CHAPTER 7:

NUTRITION EDUCATION:
THE
INTERVENTION
 GENERAL OBJECTIVES
•To recognize the importance of
nutrition education as an intervention
in promoting health and nutrition
well-being.
 SPECIFIC OBJECTIVE
• 1. Familiarize with nutrition education as an
intervention to malnutrition.
• 2. Enumerate and describe successful nutrition
education programs implemented in the Philippines
or in specific localities to alleviate malnutrition.
• Determine nutrition assessment indices and
mythology in health care setting.
 SPECIFIC OBJECTIVE
• 4. In planning a strategy for a nutrition education
program, how would you address the gaps in
information gathering?
• 5. A good choice of message delivery channels will
result in message effectiveness; what are the five
channels and their sources?
• 6. Consumers have become well-informed because
of information technology; how will you encourage
public acceptance of nutrition and health message.
 NUTRITION INTERVENTION
•The purpose of a nutrition intervention is to
resolve or improve the nutrition diagnosis or
nutrition problem by provision of advice,
education, or delivery of the food
component of a specific diet or meal plan
tailored to the patient/client's needs.
 NUTRITION EDUCATION IN THE
PHILIPPINES
• Promoting better eating habits
• Health behaviors
• Philippine Plan of Actions for Nutrition (PPAN)
• Inform people about the National Nutritional
Education Programs as the key implementors of the
nutrition programs.
 NUTRITION EDUCATION IN THE
PHILIPPINES
• It has been done in the Philippines since the 1940s either as a sole
intervention or in combination with other interventions. Carried out
by different group in different ways, it has been an integral part of
national and local nutrition programs. Before devolution in 1991,
national nutrition education programs were conducted through
which national offices formulated guidelines to be followed by line
personnel at local level. With devolution, local government units
seem to have been left on their nutrition education program.
However, selected national government agencies continued to
conduct activities related to nutrition education.
• The National Nutrition Council (NNC) policy requires member
agencies to actively pursue nutrition information, education,
and communication (IEC) campaigns directed to priority
groups. The directions for Nutrition Education under the
Philippine Plan of Action for Nutrition (PPAN) from 1993 to
2004.
ELEMENT PPAN, 1993-1998
OBJECTIVE To promote the adaptation of
desirable practices which ensure
nutritional well being.
SUBSTANTI The Philippine Nutritional
VE FOCUS Guidelines to be used in basis for
specific behaviors to be promoted.
They included:
1. Increase consumption of calorie,
vitamin A, iron, and iodine-rich
foods; including fortified foods.
2. Exclusive breastfeeding for the
first six months of life;
PPAN, 1999-2004
Aims for the adaptation of desirable food
and eating practices that ensure nutritional
well being, by increasing the level of
awareness and knowledge about nutrition.
The 2000 NGF shall provide the basis for
specific behaviors to be promoted.
1. Eat a variety of foods every day.
2. Breastfeed infants exclusively from birth
to 4 to 6 months, and then, give
appropriate foods while continuing
breastfeeding.
3. Maintain children’s normal growth
through proper diet and monitor their
growth regularly.
3. Introduction of calorie-dense weaning
foods by the age of six months;
4. Monthly monitoring of child growth;
5. Personal hygiene and other practices
related to food quality and safety;
6. Establishment at home and community
gardens;
7. Appropriate use and application in
nutrition and related services, projects and
activities.
8. Adoption of healthy lifestyle to address
emerging nutritional problems of obesity
and diet-related non-communicable
disease.
4. Consume fish, meat, poultry or dried
beans.
5. Eat more vegetables, fruits, and root crops.
6. Eat foods cooked in edible cooking oil in
daily meals.
7. Consume milk, milk products and other
calcium-rich foods such as small fish and
dark green leafy vegetable every day.
8. Use iodized salt but void excessive intake
of salty foods.
9. Eat clean and safe foods.
10. For healthy lifestyle and good nutrition
exercise regularly, do not smoke, avoid
drinking alcoholic beverages.
Target 1. Mothers with underweight children 1. Primary targets: nutritionally vulnerable
2. Pregnant and lactating women groups, namely;
3. School children a. Preschoolers
4. Fathers b. School children
5. Out-of-school youth c. Pregnant and lactating women
6. General public d. Mothers
e. Fathers
f. Adolescents
2. Secondary Targets
g. Nutritionist-Dietitians
h. Health workers & other professionals
i. Journalists, and media personalities
3. Tertiary targets include local chief
executives and legislators.
 ELEMENT PPAN, 1993-1998 PPAN, 1999-2004
1. Home
2. Communities
3. Workplace
Setting None Indicated
4. Business establishment
5. Other possible setting

