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Title:

A health promotion intervention to create awareness of the health benefits of healthy eating among female London Metropolitan University Students.
Contents

Introduction:

This paper focuses on the health intervention to create awareness of the health benefits of healthy eating among female London Metropolitan university Students. As per Teague (2007), health is currently a global and national problem in the UK. Given the high obesity rates in England which had tripled over the last 20 years and continuously rising. Diet has a crucial impact on health; not eating a healthy diet will increase the morbidity of some chronic disease such as cancer, heart disease and type two diabetes (Lewis, 2006).

Rationale:

There is a high percentage of University Students who gain weight during the first few years. This is largely due to the fact that most student will be living an independent life for the first time away from home. Data collected in 2007-2008 from students at seven different universities in the UK suggests that only a low proportion of students consumed the recommended daily intake of 5 or more fruit and vegetable. In their health promoting behaviours and lifestyle character tics of students. It has been revealed that only 16.5% of female students ate the daily recommended vegetable servings. Thus, it is important to create awareness of the health benefits of healthy eating among London Metropolitan university Students.

Aim of the paper:

The aim of this health promotion intervention is to create awareness of the health benefits of healthy eating among female London Metropolitan Students.

Objectives of the paper:

At the end of this intervention all participant should be able to:

1. State five health benefit of healthy eating
2. Identify the five health group
3. List five places in the community where information is provided on healthy eating.

Literature review:

Health promotion:

The health promotion involves policies, plans and programs of public health actions to prevent people from exposing themselves to conditions and determinants of diseases. They can comprise of health education programs that purport to teach people to care for their health. It also encourages appropriate practices to improve the quality of life, distinguishing primary care or actions of preventive medicine. It also helps in early identification of the damage and or control of the exposure of the host to the causal agent in a given environment. Each of the elements is determined by a set of characteristics attributed to the "Natural History of Disease", for example, in relation to the natural history of syphilis, following factors were acquired:

• Agent factors - biological characteristics, prerequisites unit, low resistance;
• Environmental factors - geography, climate, family instability, low-income, housing, inadequate recreation facilities, diagnostic facilities;
• Guest factors - age, sex, race, personality development, ethics and sex education, promiscuity, prophylaxis (Lauver, 2011).

Accredited International Studies conducted a quantitative estimate of the impact of certain factors on the longevity of the community, which is used as an indicator of health. The socio-economic factors and lifestyles contribute to 40-50%, the state of the environment and conditions for 20-33%, genetic inheritance for another 20-30%, and health services for the remaining 10-15%. The socio-economic gradient appears to be the most relevant factor for the amount of life (and probably quality), and consequently it is more important than other factors such as, for example, the contribution of health systems (Heckheimer, 2009). In fact, when evaluating and comparing the results of health systems in terms of longevity of the reference populations, it is seen that the advanced industrialized countries have equitable access to services; there is virtually no correlation between spending (and therefore the availability services and health care) and life expectancy. This fact should not surprise indeed because, other factors are more likely to produce "longevity", and then to explain these differences. The "culture" of the Mediterranean, for example, is essentially linked to specific dietary factors and climate gives an "annuity" of about 3-4 years to start in terms of life expectancy of the people of the South Europe compared to those of North, regardless of the efficiency and effectiveness of health services (Heckheimer, 2009).

The theoretical model of explanation / intervention related to health is called health promotion substitute (redefining). This is a triadic model of agent-host-environment (seen as ecological) for a quadrupole scheme consisting of: human biology, environment, lifestyle and health service system. It is more effective especially for "realizing" the rise of chronic diseases - degenerative or non – communicable diseases featuring the modern world. The emphasis is on collective subject - the community and the "creation" (implicit) (Lauver, 2011). The concept of empowerment is seen as a requirement of their operations to improve their quality of life and health. Health promotion is a proposal in the contemporary global public health disseminated by the World Health Organization since 1984, establishing itself as a new paradigm and that this contrasts with the model expressed through individualism (attention to individual), the expertise, and the technologization in health care, prevalent until then in health practices. Health promotion is done through different strategies (Degeling, 2010). The most common ones are billboards, posters, display ads, etc. Another strategy is distributing infographics and leaflets at strategic locations which are frequented by target groups. TV commercials and videos are used too. Seminars, health talk meetings, roadshows and different kinds of events can be organized by communities in order to spread awareness. At times, celebrities are also involved in order to increase impact (Cribb, 2012).

