ARTICLE IN PRESS

GEM No. XXX

“Nutritainment” − A Nutrition Education Module for Indian
Adolescents
Radhika P. Hedaoo, MSc1; Pallavi Kabra, MSc2; SubbaRao M. Gavaravarapu, PhD3

INTRODUCTION and make them the necessary life nutrition and lifestyle knowledge of
skills.8 12−14-year-old adolescents are ex-
Health education is considered one of Entertainment education, also pounded.
the key drivers for promoting health- known as edutainment, is a communi-
related behaviors.1 Nutrition and life- cation strategy for social and behavior
style information presented convinc- modification that combines education MODULE DEVELOPMENT
ingly to adolescents has the potential with entertainment.9 Gardner’s 8.5 AND DELIVERY
to influence their behaviors. As ado- multiple intelligences theory suggests
lescents go through rapid cognitive that humans possess verbal/linguistic, The topics covered in Nutritainment
transitions, there is a constant need to visual/spatial, and musical/rhythmic were based on the dietary guidelines
experiment with innovative trajecto- interpersonal intelligence among for Indian adolescents and topics
ries in nutrition communication that other intelligences corresponding to covered in the school curricula pre-
are adolescent “psyche”-centric rather different learning styles.10 Therefore, scribed by the Central Board of Sec-
than “topic”-centric.2 In India, which learning can be boosted by using ap- ondary Education, India.11,12 The
has the world’s highest adolescent posite nutrition education strategies, possible topics to be covered were
population, this is a continuous and which mesh well with these varied listed by the research team and then
demanding process.3 With the general intelligences possessed by adolescents. reviewed by a panel of 4 experts: 2
enrollment rate of more than 80% The edutainment approach can nutritionists, a health communica-
−93% in grades 1 to 10, schools can invoke multiple intelligences of the tion professional, and a school sci-
be avenues for nutrition education.4 recipient and makes learning interest- ence teacher. The topics thus
However, nutrition and lifestyle ing. For example, individuals with a identified were balanced diet and
topics covered in school curricula in visual/spatial learning style compre- nutrition including food groups and
India are sparse and scattered and hend a subject better with visual cues diet diversity; nutrients and their
involve technical terms and jargon, such as videos, animation, and pic- functions; Indian food pyramid and
which are often difficult to compre- tures; similarly, people with kines- ideal food plate; food labels; healthy
hend and may lead to weariness.5 thetic/bodily learning style can eating and lifestyles; duration,
A content analysis of textbooks comprehend a subject better when nature, and importance of physical
concluded that content related to given hands-on tactile experiences. activity; diet-related deficiency disor-
nutritional needs of adolescence, The current study aimed at creat- ders and noncommunicable diseases.
healthy eating and lifestyles are sparse ing awareness about nutrition and Theoretical constructs evidenced to
and should be included in the curric- healthy lifestyles using an edutain- have made nutrition education suc-
ula.6 Although nutrition content in ment module called Nutritainment cessful and effective in school set-
school syllabi needs to be reoriented,7 (nutrition education combined with tings were reviewed and identified to
there is a felt need to present these entertainment). Herein, the develop- guide the development of the Nutri-
topics in a more engaging manner to ment of Nutritainment modules, tainment module. The components
promote their practical application their delivery and impact on the of the module were broadly based on
the Social Cognitive Theory concepts
of connection, independence, skill
1
Nutrition and Dietetics Department, Symbiosis Institute of Health Sciences, Symbiosis development and healthy norms,13,14
International (Deemed University), Lavale, Pune, India cognitive theory of multimedia learn-
2
Freelance dietitian, Pune, Hyderabad, India ing,15 experiential learning model16
3
Nutrition Information, Communication & Health Education Division (NICHE), Indian collaborative and shared learning the-
Council of Medical Research−National Institute of Nutrition, Hyderabad, Telangana, India ory,17 and classroom management
Conflict of Interest Disclosure: The authors have not stated any conflicts of interest. theory18 (Table 1). The preference and
Address for correspondence: SubbaRao M. Gavaravarapu, PhD, Nutrition Information, liking for the mode of delivery (kind
Communication & Health Education Division (NICHE), Indian Council of Medical of component) to be included in the
Research−National Institute of Nutrition, Jamai-Osmania PO, Tarnaka, Hyderabad 500007, Nutritainment module was assessed
Telangana, India; E-mail: subbarao.gm@icmr.gov.in using a preference rating scale that
J Nutr Educ Behav. 2020;&&:&&-&& listed 7 options. Of these, the most
Ó 2020 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights preferred 4 were selected (Table 1).
reserved. The Nutritainment module con-
https://doi.org/10.1016/j.jneb.2020.11.002 sisted of 4 distinct components as