Quality nutrition counselling 1. Mass media

Quality group counselling
Multimedia campaign
Approaches Community-based information
campaigns using indigenous media
Integration of nutrition concept in
the school curriculum
2. Individual and group
counselling
3. Community-based information
campaigns using indigenous
media
4. Other tested method
 NATIONAL NUTRITION EDUCATION
PROGRAM
• This serves as the roadmap for all nutrition education efforts.
The NNEP translate and operationalizes the National Education
impact program of the Philippine Plan of Action (PPAN) into
doable and concrete actions and projects to achieve the goals. It
is envisioned to integrate, rationalize and harmonize for all
nutritional education efforts initially by key government
agencies and selected nongovernment organizations(NGOs), and
eventually, efforts of the other NGOs, including private
voluntary organizations and civic organization, local
government units, and business corporations
 NNEP OBJECTIVES FOR 2005-2010
• Aims to improve nutrition and health-related practices
of pregnant and lactating women, children 0-5 years
old and school-aged children, including key
influencers or those who can affect or influence the
behaviors of the primary targets.
 NNEP OBJECTIVES FOR 2005-2010
• More specifically, the program aims to improve:
• Infant and child feeding practices by pregnant and
lactating women, mothers and other caregivers
• Care of pregnant and lactating women
• Availment of child-related services
• Nutrition and related practices among children 6-12
years old
• Practice of hand washing
 NNEP TARGET GROUPS
• Using the lifespan approach is a way of ensuring that
the needs of a whole population are assessed and
taking into account their developmental needs. Stage
of life is one of the most important determinants of
nutritional status, as the nature of demands for
nutrients and the way in which those demands are met
undergo profound changes over the human lifespan
(Langley-Evans,2009).
 NNEP PRIMARY TARGET
• Pregnant and lactating mothers
• Mothers of preschoolers
• School-aged children
 NNEP SECONDARY TARGET
• Mother/mother-in-law/lola/significant others/other caregivers
• Husbands
• Adolescents
• Friends and relatives
• Religious, NGOs and private sector
• Local chiefs executives/local sanggunian
• Traditional birth attendants
• Health and nutrition workers
• Business sector/food manufacturer
 NNEP SECONDARY TARGET
• Business sector/non-food manufacturer
• Advertising agencies
• Fruit, vegetables, and animal producers
• Teachers and academe scriptwriters (Tv and film) and disk jockeys
• Senators and Congressmen
• President of the Republic of the Philippines
• Local school boards
• Dep Ed secretary, superintendent, school boards and PTAs of
respected schools
 PROGRAM FRAMEWORK
1. Core Components
• International communication
• Multimedia communication
• Special events
2. Support Components
• Training
• Development, production and distribution of
information, education and communication (IEC)
materials
 PROGRAM FRAMEWORK
• Networking and mobilization of media and other
support groups
• Monitoring supervision and evaluation
• Management and coordination
 PROGRAM FRAMEWORK
• To increase the public awareness on the importance of
nutrition, the National Nutrition Council utilizes the
multimedia approach to nutrition information and
education. Information materials such as information
planners, flyers, poster, jingle radio and TV plugs are
developed, distributed and /or aired.
 PROGRAM FRAMEWORK
• The development of Nutritional Guidelines is one of
the key strategies to promote appropriate diets and
related health practices to achieve the goal of
improving the nutritional condition of the population.
The development of dietary goals and/or guidelines can
be valuable tool for the direction of dietary change
desirable in a country. They need to develop both risk
reduction and health enhancement programs
particularly in situations of rapid social and economic
change are imperative.
 PROGRAM FRAMEWORK
• The main tool used for nutrition education is the 2000
edition of Nutritional Guidelines for Filipinos (NGF).
It is a 10-message set of simple recommendations on
adequate and balanced diet and maintaining healthy
lifestyles. Nutritional Guidelines are primary
recommendations to promote health through proper
nutrition. The NGF aims to encourage the consumption of
the adequate and well-balanced diet and promote
desirable food and nutrition practices as well as nutrition-
related health habits in the general population
(FNRI,2000).
 NUTRITIONAL GUIDELINES FOR
FILIPINOS
1. Eat variety of food every day
• The human body needs more than 40 different nutrients for
good health.
 NUTRITIONAL GUIDELINES FOR
FILIPINOS
2. Breast-feeding infants exclusively from birth to 4-5 months and
then, give appropriate foods while continuing breast-feeding.
• Infants and children up to 2 years of age are most vulnerable to
malnutrition. Breast-feeding is one of the most effective strategies to
improve the child survival. Nutritional requirements of an infant can
be obtained solely from breast milk for the first 6 months of life. After
that time, breast milk must be complemented with appropriate foods,
but breast-feeding should be continued for up to 2 years of age.
• The decision to breast-feed is made by the mother. Nonetheless, the
husband and other family members, health workers, neighbors,
community organizers, officemates and employers must be encourage
her to breast-feed her infant.
 NUTRITIONAL GUIDELINES FOR
FILIPINOS
3. Maintain children’s normal growth proper diet and monitor
their growth regularly.
• An adequate diet for an active child is one that promotes good health
and normal growth.
• A well-nourished child is healthy, strong and alert, has good
disposition, and grows at normal rate.
• A poorly nourished child exhibits sluggish if not permanently
delayed physical and mental development. In addition, he is lethargic
and frequently ill because of low resistance to infection.
• Over nutrition on the other hand, may lead to obesity that may cause
physical and emotional problems in childhood and later in life.
 NUTRITIONAL GUIDELINES FOR
FILIPINOS
4. Consume fish, lean meat, poultry or dried beans.
• To improve the Filipino diet, not only should the total quantity of food
be increased but the quality of diet should also be improved by
including animal products of substitute.
• Including fish, lean meat, poultry, or dried beans in the daily meals will
not only enhances the protein quality if the diet but also supply highly
absorbable iron, performed vitamin A and Zinc.
• Fish, lean meat, poultry without skin, and dried beans, in contrast to
fatty meats, are low in saturated fats, which are linked to heart disease.
 NUTRITIONAL GUIDELINES FOR
FILIPINOS
5. Eat more vegetables, fruits, and root crops.
• In general, most people do not eat vegetables, fruits, and root crops.
Results of good consumption surveys counted by FNRI shows that
the average consumption of green leafy vegetables, vitamin-C fruits
and root crops are low in Filipino diet.
• The consumption of vegetables, fruits and root crops is encourage to
