Nutrition knowledge, eating attitudes, nutrition behavior, self-efficacy of childcare center foodservice employees by stages of behavioral change in reducing sodium intake

Yun Ahn; Kyung Won Kim; Kyungmin Kim; Jinwon Pyun; Ikhyun Yeo; Kisun Nam

doi:10.4163/jnh.2015.48.5.429

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Ahn, Kim, Kim, Pyun, Yeo, and Nam: Nutrition knowledge, eating attitudes, nutrition behavior, self-efficacy of childcare center foodservice employees by stages of behavioral change in reducing sodium intake

Research Article

J Nutr Health 2015;48(5):429-440.

Published online: 19 January 2015

DOI: https://doi.org/10.4163/jnh.2015.48.5.429

Nutrition knowledge, eating attitudes, nutrition behavior, self-efficacy of childcare center foodservice employees by stages of behavioral change in reducing sodium intake

Yun Ahn¹, Kyung Won Kim², Kyungmin Kim³, Jinwon Pyun⁴, Ikhyun Yeo¹, Kisun Nam^1,^†

¹Division of Diet Research, Institute of Food and Culture, Pulmuone Co., Ltd., Seoul 03722, Korea

²Department of Food and Nutrition, Seoul Women's University, Seoul 01797, Korea

³Department of Food and Nutrition, Baewha Women's University, Seoul 03039, Korea

⁴Department of Food and Nutrition, Suwon Women's University, Gyeonggi 16632, Korea

^†To whom correspondence should be addressed. tel: +82-2-3277-8516, e-mail: ksnama@pulmuone.com

Received 8 April 2015 Revised 22 April 2015 Accepted 7 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purpose of this study was to examine sodium-related nutrition knowledge, eating attitudes, eating behaviors, and self-efficacy by stages of behavioral change in reducing sodium intake among childcare center foodservice employees.

Methods:

Subjects (n = 333) were categorized according to two groups based on the stages of change; Pre-action stage (PA group: precontemplation/contemplation/preparation stage), Action stage (A group: action/maintenance stage).

Results:

A major source of sodium-related nutrition information was TV/radio (56.6%) and only 166 people (49.8%) have experienced nutrition education specific to sodium. Although the A group showed slightly higher scores for nutrition knowledge than the PA group, the difference was not significant. The percentages of correct answers for ‘daily goal of sodium intake for adults (27.0%)’, ‘calculation of sodium content in nutrition labeling (30.3%)’ were low for both groups. The A group (total score: 40.3) had more desirable eating attitudes regarding reducing sodium intake than the PA group (36.6, p < 0.001). The total score for eating behaviors was slightly higher in the A group (49.6) than in the PA group (48.5), but without statistical significance. The A group (total score: 58.2) also received higher scores for self-efficacy regarding reducing sodium intake than the PA group (52.5, p < 0.001).

Conclusion:

This study suggests that nutrition education for childcare center foodservice employees should be expanded and customized education should be implemented according to the stages in reducing sodium intake. It is also suggested that food companies make efforts to develop low-sodium products.

Keywords: sodium reduction, stages of change, nutrition knowledge, eating attitudes, self-efficacy

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Table 1.

General characteristics of the subjects

Variables	Total (n = 333)
Age (years)	48.5 ± 8.4¹
Age group (years)²⁾
Prime-aged (20~44)	97 (29.5)
Middle-aged (45~64)	225 (68.4)
Old-aged (≥ 65)	7 (2.1)
Height (cm)	158.4 ± 4.7
Weight (kg)	57.7 ± 7.6
BMI (kg/m²)	23.0 ± 2.8
Area
Seoul	255 (76.6)
Gyeonggi-do & ChungChong-Do	78 (23.4)
Interest in sodium-related diet management³⁾
Very much interested	182 (54.8)
Interested	80 (24.1)
Average	65 (19.6)
Not interested	4 (1.2)
Not interested at all	1 (0.3)
Sources of nutrition information about sodium⁴⁾
TV/radio	155 (56.6)
Hospitals/public health centers/healthcare centers	40 (14.6)
Internet	36 (13.1)
Newspapers/magazines	22 (8.0)
Books/Families & friends	9 (3.3)
Others	12 (4.4)
Subjects experienced in nutrition education about sodium (n = 166)
Frequency of experiences (times) (n = 159)
1	79 (49.7)
2~3	61 (38.4)
≥ 4	19 (11.9)
Contents of education (n = 564)⁵⁾
Relevance of sodium to blood pressure	96 (17.0)
Relevance of sodium to diseases	96 (17.0)
Sodium content in foods	81 (14.4)
Selecting low sodium foods	65 (11.5)
Cooking methods to lower sodium content level	120 (21.3)
Salty taste assessment	30 (5.3)
Salinity measuring instrument	76 (13.5)

