Healthy eating on a plate: eating for health for CALD communities User Guide
Contents Background... 3 Purpose... 3 Aim... 3 Target audience... 3 Program outline... 3 Program resources... 4 How to use the resources... 4 Module Handbook... 4 Flashcards and script... 6 Feedback.....6 Appendices Appendix A: Nutrition Education for Groups: Module Summary Table... 8 Appendix B: Session Evaluation Sheet.. 12 Appendix C: Session Attendance Form....14 Appendix D: Focus Group Overall Evaluation Sheet 15 Healthy eating on a plate: User Guide, June 2013 Page 2
Background New arrivals and migrants from non-english speaking backgrounds (NESB) face a new food supply and food practices on arrival in Australia. This involves a negotiation between traditional and new food practices. It is important to have a basic understanding of how to select, prepare and store healthful foods given the influence of diet on lifestyle related diseases such as cardiovascular disease and type 2 diabetes. This may be complicated by limited formal education and low literacy levels commonly experienced by new arrivals. This food literacy program has been developed in collaboration with groups from culturally and linguistically diverse (CALD) populations who attend local community centres and is targeted to address specific nutrition related issues identified by them during focus groups facilitated by the HELPP team. Purpose The purpose of the program is to enable people with no nutrition background to deliver practical nutrition and food safety information in a group education format. The program has been piloted, reworked and packaged with the intention to disseminate it throughout various organisations and ideally to disseminate it state-wide via the HELPP website. Aim To provide participants with practical information to address nutritional and food related issues. Target audience This program has been developed, piloted and evaluated with CALD groups from a range of backgrounds and varying levels of English literacy and spoken English, however the program can be adapted for any group requiring a basic nutrition program. The program has been piloted with participants ranging in age from 16 to 85 years residing in Australia from one month and up to 15 years. Program outline The Food Literacy Program consists of seven modules (Module 2 is in two sections), each of 30 minutes duration. 1. Food Handling and Storage 2. General Healthy Eating (Part 1 & Part 2) 3. Cooking and Processing Methods 4. Label Reading 5. Key Nutrients 6. Food and Your Teeth In addition the section on safe food handling, which is incorporated into Module 1: Food Handling and Storage, has been included as a separate standalone module that may be presented at the start of any program that includes cooking to remind participants of safe food handling practices. It is approximately five minutes in duration. Healthy eating on a plate: User Guide, June 2013 Page 3
The modules can be run as single sessions or an entire program over six - seven weeks (Module 2 may be split into two parts). Please refer to the Module Summary Table (Appendix A) for a brief summary of each module including the background of the topic, learning outcomes and key messages. Additional modules may be developed as the need arises. They will be available for download on the HELPP website www.wecanhelpp.com.au. Program resources Each module consists of a Presenters Handbook and A3 flashcards with a corresponding script, class activity sheets (with answers) and detailed instructions for demonstrations that illustrate key points. Some modules also include hand outs and fact sheets, which are included as appendices in the Presenters Handbook. How to use the resources Presenters Handbook The Presenters Handbooks are supporting resources for the presenter and are designed to assist with the preparation and running of each session. Each Handbook includes: Learning outcomes that describe what participants should be able to do by the end of the session Key messages that the module aims to communicate to participants A checklist for the session which lists all of the equipment and resources required to run the session Session outline that describes discussion topics, any activities, estimated time and resources required. (NB: The time allocation may need to be adjusted to suit the needs of the audience. For example, if presenting to participants with minimal English allow more time to explain concepts) Presenter notes which provide a greater level of detail than what is presented to participants. The Handbook also includes symbols which suggest when the facilitator should carrying out specific tasks during the session. The symbols and their explanation are as follows: Display flashcard - The flashcards are used to explain a concept or idea with participants. A script accompanies each flashcard. Demonstration - Some of the modules include demonstrations to support the content of the session. Any equipment required for the demonstration will be listed in the checklist in the front of the Presenters Handbook, along with more detailed instructions under the appropriate heading on how to conduct the demonstration. Instructions on how to conduct demonstrations also appear in the script. Ask participants - Group discussion can enrich the session. This symbol will appear in some modules alongside a suggested question intended to generate discussion on an aspect of the module. Group discussion may not always be appropriate, depending on the group e.g. those with limited spoken English. It is up to the discretion of the presenter to decide if it is appropriate. Healthy eating on a plate: User Guide, June 2013 Page 4
