Evaluating the effectiveness of a family-based nutrition intervention to enhance healthy eating among children aged 6–12 years in Tbilisi, Georgia
Objective: This study aimed to assess the effectiveness of a family-based nutrition intervention, delivered through a tailored digital nutrition education package, in promoting healthy eating among children in Tbilisi, Georgia. Materials and Methods: 328 parents of primary public and private school children living in Tbilisi were recruited for the study. A 10-week intervention programme has been developed, optimised and implemented to educate parents about children's nutrition using the digital nutrition education [DNE] package in the Georgian language about healthy food choices and dietary habits. Results: Findings of the semi-quantitative Food Frequency Questionnaire (FFQ) and Knowledge, Attitude and Practice (KAP) Questionnaire have been compared before and after the intervention to evaluate the effectiveness of the DNE package. The effect of parents’ educational intervention using a tailored DNE package was associated with the BMI-forage reduction; however, it was insignificant (P=0.183). Nevertheless, healthy habits, like eating a regular breakfast, increased significantly by 8.3% (P=0.010), as well as parents’ awareness about malnutrition (P=0.021), iron (P<0.001) and vitamin A deficiencies (P<0.001) were considerably raised. Even though the ratio of macronutrient intake (CHO, proteins and fats) of pre- and post-intervention remained constant (P>0.05), the daily mean consumption of vegetables and fruits increased significantly by 50% (P<0.001) and 32% (P<0.001). The frequency and duration of physical activity have increased, especially ‘daily 60-minute physical activity’ by almost 15% (P=0.004). FFQ results show that the daily mean total energy intake, carbohydrate and fat intake tend to decrease (from 3398kcal to 3310kcal; from 454g to 440g; from 131g to 128g respectively), while protein, fibre, iron, calcium, vitamin A, and zinc content have increased (from 121.6g to 122.4; from 41g to 43; from 33.1mg to 33.6 mg; from 1056.7mg to 1112.9mg; from 2801.9µg to 3029.1µg; from 14.3mg to 14.5mg respectively). However, none of the observed outcomes were significant (P<0.05). Findings related to Family income and dietary intake indicated that a portion of daily vegetable intake is larger in families with higher income. In all types of income groups (500-2000GEL, 2000 5000GEL, >5000GEL monthly) except the lowest one (<500GEL), the difference before and after intervention looks significant (P<0.05). In addition, results show that the mean daily intake of the protein food group increased significantly (P<0.001) in families with higher income (>5000GEL monthly). A significant difference was registered between the cases related to the private and public schools after intervention. However, no significant difference (P>0.05) was found before intervention between the diet of the children from the private and public schools. The results of the multiple linear regression explored different predictors of mean daily energy intake (calories) of the children and the outcome showed that food costs, BMI percentile, weight status, and gender were significant predictors. Qualitative results revealed that online weekly meetings provided a valuable opportunity to discuss gaps in nutritional knowledge, the absence of the necessary nutrition literature in the Georgian language, the need for practical nutrition guidelines and meal ideas. The parents shared comments about the challenges they face related to diet and habits, as well as their feedback on the intervention. It was noted that after receiving the necessary information or requested practical recommendations, they became more confident and motivated to improve their children’s diet. Conclusion: The intervention through the DNE package significantly impacted the development of healthy eating habits and balanced diets among schoolchildren, especially increased vegetable and fruit intake in a representative sample of Tbilisi, Georgia. Therefore, the tailored DNE package proved its effectiveness in promoting healthy eating and addressing malnutrition among children in Tbilisi. The outcomes of this study are sustainable (SDGs 3, 4 and 10) and will contribute to policy modifications aimed at improving the nutritional status and dietary intake of schoolchildren in Georgia.
children, nutrition, malnutrition, obesity, parents, education, food intake, awareness, e-health, diet, habits, behaviour
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