choices.
III. Draw from Current Research on Consumer Behavior
 Many theories have been proposed to explain the decision-making process as it relates to health.
 Theories are sometimes presented in the form of models, which are simple images of the
decision-making process.
A. The Stages of Change Model
1. The Theory. The Stages of Change Model is founded on three assumptions:
IM for Community Nutrition in Action 4e, by Melanie Burns of Eastern Illinois University
a.
b.
2.
3.
Behavior change involves a series of different steps or stages.
There are common stages and processes of change across a variety of health behaviors:
1. Precontemplation is when the individual is either unaware of or not interested in
making a change.
2. Contemplation is when the person is thinking about making a change, usually within
the next six months.
3. Preparation is when the person actively decides to change and plans a change,
usually within one month.
4. Action is when the individual is trying to make the desired change and has been
working at making the change for less than six months.
5. Maintenance is when the individual sustains the change for six months or longer and
the changed behavior has become a part of his or her daily routine.
c. Tailoring an intervention to the stage of change in which people are at the moment is
more effective than not considering the stage people are in.
d. The model resembles a spiral, with people moving around the spiral until they
eventually achieve maintenance and termination.
e. People in the contemplation stage are seeking information whereas people in the
maintenance stage are likely to be looking for information and searching for ways to
strengthen the behavior.
The Application—Individual – the Smithfield Fitness Club (members in various stages)
The Application—Communities – city of Scottsville (in precontemplation stage)
B. The Health Belief Model
1. The Theory. The Health Belief Model was developed to explain why people failed to
participate in programs designed to detect or prevent disease.
a. The model has three components:
1. The perception of a threat to health.
2. The expectation of certain outcomes related to a behavior.
3. Self-efficacy or the belief that one can make a behavior change.
b. Other variables, such as education, income, sex, age, and ethnic background influence
health behaviors in this model, but they are believed to act indirectly.
2. The Application – American Cancer Society’s public awareness campaign
C. The Theory of Planned Behavior
1. The Theory. The Theory of Reasoned Action, also called the Theory of Planned Behavior, is
a fundamental model for explaining virtually any health behavior over which the individual
has control.
a. Behavior is determined directly by a person’s intention to perform the behavior.
b. Intentions are the instructions people give to themselves to behave in certain ways.
c. In forming intentions, people consider the outcome of their behavior and the opinion of
significant others before committing themselves to a particular action.
d. In other words, intentions are influenced by attitudes and subjective norms, or perceived
social pressure to perform or not perform a behavior.
e. Attitudes are determined by:
1. The individual’s belief that a certain behavior will have a given outcome.
2. An evaluation of the actual outcome of the behavior.
3. A perception of his or her ability to control the behavior.
2. The Application – Fairlawn Weight Management Center’s “Get Fit Now” program
IM for Community Nutrition in Action 4e, by Melanie Burns of Eastern Illinois University
D. Social Cognitive Theory
1. The Theory. Social Cognitive Theory explains behavior in terms of a model in which
behavior, personal factors such as cognitions, and the environment interact constantly, such
that a change in one area has implications for the others.
a. The environment includes both the social real (family, friends, peers, coworkers) and the
physical real (the workplace, layout of a kitchen, etc.).
b. The strength of this model is that it focuses on certain target behaviors rather than on
knowledge and attitudes.
2. The Application – peer counseling course to reduce pica among WIC participants
E. The Diffusion of Innovation Model
1. The Theory. Diffusion of Innovation Model was developed to explain how a product or idea
becomes accepted by a majority of consumers and it consists of four stages:
a. Knowledge is when the individual is aware of the innovation and has acquired some
information about it.
b. Persuasion is when the person forms an attitude either in favor of or against the
innovation.
c. Decision is when the individual performs activities that lead to either adopting or
rejecting the innovation.
d. Confirmation is when the individual looks for reinforcement for his or her decision and
may change if exposed to counter-reinforcing messages.
e. Consumers are classified according to how readily they adopt new ideas or products:
1. Innovators adopt the innovation quite readily and they perceive themselves as
popular and financially privileged.
2. Early adopters are the next to adopt and these individuals, who include opinion
leaders, are integrated into the community and are well respected by their families
and peers.
3. Early majority tend to be cautious.
4. Late majority are skeptical and usually adopt an innovation only through peer
pressure.
5. Laggards are the last to adopt and they tend to come from small families, to be single
and older, and to be traditional.
2. The Application – seeking early adopters for the “Heart-Healthy Living” program
IV. Put It All Together: Case Study 1
A. Defining levels of intervention for target groups
B. Formative evaluation and literature review
C. Influence of theories of consumer behavior on health promotion activities
V. Use Entrepreneurship to Steer in a New Direction
A. One of the major challenges for community nutritionists is to think of new ways of delivering
health messages and services to vulnerable populations.
B. We need a better understanding of the community factors that influence change and the reasons
why consumers resist change.
IM for Community Nutrition in Action 4e, by Melanie Burns of Eastern Illinois University
C. When you plan community interventions, think of new ways to reach your target audience, plan
strategies for finding out why your clients are resisting a behavior change, and apply your
creativity to influencing people to achieve behavior change.
IM for Community Nutrition in Action 4e, by Melanie Burns of Eastern Illinois University