Distribute class activity sheet - Each module includes an activity sheet which allows participants to put learning into practice. These are located in the Resources section of the Presenters Handbook. It is recommended that these are given to participants and then discussed as a class. The accompanying answer sheet is also included in the Resources section of the Presenters Handbook for the presenter s reference. Idea or suggestion - The modules may include ideas or suggestions for the presenter to incorporate into the session. For example, participants could be asked to bring food packaging from home to look at during the label reading session. This symbol may also appear when concepts are described in greater detail. Considerations when presenting the module - A list of considerations that have arisen during the development and piloting of the program have been included to assist presenters. The list includes practical aspects of the program, for example simplified explanations of content for participants with low levels of English literacy. Cultural considerations such as religious food preferences and information on traditional dishes have also been included. Group discussion and session evaluation - It is very important to get feedback from participants, to ensure that the program is meeting their needs and to inform the development of further modules. During the pilot of the program, it was found that talking to participants and recording their answers was a more practical and valuable way of gaining feedback than asking them to fill out evaluation forms. At the end of each session the presenter will ask participants questions to determine any change in their level of knowledge, confidence and intention to change as a result of attending the program: o o o What will you take away from today s session? Do you feel more confident now that you can? (insert appropriate question for each module e.g. choose healthier foods in the supermarket) What will you change as a result of today s session? A Session Evaluation Sheet (Appendix B) can be photocopied and used by the presenter to record and summarise the answers. This sheet can also be used to record any other relevant comments or questions that may arise during the session. Session attendance is also an important aspect of evaluation. Presenters can choose to simply record the number of participants at the top of the Session Evaluation Sheet (Appendix B) or photocopy and record individual attendance on the Session Attendance Form (Appendix C). Overall Evaluation - In addition, if the modules are presented over several weeks, a focus group may be held to gain an overall evaluation of the modules. This can be incorporated into the last session, or an additional session can be scheduled. Inviting participants to bring a plate of food to share that showcases their culture is a good way to increase attendance at the focus group. A summary of how to conduct the focus group is included (Appendix D) along with a sheet to record and summarise the feedback. Healthy eating on a plate: User Guide, June 2013 Page 5
Website resources - A list of suitable websites has been included for further reading to clarify any content if needed. Resources - Each Handbook contains a copy of the flashcards, script and in-class activity and answer sheets. Some modules also include fact sheets and handouts for participants. Resources that need to be photocopied or printed for the session e.g. activity and fact sheets are listed in the session checklist. The flashcard and script is also available as a separate file for ease of printing (see next section). Flashcards and script A set of flashcards has been developed for each module. They contain pictures and key points which can be displayed to participants during each session. Each card has a corresponding script to support the content of the card. For ease of use, each script card includes a thumbnail picture of the flashcard that the script refers to. There are three suggested ways of presenting the flashcards to the group, depending on the facilities and resources available. These are as follows: Laminated flashcards The simplest way to use the flashcards is to print (in colour if possible) the A3 flashcards doublesided (with the flashcard on one side and the script on the other) and laminate them. The cards are held up by the presenter, the participants see the picture side and the presenter follows the script on the back. Easel display book A convenient, hands-free way to present the flashcards with a group is with an A3 easel display book (as per the picture). These can be purchased online or at a stationery store and cost approximately $50. The printer settings to print the cards suitable for the easel are: A3 (select the appropriate tray) 2 sided portrait booklet setting (print to top) When the cards are placed in the easel, one side of the book should display the flashcard and the corresponding script will be on the other side. Each module consists of around 10-12 pages and the easel display books generally come with 10 refill pages. Modules can be alternated into easel book sleeves as required and the other modules can be stored in an A3 ring folder. Refill sleeves are available for purchase (approximate cost is around $20 for a 10 pack). PowerPoint The program has deliberately been developed to be presented in a low tech environment; however some centres have requested that the program be made available on PowerPoint. Some modules have been transferred to Microsoft PowerPoint 2010 and the accompanying script for each slide can Healthy eating on a plate: User Guide, June 2013 Page 6