help correct the micronutrient deficiency consistency noted in
national nutrition surveys. Eating root crops will add dietary energy
to the meal.
 NUTRITIONAL GUIDELINES FOR FILIPINOS
6. Eat foods cooked in edible/cooking oil daily.
• In general, Filipino use very little oil in cooking. Boiling is the most common method of
food preparation. Hence, the total fat and oil consumption in a Filipino diet is low.
• Fats and oils are concentrated source of energy. A low fat and oil consumption results in
a diet low in energy value, contributing to chronic energy deficiency. Fats and oils are
also essential for absorption and utilization of fat-soluble vitamins, such as vitamin A. A
low fat intake may be one of the cause of vitamin A deficiency among Filipinos.
• To ensure adequate fat intake, Filipinos should be encourage to stir-fry foods in
vegetable oil or to add fats and oils whenever possible in food preparation. This will
guard against chronic disease energy deficiency and help lower the risk of vitamin A
deficiency.
• The excessive use of saturated fats and oils, however, may increase the risk of heart
disease. The proper choice of fats and oils therefore is essential.
 NUTRITIONAL GUIDELINES FOR
FILIPINOS
7. Consume milk, milk products and other calcium-rich foods such
as small fish dark green leafy vegetables everyday.
• Nutrition surveys indicates a consistent failure of Filipinos to meet
dietary recommendations for calcium. An adequate amount of calcium
in the diet starting from childhood all through adulthood will help
prevent osteoporosis in later life.
• Milk, milk products provide highly absorbable calcium beside being
good sources of protein, vitamin A and other nutrients.
• Milk and other calcium-rich foods are valuable addition to our rice/plant
based diets, whish are not only poor sources of calcium but also contain
calcium-inhabiting substances.
 NUTRITIONAL GUIDELINES FOR FILIPINOS
• 8. Use iodized salt, but avoid excessive intake of salty foods.
• Goiter and Iodine Deficiency Disorders are rampant inn many areas
of the Philippines, causing physical and mental retardation in
children. The regular use od iodized salt in the table and in cooking
in addition to taking iodine-rich foods, will greatly help in
eradicating this preventable disease
• On the other hand, excessive intake of salt and salty foods
particularly in susceptible individuals increases the risk in
hypertension and hence of heart disease. Avoiding of too much table
salt and overly salty foods may help in the prevention and control of
these conditions.
 NUTRITIONAL GUIDELINES FOR
FILIPINOS
8. Eat clean and safe food.
• Food and water are essential to life but they may also carry disease-
causing organisms like bacteria, viruses, fungi and parasite, or
harmful chemical substances.
• It is important to buy foods that are safe. Purchase foods only from
reliable sources. In addition, care must be taken when preparing and
serving meals to prevent food-borne disease.
• Sharing in the effort to improve environmental hygiene and
sanitation in the community will greatly contribute to food safety in
the home.
 NUTRITIONAL GUIDELINES FOR
FILIPINOS
9. For a healthy lifestyle and good condition, exercise regularly, so
do not smoke and avoid drinking alcoholic beverages.
• With the changing lifestyle of Filipinos, chronic degenerative
disease are becoming significant public health problem. Healthy diet,
regular exercise, abstinence from smoking moderate alcohol intake
are key components of a healthy lifestyle.
NUTRITIONAL
EDUCATION
PROGRAMS, PROJECTS
AND CAMPAIGNS
 CHILD GROWTH PROJECT/EARLY CHILD
GROWTH DEVELOPMENT
• 5-year joint project of the DOH and HKI that focuses on
breastfeeding, weaning and growth monitoring and promotion;
• Aimed to improve specific infant feeding behaviors for mothers of 0-
12 month’s old children.
• Involves nutrition classes and trainings
 MACK -P
• Aimed to help address vitamin A deficiency through increase
consumption of vitamin A rich foods specially:
• Malunggay-Alukbati-Camote-Kadyos/pigeon pea-Papaya
• Use social marketing approach, the project aired cinema, radio, and
TV plugs MACKP
• Held nutritional classes targeting mothers, school children and social
workers
• Promoted the establishment of vegetable gardening in the home
yards, school yards and spaces in day care centers and barangay
health centers.
 NUTRICOMNET
• Targets local mass media
• Implemented by Nutrition Research Institute
• Involves:
• A. organizations of a network of local mass media personalities
• B. technical personalities
• C. distribution of IEC materials
 NUTRITIONAL EDUCATION REINFORCEMENT
PROJECT
• CARE Philippines led the implementation of this project, with the
DOH and NNC Secretariat as partner.
• Involves the conduction of nutritional classes using fun learning
activities, which were packed with FLANE (Fun Learning Activities
for Nutrition Education) kit.
• Classes focuses on vitamin A, iron, and iodine.
• Frontliners are also trained using the FLANE materials.
 NUTRI-BUS PROJECT
• A mobile and comprehensive system organized in 1978 to provide
support to the barangay health and nutrition workers (rural areas).
• Shown on the bus were video tapes on health and nutrition using
communication techniques to change or modify the behavior of
targeted vulnerable groups, especially pregnant, lactating women
and their preschool and school-aged children.
• The bus contained Nutri-Pak supplies, seeds and seedlings of
vegetables for distribution to target populations, and food
prescription packs.
 BARANGAY PROGRAM OF ACTION FOR NUTRITION
(BPAN)
• Improve the nutritional status of women and children through the
delivery of doable, minimum nutrition services, Nutrition
Information and Education, Home Food Security, Micronutrient
Supplementation (Vitamin A, Iron, Iodine), Food Fortification and
Growth Monitoring at the grassroots under the cooperation and
leadership of local officials.
 PARTICIPATIVE DOMICILIARY NUTRITION
REHABILITATION (PDRN) OR SAGIP BATA
• An individualize approach to rehabilitate severely and moderately
underweight children. It involves nutrition education classes and
counseling, supplementary feeding and food production. It is
implemented in BIDANI areas. Its sustainability and replication
seems to be dependent on funding support that can be generated for
BIDANI (Barangay Integrated Development Approach for Nutrition
Improvement)
 THE TEACHER-CHILD-PARENT (TCP) APPROACH
• Integrates health and nutrition in elementary school curriculum
(Solomon 2006)
• A key feature of this approach is a set of manuals each of which
covers specific program area in the curriculum.
• The manuals contain the nutrition and health messages that are
presented as lesson plans for the school teacher.
• Messages are relayed from the teachers through the children to the
parents who are expected to practice these messages at home.
• Key element of TCP approach are IEC, training supplementary
feeding, food production, health and environmental sanitation
income generating projects and monitoring.
 NUTRITION ON THE AIR (MASS MEDIA EDUCATION
STUDY)