Journal of Nutrition Education and Behavior  Volume 000, Number 000, 2020 1
 ARTICLE IN PRESS
2 Hedaoo et al Journal of Nutrition Education and Behavior  Volume 000, Number 000, 2020

Table 1. Framework of Underlying Theories for Nutritainment Module Development

Nutritainment Underlying
Component Behavioral Theory
Nutri-Animation clip Social Cognitive Theory14
6 min 30 s Cognitive theory of multi-
media learning15
Nutri-Bites Experiential learning
(recipe demonstration) model16
Nutri-Quiz Collaborative learning and
shared learning theory17
Nutri-Lecture Classroom management
theory18
Salient Principles Application
 Pictorial channel Use of graphic or pictorial and aural
 Verbal channel or vocal media for better learning
 Inspirational experience through fun element.
experience
 Social influence
 Increase in self-
efficacy
 Reflective observation “Reflective observation” while wit-
(watching) nessing recipe making. Consider-
 Abstract (thinking) ing the idea of cooking and acting
 Concrete experience on the same is “abstract con-
(feeling) ceptualization.”
 Active experimentation Learning to make the recipes or to
(doing) cook was concrete experience
and active experimentation.
 Creating environment Engagement of the learners with a
for empowered action self-evaluation tool that encour-
 Learning from ages social interaction, team
experience spirit, competitiveness, and pro-
 Acknowledging that motes thinking and learning
participants have together.
capability and capac-
ity to effect change
 “With-it-ness” Effective coverage of topics by way
 Overlapping of transitioning from 1 topic to the
 Momentum another.
 Smoothness Reiteration of messages learned in
 Group focus other ways while maintaining
group focus and by engaging in
group activities to keep students
attentive and be with it.

shown in the Figure: (1) Nutri-Ani-
mation clip: The animation clip
showed a basketball match between
less healthful food, such as burgers,
chips, and fries, and healthful food,
such as salads, fruits, and vegetables.
The clip, developed using Adobe
Flash (version 27.0.0.187), Illustrator,
and Photoshop softwares (Adobe
Inc., San Jose, CA, 2017), combined
fun and humor components in the
story in which the salads, fruits, and
vegetables team wins the match; (2)
Nutri-Quiz: A quiz titled “Kaun
banega Nutriking or Nutriqueen?”
(Who will be the Nutriking or Nutri-
queen?) was modeled around the
widely viewed television quiz show
“Kaun Banega Crorepati” (Indian
adaptation of “Who Wants to be a
Millionaire”). The quiz had 12 ran-
domly generated questions on food
groups, nutrients, and deficiency
diseases. The average duration taken
to complete the quiz was approxi-
mately 4 minutes 30 seconds; (3) Nu-
tri-Bites: Five healthy snacks recipes
were finalized on the basis of criteria
such as nutritional quality, ease of
making with minimum parental
guidance, seasonality, local availabil-
ity of ingredients, and appeal. The
recipes incorporated sprouted le-
gumes and pulses in sandwiches; mil-
let-based wraps, which were healthy
analogs to street food snacks pre-
ferred by children; nut-based spreads
and smoothies with a combination of
fruits and vegetables. The duration of
the demonstration was 30 minutes for
all recipes. Prepreparation was done in
advance, and adolescents were briefed
about the prepreparation required; (4)
Nutri-Lecture: An interactive lecture
was conducted using a slideshow
made using Microsoft PowerPoint
2016 (Redmond, WA). The topics cov-
ered included the food guide pyramid,
deficiency diseases, noncommunicable
diseases, and physical activity followed
by a brief activity with students.
IMPLEMENTATION
After seeking the necessary approvals
from the Institutional Ethical Com-
mittees of the Indian Council of
Medical Research−National Institute
of Nutrition, Hyderabad, India and
Symbiosis International (Deemed
University), Pune, India, approvals
from the school management and
the principal were taken. Written
informed consents of parents and as-
sents of adolescents were obtained.
Apparently healthy adolescents in
the age group of 12−14 years belong-
ing to the upper middle−income
group were recruited (n = 110,
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Journal of Nutrition Education and Behavior  Volume 000, Number 000, 2020 Hedaoo et al 3