be printed from the notes section for the presenter to follow. Simply save the PowerPoint onto a USB and open on the session computer. Remember to check if your computer is capable of reading the program before the session. It is also a good idea to save an extra copy as a backup in case the USB doesn t work. Feedback We welcome your feedback on the modules. For more information, enquiries or to give us your feedback about the Healthy Eating on a Plate program please contact the Healthy Eating Local Policies and Programs (HELPP) team on 08 7421 9975 or alternatively email helpp@flinders.edu.au. Healthy eating on a plate: User Guide, June 2013 Page 7
Appendix A: Healthy eating on a plate: Module Summary Table Module Module 1: Food safety and storage Content New arrivals and migrants from non-english speaking backgrounds may have shopped for food on a daily basis previous to their arrival in Australia and find the concept of weekly shopping and storing perishable foods unfamiliar. This module steps participants through how to prepare, handle and store food safely in the home to prevent foodborne illness. By the end of the session participants will be able to: Follow safe practices related to food preparation and food handling Understand the difference between use by and best before date marks Identify risky foods and how to store them safely. Key messages: Personal hygiene and correct food storage is the best way to prevent foodborne illness Wash hands with warm water and soap before, during and after handling food and always dry hands thoroughly Keep cold foods cold and hot foods hot If in doubt throw it out. Module 2: Healthy Eating (Part A) New arrivals may not have had the opportunity to learn about healthy eating and its importance for good health. This module gives an overview of the basic principles of healthy eating and how they can be incorporated into the daily diet. By the end of the session participants will be able to: Identify the five core food groups Understand that eating a variety of food from different food groups each day is important for good health Identify what a main meal looks like when it is plated up in the recommended proportions Understand the importance of drinking water and the benefits of tap water. Key Messages: Eating a variety of food every day is the best way to get all the nutrients your body needs Eat more vegetables and fruit Eat meals in balanced proportions Drink plenty of water (especially tap water). Healthy eating on a plate: User Guide, June 2013 P a g e 8
Module Module 2: Healthy Eating (Part B) Content The Australian food supply consists of many foods which may not have been readily available in to migrants in their country of origin. This module discusses foods and nutrients that can have negative consequences on health if eaten in excess and offers practical tips to reduce consumption of these foods. By the end of the session participants will be able to: Understand that our bodies do not need large amounts of fat or added salt and added sugar and that over consumption of these nutrients can have negative consequences on health Be able to identify ways to limit saturated fat and added salt and added sugar Key Messages: Moderate overall fat consumption and limit saturated fat, added salt and added sugar Choose plant-based fats and oils Foods high in fat, salt and sugar can be eaten occasionally as part of a healthy balanced diet. Module 3: Cooking and processing methods During the focus groups there was confusion about whether canned and frozen produce are healthy, especially frozen produce. The best value for money is still to buy fresh produce in season, however depending on how the produce is handled; it may not retain many vitamins by the time it gets to the table. In Australia, modern processing practices, means that produce is canned or frozen very quickly after harvesting. The freshness of the produce when it is frozen or canned offsets to a large degree losses during the canning and freezing process. This module steps participants through practical ways to preserve vitamins when storing, handling and preparing food in the home. By the end of the session participants will be able to: Understand how different food processing methods (frozen, canned, fresh) affect the vitamin content of food Identify practical ways to prepare fruit and vegetables that will prevent vitamin loss during food preparation and cooking. Key Messages: Buying fruit and vegetables in season is the best value for money Frozen and canned fruit and vegetables are good alternatives if fresh produce is unavailable. Healthy eating on a plate: User Guide, June 2013 P a g e 9