• Mass Media Education Study (1975) in Ililo Province demonstrated

the power of radio to educate and change behavior.
• 60 second messages broadcast by commercial radio three to four
times daily a year.
• Study found an increase in the number of mothers who adopted the
new behavior of enriching porridge with oil, fish and vegetables
(Solomon,2006)
• This also help our nutritionist to widely spread the messages of
nutritional and healthy life.
 INTEGRATED MULTIMEDIA CAMPAIGN ON
FRUITS AND VEGETABLES (IMCFVS)

• A campaign that encourages the increased consumption of

fruits and vegetables to address micronutrient specially
vitamin A and iron deficiencies.
• Involves the production and distribution of various IEC
materials such as posters, calendars, poster-calendar, recipe
book, and the radio and television plug.
 CAMPAIGN ON IODIZED SALT
• Aimed to promote the consumption of iodized salt to address
iodine deficiency disorders.
• Involves the production and dissemination of IEC materials,
e.g. posters, stickers, flyers, radio and television plugs,
among others. It also involved modeling of how local
government, salt producers and traders, the national
government, and NGOs could work together in increasing
both the supply and demand for iodized salt.
 CAMPAIGN ON VITAMIN A, IRON, IODINE IN
CONNECTION WITH THE ARAW NG SANGKAP
PINOY (ASAP) AND GARANTISADONG
PAMBATA (GP)
• ASAP and GP involve in the provision of vitamin a capsules,
iron tablets and, iodine oil capsules to naturally at risk groups,
these national event have also been a venue of nutrition
education and campaign for home and the community food
production and the promotion of healthy lifestyle and
practices.
 CAMPAIGN ON THE SANGKAP
PINOY SEAL (SPS)
• Aims to make the general public aware of the availability of
fortified foods, particularly those with the Sangkap Pinoy Seal
and thus encourage them to such products.
• Involves the production and dissemination of various IEC
materials.
• DOH has developed generic IEC materials on fortified foods,
food manufacturers with SPS-bearing products that have
integrated nutrition messages in their radio and television
commercials.
 CAMPAIGN FOR HEALTHY
DIETS
• Short-lived campaign that was part of the DOH project for healthy
lifestyles.
• It points to a diet low in fat and sodium to prevent lifestyle-related
degenerative disease. It also aims to institutionalize and strengthen
diet counseling as an activity at the RHU level and at the hospital
where NDs were trained on their use.
• IEC materials under IWAS SAKIT slogan have been developed.
 NUTRITION MONTH CELEBRATION
• Section 7 of PD 491 designated the month of July as Nutrition Month
to create awareness among the people on the importance of nutrition.
• It is celebrated nationwide, at the barangay, municipal, city, provincial
and regional levels, with the support of public and private
individuals/institutions and using trimedia approaches.
• It focuses on the public’s attention on specific nutrition issue or
concern, which is embodied in a selected theme.
• Nutrition month activities include launching and awarding
ceremonies at both national and local levels; multimedia campaign;
conduct of various contest; production and distribution of various IEC
materials; and concernment of awards to outstanding performers in
nutrition.
NEWER NUTRITION EDUCATION PROGRAM
OR PROJECT PACKAGES
• To provide preferential access to social assistance
• Launched by Pre. Gloria Arroyo in 2005
• Council for the Welfare of Children (CWC) disbursed PhP5 million as
need money to the 24 most nutritionally depressed municipalities
(NDMs) in Region V and VIII to implement the program, benefiting
2,160 children and their families.
• A. deworming and supplemental feeding for 3-5 years old underweight
children;
• B. nutrition education for parents (PABASA sa Nutrisyon);
• Livelihood and food production training and activities (Food is Always
in the Home or FAITH).
 BRIGHTER CHILDREN, WEALTHIER FARMERS
(BCWF) PROGRAM
• Aims to put greater emphasis on the child health and nutrition, the
NNC, in coordination with the NDA, PCA, DSWD and FNRI
implemented this program also called “Malusog na Simula” in the
last quarter of 2005.
• Covered 60,000 children in day care centers, where they were
provided for about 60 days with a glass of milk from the local dairy
farmers and coco pan de sal from local bakeries trained by the FNRI.
• DSWD coordinated the overall implementation of the program which
had a total budget of PhP50 million covering 658 day-care centers in
90 municipalities and 27 provinces nationwide.
 NUTRITION EDUCATION COMPONENTS IN THE
ACCELERATED HUNGER MITIGATION PROGRAM
• By the end of 2006, the government developed and launched AHMP
• To address hunger from both the supply and demand sides.
• It targets as high priority the 54 most-in-need provinces in terms of subsistence,
poverty and food insecurity.
• Supply: a. production of more food; and b. enhancement of logistics and food
delivery.
• Demand: a. generation of income and employment; b. promotion of good nutrition;
c. management of population.
• Strategies: 1) conduct of social marketing; 2) promotion of exclusive
breastfeeding, appropriate complementary feeding and increased consumption of
vegetables; and 3) nutrition education in primary and secondary schools through
the Department of Education.
 ESSENTIAL HEALTH CARE PROGRAM
(EHCP)
• A simple cost-effective school-based health program of DepEd in partnership with
the local government units, the private sector and other community stakeholders.
• Address to public school children that started in June 2009 and aims to improve
their academic performances and reduce drop-out rate through desirable health
practices such as handwashing, toothbrushing, and deworming.
• Each child gets a free kit that has a:
• A. toothbrush
• B. toothpaste
• C. soap
• Deworming tablets
NUTRITION
EDUCATION
In MTPPAN 2005-2010
 MAIN OBJECTIVE

