LIST OF TABLES (continued) PAGE Table 6.7 Interpretations of how often fatty foods should be eaten as 110. LIST OF TABLES (continued) PAGE Table 6.20 Reasons why "water" is not considered food as reported by.
INTRODUCTION
The purpose of this meeting was to discuss the development of FBDGs as an effective nutrition education tool to promote appropriate diets and lifestyles. In addition, the suitability of the proposed South African FBDGs as a country-specific nutrition education tool will be assessed in terms of consumer understanding and application of the guidelines.
DEFINING FOOD-BASED DIETARY GUIDELINES
The documentation and critical analysis of the South African FBDGs process and the incorporation of extensive consumer testing as an integral part of this process are therefore important contributions to the FBDG's development process, not only for South African research, but also internationally. In this regard, the development of country-specific dietary guidelines is an attempt to provide consistent nutritional messages with the aim of describing recommended dietary patterns that South Africans should strive for, whether under-, over- or adequately nourished.
FORMULATING FOOD-BASED DIETARY GUIDELINES
DEFINING FOOD GUIDES
DESIGNING APPROPRIATE FOOD GUIDES
THE ROLE OF CONSUMER TESTING IN CREATING EFFECTIVE NUTRITION EDUCATION TOOLS
Motivated by F AO/WHO initiatives, the South African Food-Based Dietary Guidelines Working Group was formed in 1997, under the auspices of the South African Nutrition Society. The South African Food-Based Dietary Guidelines Working Group therefore agreed that formal consumer research studies should be conducted in as many of South Africa's nine provinces as resources allow.
AIM AND OBJECTIVES OF THE STUDY
To assess the suitability of the proposed South African FBDGs in terms of consumer understanding and implementation of the guidelines among women living in KwaZulu Natal. The findings will be evaluated and used to make recommendations regarding the compatibility of the proposed South African FBDGs in terms of consumer food categorization and whether food guides commonly used in South Africa for nutrition education are useful additions to the proposed FBDGs.
PARAMETERS OF THE STUDY
To assess the compatibility of the proposed South African FBDGs in terms of food categorization as perceived by women living in KwaZulu Natal and as described in food guides commonly used in South Africa for nutrition education. To identify personal food categorization (the ways in which common foods/drinks are categorized by study participants without food group prompting).
ASSUMPTIONS
Measuring the effectiveness of FBDGs as a nutrition education tool is not part of this study, nor is measuring the impact of nutrition education on dietary behavior and nutritional status.
ETHICAL CONSIDERATIONS
STRUCTURE OF THE THESIS
The use of food guides as an additional nutrition education tool to aid in the implementation of dietary guidelines is also discussed. The chapter concludes with a review of the role of the consumer in the development of dietary advice and food guides, and the impact of dietary advice and food guides on nutritional behaviour.
DEFINING EFFECTIVE NUTRITION EDUCATION
The emergence of food-based dietary guidelines (FBDGs) as a tool for conducting effective nutrition education is highlighted, with particular emphasis on the differences between nutrient-based and food-based dietary guidelines, in the process of developing recommended F AO/WHO FBDGs, and an analytical comparison of dietary guidelines used in different countries. In light of this, it is recommended that health promotion and communication models be used when developing nutrition education materials/programs.
THE EMERGENCE OF FOOD-BASED DIETARY GUIDELINES AND APPROPRIATE FOOD GUIDES
The rationale behind this is that nutrition education should go beyond "teaching people to make better use of available food resources" and include strategies that address the problem of inadequate, confusing, or insecure food sources. This, in turn, could provide more precise guidance on how such nutrition education efforts should be modified to improve their effectiveness.
HEALTHY EATING
The process of developing food-based dietary guidelines
India provides two sets of dietary guidelines – one for the poor (promoting the use of cheap and traditional foods and the consumption of grains and pulses with some milk and vegetables every day) and one for the wealthy (emphasizing fat, sugar and salt restriction). The South African Food-Based Dietary Guidelines (SA FBDG) Working Group was officially formed in May 1997 (NSSA 1996).
The emergence of food guides in South Africa
The Puerto Rico Food Guide Pyramid therefore includes "viandas" as part of the cereal group, as this reflects consumer categorization of these foods (Macpherson-Sanchez 1998). Consumer research is rarely targeted at assessing the acceptability of the selected food groups for the consumer for whom the food guide is intended.
SUMMARY
The IDdd documentation critical analysis of the South African FBDG process and the inclusion of extensive consumer testing as an integral part of this process are therefore important contributions to the FBDG development process, not only for South African research. , but also internationally. This discussion covers study objective 1 - documentation and critical analysis of the process of South African FBDGs in relation to the 10-step development process recommended by the F AO/WHO consultation.
DEVELOPMENT PROCESS OF THE SOUTH AFRICAN FBDGs
- Household food insecurity
- Nutrition-related public health concerns
- Dietary practices and nutrient intake patterns
- Construction of the preliminary FBDGs
- Aim of the dietary guidelines
- Target groups of the dietary guidelines
- Content of the dietary guidelines
- Formulation of a draft set of FBDG statements
10/22/1997 present: 12 SA FBDG Working Group The overall objective of the FBDG should be to address the experienced transition to nutrition. Congress comments on nutrition were discussed at the seventh meeting of the SA FBDG working group (18-10-2000). These guidelines were developed by an independent group on behalf of the Department of Health, but in consultation with the SA FBDG Working Group.
