Razi Journal of Medical Sciences

fa سنجش اثربخشی آموزش گروهی تغذیه صحیح بر اساس بازی‌درمانی بر گرایش به تنوع غذایی و اضطراب در کودکان پیش‌دبستانی دارای اختلال اجتناب/ محدودیت غذا Measuring the Effectiveness of Group-Based Proper Nutrition-Training Therapy on Tendency to Food Diversity and Anxiety in Preschool Children with Avoidance / Restriction Disorders روانشناسی بالینی Clinical Psychiatry پژوهشي Research زمینه و هدف: پژوهش حاضر با هدف سنجش اثربخشی آموزش گروهی تغذیه صحیح بر اساس بازی‌درمانی بر اضطراب و گرایش به تنوع غذایی در کودکان پیش‌دبستانی دارای اختلال اجتناب/ محدودیت غذا انجام شد. روش کار: طرح پژوهش، نیمه آزمایشی از نوع پیش آزمون- پس آزمون با گروه کنترل و یک مرحله پیگیری بود. جامعه موردمطالعه، کودکان پیش‌دبستانی (3 تا 5 سال) در دسترس دارای یکی از اختلال‌های خوردن بودند. به وسیله نمونه‌گیری هدفمند 20 نفر کودک که دارای نشانگان بالینی اختلال اجتناب/ محدودیت غذای ساکن در شهرستان سنندج، بودند، در سال 1400 انتخاب گردیدند؛ که در دو گروه آزمایش و کنترل به صورت تصادفی قرارداده شدند. گروه آزمایش به مدت 8 جلسه 120 دقیقه‌ای آموزش گروهی تغذیه صحیح به روش بازی درمانی را دریافت کرد، برای گردآوری داده‌ها از پرسشنامه‌های رفتار خوردن کودکان واردل، گاتری، ساندرسون و راپاپورت (2001) و مقیاس تجدیدنظر شده اضطراب آشکار کودکان (CMAS) رینولدز و ریچموند (1987) استفاده شده است. برای پاسخ به سؤالات از آزمون تحلیل واریانس با اندازه‌گیری مکرر و کوواریانس چند متغیره استفاده گردید. یافته‌ها: سطح معنی‌داری متغیرهای اضطراب و گرایش به تنوع غذایی کمتر از 05/0 است. یعنی بین میانگین نمرات این متغیرها در مراحل پیش آزمون، پس آزمون و پیگیری تفاوت معناداری وجود دارد؛ و با توجه به معنی‌داری اثر متقابل مراحل * گروه؛ میزان تغییرات این متغیرها در طی مراحل پیش آزمون، پس آزمون و پیگیری در دو گروه آزمایش و کنترل یکسان نبوده است. همچنین بین مراحل پس آزمون و پیگیری تفاوت بین میانگین‌ها وجود نداشت (../1)؛ یعنی اثربخشی مداخله در مرحله پیگیری پایدار مانده است. نتیجه‌گیری: بسته آموزشی و درمانی تغذیه صحیح گروهی کودکان پیش‌دبستانی بر اساس روش بازی‌درمانی، به‌طور مؤثر می‌تواند تنوع غذایی کودکان دارای اختلال اجتناب/ محدودیت غذا را گسترش داده (سطح معنی‌داری 02/0) و اضطراب آن‌ها را هم کاهش دهد (سطح معنی‌داری 001/0). <div style="text-align: justify;">Background & Aims: The aim of this study was to evaluate the effectiveness of group nutrition training based on play therapy on anxiety and tendency to food diversity in preschool children with avoidance- restriction of food. Methods: The design of this study was a quasi-experimental pretest-posttest with a control group and a follow-up stage. The study population, available preschool children (3 to 5 years) had one of the eating disorders. By purposive sampling, 20 children with clinical symptoms of avoidance disorder / food restriction living in Sanandaj were selected; Which were randomly assigned to experimental and control groups. At first, a 3-hour group training session was held for the mothers of the children in the experimental group on parenting style, child nutrition and introduction of games. Subsequently, the experimental group received 120 minutes of 120 minutes of group nutrition training through play therapy, to collect data from the Wardell, Guthrie, Sanderson, and Rapaport (2001) Children's Eating Behavior Questionnaire and the Revised Child Anxiety Anxiety Scale (CMAS). Reynolds and Richmond (1987). To describe the data, tables and graphs were used frequently, as well as central indices and scatter indices such as mean and standard deviation. To answer the questions, repeated measures analysis of variance and multivariate covariance were used. Data were analyzed using SPSS software version 24. Results: An educational and treatment package to reduce avoidance- restrictive eating disorder was developed by a therapist who was validated by child clinical psychologists and nutrition and education experts. Findings showed that the significance level of anxiety and tendency to food diversity variables is less than 0.05. As a result, it can be said that there is a significant difference between the mean scores of these variables in the pre-test, post-test and follow-up stages. Considering the significance of the interaction of the stages * of the group, it is concluded that the rate of change in the variables of anxiety and tendency to food diversity during the pre-test, post-test and follow-up stages were not the same in the experimental and control groups; That is, treatment based on group nutrition education of preschool children with avoidance / restriction disorder based on play-therapy has been effective in reducing anxiety and tendency to