• To improve nutrition and health-related practices of pregnant

and lactating women, children 0-5 years old, school children
including key influences or those who can affect or influence
the behaviors of the above mention groups
 APPROACHES
1. Nutrition/Diet counseling using interpersonal communication strategies
2. The use of multi-media and community-based information campaign.
3. The wide use of Teacher-Child-Parent approach.
4. Conduct of nutrition education classes for parents and caregivers.
5. Provision of technical assistance in the field of community nutrition through
residency training, library and reference services.
6. Distribution of growth monitoring charts.
7. Integration of nutrition concepts in the school curricula, both elementary and
secondary levels.
8. Conduct of Pabasa sa Nutrisyon as an innovative way of educations classes for
parents and csregivers.
9. Conduct of regular growth monitoring to detect early growth faltering as well as
overweight, which may lead to obesity, if not detected early.
 IMPLEMENTATION ISSUES
ON PHILIPPINE NUTRITION
EDUCATION PROGRAMS
AND PROJECTS AND
PROPOSE STRATEGIES
ISSUES RELATIVE TO IMPLEMENTATION

NUTRITION EDUCATION IN GENERAL

• Activities are not standardized
• Low priority for nutrition education activities
• Lack of funding
• Weak translations of data gathered
• Lack of baseline of survey data about the clientele
• IEC materials are conflicting and misleading
• Negative influence of media
• Inadequate KAS among private sector organization
 STRATEGIES TO ADDRESS THE ISSUE
1. Formulate policies and guidelines for nutrition education in schools, community,
work place, in times of disasters.
2. Work on the proper implementation of guidelines and policies pertinent to health
and nutrition.
3. Ensure inter-agency and multisectoral involvement.
4. Continuously advocate to LECs and Sanguniang Bayan for more funds for nutrition
education projects.
5. Tap NGOs and other groups to develop and produce IEC materials. Strengthen
linkage and networking with GOs, NGOs, and Pos.
6. Organize health/nutrition response teams at all levels.
7. Support continuing activities for NDs.
8. Organize support groups among caregivers, implementors and LECs.
9. Empower all information officers of the government to disseminate nutrition
messages at every opportunity.
ISSUES RELATIVE TO IMPLEMENTATION
NUTRITION EDUCATION IN SCHOOL
• Inadequate IEC materials
• Inadequate training of teachers on nutrition
• Lack of pertinent orientation/needed training
• Pre-school curriculum does not allow flexibility to meet the pre-school
education
• Noncompliance with guidelines in the proper implementation of nutrition
education among teachers
• Inadequate competencies in the elementary and high school curricula
• Abolition of the position item for nutrition and health supervisors
• Inadequate funding for the trainings of teachers
• Home Economics included in the Edukasyong Pantahanan at Pangkabuhayan
• There is no nutritionist assigned to the division offices
 STRATEGIES TO ADDRESS THE ISSUE
1. Redesign and refocus the education curriculum not only for pre-school children
but for all levels, specifically for teacher training institutions to include
nutrition concept with corresponding teaching strategies and techniques.
2. Conduct refresher course on nutrition for all teachers.
3. Include or published articles on nutrition and nutrition education in teachers
journal.
4. Restore nutrition and health supervisor positions at the Department of
Education.
5. Nutrition supervisors and teachers to conduct simple surveys and research
studies on the KAS of pupils.
6. Discuss nutrition during parent-teacher organization meetings.
7. Orient or train teachers and administrators on the school nutrition program and
on the utilization of the Teacher-Child-Parent manual.
ISSUES RELATIVE TO IMPLEMENTATION COMMUNIT
• Inadequate IEC materials and other resource materials Y
• Lack of follow up and monitoring of IEC utilization
• Inadequate knowledge and skills
• Weak interpersonal communication
• Inadequate parent participation
• Inadequate funding for training of frontline workers
• No ethnographic data on food management during disasters
• Nutrition education providers during disasters are victims themselves
 STRATEGIES TO ADDRESS THE ISSUE
1. Maximize the use of Population, Health and Nutrition Community Centers.
2. Develop simple community-based monitoring and evaluation system, specially on
the utilization of IEC materials.
3. Conduct regular in-service training for health workers/hospital personnel.
4. Build capabilities/train frontline workers and community nutrition and health
volunteers on nutrition education.
5. Give incentives to writers of IEC materials and reproduce the IEC materials in
module form.
6. Strengthen NutriComNet.
7. Develop IEC materials on nutrition intervention during disasters.
8. Conduct research studies to gather date on food management during disasters.
9. Improve the existing disaster management protocol to include a nutrition
component.
 QUALITY CARE AND
INDIVIDUAL NUTRITION
EDUCATION
 QUALITY OF CARE
• Can be defined as the degree to which the health services for
individuals and populations increase the likelihood to desired health
outcomes and the degree to which the health services are consistent
with current professionals knowledge. (IOM,1997)
HEALTH SERVICES
• Refers to a wide array of services that effect health, including those physical
and mental illness.
• Applies to many types of health care practitioners (Physicians, nurses, dentist,
dietitians, therapist, and other health professionals) and;
• to all setting of care (from hospitals and long –term care facilities to physicians’
offices, community clinics, and private homes).
 INDIVIDUALS AND POPULATION
• Draw attention to the different perspective that need to be addressed:
the quality of care that health plans and clinicians deliver to
individuals, and the quality of care across the entire system.