Five benefits of healthy eating:

Five benefits of healthy eating are mentioned as follows:

• Healthy heart: A healthy diet can ensure that a person has reduced risks of heart diseases. If the diet is balanced, the heart functions effiiciently and cardiovascular diseases do not affect the body (Seedhouse, 1997).

• Strong bone and teeth: A heathy diet makes sure that the bones and teeth do not suffer from calcium deficiency. If the diet is balanced, adequate amounts of calcium, sodium and Vitamin D intake will be there (Tannahill, 2012).

• Energy: A healthy diet helps in buring fat and producing more energy. Thus, with a proper diet, a person can have high energy levels all through the day. This factor also helps in losing excess weight (Degeling, 2010).

• Health brain: A good diet ensures that the flow of blood to the brain is adequate. This helps in efficient functioning of the brain. This can even help avoid Alzheimer’s disease (Tannahill, 2012).

• Weight loss: As mentioned before, a healthy diet helps in burning excess fat. A person can tone down a lose excess weight by opting for a balanced and healthy diet (Cribb, 2012).

The five health groups:

The five health groups stand for the five healthy food categories. These categories have been differentiated under a food pyramid. This is a pyramid-shaped nutrition recommendation, in which the relative proportions are represented by food groups that are recommended for a healthy diet. At the base of the pyramid are the foods that are quantitatively most preferable. The items entered at the top should be taken in a smaller amount, so that the approximate ratio is presented (Bracht, 1999). The first-known food pyramid was that of the United States Department of Agriculture (USDA), which has now been adapted several times. Their structure is not without controversy and other governmental and non-governmental organizations in many countries made recommendations in the form of modified food pyramids. The original aim of the pyramidal recommendations for a healthy diet was only a quantitatively adequate supply of food ingredients. The original five food groups were: proteins, carbohydrates, fats, vitamins and minerals. Later pyramids were published, which went beyond health goals above and included qualitative ratings of food (via the hierarchical level of the placement), motivated example of the connection between diet and the disease frequency (Kreuter,1999).

Other food groups:

Expanded pyramid by USDA: The current food pyramid by the USDA was created in 2004. It is called MyPyramid, and consists of six food groups based on hierarchical presentation. No general absolute serving information is provided (called Portions / Servings) but only relative quantities are shown. In addition, a customized version with absolute dose information is available that is generated on the basis of gender, age, weight and physical fitness (Kreuter,1999).

Comparison between health pyramids

WHO pyramid: In 2000, the WHO Regional Office for Europe which gave CINDI dietary guide within the CINDI (Countrywide integrated noncommunicable disease intervention) program, included a food pyramid. It is composed of three hierarchical levels with four food groups, in addition, a traffic light color coding from green to red. The carbohydrate carrier / vegetable / fruit group is in the second level; the two groups of dairy products and proteins (animal and vegetable) is at the bottom and high sugar and fatty foods are at the top (Tannahill, 2012).

Healthy Eating Pyramid of the Harvard School of Public Health: On the basis of new scientific evidence regarding the individual food classes by new studies and meta-studies Walter C. Willett and Meir J. Stampfer of the Harvard School of Public Health, created a new food pyramid in 2003. Vegetable oils (from olive, canola, soybean, corn germ, sunflower seeds or peanuts) can now be found at the base at the fiber rich cereal products; while husked rice, white bread, potatoes and pasta, butter and red meat are found at the top, ie at the only in small amounts to consuming food stand. Meat is differentiated between poultry and red meat; poultry is considered to be healthier and therefore should be eaten more often. Poultry, fish and nuts are to be the main sources of protein, while red meat and cheese should be eaten as seldom as possible. However, the authors admit also that there is some uncertainty about the connection between eating habits and health (Tannahill, 2012).

