Evaluation of a self-help dietary intervention in a primary care setting.

Abstract

BACKGROUND. Dietary intervention to reduce fat consumption and increase fiber consumption has been recommended by the National Cancer Institute, but there is little evidence concerning the effectiveness of self-help materials. The purpose of this study was to evaluate such self-help materials, introduced by a nurse in a primary care setting. METHODS. A randomized controlled trial involving 242 subjects was conducted in two primary care clinics in Chapel Hill, NC, in 1987. Changes in fat and fiber consumption in the intervention and control groups during the 3-month interval between interviews were compared using analysis of covariance. RESULTS. The estimated reduction in fat was 3.8g larger for the intervention group than for the control group, but the confidence interval included zero. For those individuals who had some responsibility for meal preparation there was a larger difference (-6.9g) in favor of the intervention group, although the difference using calorie-adjusted values was -3.8g with a 95% confidence interval (-7.1, -0.4). The differences for fiber change were smaller. CONCLUSIONS. We found significant small but consistent differential changes associated with a minimal self-help intervention, but we cannot rule out the possibility of some response bias. Nonetheless, this study demonstrates that the use of self-help materials for dietary change is feasible, and may be effective.

Mediation of Adult Fruit and Vegetable Consumption in the National 5 A Day for Better Health Community Studies

“…Autonomy/responsibility for food-related behaviors was considered as a possible mediator based on previous work of Beresford et al [12,13] who found in their study of primary care patients that autonomy/responsibility was strongly related to F&V change. We had hypothesized that project activities and education might increase participants' level of food-related responsibility.…”

“…The psychosocial measures were knowledge/awareness of the 5 A Day recommendation, selfefficacy, stage of readiness to increase F&V, and autonomy/ responsibility for food-related behaviors. These constructs were selected based on prior research indicating that they were potential determinants of dietary behavior [3,[10][11][12][13]. For example, the national 5 A Day Baseline Survey conducted in 1991 indicated that knowledge of the number of F&V servings recommended each day accounted for a significant portion of the variance in consumption [10].…”

“…For example, the national 5 A Day Baseline Survey conducted in 1991 indicated that knowledge of the number of F&V servings recommended each day accounted for a significant portion of the variance in consumption [10]. In previous research focused on reducing dietary fat intake, participants with complete autonomy (independent responsibility and control) regarding food choice made larger changes attributable to intervention [13]. The sites therefore included a set of three questions on autonomy to explore its possible link to F&V behavior and intervention impact.…”

Stages of Change for Increasing Fruit and Vegetable Consumption among Adults and Young Adults Participating in the National 5-a-Day for Better Health Community Studies

“…In previous research focused on reducing dietary fat intake, participants with complete autonomy (independent responsibility and control) regarding food choice made larger changes attributable to intervention. 33 The role of autonomy in increasing fruit and vegetable consumption has not been examined before. Five sites included a set of three questions on autonomy to explore its possible link to fruit and vegetable behavior.…”

A dietary intervention in primary care practice: the Eating Patterns Study.

“…'5 Further, it has been found that many people prefer self-help materials as an approach to the promotion of changes in health behavior. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The importance of these lowintensity interventions lies in their potential to affect large numbers of the population.7 Although the resulting change in behavior may be quite small at the individual level, its impact at the population level can be quite dramatic.…”