N (%)

¹⁾ Mean ± SD

²⁾ No response: 4

³⁾ No response: 1

⁴⁾ No response: 59

⁵⁾ multiple responses

Table 2.

Nutrition knowledge regarding sodium

Variables	Total (n = 333)	Pre-action (n = 65)	Action (n = 268)
1. Salt is thoroughly consisted of sodium.	62.8¹⁾	60.0	63.4
2. We need salt intake for water balance in body.	79.3	86.2	77.6
3. The goal for sodium intake per day for an adult is 2,000 mg.	27.0	32.3	25.8
4. Soy sauce and Soybean paste do not contain sodium.	89.5	87.7	89.9
5. Sodium influences level of blood pressure, but it is not relevant to osteoporosis.^∗∗2)	83.2	72.3	85.8
6. Eating salty foods with vegetables help excrete sodium from body.	70.9	72.3	70.5
7. Natural foods such as milk and meat without seasoning do not contain sodium.	69.7	66.2	70.5
8. Vegetables with dressing should be cooked last to lessen sodium level.	73.9	66.2	75.8
9. Foods are seasoned when the cooking is finished, after it cools down in order to reduce sodium intake.	83.8	84.6	83.6
10. The end point of a salimeter should touch the ingredients to assess the salinity of the soup.	75.1	70.8	76.1
11. Processed foods contain high level of sodium than natural foods (grain, vegetables, etc.).	92.5	92.3	92.5
12. Adequate sodium intake is very important to infants because their intake will influence the eating habits when they become adults.	96.1	96.9	95.9
13. This nutrition labeling shows you that potato chips (90 g) contain sodium 150 mg.	30.3	30.8	30.2
Nutrition knowledge score³⁾
About sodium (7 items)	5.7 ± 1.2⁴⁾	5.6 ± 1.3	5.8 ± 1.1
About reducing sodium skills (6 items)	3.6 ± 1.1	3.6 ± 1.1	3.6 ± 1.1
Total	9.3 ± 1.8	9.2 ± 2.1	9.4 ± 1.7

¹⁾ %, Percentages of correct answers

²⁾ ∗∗p < 0.01 by χ-test

³⁾ Correct answer was given 1 point. The possible total score: 0~13

⁴⁾ Mean ± SD

Table 3.

Eating attitudes regarding reducing sodium intake

Variables	Total (n = 333)	Pre-action (n = 65)	Action (n = 268)
1. I think that my current eating habit will influence my health.^∗1)	4.5 ± 0.7²⁾	4.3 ± 0.7	4.5 ± 0.7
2. I think wrong dietary habits should be corrected.	4.5 ± 0.6	4.4 ± 0.7	4.5 ± 0.6
3. I think nutrition information should be applied to dietary life.^∗	4.4 ± 0.6	4.2 ± 0.7	4.4 ± 0.6
4. I think my foods should be as bland as possible.^∗∗∗	4.4 ± 0.7	4.2 ± 0.7	4.5 ± 0.6
5. I think that I should reduce the usage of salt and soy sauce when cooking.^∗	4.4 ± 0.6	4.3 ± 0.6	4.5 ± 0.6
6. I think that I should be informed of sodium content in foods.^∗	4.4 ± 0.6	4.2 ± 0.6	4.4 ± 0.6
7. I prefer having foods salty.^∗∗∗	2.3 ± 1.0	2.8 ± 1.0	2.2 ± 0.9
8. I prefer to have soup, stew when I have a meal.^∗∗∗	2.8 ± 1.1	3.3 ± 1.0	2.7 ± 1.1
9. I prefer to eat kimchi, salty pickles when I have a meal.^∗∗∗	3.1 ± 0.9	3.5 ± 0.9	3.0 ± 0.9
10. I prefer to eat noodles, ramen, udon, naengmyeon.^∗∗∗	2.9 ± 1.1	3.4 ± 1.0	2.8 ± 1.1
Total score^3)∗∗∗	39.6 ± 4.5	36.6 ± 4.4	40.3 ± 4.3