DESIRED HEALTH OUTCOME

• The curial link between how care is provided and its effect on health.
• It underscore the importance of being mindful of people’s well-being
and welfare and of keeping patients and their families well informed
about alternative health care intervention and expected outcomes.
 CURRENT PROFESSIONALS KNOWLEDGE
• Emphasizes that the health professionals must stay abreast of the
dynamic knowledge base on their profession and take responsibility
for explaining to their patients the process and expected outcomes of
care.
 Nutritional Screening
• A quick, simple and general
procedure used by nursing, medical or
other healthcare staff, often at first
contact with the patient/service user,
to detect those at risk of nutritional
problems, so that a clear plan of
action can be implemented
• Must be an integral part of multi-
disciplinary team assessment .
Nutritional Assessment
• A more detailed, specific and in-depth
evaluation of nutritional status,
typically undertaken by an individual
with nutritional expertise (ex.
Dietician, clinician with an interest in
nutrition, or nutrition nurse
specialist), so that a specific dietary
plan can be implemented.
• Often used for more complicated
nutritional problems.
 REASONS WHY ROUTINE SCREENING FOR
MALNUTTRITION AND RISK OF MALNUTRITION IS
NOW RECOMMENDED BY GOVERNMENT AND
PROFESSIONAL ORGANIZATION
• Malnutrition is common and yet often under-recognized and under-
treated;
• Malnutrition has detrimental physiological, clinical, and economic
effects;
• Malnourished patients stays in hospitals longer;
• Malnutrition, once identified, can be effectively treated;
• Malnutrition increases the livelihood of re-admission to hospital.
 NUTRITIONAL COUNSELING
• An individualize d process that can help manage personal
nutrition care effectively.
• A process of providing expert advice to help a person with
current or potential nutrition problems.
• An essential service, particularly for those at risk and may be
used to obtain more information, to review and strengthen
acquired knowledge or desirable habits, or to help set personal
goals and make individualized decision (ADA,1996)
 NUTRITIONAL COUNSELING IN THE HEALTH
CARE FACILITY
• Involves a great deal of knowledge and skill in interviewing and educating
people.
• Effective Nutritional counseling should star with establishing rapport, stating
the objectives of the session and the benefits derived from dietary adherence,
and identifying possible problems that the client may encounter with the
dietary regimen and meal plan.
• After the initial counseling session, an aftercare plan or follow-up is essential.
• Long-term adherence and positive results leading to the client’s recovery or
maintenance of good nutritional status are the most challenging aspects of
nutritional counseling.
• The counselor needs to assess learning needs, decide on the level of education,
select an optimal method, and choose appropriate nutrition education tools.
 NUTRITIONAL EDUCATION TECHNIQUES
• Nutrition counseling is a primary educational activity of the
nutritional professional, who is assisted by the health workers in
hospitals, clinics, and communities.
• It is the means by which an individual patient, client, or family learns
food choices and eating habits designed to maintain health or to treat,
control, or prevent a specific illness.
 PROBLEM SOLVING
• Identifying and solving nutrition related health problems requires an
awareness of the psychologic effects of illness or a restrictive diet.
• Be familiar with the stages of childhood and adult development to
understand why the client reacts in a unique way to a particular form
of stress.
• Knows way to help the patient make those change necessary for
health maintenance.
• Be aware of serious problems that may arise for which referral to
other professionals may be appropriate.
 EDUCATIONAL TECHNIQUES
• The goal-setting approach takes a longer time, although it achieves
greater long-term results.
• A constant validating exchange between counselor and client about
the learning involved is needed.
 MOTIVATIONAL TECHNIQUES
• Human behavior plays a central role in the maintenance of health, and
the prevention of disease.
• Professionals must help the patients to follow the desired health
behavior the set for them.
• Health professionals have turned to models of behavior change to
guide the development of strategies that foster self-protective action,
reduce behaviors that increase health risk, and facilitate effective
adaptation to and coping with illness. Several decades of concerted
effort to promote health and decrease risk through individual behavior
change have produced successes, failures, and lessons learned.
SEVERAL FACTORS CONTRIBUTE TO A LACK OF MOTIVATION
PSYCHOLOGICAL FACTOR
• Depression, anxiety, or phobia, induced by the illness itself, any
required lifestyle changes, or medication effects may hinder ability to
comply with the desired health behavior changes.
PSYCHOSOCIAL FACTOR
• May prevent clients from expressing concern for their health.
• May lead to lack confidence in the health professionals as an
individual or;
• Simply be unable to cope with dietary changes at that particular time
because of the degree of illness or other personal problems.
PHYSICAL FACTOR
• Drugs or illness that may induce pain, fatigue, or depression, which in
turn may block the desire or ability to follow health care instructions.
SEVERAL FACTORS CONTRIBUTE TO A LACK OF MOTIVATION