Cooperation between study supervisors and members of the SA FBDG Work Group has therefore helped the researcher to maintain objectivity. A crucial final step in the FBDGs development process is to measure the impact of the FBDGs.
STUDY POPULATION
SAMPLING PROCEDURE
Urban formal Black Zulu speaking;. random sampling of two geographically distinct magisterial districts within each selection tier - one magisterial district for focus group discussions and one for semi-structured interviews. magisterial districts provided by Statistics SA). Women who (a) make decisions about purchasing and preparing food in the household, and (b) have received no formal training in nutrition, and (c) agree to participate in the study. Study participants for both focus group discussions and individual interviews for all catchment areas were recruited during weekdays using convenience sampling, that is, field workers moved from residence to residence and recruited whoever was home at the time.
SAMPLE SIZE
When calculating the sample size for individual interviews, a “rule of thumb” was used, which states that the larger the population, the smaller the sample (Terre Blanche & Durrheim 1999). No variance was available to calculate a representative sample size because no research has been conducted in this area. The sample size for the rural census area was increased by 1 (n=70) to reflect the greater proportion of rural and urban residents in KwaZulu Natal (see Table 4.4).
DATA COLLECTION
- Individual interviews
- Motivation for choice of individual interview methodology
- Use of individual interview methodology in the study
- Answering of questions
- Remuneration of participants
Focus group discussions were conducted using a selection of 119 color photographs of food (see Appendix 5) and a pre-tested topic guide (see Appendix 6). The main part of the focus group discussions concerned the eleven proposed food-based dietary guidelines (FBDGs). The selection of color photographs of food was the same as those used for focus group discussions.
DATA ANALYSIS .1 Focus group discussions
- Individual interviews
To increase the validity of this study, "triangulation" was used in the form of focus group discussions, individual interviews, and conscious participant observation and feedback to determine whether participants considered the results to be a fair account of their experiences. Participants were informed that they would not be paid for their participation in the study. Single factor analysis of variance (ANOV A) tests were conducted to test for significant differences in mean age within focus group samples, within interview samples, and between focus group and interview samples.
SUMMARY
Chi-square tests were calculated to determine the significance of any associations for questionnaire responses within the interview sample. Descriptions are provided regarding the size and composition of the study sample, the types of settlements, age, education level, employment, religion, and sources of cooking fuel and water.
SIZE AND COMPOSITION OF THE STUDY SAMPLE
Rural Black participants came from villages in Estcourt and Eshowe, where homes were mostly mud huts. Water was collected from nearby rivers or communal outdoor taps, and firewood was used for heating and cooking (see Figure 5.1). Here, the participants used paraffm as the main source of cooking fuel, with water obtained from communal taps (see Figure 5.3).
AGE OF SAMPLE
EDUCATION LEVELS OF SAMPLE
Higher levels of education were clearly evident among all urban EAs for focus groups and interviews. These differences between different ethnic groups in South Africa are not unexpected and reflect South Africa's pre-1994 education policy, which disadvantaged black South Africans. The educational level of the research group was therefore considered to reflect contemporary South African society.
EMPLOYMENT LEVELS OF SAMPLE
RESOURCES - WATER AND COOKING FUEL
Urban black interviewees living in Umlazi (a well-established suburb) had electricity and indoor taps in most homes. Urban Indian and White participants, for both focus groups and interviews, had electricity and indoor taps in all homes. Availability of water and cooking fuel sources for the study sample was therefore considered a reflection of current South African society.
SUMMARY AND DISCUSSION OF SAMPLE CHARACTERISTICS
Therefore, the level of employment was considered to be a reflection of the current South African society and had no effect on the outcome of the study. The availability of water and cooking fuel resources was therefore considered a reflection of current South African society and had no effect on the outcome of the study. 16% of households in South Africa are located in informal urban settlements, the majority of whom are black South Africans.
- Perceived importance of applying each FBDG
- General overview
Participants in the urban informal and rural focus groups reported higher optimal intakes (8-12 glasses/day) than their counterparts (1-8 glasses/day). Most focus group participants were in favor of this guideline in terms of health-related outcomes. Focus group participants recognized the importance of this guideline in terms of overall health (“good for body and skin”) and disease prevention (“disease resistance”).
- Personal food categorisation (way/s in which common foods/drinks are categorised without food group prompting)
- FBDG food categorisation
- Starchy foods
- Foods from animals
- Snacks
A minority of the interview participants (all urban formal residents) mentioned additional foods/drinks that are frequently consumed (ie, frequently consumed foods/drinks for which there were no food photos) (see Table 6.38). Indecision about personal categorization of certain common foods as cited by urban formal Indian and White interview participants. Interview participants were shown color (A4) illustrations of 5 food guides commonly used in South Africa for the purposes of nutrition education, namely the 3 food groups, 5 food groups, food guide pyramid, food square and mixed meal guide (see Appendix 8).
- General understanding and specific interpretations regarding concepts, terminology and descriptions used in the proposed FBDGs
Evaluations of the Soul City Project (lUPHC 1995) showed that among those watching the television series, the majority (69%) were urban, while listeners to the radio series were largely rural (44%). Urban formal Indian and White participants cited/chosen a greater variety of the more expensive "starchy foods." breakfast cereal, pasta, oatmeal, sweet com). Interpretations by interview participants were similar to those of the focus groups, with only urban formal Indian and White participants also including 'latty foods'.
