Running head: NUTRITION EDUCATION TEACHING 1

Nutrition Education Teaching at Banta Elementary

Melissa L. and Jennifer L. Rouse

California State University, Stanislaus

NUTRITION EDUCATION TEACHING 2

Nutrition Education Teaching at Banta Elementary

In community health nursing, one of the main goals is to teach about healthy behaviors

and lifestyles in order to prevent serious illness, disease and to promote a positive and productive

life. The Center for Disease Control and Prevention (CDC) explains community health as

“working at the community level to promote healthy living and preventing chronic disease which

will bring great health benefits to those in need” (2014). One of the most preventable, yet

problematic health concerns today is obesity. According to the CDC (2015), “in 2011 it was

estimated that 17% of 2-19 year-olds are obese. Obesity was defined as a body mass index at or

above the 95th percentile for the BMI age growth charts specific to the child’s sex” (CDC, 2015).

The Lucile Packard Foundation for Children’s Health’s Kidsdata website estimated that in the

year 2010, 37.6% of students in the city of Tracy were considered obese (Lucile Packard

Foundation for Children’s Health, 2015). In the research done by Lynn Roblin (2007), she

indicates that the increase in childhood obesity has many contributing factors such as eating

higher caloric foods, eating out, eating pre-prepared foods and exercising less. In the article, The

Consequences of Childhood Overweight and Obesity, author Stephen R. Daniels (2006) outlines

that many of the problems stemming from obesity that were once thought to only affect adults

are now applicable in children and with increasing frequency. These health conditions include:

hypertension, early signs of atherosclerosis, type 2 diabetes, nonalcoholic fatty liver disease,

polycystic ovary disorder and sleep apnea (Daniels, 2006). With this information, the student

nurses at Banta Elementary in Tracy, CA determined that in order to address this issue, they

would begin with primary prevention including nutrition education in the school setting. The

information taught to the students consisted of the “Go, Slow and Whoa (GSW)” foods which

break down types of foods based on which to eat most often (Go), foods to eat sometimes

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(Slow), and foods to eat the least amount of time (Whoa) (National Institutes of Health [NIH],

2013). A study done in Tennessee in 2011, as featured in the Journal of School Health,

implemented an obesity prevention project by teaching the GSW foods in order to integrate

healthier foods in the cafeterias (Slawson et al, 2013). This study was based off of a pilot study

which revealed that after teaching of GSW foods, students were less likely to purchase the foods

with high fat and sugar content. The study incorporated teachers into the curriculum who

expressed a moderate level of confidence that the GSW foods would influence the dietary

choices of children (Slawson et al., 2013). The purpose of teaching the students at Banta’s Give

Every Child a Chance (GECAC) after school program was to educate children and get them

thinking about the choices they are making when choosing what to eat. Although children are not

always in control of what they eat, early awareness and education may promote healthier choices

now and later in life and hopefully reduce the percentages of obese adolescents as well as

obesity-related diseases (Slawson et al., 2013; Roblin, 2007). This paper will address the

September 21st, 2015 teaching of GSW foods to the GECAC after-school program’s second

through fourth grade students at Banta Elementary School in Tracy, CA.

Nursing Theory

Community health relies heavily on teaching as primary and tertiary prevention to

promote healthy behaviors and to address the issues of disease once it is present. One of the

nursing theory models used in community health is the Health Belief Model. According to

Montanaro and Bryan (2014), this model recognizes six categories that help determine a person’s

health-related behaviors. The first, perceived susceptibility is a person’s perception that the

health issue or problem is relevant to them or if it is even regarded as accurate. The second,

perceived seriousness follows the first in that if a person believes they are susceptible, action will

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not occur unless they believe that the issue is serious enough to have major consequences. The

third category is perceived benefits, which is the belief that actions or behavior will either help to

cure or treat the problem. The fourth category, perceived barriers are the issues that affect a

person’s ability to access cure or treatment based on affordability, resources and education on the

matter. The fifth is self-efficacy, which is a person’s perception of his or her own ability of to

take action. The sixth category, cues to action is the factors or events that take place which

motivate people to change their behaviors (Montanaro & Bryan, 2014). This model can be

applied to the health education teaching to the second through fourth grade students at Banta

Elementary. By teaching the students their susceptibility to poor health if they make poor food

choices, they will learn that nutrition is a serious aspect vital to their health. They will then

perceive that the benefits of healthy eating can promote health, energy and growth and prevent

disease. In this example, the perceived barriers may be the students not having access to healthy

(go) foods because they are not provided in the home or the limited options of food provided by

the school. Self-efficacy would be measured by the students’ ability and confidence to identify

GSW foods, the importance of healthy eating, and how they can make better food choices. Cues

to action may be promoted when the child sees an ill family member who eats many “slow” and

“whoa” foods or a friend who has trouble keeping up because he/she is overweight/obese.