PERSONAL FACTORS
• These are the language barriers within the individuals that needed
care and the professionals.
• Lack of transportation or money for clinic visits
COUNSELOR RELATED FACTOR
• A personality conflict between the client and the counselor.
 ASSESSING LEARNING NEEDS
• Assessment of learning needs should be an integral part of nutrition
counseling.
• Additional items that are added to gather information pertinent to the
individual and their clinical condition.
• 55% of a counseling session is devoted to the assessment phase that
why variety of approaches where used to reduce time spent on
assessment like;
• Before the counseling session, data can be collected from medical
records and patients can be asked to submit information.
• Questionnaires sent and received by mail, via fax, through internet,
or completed by the client in the waiting room/area before visit.
 Learner
Social Health Habits
(Characteristics)
• Family Status • Eating Patterns • Previous Health
• Living • Physical Activity Clinical Education
Demographic
Environment • Smoking Status • Expectations for
• Age
• Social Network • Medical HistoryCurrent Education
• Alcohol Intake
• Gender
• Cultural Factors • Medication • Preferred Learning
• Health Practices
• Occupation • Height/Weight Methods
• Religious • Use of Health
• Education • Food • Learning Style
Practices Services Allergy/Intolerance
• Health Beliefs • Readiness for
Change
LEVELS OF
EDUCATION
Nutrition Education
- Should be planned as a continuum of learning that starts
with fundamental guidelines, then incrementally adds more
complex information as basic applications are mastered.
The terms initial/survival, practical and continuing have
been used to differentiate three levels of education
(Coulston,2008)
 1. SURVIVAL LEVEL
• Focuses on essential information that the client needs in order to make important
fundamental adjustments in health behaviors.
• Initial education will occur shortly after diagnosis.
• Needs to be simple and directive;
• The dietitian serves as a teacher providing concrete guidelines on what the
patient should and should not do.
2. PRACTICAL LEVEL
• Occur as follow-up to initial counseling or as a new encounter; with the patient
had initial instruction some time before.
• At this level the dietitian serves as a counselor by providing guidelines for the
patient to use in making decisions.
3. CONTINUING EDUCATION
• Used to reinforce learning, update information, and achieve higher levels of
education;
• The dietitian at this level serves as a consultant helping the client synthesize and
personalize information.
 INTERVIEWING
• A way of gathering information through communication between someone who
wants information and people who can supply the information.
PURPOSE OF AN INTERVIEW CAN BE ANY OF THE
FOLLOWING
• To establish rapport
• To establish or maintain health professional-client relationship
• To obtain information
• To identify or clarify problems
• To give information to the client or teach him or her
• To counsel and/or assist the client in finding solutions to problems
TWO STRUCTURES OF INTERVIEW
• Directive : highly structured, through which specific information is sought.
• Nondirective: interviewer clarifies statements and encourages elaboration to
assist client in reaching conclusions.
 GUIDELINES IN AN EFFECTIVE
INTERVIEW
• Identify the needed information prior to interview.
• Minimize distractions in the environment.
• Sit facing the client. (sitting suggest relaxation and indicates that time
will allowed for the interview)
• Provide privacy, and attend the client comfort.
• Use vocabulary understandable to the client. Use simple language.
• Explain the purpose of the interview, how long it will last, how the
information will be used.
• Remain alert for answers that may be socially acceptable but not
entirely accurate.
 GUIDELINES IN AN EFFECTIVE
INTERVIEW
• Conduct interview at eye level with client.
• Avoid rushing the client; allow time for thought.
• Avoid interruptions and the appearance of being distracted or bored.
• Avoid tiring the client.
• Summarize the interview for client to be sure that the information is
correct.
• Document information clearly and succinctly.
COMMUNICATION TECHNIQUES THAT
BLOCKS EFFECTIVE INTERVIEWING
1.Probing
2.Giving Advance
3.False Reassurance
4.Moralization
5.Belittling
 INFORMATION NEEDED FOR A COMPLETE
HEALTH HISTORY
1. Personal Data
2. History of Present Illness
3. Past Health History
4. Drug History/Current Medications
5. Personal Habits and Patterns of Living
6. Activities of Daily Living
7. Socio-economic History
8. Diet History
 PSYCHOSOCIAL HISTORY
• An important in any assessment that considers a holistic view
of the client, especially in a community or long-term-care
setting.
• Involves the client’s relationship to others .
GENERAL COMPONENTS OF THE MENTAL STATUS ASSESSMENT
• Mental status exam is the basis for understanding the client’s presentation and
beginning to conceptualize their functioning into a diagnosis.
THINGS TO CONSIDER ON MENTAL STATUS ASSESSMENT
• Level of conscience • Intelligence
• Appearance • Abstract Thinking
• Eye contact • Thought Content
• Orientation • Writing
• Speech • Insights
• Language • Attitude
• Affect • Activity Level
• Mood • Response to Assessment
 FUNCTIONAL ASSESSMENT
• An essential component of total health assessment.
• a continuous collaborative process that combines observing,
asking meaningful questions, listening to family stories, and
analyzing individual child skills and behaviors within naturally
occurring everyday routines and activities across multiple
situations and settings.
 INSTRUCTOR QUALIFICATIONS
• A skilled counselor or teacher does not simply know the subject but creates an
environment in which persons feel psychologically safe enough to want to learn
for themselves.