¹⁾ ∗p < 0.05, ∗∗∗p < 0.001 by t-test

²⁾ Mean ± SD, Subjects were asked to respond in 5-point scales ranging from 1 (very disagree) ~ 5 (very agree). 3) The possible total score: 10-50, To calculate the total score, items from 7 to 10 were scored reversely. The higher score means the better eating attitude.

Table 4.

Eating behaviors

Variables		Total (n = 333)			Pre-action (n = 65)			Action (n = 268)
How often do you... (days/week)	0-2	3-5	6-7	0-2	3-5	6-7	0-2	3-5	6-7
1. Eat meals regularly	22.2	38.9	38.9	26.1	38.5	35.4	21.4	38.9	39.7
2. Eat too many meals	23.2	52.3	24.5	34.4	45.9	19.7	20.6	53.8	25.6
3. Eat multigrain rice^∗1)	15.2	37.0	47.8	23.8	41.3	34.9	13.1	35.9	51.0
4. Eat protein foods (meat, fish, eggs, beans) more than two meals a day	21.1	51.4	27.5	23.4	45.3	31.3	20.5	52.9	26.6
5. Eat vegetables, seaweeds more than two meals a day	15.6	54.0	30.4	18.7	51.6	29.7	14.9	54.6	30.5
6. Eat dairy foods (milk, soy milk), anchovy	30.1	50.0	19.9	26.2	60.0	13.8	31.0	47.5	21.5
7. Eat fruits	13.1	41.2	45.7	9.4	46.9	43.7	14.0	39.8	46.2
8. Eat greasy foods^∗	74.1	22.3	3.6	60.0	35.4	4.6	77.6	19.0	3.4
9. Eat sweets (candy, chocolate, soft drinks)	83.2	13.7	3.1	79.0	16.1	4.9	84.2	13.1	2.7
10. Drink alcoholic beverages	90.1	7.9	2.0	82.7	12.1	5.2	91.8	7.0	1.2
11. Eat soup and stew	36.0	50.3	13.7	26.1	58.5	15.4	38.4	48.3	13.3
12. Eat soup of ramen and noodles	70.4	24.3	5.3	60.3	30.2	9.5	72.9	22.9	4.2
13. Eat fermented salty fishes and seafoods	79.1	17.1	3.8	75.8	17.7	6.5	79.9	17.0	3.1
14. Eat kimchi and salty pickles	39.9	37.5	22.6	41.5	35.4	23.1	39.5	38.0	22.5
15. Eat stir-fried foods with salt, soy sauce, hot-pepper sauce	37.0	51.5	11.5	42.9	49.2	7.9	35.6	52.1	12.3
16. Eat foods with salt, soy sauce, hot-pepper sauce^∗∗	75.3	20.0	4.7	72.6	14.5	12.9	76.0	21.3	2.7
17. Eat processed foods and canned foods^∗∗	91.8	6.3	1.9	85.2	8.2	6.6	93.3	5.9	0.8
18. Eat-out and have delivery foods^∗∗	90.1	7.7	2.2	80.7	12.9	6.4	92.4	6.4	1.2
19. Eat fast foods (hamburger, pizza)^∗	94.2	4.2	1.6	86.9	8.2	4.9	96.0	3.2	0.8
20. Eat salty snacks^∗∗	94.7	3.3	2.0	86.8	6.6	6.6	96.7	2.5	0.8
Eating behaviors score²⁾ General eating (1~10)	23.3 ± 3.2³⁾			22.8 ± 3.3			23.4 ± 3.2
Sodium-related eating (11~20)	26.3 ± 2.9			25.8 ± 3.3			26.5 ± 2.7
Total	49.6 ± 4.8			48.5 ± 5.3			49.9 ± 4.6

