THEORETICAL FRAMEWORK
FOR
SCHOOL-BASED NUTRITION EDUCATION
In adapting to urgent health challenges, old and new, nutrition education has changed its approach considerably (1-3) with regard to the learning models and the scope or reach of its activities. A main movement (4-5) has been from a knowledge orientation to a behavioral orientation, following from research evidence that gains in knowledge and attitudes do not usually or necessarily result in changes in practice (3-5) and that aiming for specific dietary behavior appears to maximize the chance of achieving it (1,3). This reorientation represents a radical change for conventional education systems (2, 6-8).
Learning Theories
Two fields of learning theory relevant to behavior change are skills learning and learner-centered approaches. Classical skills theory has been expanded for health and nutrition education (9, 10) to encompass life skills and the mediating effects of social context and interaction. The theoretical rationale stems from social learning theory (11) and social marketing (12). Skills theory highlights the effects of previous learning (which distinguish nutrition education sharply from other school subjects) and the need for maintenance of new behavior, seen as a priority for nutrition education (2, 13).
The learner-centered approach, associated with constructivism and reflective learning (14-16), operationalizes much of social learning theory and has been widely endorsed for health education (6, 17). Learner-centeredness is open to definition (18) but broadly assumes that it is what the learner does and thinks that counts; it draws on learners’ experience; encourages discussion and participation, enquiry and speculation; and promotes learner activity, physical, social and mental. Teachers are seen as guides, resources and role-models, as well as sources of experiences and as learners learning about learners.
The Holistic Approach
It is increasingly accepted that the effectiveness of nutrition education depends as much on activities outside the classroom as within it and this wider scope, taking the cue from the principles of health promotion, has been embraced in policies, projects and manuals (2, 3, 9, 17, 19-23). Actions include developing school policy, improving the social and physical school environment and making it a locus for education, involving the community (21, 24) and involving learners’ families (1, 3, 25, 26). The impact of family involvement depends on the duration and nature of the involvement. In countries with poor communication infrastructure and services, learners are often seen as carriers of nutrition messages to the home (2, 19, 20, 27).
In this wider picture the learning populations include teachers, head teachers, cooks, parents, textbook writers and curriculum developers, with diverse learning needs, some of which (like healthy eating) may call for a paradigm shift in attitudes and practices. Teacher development generally has a significant effect on health outcomes (20, 28, 29) but is lacking in the area of nutrition education, especially in developing countries (7, 30, 31) and generally gives more weight to nutrition information than to the equally essential learning methodology (8, 26, 32). For sustainability, training should be supplemented by in-service work, and maximum use should be made of good course books as a relatively economical and effective teacher training instrument.
Learning Activities and Materials
Activities, the bridge between objectives and outcomes, should embody learning principles and enable learners to translate knowledge and skills acquired into practical action. Specific activities need to correspond qualitatively to learning objectives, whether knowledge, concept, attitude, behavior, practical skills, life skills or a combination (17). At the same time, enabling skills, cognitive, verbal and scholastic, need appropriate attention. Course books and Teacher’s Guides are “key vehicles for the cost-effective improvement of the quality or primary education” (33, 34), may compensate for language difficulties, help to train teachers and substitute for poor or absent ones, and thus have important roles in developing countries (8).
Curriculum Development
The profile of nutrition education in school curricula across the world is still low, the time dedicated is small and progress is slow, due partly to lengthy curriculum revision processes, pressure on school timetables and conceptual innovations (5, 8, 20, 30, 35). Of the various curriculum options, the most favored is integration into existing subjects (2, 36, 37, 38); in this case the academic status of the host subject(s) may be a prime consideration (8).
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