Healthy Eating Pyramid of the Harvard School of Public Health

Five places in the community where information is provided on healthy eating:

There are a lot of community health oriented organizations which promote healthy eating in London. These organizations can provide support and guidance about health eating. Five of the most significant options are:

• Sustain: Sustain is an organization in London that aims at the generation of better food. It focuses on improving agricultural processes and food manufacturing processes in order to make food items healthier. It also promotes health eating and provides information about different health food options in and around London.

• World preservation foundation: This foundation promotes plant based diets and veganism. It believes that over consumption of red meat and other meats are is the root cause of many health issues like cardiovascular diseases, obesity, etc. Hence, it provides guidance and information about vegan and plant based diets.

• Well: Well is an organization that that promotes health among different communities. It raises awareness about different health issues and shares information about different healthy living and eating options through events like seminars, roadshows, etc. It also provides training on different health related courses and also provides accreditation and certification on health and quality of products, foods, etc. (Kreuter,1999).

• Patient: This is another organization dedicated to improving the lifestyles and eating habits of people. It increases awareness through leaflets, events, etc. It provides screening tests for a lot od health issues including Cancer.

• Change for life: This is program created by NHS aimed at improving life. It promotes phsical activity, fitness, health eating, etc. and provides information about strategies than can improve health. It also provides guidance through videos (Denham, 2012).

All of these organizations have strong web and social media presence. They can be accessed very easily through their websites or through social networking sites. They can provide support through phone too.

Health promotion strategies:

The health promotion strategies used in this paper is a health talk meeting and leaflets. At first, a survey was done with open ended questions to find out the gaps in the knowledge about healthy eating. Then, a power point presentation was used to increase awareness about the need for a healthy diet. The meeting pointed out the problems related to an unhealthy diet, advantages of a healthy diet, etc. It also identified five community based organizations which can provide help, guidance and support related to improving eating habits. Also, an ideal healthy diet was recommended to the women who were involved in the meeting. Leaflets were distributed too. After this, another survey, using the previous set of questions was used in order find out whether the gaps in knowledge have been overcome or not (Tannahill, 2012).

Methods:

The first step is to give out consent form before carrying out the intervention. After this, autonomy will be promoted by letting the participants select to be part of the intervention. The intervention is going to maintain confidentiality by using numbers to identify participants instead of their names. The participants will have the right  and same information and no harm will be caused to them (Non-Maleficence). The intervention will be carried out in a conductive environment by ensuring safety. Four weeks have been taken to plan and carry out the intervention. In the first week, the participants have been sourced. In the second week, the questionnaire and leaflets have been designed. In the third week, the intervention has been carried out. The evaluation has been done in the last week.
Sampling:

10 self selected Female undergraduate student from London Metropolitan University will be the target group from this intervention. Their age ranges from 19-45
 Brief description of contents of health talk and leaflets:

This paper recommended some effective strategies to improve eating habits and lifestyle of the women involved in the health promotion through leaflets and health talk. The women were recommended to make sure that they have:

• Daily intake of min. 1.5 liters of water and alcohol-free or low-energy drinks.
• Daily 3 servings of vegetables or legumes, and 2 servings of fruit.
• Daily 4 servings of cereals, breads, pasta, rice or potatoes (5 servings for active athletes and children) - preferably wholegrain.
• Daily 3 servings of low fat milk and milk products.
• Per week, 1-2 servings of fish. Per week up to 3 servings of lean meat or low-fat sausages. Per week up to 3 eggs.
• Daily 1-2 tablespoon of vegetable oils, nuts and seeds. String, baking and frying fats and high-fat dairy products should be used sparingly.
• Fat, sugar and salt-rich foods and energy drinks infrequently (Denham, 2012).

Results:

Pre-intervention questionnaire:

1. What are five health problems caused by unhealthy diet and eating habits?
2. What are five advantages of healthy eating?
3. What are the five health groups?
4. Name five places in the community where information is provided on healthy eating.

