Razi Journal of Medical Sciences

Background: Fasting school and increasing consumption of low-value meals among children is associated with adverse health consequences and chronic diseases in adulthood. Since most bad hygienic behaviors are rooted in childhood experiences, the present study examined the effectiveness of educational interventions based on application of the theory of planned behavior (TPB) in improving the breakfast and healthy snacks in elementary school students in the second half of 2011 in Qazvin.

Methods: Randomly, 150 students, in case and control group, from six schools participated in a quasi randomized controlled experimental study. Variables were evaluated before and 3 months after intervention. In treatment group, the educational program was conducted with targeted educational pamphlets. The program included five 30-minute sessions that developed regarding the beliefs and structures extracted from the qualitative study and constructs of theory of planned behavior. Data regarding TPB were collected using valid and reliable questionnaire with 40 items by self report method. The food frequency checklist was used to assess students' nutritional habits. Finally, the data were entered into SPSS 17.0 software and statistical tests such as chi square, independent and pooled t test, McNemar and one-way ANOVA with Scheffe post hoc test were used for data analysis.

Results: Student’s average age was 8.43 ± 0.83 years old and their sex ratio was equal. Before educational intervention, 57.3 % in the intervention group and 53.3 % in the control group did not use the breakfast. After educational intervention, significant improvement of about 12.6% was seen regarding breakfast eating (p < 0.001). However, significant changes weren’t seen in the control group. There were no significant differences between two group regarding constructs of TPB in the pretest period, however after intervention significant changes in attitude (from 53.26±25.7 to 74.72±28.18) (p<0.001), subjective norms (from 56.97±26.6 to 68.07±26.28) (p<0.001), perceived behavioral control (from 32.57±19.6 to 57.66±35.7) (p<0.001) and intention (from 8.5±3.3 to 11.37±3.11) (p<0.001) was seen in case group. Moreover, results showed that consumption of soft drinks and junk food such as chips, etc. decreased from 74.6 % to 58.3% in case group after education (p<0.05).

Conclusions: The finding of this study demonstrates the high prevalence of inappropriate eating behavior in this sensitive period. Educational intervention with the appropriate application of psychological theory correct behaviors associated with a healthy breakfast and snacks at the elementary school. According to appropriate educational field and cost-effective educational intervention in schools, generalization of such training programs in other areas seems critical.