Figure. Nutritainment−educational aids. (1) Adolescents participating in Nutri-Bites recipe demonstration; (2) image
showing Nutri-Bites recipes; (3) image showing Nutri-Animation clip; (4) image showing Nutri-Quiz.

girls = 58 and boys = 52). The Nutri-
tainment module was administered
during their socially useful produc-
tive work classes through 1 contact
session per week for a period of 3
weeks by the research team. The sci-
ence teachers were engaged through-
out the module delivery for support
and coordination. The impact of Nu-
tritainment module on nutrition
knowledge of the adolescents was as-
sessed by conducting pre- and poste-
valuations using a pretested and
precoded nutrition knowledge ques-
tionnaire containing 25 questions.
In addition, pre- and postevaluations
were done to assess the preference of
the modules using a 7-point scale of
ranking (from best-7 to worst-1).
The pre- and postintervention
nutrition knowledge scores were ana-
lyzed using paired t tests with SPSS
package (version 19.0, IBM Corp, Ar-
monk, NY). A Wilcoxon signed rank
test was used to evaluate the differ-
ence between the pre- and postinter-
vention scores for the educational
aids preferred by the adolescents.
There was a significant (P < 0.001)
difference in the mean (§ SD) pre-
(9.0 § 2.29) and postintervention
(17.8 § 1.70) knowledge scores
(Table 2).
The Wilcoxon signed rank test re-
vealed a significant (P < 0.001) differ-
ence in pre- and postintervention
scores for preference of all Nutritain-
ment components, such as quiz,
animation, and recipe demonstration,
except for the lecture session (Table 3).
IMPLICATIONS FOR
PRACTICE
The Nutritainment module, which
was based on the edutainment
approach, was effective in improving
the nutrition knowledge scores of
the adolescents. Considering the pre-
ferred learning methods of the
adolescents, the assorted teaching
pedagogies were combined for sus-
tained attention. The study found
the need for dedicated sessions for
nutrition education in the school cur-
riculum and necessary skills can be

Table 2. Difference in Pre- and Postintervention Scores of Adolescents (n = 100)

Pretest Score Posttest Score

Topics No. of Questions Mean § SD Mean § SD
Balanced diet and nutrition 17 7.0 § 2.26 13.5 § 1.07
Food labels 3 1.3 § 1.01 1.7 § 0.63
Deficiency diseases and noncommunicable diseases 2 0.6 § 0.79 0.9 § 0.57
Physical activity 3 0.1 § 0.45 1.7 § 0.72
Total score 9.0 § 2.50 17.8 § 1.74
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Table 3. Pre- and Posttest Scores of Preference of Various Edutainment Aids Among Adolescents (n = 100)

Median Median Wilcoxon Signed

Educational Aid Preintervention Postintervention Rank Test Value P
Nutri-Animation 4 2 5.9 0.001*
Nutri-Quiz 3 4 7.0 0.001*
Nutri-Bites 2 3 6.9 0.001*
Nutri-Lecture 1 1 0.0 0.93
*Significance P ≤ 0.001; Wilcoxon signed rank test was employed.

better inculcated through experiential
learning, and the edutainment
approach can be effective in doing so.
The time allotted for recipe demon-
strations did not cover the preprepara-
tion phase, and more time for this
component can enhance the group
learning opportunity of the students.
The topics covered in the Nutri-
tainment module were essentially
from those covered in the school cur-
ricula, and this study shows that the
edutainment approach has a great
potential to complement the conven-
tional teaching and thus supplement
the inadequacies of curriculum-ori-
ented nutrition education. This is in
alignment with the recently intro-
duced National Education Policy 2020
of India, which emphasizes effective
techniques in pedagogy and learner-
centered and collaborative learning
methods.19 Therefore, they can be
adapted with tailor-made, age-specific
contents for various age groups of stu-
dent audiences. Nevertheless, knowl-
edge gain does not always guarantee
behavior change; and therefore, a pro-
spective case control study needs to
be performed to assess its impact on
knowledge retention and behavioral
change among adolescents. In addi-
tion, the small sample size was a limi-
tation, and therefore, the outcomes
may not be generalizable. However, a
short-term professional course in
nutrition education delivery methods
for teachers may help complement
the current pedagogies that they use.
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