Findings from pre-intervention questionnaire:

Objectives	– target group (10)
	n	%
Identify fivev problems caused by unhealthy diet	5	50
Identify five health benefits of healthy diet	4	40
Identify five health groups of food	3	30
Identify five places in the community where information is provided on healthy eating	3	30

Table 1: Findings from pre-intervention questionnaire

Discussion:

The findings from pre-intervention questionnaire reveal that there is a huge lack of awareness about health groups of food and places in the community where information is provided on healthy eating. Awareness about health benefits of health eating is low too, while awareness about health problems caused by unhealthy diet is moderate. \

Evaluation:

In order to evaluate the effectiveness of the intervention, a survey with open ended questions was used.
Post-intervention questionnaire:

1. What are five health problems caused by unhealthy diet and eating habits?
2. What are five advantages of healthy eating?
3. What are the five health groups?
4. Name five places in the community where information is provided on healthy eating.

Findings from post-intervention questionnaire:

Objectives	– target group (10)
	n	%
Identify five health problems caused by unhealthy diet	10	100
Identify five health benefits of healthy diet	10	100
Identify five health groups of food	9	90
Identify five places in the community where information is provided on healthy eating	9	90

Table 2: Findings from post-intervention questionnaire

The findings from the post-intervention questionnaire reveal that there is a huge improvement in awareness about health problems of unhealthy diet, health benefits, health groups of food and places in the community where information is provided on healthy eating. Thus, it can be concluded that the health promotion/intervention initiative has been successful in making the London Metropolitan student women aware about health benefits of healthy eating.
Conclusion and recommendations:

From this intervention, it can be concluded that a healthy diet ensures that a person has reduced risks of heart diseases and that the heart functions effiiciently and cardiovascular diseases do not affect the body. It also ensures that brain functioning is perfect and a person has high level of energy. It is important to follow the health group pyramids in order to have a health diet. The original five food groups were: proteins, carbohydrates, fats, vitamins and minerals. There are a lot of community health oriented organizations which promote healthy eating in London. These organizations can provide support and guidance about health eating.
From this intervention, it can be recommended that women need to have balanced diet that involves:

• Daily intake of min. 1.5 liters of water and alcohol-free or low-energy drinks.
• Daily 3 servings of vegetables or legumes, and 2 servings of fruit.
• Daily 4 servings of cereals, breads, pasta, rice or potatoes (5 servings for active athletes and children) - preferably wholegrain.
• Daily 3 servings of low fat milk and milk products.
• Per week, 1-2 servings of fish. Per week up to 3 servings of lean meat or low-fat sausages. Per week up to 3 eggs.
• Daily 1-2 tablespoon of vegetable oils, nuts and seeds. String, baking and frying fats and high-fat dairy products should be used sparingly.
• Fat, sugar and salt-rich foods and energy drinks infrequently (Dychtwald, 2012).

Along with a healthy diet, it is important to incorporate moderate to high physical activity into the lifestyles of the women. Activities like jogging, cycling, swimming, walking, etc. can be adequate.
References:

Taylor, R.B.; Ureda, J.R.; Denham, J.W. (2012). Health promotion: principles and clinical applications. Norwalk CT: Appleton-Century-Crofts.

Dychtwald, K. (2012). Wellness and health promotion for the elderly. Rockville MD: Aspen Systems.

Green, L.W.; Lewis, F.M. (2006). Measurement and evaluation in health education and health promotion. Palo Alto CA: Mayfield.

Teague, M.L. (2007). Health promotion programs: achieving high-level wellness in the later years. Indianapolis: Benchmark Press.

Heckheimer, E. (2009). Health promotion of the elderly in the community. Philadelphia: W.B. Saunders.

Fogel, C.I, & Lauver, D. (2011). Sexual health promotion. Philadelphia: W.B. Saunders.

Hawe, P. & Degeling, D. (2010). Evaluating health promotion: a health worker's guide. Indianapolis: Benchmark Press.

Dines, A. & Cribb, A. (2012). Health promotion: concepts and practice. Blackwell Science.

Downie, R.S. & Tannahill, C. (2012). Health promotion: models and values (2nd ed.). Oxford University Press.

Seedhouse, D. (1997). Health promotion: philosophy, practice, and prejudice. New York: Wiley.

Bracht, N.F. (1999). Health promotion at the community level: new advances (2nd ed.). Thousand Oaks: SAGE.

Green LW, Kreuter MW (1999). Health promotion planning: an educational and ecological approach (3rd ed.). Mountain View CA: Mayfield