CHAPTER 3: STUDY METHODOLOGY
3.3 Survey methods and material
3.3.1 Questionnaire development
Two different questionnaires were developed2 in order to gain a clear understanding of the effectiveness of the game and ESM on knowledge retention surrounding nutrition. The first questionnaire was given to the learners as a pre-test to measure their baseline knowledge and again as a post-test after the intervention to determine if any knowledge had been retained because of the intervention. The second questionnaire was provided for the educators to express their opinions on the intervention they used. They were asked to evaluate the game or
2 For the purpose of this study the first questionnaire will be referred to as the learner questionnaire; while the second will be referred to as the educator questionnaire.
School 1
Intervention class
Game
Intervention class
ESM
School 2
Control class
No intervention
Intervention class
Game
School 3
Control class
No intervention
Intervention class
ESM
School 4
Intervention class
Game
Intervention class
ESM
ESM in terms of ease of use, effectiveness in promoting knowledge retention as well as potential use in the future. The development of each of these will now be discussed.
3.3.1.1 Learner questionnaire
For the purpose of measuring nutrition knowledge retention this questionnaire had five parts (Appendix A, p108). The overall questions in this study were developed based on the Food Based Dietary Guidelines for South Africa, and other information that the children should have learned with the new CAPS curriculum (DOE 2011). The questionnaire narrowed down the broad topic of “nutrition” into the poor eating habits that were observed in Sweetwaters and found in other rural areas. These poor eating habits include a high intake of starchy and fatty foods and a low intake a lean protein, fruit and vegetables along with limited exercise (Oosthuizen et al 2011b). The questionnaire was then divided into two sections with section A containing: demographic information and the learners source of prior nutrition knowledge, and section B including questions regarding nutrition knowledge. Section B was further sub- divided into four sections; FBDG knowledge, food groups, nutrient content of foods, and nutritional benefits and deficiencies. A code was assigned to the questionnaire for test-retest purposes to ensure the same learners answers could be compared. Each section was developed as follows:
Section A:
Demographic information and sources of prior nutrition knowledge – this section included questions determining the age, gender and race of the learners, as well as the source of nutrition knowledge received by learners prior to this study.
Section B:
Questions regarding nutrition knowledge – these questions made up the bulk of the questionnaire however were limited to 23 questions. This was done in order to retain the attention of the Grade 5 learners, taking into account that English was their second language.
Although the learners could read, many of them read very slowly and may have required more time to understand/interpret what was being asked from them. This section was subdivided into 4 parts.
Part 1: FBDG knowledge – This section consisted of four questions which focused on the South African Food Based Dietary Guidelines (FBDG) that were not related to food. The
purpose of this was to determine if the learners understood that health as a whole is not only related to eating or avoiding certain foods, but involves exercise and personal hygiene as well.
Part 2: Food groups – This section consisted of nine questions that highlighted the different food groups contained within the FBDG. Oldewage-Theron and Napier (2011) found it necessary to include the food groups when developing their game as it made the content easier for learners to understand and remember. Consequently a similar structure was used when developing this questionnaire. The questions focused on the negative eating habits seen in children across the country in rural and semi-rural areas. These include a high intake of starchy foods and sugary foods, with a low intake of fruit, as well as a limited intake of protein rich foods (Oosthuizen et al 2011b; Oldewage-Theron & Egal 2009). The questions were designed to make the information “practical” by showing that the learners had not only obtained the knowledge but were also able to apply this knowledge to action. For example, instead of asking “how many fruit they should eat a day” the question asked “how they could increase their fruit intake if they had been instructed to”. This forced them to think about how they could apply what they had learned if they were required to. The options given in the multiple choice answers are foods that were known and consumed regularly in their local community.
Part 3: Nutrient content – These questions determined which foods contained various macro- and micro-nutrients. This was included to determine if the learners could identify what nutrient specific foods contained in addition to how often these foods should be eaten and what they could do to increase or decrease the intake thereof.
Part 4: Nutritional benefits and deficiencies – A basic needs assessment prior to the study indicated that children and adolescents in the area where less likely to eat certain foods because they were unaware of the benefits of that food. As a result they ate the food because they were told to and stopped eating it as they got older if they did not like it. Therefore it was hypothesised that helping to provide a basic understanding of the benefits of some of the foods could produce an awareness that would encourage the consumption of less desirable foods because it would be health promoting. Thus five questions that focussed on the benefits of certain nutrients and some of the negative consequences of not consuming enough of specific nutrients were included. The micro-nutrients that were emphasised were those that
have been a focal point in South Africa for a number of years due to the previously high rate of deficiencies. These include vitamin A and iron, along with calcium as anecdotal evidence showed a large number of children having rotten teeth in this community (SANHANES-1 2013).
3.3.1.2 Educator Questionnaire
A questionnaire was developed for the educators to provide an opportunity for feedback on the ESM (Appendix B, p114) or game (Appendix C, p120) given to each educator. The questionnaire was divided into four sections: clarity of explanation, ease of use, effectiveness and a general evaluation. The first three sections were made up of a number of multiple choice questions, while the last section consisted of five questions using a Likert scale of
“strongly agree to strongly disagree”. The responses helped the researcher to obtain perspective on the educators’ opinions of the game or ESM.