BASIC FACTORS UNIQUE TO THE FIELD OF NUTRITION AND LEARNING

1. Individuality – food and eating habits are very personal issues.
2. Flexibility – be flexible enough to consider new ideas, relying on knowledge of
scientific principles to evaluate them carefully.
3. Self-Awareness – own feelings can influence your ability to perceive the needs
of others.
4. Self-education – continuing education in the area of listening, verbalizing,
encouraging, and supporting the learner is just as significant as updating clinical
knowledge.
BEHAVIORAL COUNSELING IN PRIMARY CARE
TO PROMOTE A HEALTHY DIET
• Help patients acquire the skills, motivation, and support needed to alter their
daily eating patters and food preparation practices.
5-A BEHAVIORAL COUNSELING FRAMEWORK
1. Assess dietary practices and related risk factors.
2. Advice to change dietary practices.
3. Agree on individual diet change goals.
4. Assist to change dietary practices or address motivational barriers.
5. Arrange regular follow-up and support or refer to more intensive behavioral
nutritional counseling if needed.
 TWO APPROACHES IN PRIMARY CARE
SETTING
• Medium – intensity face-to-face dietary counseling delivered by a
dietitian or nutrition educator.
• Lower - intensity interventions that involves 5 minutes or less of
primary care provider counseling supplemented by patient self-help
materials, telephone counseling, or other interactive health
communications.
 MOTIVATIONAL INTERVIEWING
• Derived from a social-cognitive theory framework (Bandura, 1986), motivational
interviewing (MI) is a style of patient-nutrition educator communication that is
specially designed to resolve the patient’s motivation for the patient’s motivation
for e ambivalence about, and build motivation for, behavior change.

TWO CRITICAL STEPS

1. Building the patient’s motivation for changing the behavior.
• Ex. Eating vegetables and medication adherence
2. Building the patient’s motivation for treatment.
• MI by pediatricians and dietitians is a promising office-based strategy for
preventing childhood obesity.
THE PHILIPPINE PLAN OF ACTION
FOR NUTRITION (PPAN), 2005-2010
• It is the country’s blueprint for achieving nutritional
adequacy for all Filipinos. The implementation of the
PPAN is being coordinated by the NNC in collaboration
with the local government units, NGOs, the business
sector, the international and local community.
 VISION
• THE PHILIPPINE PLAN OF ACTION FOR NUTRITION
envisions a Philippines which has achieved;
• NIChood in nutrition sense – a Nutritionally Improved
Country whose people are well nourished, healthy, intelligent,
and socially and economically productive with high sense of
human dignity.
GOAL
• To improve the quality of life of Filipinos through better
nutrition, improve health ang increase productivity .
 OBJECTIVES
1. Reduction in the proportion of Filipinos households with intake below 100%
of the dietary energy requirements from 53.2% to 44%.
2. Reduction in:
• 1. underweight among school children
• 2. chronic energy deficiency among pregnant women.
• 3. iron deficiency anemia among infants and children
• 4. vitamin A deficiency disorders among children and lactating women
• 5. prevalence of overweight and obesity and associated non-communicable
diseases.
3. Reduction in the prevalence of iodine deficiency disorders among lactating
women.
4. Eliminating moderate and severe IDD among school-aged children and
pregnant women.
5. Contribute to reduction in the prevalence of low birthweight.
 STRATEGIES

1. Food based interventions for sustained improvements in nutritional

status.
2. Life-cycle approach with strategic attention adolescent females,
pregnant/lactating women and children 0-3 years.
3. Effective complementation of nutrition interventions with other
services
4. Geographical focus to needier areas.
 IMPACT PROGRAMS

HOME, SCHOOL AND COMMUNITY FOOD PRODUCTION

1. Establishment of kitchen gardens in homes, School and communities

in urban and rural areas.
2. Establishment of demonstration centers and nurseries.
3. Distribution of planting materials, small animals, fingerlings, and
provision of technical assistance.
 FOOD FORTIFICATION

1. Addition of a nutrient to a food vehicle commonly consumed by the

population to prevent or correct micronutrient deficiencies.
2. Private sector/food industry-led with government providing an
enabling policy environment.
3. Voluntarily fortification of processed foods through the Sangkap
Pinoy Seal Program.
4. Mandatory fortification of salt with iodine, rice with iron, flour with
iron and vitamin A, and sugar and cooking oil with vitamin A.
 MICRONUTRIENT SUPPLEMENTATION

1. Distribution of vitamin A and iron supplements.

2. Focus on infants, pregnant and lactating women for vitamin A and
iron, adolescents for iron supplements.
 NUTRITION INFORMATION, COMMUNICATION AND EDUCATION

1. Promotion of the Nutritional Guidelines through:

• 1. interpersonal communication
• 2. multimedia campaigns
• 3. special events
2. Training of professionals and frontline workers.
3. Development of appropriate protocols and guidelines.
4. Networking and mobilization of key stakeholders.
 FOOD ASSISTANCE
1. Center-based complementary feeding
2. School feeding
3. Rice distribution through school system
4. Food discount through Tindahan Natin Program.
 LIVELIHOOD ASSISTANCE
1. Provision of credit and livelihood opportunities to poor household.
2. Complementation with other interventions such as training on
functional literacy, enterprise education and health and nutrition
education, including values formation.
 NUTRITION IN ESSENTIAL MATERIAL AND CHILD HEALTH SERVICES

1. Delivery of essential maternal and child health and nutrition package

of services.
2. Include newborn screening, promotion of infant and young child
nutrition including promotion of breastfeeding.
 FACILITATING ACTIVITIES
1. Human Resources Development
2. Nutrition Advocacy
3. Policy and Standards Formulation
4. Research and Development
5. Resource Generation and Mobilization
 THANK YOU
Prepared by: Gasic, Dannielle Daphne C.