Module Module 4: Label reading Content The Australian food system can be difficult to navigate for new arrivals, with a seemingly endless range of products on the supermarket shelves. Naturally people will be curious about the abundance of new foods on offer in Australia and children will want to have the same types of foods they see other children eating at school. It can be challenging to work out which food is the healthier choice. There is a lot of information presented on food labels; however the focus groups identified some key areas of concern for new arrivals: How to know what to believe when looking at food labels? How to choose which brand of food to buy e.g. which cereal is the best one to buy? Confusion about numbers and warnings on Australian food packaging. Note: use by, best before and storage instructions on labels are dealt with in Module 1 Food Handling and Storage. By the end of the session participants will be able to: Understand common nutrition and health related claims on labels Use a simple tool to make healthier food choices within food groups Identify allergy advice on labels. Key Messages: Limit saturated fat, added sugar and salt Allergy advice on labels is intended to protect people with diagnosed conditions. Module 5: Key nutrients There is no reliable data about the nutritional health of new arrivals in Australia; however our focus groups revealed people were concerned about many of the same health issues as Australian born people. Participants wanted to know about the best ways to overcome iron and vitamin D deficiency and were very concerned about the need to take supplements, including calcium supplements. By the end of the session participants will be able to: Identify which foods are the best sources of iron and calcium Implement simple strategies to address key nutrient deficiencies Understand that adequate exposure to sunlight and not diet is the best way to gain sufficient vitamin D Key Messages: Eat three serves of reduced-fat dairy (or alternatives) each day Eat fruit or vegetables with each meal to enhance iron absorption Sun exposure and not food is the best way to maintain vitamin D levels Healthy eating on a plate: User Guide, June 2013 P a g e 10
Module Module 6: Food and your teeth Content Access to dental services and information on how to achieve good dental health may not have previously been available to new arrivals and migrants from NESB. Consequently, dental health of these populations and their children may be sub-optimal. This module provides basic information on tooth decay and how it can be prevented with emphasis of children s dental health. By the end of the session participants will be able to: Understand the basic process of tooth decay Identify food and drinks that can cause tooth decay Which food and drinks are best for teeth health Identify simple changes to eating habits which prevent tooth decay Key messages: Breastfeed your baby if possible Swap snacks high in added sugar for those with no added sugar like fruit and vegetables Have sugary food and drinks as part of a meal rather than on their own Eat at set times during the day rather than grazing Drink plain tap water Brush teeth twice a day(after breakfast and before bed), and go for regular check-ups with the dentist Spit toothpaste out, but do not rinse Once teeth are through - lift the lip of children once a month to check for early signs of tooth decay Healthy eating on a plate: User Guide, June 2013 P a g e 11
Appendix B: Session Evaluation Sheet Healthy eating on a plate Presenters Name.Number of participants... Date..Venue Module being evaluated ( e.g. 1,3,5).. What will you take away from today s session? (Increase in knowledge) Record some participant comments here that represent the majority of answers e.g. I didn t know that eating too much salt was bad for my calcium levels. Place a tick in the box that most closely matches the following statement: Participants felt they learnt something from today s session. All Almost All Some None Do you feel more confident now that you can? (insert appropriate question for each module e.g. choose healthier foods in the supermarket) (Change in attitude) Record some participant comments here that represent the majority of answers e.g. Now I know how to read labels I feel I can make better choices. Place a tick in the box that most closely matches the following statement: Participants felt more confident about making healthy choices as a result of today s session. All Almost All Some None What will you change as a result of today s session? (Intention to change behaviour) Record some participant comments here that represent the majority of answers e.g. I will switch to reduced-fat milk Place a tick in the box that most closely matches the following statement: Participants intended to make healthy changes as a result of today s session. All Almost All Some None Evaluation: Healthy eating on a plate, June 2013 Page 12
Appendix B: Session Evaluation Sheet Healthy eating on a plate To tie in with the state Go for 2&5 objectives regarding increasing consumption of fruit and vegetables - also ask the participants the following questions and record the number of answers. How many serves of vegetables do you usually eat each day? o A serve is ½ cup cooked vegetables, 1 cup salad vegetables, 1 medium potato or ½ cup legumes How many serves of fruit do you usually eat each day? o A serve is 1 medium-sized piece (e.g. apple), 2 small pieces (e.g. kiwi fruit), 1 cup canned or chopped fruit, ½ cup (125 ml) 100% fruit juice or 1 ½ tablespoons dried fruit None 1 2 3 4 5 or more e.g. 5 1 or less serves 2 serves More than 2 serves Do you intend to increase the amount of fruit and vegetables you eat each day as a result of attending Yes No No change this session? Would you like more sessions on healthy eating? Yes No Undecided How did you feel about the length of the session? Too long Too short About right What did you think about the venue? Good Okay Prefer it was somewhere else What did you think about the resources? - Flashcards - Handouts - Activity sheets Any other comments about how the program was presented? Easy to understand Some were difficult to understand Difficult to understand Evaluation: Healthy eating on a plate, June 2013 Page 13