Objectives

The goal for the health education teaching session of the GSW foods is for the students to

learn how to distinguish between GSW foods. By the end of the teaching, the student nurses

hope to meet the following objectives: the students will be able to state three foods from each

section in GSW, the students will be able to describe three reasons why foods might be “whoa”

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foods, and the students will be able to create a list of three “go” snacks that they, specifically,

enjoy.

Hunter’s Eight Essential Elements for Effective Instructional Delivery

The nutrition teaching for the second through fourth grade students at Banta Elementary

School was planned and performed using the steps of Hunter’s Eight Essential Elements for

Effective Instructional Delivery. Hunter’s Essentials include an anticipatory set, purpose and

objectives, input, modeling, guided practice, checking understanding, independent practice, and

closure (Herr, 2007). Including each of these steps helps instructors to teach more effectively,

and including each of the three major learning styles can further increase this effectiveness (Herr,

2007; University of Massachusetts Dartmouth [UMass], 2015).

Anticipatory Set, Purpose, and Objectives

In order to gain the learners’ attention, the anticipatory set was in the form of oral

questions addressed to the students. They responded to these questions by raising their hands and

answering. These questions included “Do you know any healthy foods?”, “Why do you think

these foods are healthy?”, “Who has heard of ‘go’, ‘slow’, and ‘whoa’ foods?”, and “What kind

of snacks do you eat at home?”. In addition to these questions, it was made known that students

who paid attention and participated would receive stickers, at the discretion of the student nurses.

Once their attention was drawn, the purpose and objectives of the teaching were made known to

the students through an oral explanation. This explanation was kept brief, in order to maintain

the students’ interest. The purpose and objectives were identified and discussed in more depth

with the GECAC Academic Manager and staff, ahead of time.

Input

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The initial input of vocabulary and ideas was performed using printed handouts, created

by the presenters, as well as spoken words (see Appendix A for handout). The student nurses

explained each group of foods, using a large stoplight diagram they created (see Appendix B for

stoplight diagram). “Go” (green light) foods are good, health foods to eat often, as they are low

in fat and sugar, but high in nutrients; “Slow” (yellow light) foods are okay to eat sometimes, as

they are higher in fat, sugar, and calories; And “whoa” (red light) foods should only be eaten

once in a while, as they are highest in fat, sugar, and calories, but lower in nutrients (NIH, 2013).

There was emphasis placed on what made foods healthy and unhealthy, as well as the positive

effects healthy, nutritious food. With the handouts and oral teaching, two of the three major

learning styles, visual and auditory, were addressed during this initial input stage (UMass, 2015).

The third learning style, known as tactile, or kinesthetic, learning was addressed primarily during

the guided practice step (UMass, 2015). Visual learners learn primarily through visual

observations, auditory learners learn primarily through hearing information, and tactile learners

learn primarily through hands-on physical experiences (UMass, 2015). The student nurses

ensured that students with each of the three learning styles had the opportunity to learn the

material in the way that suited them best.

Modeling and Guided Practice

After input, the student nurses modeled the action of placing foods where they belonged

on the stoplight. Different foods were spread out on a table in the front of the class, and each had

its own little token on a paper clip that was then to be placed on the red, yellow, or green light.

After the student nurses performed a few examples for the class, and discussed the rationale

behind each food’s placement on the stoplight, it was the students’ turn. For their guided

practice, the students were each invited to the front of the room, one by one, to choose a food

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from the table and then clip its clip to the stoplight light where they thought that food went. They

were either congratulated or nicely asked to try another section, until they got it right. Every

child participated, and each was given a sticker for participating. The combination of this hands-

on experience, the oral instruction, and the printed handouts helped to accommodate all three

major learning styles in this nutritional lesson, so that every child was given equal opportunity to

learn the material (UMass, 2015).

Checking Understanding and Independent Practice

Next, the student nurses checked the understanding of the learners. They asked if the

students had any questions, and received quite a few. Most of the students wanted to find out or

confirm where they thought some of their preferred foods would fit on the stoplight. The

majority of the students were still interested and paying attention at this point. Once their

questions were answered and their understanding was verified, they were given time to perform

independent practice. For independent practice, the students colored in their own stoplights and

were instructed to write three foods that they, specifically, ate and enjoyed in each GSW section.

