Dairy intake-related attitudes, subjective norms and perceived - PowerPoint PPT Presentation

Dairy intake-related attitudes, subjective norms and perceived behavioural control of South African nutrition professionals Friede Wenhold Zelda White Department Human Nutrition, University of Pretoria

Dairy intake-related attitudes, subjective norms and perceived behavioural control of South African nutrition professionals

Introduction • Intakes of dairy-related nutrients of South Africans are low (NFCS, 1999; NFCS 2005; Shisana et al, 2013) • SA Food-based dietary guideline “ Have milk, maas or yoghurt every day ” (Vorster et al, 2013) • Nutrition professionals influence dietary behaviour → their own disposition related to dairy: unknown

Aim To describe (in relation to dairy in general and in respect of selected dairy products) o Behaviour: USUAL INTAKE o Behavioural beliefs & outcome evaluations: ATTITUDES o Normative beliefs and motivation to comply: SUBJECTIVE NORMS o Barriers and facilitators: PERCEIVED BEHAVIOURAL CONTROL of SA nutrition professionals → within Theory of Planned Behaviour (TPB)

Conceptual / theoretical framework: THEORY OF PLANNED BEHAVIOUR (Ajzen, 1991) Dairy-related ATTITUDES Nutrition Dairy-related Dairy-related Own SUBJECTIVE professionals intake INTAKE NORMS INTENTIONS (= Behaviour) (significant others) Adult clients’ / PERCEIVED Patients‘ BEHAVIOURAL CONTROL

“ Have 2-3 servings of milk, maas, yoghurt or cheese daily” BEHAVIOURAL BELIEFS ATTITUDES X BEHAVIOUR OUTCOME EVALUATIONS INTENTIONS NORMATIVE BELIEFS SUBJECTIVE NORMS X MOTIVATION TO COMPLY PERCEIVED BEHAVIOURAL CONTROL BELIEFS CONTROL X PERCEIVED POWER

Methods • Design o Cross-sectional survey • Population o SA Nutrition professionals registered with ADSA / NSSA in 2015 • Instrument development o TPB principles (item generation:→ elicitation : previous studies, expert group discussion); scales→ Likert 7- point) o Dairy in general & specific products : → milk, maas, yoghurt & cheese

Methods • Data collection o Online (Qualtrics ) → testing o Paper-based (2 CPD events in Gauteng) • Data analysis (Stata release 14 ; 2015) o Descriptive statistics according to TPB o Cronbach’s alpha o Pearson’s correlations o Instrumental-variables regression analysis

Results Description of sample: Response rate: Total number of responses: 306 Usable responses: 282 → Response rate: 15%

Results Description of sample: Mean age: 36.4±10.5y; 90% dietitians; 42% from Gauteng 140 120 Number of respondents 100 >50 y 80 >41 - ≤50 y 60 >30 - ≤40 y 40 ≤30 y 20 0 Provinces AGE GROUP AND PROVINCE OF RESIDENCE OF RESPONDENTS

Results Description of sample: PRIMARY WORK ENVIRONMENT (N=282) n % Public sector: Clinical 60 21.3 Public sector: Non-clinical 15 5.3 Private sector: Non-clinical 20 7.1 Private sector: Clinical (hospital-based) 24 8.5 Private practice 90 31.9 Academic / research institution 37 13.1 Private practice 34 12.1 Total 282 100

Results Dairy-related ATTITUDES Dairy-related Dairy-related SUBJECTIVE intake INTAKE NORMS INTENTIONS (= Behaviour) (significant others) PERCEIVED BAHEVIOURAL CONTROL

Results General dairy intake 33.3 35 30 25.4 25 % Respondents 21.1 20 15 10 8.2 6.1 5.7 5 0.0 0 Never Once per month 2-3 times per Once per week 2-3 times per 4-6 times per Every day month week week "How often is your daily dairy intake 2-3 servings or more?"

Results Intake of selected dairy products: MILK n % Consumption as such? Yes 127 45.5 No 152 54.5 Portion size? S (±125 mL) 44 34.6 M (±250 mL) 79 62.2 L (±500 mL) 4 3.2 Consumption with other foods? No 13 4.7 Yes 266 95.3 Companion foods Coffee /Tea 242 (> 1 could be chosen) Cereal / Porridge 219 Shakes / Drinks 104 Other 198

Results Intake of selected dairy products: MAAS n % Consumption as such? Yes 32 11.5 No 247 88.5 Portion size? S (±125 mL) 19 59.4 M (±250 mL) 11 34.4 L (±500 mL) 2 6.3 Consumption with other foods? No 163 58.4 Yes 116 41.6 Companion foods Cereal 31 (> 1 could be chosen) Other 93

Results Intake of selected dairy products: YOGHURT n % Consumption as such? Yes 262 93.9 No 17 6.1 Portion size? S (±100-175 mL) 209 79.8 M (±250 mL) 50 19.1 L (±250 mL) 3 1.1 Consumption with other foods? No 87 31.2 Yes 192 68.8 Companion foods Cereal 143 (> 1 could be chosen) Shakes / 73 Smoothies Other 104