food diversity. There is a difference between pre-test and post-test stages; That is, the intervention was effective in reducing anxiety and promoting dietary diversity. There is also a difference between the pre-test and follow-up stages and the significance level of 1.00 shows that there is no difference between the means between the post-test and follow-up stages; That is, the effectiveness of the intervention in the follow-up phase has shown that it has remained stable. It can be said that there is a difference between the children in the experimental group who received the intervention and the children in the control group in at least one of the variables of anxiety. The difference is 44% in the post-test and 78% in the follow-up. The level of significance obtained also shows that there is a difference between the children in the experimental group who received the intervention and the children in the control group at least in terms of one of the variables of the tendency to food diversity. The difference is 92% in post-test and 96% in follow-up. In the post-test, the level of significance of the components of physiological symptoms and anxiety is significant at the level of 0.05; That is, the intervention had an effect on reducing the physiological symptoms of anxiety and worry in children in the experimental group; However, the significance level of 0.102 obtained by Mankova test in the third component (social anxiety) shows that the intervention was not effective in reducing children's social anxiety in the post-test stage. In the follow-up stage, the level of significance of the components of physiological symptoms, anxiety and social anxiety is significant at the level of 0.05; That is, the intervention had an effect on reducing the physiological symptoms of anxiety, worry and social anxiety in children in the experimental group, and the rate of this effect in the component of physiological symptoms was 51%, anxiety 67% and social anxiety 42%. Also, the level of significance of the components of food pleasure, desire to drink, emotional overeating, excuse about food and emotional undereating is significant at the level of 0.05; That is, the intervention had an effect on the mentioned components in the post-test stage of the experimental group. The extent of this effect was in the components of food enjoyment (82%), desire to drink (72%), emotional overeating (82%), food excuses (42%) and emotional undereating (56%); However, the significance level of 0.183 and 0.433 obtained by Mancoa test in the fourth and fifth components (satiety responses and slow eating) shows that the mentioned intervention was not effective on these components in the post-test stage. In the follow-up stage, the significance level of all components is significant at the 0.05 level; That is, the intervention had an effect on the tendency to food diversity in children in the experimental group and the extent of this effect on the components of food enjoyment (90%), desire to drink (81%), emotional overeating (90%), satiety responses (35%), There were slow eating (51%), food excuses (57%) and emotional undereating (70%). Conclusion: According to the findings and the effect of the treatment package developed in this study on dependent variables, its use in therapeutic settings for children with avoidance / restriction of food is recommended to reduce anxiety and expand their dietary diversity. Also, considering that the subject of this study was to reduce children's social anxiety, satiety responses and slow eating; It has not been effective, so researchers can look into this in future research. </div> آموزش گروهی, بازی‌درمانی,اختلال اجتناب/ محدودیت غذا, کودکان پیش‌دبستانی,اضطراب Group training, Play therapy, Avoidant-Restrictive Food Intake Disorder, Preschool children, Anxiety 51 62 http://rjms.iums.ac.ir/browse.php?a_code=A-10-6620-1&slc_lang=fa&sid=1 Aboubakr Karimi ابوبکر کریمی aboubakr.karimi@yahoo.com 3900319475328460076081 3900319475328460076081 Yes PhD in Educational Management and Ph.D Candidate in Clinical Psychology, Department of Clinical Psychology, Kish International Branch, Islamic Azad University, Kish Island, Iran دکترای تخصصی مدیریت آموزشی و دانشجوی دکترای تخصصی روان‌شناسی بالینی، گروه روان‌شناسی بالینی، واحد بین‌المللی کیش، دانشگاه آزاد اسلامی، جزیره کیش، ایران Mahnaz AliAkbari Dehkordi مهناز علی اکبری دهکردی 3900319475328460076082 3900319475328460076082 No Professor, Payam Nour University, Tehran, Iran استاد، دانشگاه پیام نور جنوب تهران، تهران، ایران