Closure and Evaluation

The final two steps of the lesson were closure and evaluation. The evaluation of the

students’ understanding and of the presentation occurred first, followed by closure. The students’

understanding was evaluated by checking the “go” foods each student had written on his or her

stoplight to evaluate the fulfillment of the third objective, and then by quizzing them orally, to

evaluate the fulfillment of objectives one and two. The oral quiz questions included “What are

some things that make a food healthy?”, “What are some things that make a food unhealthy?”,

and “Can you name three foods that are (go, slow, or whoa)?”. The student nurses listened to

many responses to each question, to check the understanding of multiple students. Then, to

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evaluate the teaching itself, the students were asked, orally, whether they felt they learned the

differences between “go, “slow”, and “whoa” foods, what made foods healthy and unhealthy,

and some delicious healthy snack options. Then they were asked what worked well for them and

what could be improved upon. By a show of hands, more than half of the children felt they had

learned the differences between GSW foods, reasons foods are healthy and unhealthy, and some

healthy snack options, but quite a few children were either unwilling to answer, did not feel they

had learned, or were no longer able to pay attention. For those who chose to answer the student

nurses’ question regarding what went well, the stoplight model, the interactive participation, the

stickers, and having actual foods to look at and use worked well. The main complaint from the

students was not related to their learning, but was that they were not given any food to eat.

Nearly every student agreed about this. Many of them suggested bringing in “go” snacks to try,

while some others suggested junk food. Unfortunately, while the request for junk food could

have been the students’ attempts at humor, it also could have been an indication that the teaching

was not entirely effective for all students. If making a similar presentation in the future, the

authors of this paper would request permission from the school to bring some “go” foods for the

students to actually eat. They would also further research ways to gain and maintain respect and

attention from students. In addition, they would utilize additional written evaluation methods.

The students filling in their “stoplight” with foods was a successful evaluation method, but the

oral questioning for the other goals may have allowed certain quiet, inattentive, or unsure

students to not answer at all.

On September 21st, 2015, the second through fourth grade students in the GECAC after

school program at Banta Elementary School were given nutritional teaching on the topic of GSW

foods (NIH, 2013). This instructional teaching, performed by two student nurses who authored

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this paper, was intended to be a primary prevention strategy against obesity and the illnesses and

diseases that can accompany it. There is evidence that links teaching to nutrition choices,

nutrition choices to obesity, and obesity to other serious health problems (Daniels, 2006; Roblin,

2007; Slawson et al., 2013). This teaching’s framework was based on the Health Belief model

and it included each of Hunter’s Eight Essentials for Effective Instructional Delivery (Herr,

2007; Montanaro & Bryan, 2014). Each student’s learning style, whether auditory, visual, or

tactile/kinesthetic, was accommodated by at least one of the various methods utilized in this

teaching (UMass, 2015). This nutritional instruction was a great example of community health

nursing, in which the student nurses used teaching to affect positive change in the health,

knowledge, and eating habits of Banta Elementary’s second through fourth graders.

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References

Centers for Disease Control and Prevention. (2014). Division of community health (DCH):

Making healthy living easier. Retrieved from http://www.cdc.gov/nccdphp/dch/about/

benefits_community_health.htm

Centers for Disease Control and Prevention. (2015). Child obesity facts: Prevalence of childhood

obesity in the United States, 2011-2012. Retrieved from http://www.cdc.gov/o

besity/data/childhood.html

Daniels, S. (2006). The consequences of childhood overweight and obesity. The Future of

Children, 16(1), 47-67.

Herr, N. (2007). Elements of lesson design (Hunter). Retrieved from:

https://www.csun.edu/science/ref/plans/lesson_design_hunter.html

Lucile Packard Foundation for Children’s Health. (2015). Kidsdata: Overweight/obese students,

by city. Retrieved from: http://www.kidsdata.org/topic/599/student-obesity-overweight-

obese-city/table#fmt=821&loc=1270&tf=46&sortColumnId=0&sortType=asc

Montanaro, E. A., & Bryan, A. D. (2014). Comparing theory-based condom interventions:

Health belief model versus theory of planned behavior. Health Psychology, 33(10), 1251-

1260. doi:10.1037/a0033969

National Institutes of Health. (2013). National heart, lung, and blood institute: Choosing foods

for your family: Go, slow, and whoa foods. Retrieved from:

http://www.nhlbi.nih.gov/health/educational/wecan/eat-right/choosing-foods.htm

Roblin, L. (2007). Childhood obesity: Food, nutrient, and eating-habit trends and influences.

Applied Physiology, Nutrition, and Metabolism, 32(4), 635-645.

Slawson, D. L., Southerland, J., Lowe, E. F., Dalton, W. T., III., Pfortmiller, D. T., & Schetzina,

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K. (2013). Go slow whoa meal patterns: Cafeteria staff and teacher perceptions of

effectiveness in winning with wellness schools. Journal of School Health, 83(7), 485-

492. doi:10.1111/josh.12056

University of Massachusetts Dartmouth. (2015). Tips for educators on accommodating different

learning styles. Retrieved from: http://www.umassd.edu/dss/resources/facultystaff/

howtoteachandaccommodate/howtoaccommodatedifferentlearningstyles

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Appendix A

Go, Slow, Whoa Handout

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Appendix B

Stoplight Diagram Used in Instruction