Results Intake of selected dairy products: CHEESE n % Consumption as such? Yes 270 96.8 No 9 3.2 Portion size? S (± 30g) 202 75.1 M (± 80g) 66 24.5 L (± 120g) 1 0.4 Consumption with other foods? No NA Yes

Results BEHAVIOURAL BELIEFS Dairy-related X ATTITUDES OUTCOME EVALUATIONS Dairy-related Dairy-related SUBJECTIVE intake INTAKE NORMS INTENTIONS (= Behaviour) (significant others) PERCEIVED BEHAVIOURAL CONTROL

Results Behavioural beliefs: “ For me 2-3 servings of milk is associated with … Good taste Milk 7 Environmental Nutritional quality concerns 6 5 4 Diabetes Bone health 3 2 1 Weight Cancer 0 management Cardiovascular Physical activity health Growth (e.g. infancy Familiarity ) Adverse reactions

Results Behavioural beliefs: “ For me 2-3 servings of maas is associated with … Behavioural beliefs Good taste Milk 7 Environmental Nutritional quality Maas concerns 6 5 4 Diabetes Bone health 3 2 1 Weight Cancer 0 management Cardiovascular Physical activity health Growth (e.g. infancy Familiarity ) Adverse reactions

Results Behavioural beliefs: “ For me 2-3 servings of yoghurt is associated with … Milk Good taste 7 Environmental Maas Nutritional quality concerns 6 Yoghurt 5 4 Diabetes Bone health 3 2 1 Weight Cancer 0 management Cardiovascular Physical activity health Growth (e.g. infancy Familiarity ) Adverse reactions

Results Behavioural beliefs: “ For me 2-3 servings of cheese is associated with … Milk Good taste 7 Environmental Maas Nutritional quality concerns 6 Yoghurt 5 4 Diabetes Bone health Cheese 3 2 1 Weight Cancer 0 management Cardiovascular Physical activity health Growth (e.g. infancy Familiarity ) Adverse reactions

Results Dairy-related ATTITUDES NORMATIVE BELIEFS Dairy-related Dairy-related SUBJECTIVE intake INTAKE NORMS X INTENTIONS (= Behaviour) (significant others) MOTIVATION TO COMPLY PERCEIVED BEHAVIOURAL CONTROL

Results Normative beliefs & Motivation to comply

Results Dairy-related ATTITUDES Dairy-related Dairy-related SUBJECTIVE intake INTAKE NORMS INTENTIONS (= Behaviour) (significant others) CONTROL BELIEFS PERCEIVED X BEHAVIOURAL PERCEIVED POWER CONTROL

Results Perceived behavioural control: Nutrition professionals (=own) & adult clients

Results THEORY OF PLANNED BEHAVIOUR Dairy-related R 2 = 0.527 ATTITUDES SUBJECTIVE Dairy-related Dairy-related NORMS intake Nutrition INTAKE (significant others) Own INTENTIONS (= Behaviour) professionals PERCEIVED BEHAVIOURAL CONTROL Internally consistent scales: Cronbach’s alpha: r = 0.7 (P < 0.001) Behavioural beliefs: 0.72 • Beta = 0.728 Outcome evaluation: 0.42 • Normative beliefs: 0.73 • Motivation to comply: 0.79 • Control beliefs: 0.86 • Perceived power: 0.81 •

Conclusions & Recommendations GENERAL PREMISE Tap on nutrition professionals’ leadership roles as nutrition • educators, advocates and agents for behaviour change for nutritional health of South Africans Assumption: Effectiveness of above role related to own dietary • behaviour and disposition Always: Emphasis on whole diet (all FBDG’s), i.e. balance, variety, • moderation Behaviour change: Function of multiple interventions - over time •

Conclusions & Recommendations BEHAVIOUR (DAIRY INTAKE)-RELATED • Maintain / strengthen current high intakes of yoghurt and cheese (emphasis: reduced fat) • Modify current intake patterns of milk by encouraging “as such” consumption, particularly among children (establish life-long habits) • Introduce maas (e.g. comprehensive “maas drive” with nutrition facts [→ new dairy regulations], tasting, recipes/ideas for use: familiarity & skills-based approach)

Conclusions & Recommendations ATTITUDE-RELATED • Strengthen existing positive attitudes (e.g. nutritional value and bone health) • Enlighten / empower regarding controversial / complex matters and strength of evidence (e.g. link to cancer, diabetes and environmental matters)

Conclusions & Recommendations SUBJECTIVE NORMS-RELATED • Use scientific evidence as significant other / communication channel • Work through universities (i.e. professional training)

Conclusions & Recommendations PERCEIVED BEHAVIOURAL CONTROL-RELATED • Development of tools that nutrition professionals can use to increase their clients’ ability to include dairy in their diets (cost, perishability & access)

Dissemination of information Full Report (Feb 2016) Stakeholder presentations Scientific poster (May & June 2016) UP: Research day (Aug 2016) Advertorial IDF: Netherlands (Oct 2016) SAJCN (Sept 2016) Manuscript: Submitted SAJCN (June 2016)