%, no response: 1 (1), 2 (10), 3 (11), 4 (6), 5 (7), 6 (7), 7 (5), 8 (5), 9 (12), 10 (31), 11 (5), 12 (12), 13 (12), 14 (2), 15 (3), 16 (13), 17 (17), 18 (20), 19 (22), 20 (28)

²⁾ p < 0.05, p < 0.01 by χ -test

³⁾ The sum of eating behavior scores. To calculate the total score, each item was measured from 1 (0-2 days/week) to 3 (6-7 days/week) and the items of 8-20 were scored reversely. The higher score means the better eating behaviors. The possible total score: 20-60

Mean ± SD

Table 5.

Self-efficacy regarding reducing sodium intake

Variables	Total (n = 333)	Pre-action (n = 65)	Action (n = 268)
I can do the followings to reduce sodium intake ...
1. Use smaller bowl for soup^∗∗∗1)	3.8 ± 0.8²⁾	3.5 ± 0.9	3.9 ± 0.8
2. Eat the main ingredients in ramen and noodles^∗∗	4.0 ± 0.9	3.7 ± 1.0	4.1 ± 0.9
3. Eat raw vegetables instead of kimchi and salty pickles	3.5 ± 1.0	3.3 ± 1.0	3.5 ± 1.0
4. Eat foods with vinegar, fruit sauce instead of salt and soy sauce^∗∗	3.4 ± 1.0	3.1 ± 0.9	3.5 ± 1.0
5. Avoid processed foods and canned foods^∗∗∗	4.1 ± 0.9	3.7 ± 0.9	4.2 ± 0.8
6. Avoid eating-out and delivery foods	4.0 ± 0.9	3.8 ± 0.9	4.0 ± 1.0
7. Avoid dipping sauce (soy sauce, etc.) when eating	3.8 ± 0.9	3.7 ± 0.9	3.8 ± 0.9
8. Do not add salt at the table^∗∗	4.0 ± 0.9	3.8 ± 1.0	4.1 ± 0.9
9. Select processed foods after checking sodium content of nutrition labeling	3.5 ± 1.0	3.2 ± 1.0	3.6 ± 1.0
10. Season foods after finishing cooking^∗∗∗	3.9 ± 0.9	3.4 ± 0.9	4.0 ± 0.8
11. Use natural seasoning instead of salt and MSG^∗∗∗	4.2 ± 0.8	3.8 ± 0.9	4.2 ± 0.8
12. Cook with low sodium sauce^∗∗∗	3.5 ± 1.0	3.1 ± 1.0	3.6 ± 1.0
13. Remove salt from salted fish soaking in water^∗	3.8 ± 0.9	3.6 ± 0.9	3.9 ± 0.9
14. Serve sauce with roasted meat without seasoning	3.7 ± 0.9	3.6 ± 0.8	3.8 ± 0.9
15. Serve sauce separately from cutlet, omelet rice and fried rice^∗	4.0 ± 0.9	3.7 ± 0.9	4.0 ± 0.9
Total score^3)∗∗∗	57.1 ± 9.2	52.5 ± 9.7	58.2 ± 8.7

¹⁾ ∗p < 0.05, ∗∗p < 0.01, ∗∗∗p < 0.001 by t-test

²⁾ Mean ± SD, Subjects were asked to respond in 5-point scales ranging from 1 (very difficult ~ 5 (very easy).

³⁾ Possible total score: 15~75. The higher score means the higher self-efficacy.

Table 6.

Pearson correlation coefficient among variables

	Nutrition knowledge	Eating attitudes	Eating behaviors	Self-efficacy
Nutrition knowledge	1.00	0.01	0.08	0.01
Eating attitudes	0.01	1.00	0.41^∗∗∗1)	0.53^∗∗∗
Eating behaviors	0.08	0.41^∗∗∗	1.00	0.37^∗∗∗
Self-efficacy	0.01	0.53^∗∗∗	0.37^∗∗∗	1.00

¹⁾ ∗∗∗p < 0.001

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