Appendix C: Session Attendance Form Healthy eating on a plate program Module 1 Module 2 Module 2 Module 3 Module 4 Module 5 Module 6 Focus (Part 1) (Part 2) Group Venue: Date: 05/06/2012 Name: e.g. Joan Smith Evaluation: Healthy eating on a plate, June 2013 Page 14
Appendix D: Focus Group Overall evaluation of the Healthy eating on a plate program Purpose The purpose of the focus group is to provide an opportunity for all participants in the program to give feedback and to determine any increase in participants knowledge, attitude and intention to change behaviour. Checklist for session Whiteboard or 2 x A3 sheets of paper Whiteboard marker or textas Pen and paper Give participants an introduction of the focus group: Explain to the participants that their feedback is important in order to improve future sessions. During the focus group they will be asked their opinion on the session content. Emphasise that the opinions of all the participants are equally important and everyone should be given a chance to express themselves. Head, heart, bag, bin exercise The head, heart, bag, bin exercise is an easy, informal way to engage participants. Draw the outline of a body on a whiteboard or a large sheet of paper. Using the words as prompts ask the participant s to reflect on the program and write down a summary of the responses. It might also be useful to briefly recap what was presented in the modules, bearing in mind that not all participants may have attended all sessions. Head: something I have learnt from the sessions Heart: something important I have felt or experienced as a result of attending the sessions Bag: something useful I will take away from the sessions Bin: anything that wasn t so useful Head Heart Bin Bag Evaluation: Healthy eating on a plate: June 2013
Appendix D: Focus Group Overall evaluation of the Healthy eating on a plate program Summary of head, heart, bag, bin exercise Presenters Name.Number of participants... Date..Venue Modules being evaluated ( e.g. All, 1,3,5).. Head: something I have learnt from the sessions (Increase in knowledge) Record some participant comments here that represent the majority of answers e.g. I now know the difference between use by and best before Place a tick in the box that most closely matches the following statement: Participants felt they learnt something from the sessions. All Almost All Some None Heart: something important I have felt or experienced as a result of attending the sessions (Change in attitude) Record some participant comments here that represent the majority of answers e.g. I enjoyed meeting new people and leaning about healthy eating. Place a tick in the box that most closely matches the following statement: Participants felt they experienced something important by attending the sessions. All Almost All Some None Bag: something useful I will take away from the sessions (intention to change behaviour) Record some participant comments here that represent the majority of answers e.g. I will think more about how much salt I add at the table. Place a tick in the box that most closely matches the following statement: Participants felt they took something useful away from the sessions. All Almost All Some None Bin: anything that wasn t so useful (Content and process) Record some participant comments here that represent the majority of answers e.g. I already knew about food handling and safety. Place a tick in the box that most closely matches the following statement: Participants felt aspects of the sessions were not useful. All Almost All Some None Evaluation: Healthy eating on a plate: June 2013 Page 16
Appendix D: Focus Group Overall evaluation of the Healthy eating on a plate program To tie in with state objectives regarding increasing consumption of fruit and vegetables - also ask the participants the following questions and record the number of responses. How many serves of vegetables do you usually eat each day? o A serve is ½ cup cooked vegetables, 1 cup salad vegetables, 1 medium potato or ½ cup legumes How many serves of fruit do you usually eat each day? o A serve is 1 medium-sized piece (e.g. apple), 2 small pieces (e.g. kiwi fruit), 1 cup canned or chopped fruit, ½ cup (125 ml) 100% fruit juice or 1½ tablespoons dried fruit Have you increased the amount of vegetables you eat each day as a result of attending this program? Have you increased the amount of fruit you eat each day as a result of attending this program? None 1 2 3 4 5 or more e.g. 5 None 1 2 or more Yes No No change The head, heart, bag, bin exercise should have opened up a useful discussion about the content of the program. To get more of an idea about how participants felt about the format (process and content) of the program the following questions could also be asked: How did you feel about the number of sessions? Too many Not enough About right How did you feel about the length of the sessions? Too long Too short About right What did you think about the venue? Good Okay Prefer it was somewhere else What did you think about the resources? - Flashcards - Handouts - Activity sheets Any other comments about how the program was presented? Easy to understand Some were difficult to understand Difficult to understand Evaluation: Healthy eating on a plate: June 2013 Page 17