Journal of Public Health | Vol. 29, No. 1, pp. 912 | doi:10.

1093/pubmed/fdl024 | Advance Access Publication 29 June 2006

Predictors of interest in nutrition topics and willingness to participate in local nutrition programmes
Katrin Engelhardt1, Byung Chul Ahn2, Sung-Il Cho1, Hyojee Joung1
1 2

Graduate School of Public Health and Institute of Health and Environment, Seoul National University, 28, Yungun-Dong, Chongro-Gu, Seoul 110-799, Republic of Korea School of Economics and Finance, Yeungnam University, 214-1 Dae-dong, Kyungsan-si, Kyungbuk 712-749, Korea Address correspondence to Hyojee Joung, E-mail: hjjoung@snu.ac.kr

ABSTRACT
Objective To investigate the predictors of interest in nutrition topics and willingness to participate in weight management courses and nutritionrelated chronic disease management courses. Methods Data from a cross-sectional survey (n = 1007 Koreans aged 30) on nutrition-related conditions, nutrition behaviours, interest in nutrition topics and willingness to participate in two types of nutrition education courses, and general characteristics. Binary logistic regression was used to identify predictors of the participants interest in the topic and willingness to participate. Results Younger, richer and more-educated participants were significantly more likely to be willing to participate in nutrition-related chronic disease management. Having a higher income and being male increased the odds of being interested in this topic. Younger, more obese, high-income females and those interested to keep their weight and reduce fatty foods were more likely to be willing to participate in weight management. Conclusion There is a need to increase awareness about the link between nutrition and related health problems, especially regarding hidden health problems to tailor the programmes especially for older, low-income and less-educated people and to focus on increasing their interest in nutrition topics. Keywords interest, Korea, nutrition education, predictors, willingness

Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on October 8, 2012

Introduction
The link between diet and disease is well researched,1 and evidence is available to help develop effective nutrition programmes.24 Evidence shows that nutrition programmes should be comprehensive and tailored, i.e. address and meet the needs of citizens. However, citizens may not realize or want to realize their needs in relation to healthy nutrition. Reasons could include the unawareness of their nutritionrelated health condition, the lack of health literacy5,6 or optimistic bias, referring to individuals who do not perceive themselves to be at risk.7 Thus, a first important step is to win the interest of citizens and generate their willingness to participate in nutrition programmes. This study examines the predictors of interest in selected nutrition topics and willingness of a Korean population to participate in nutrition programmes if given the opportunity to do so. There is a strong need for effective nutrition programmes in Korea, a country still facing problems of undernutrition and in which problems associated with over consumption and nutrition-related non-communicable diseases are on the rise.811

We hypothesized that people with a nutrition-related disease are more willing to participate in nutrition courses and more interested in nutrition topics. The results of this study could support local public health centres (PHCs), which are responsible for nutrition services in Korea,12 in their efforts to fulfil their mandate to promote the health of citizens through nutrition improvement programmes.

Methods
One thousand and seven subjects (714 females and 293 males aged 30) were recruited in Chuncheon, Korea, which includes 0.7% of this citys population in this age group. Study participants were recruited in communities, which

Katrin Engelhardt, Visiting Research Fellow Byung Chul Ahn, Associate Professor Sung-Il Cho, Assistant Professor Hyojee Joung, Associate Professor

The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

10

JOURNAL OF PUBLIC HEALTH

have branch offices of local PHCs. Well-regarded representatives of these communities advertised for the survey with leaflets and public announcements. The representatives sent all interested citizens to the PHC to receive further information. The incentive for participation was a free health examination and the inclusion criterion was age 30. After signing the consent form, trained interviewers conducted the 40-min long face-to-face interviews, and nurses conducted the health examination. Interview components included (i) socio-demographic indicesage, gender, marital status, income and educational levels; (ii) willingness to participate in nutrition education programmes [Would you participate in (a) courses about nutrition-related chronic disease management (NCDM) and (b) weight management (WM), if offered by the PHC?]; (iii) interest in nutrition-related topics [Are you interested in (a) NCDM and (b) WM?]; (iv) nutrition behavioursreducing consumption of fatty foods and salty foods, and keeping
Table 1 Predictors and their odd ratios (95% CI)

normal weight; (v) perceived dietary status and (vi) health statusheight, weight, blood pressure (BP), haemoglobin and haematocrit, and plasma cholesterol. Binary logistic regression estimated the odds of the willingness to participate in nutrition programmes and interest in nutrition topics (using SPSS 12.0). Independent variables included age, gender, income, education, marital status, health status variables, interest in keeping weight, reducing fatty foods, reducing salty foods, perceived health status and diagnosis of hypertension, anaemia, diabetes or hyperlipidaemia. Variables for regression were selected if bivariate chisquare statistics between dependent and independent variables were significant.

Results
Table 1 summarizes the main results. Predictors for willingness to participate in NCDM are age, income and education.

Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on October 8, 2012

Nutrition programmes NCDM Willingness to participate Age* Gender Income Education Marital status Obesity Keeping normal weight Reducing fatty foods Reducing salty foods Interest in nutrition topic Age* Gender Income Education Marital status Obesity Hypertension Anaemia Reducing fatty foods Continuous variable 0 = male, 1 = female 0 = low, 1 = high 0 = <12 years, 1 = 12 years 0 = unmarried, widowed, divorced; 1 = married 0 = no, 1 = yes 0 = normal, 1 = hypertension 0 = normal, 1 = anaemic 0 = no, 1 = yes 0.542 (0.400, 0.733) 1.764 (1.286, 2.420) 0.936 (0.664, 1.319) 1.740 (1.053, 2.874) 3.796 (2.468, 5.837) 1.411 (0.949, 2.098) 0.481 (0.225, 1.024) 1.089 (0.671, 1.768) 0.965 (0.947, 0.984) 1.964 (1.240, 3.113) 0.818 (0.521, 1.285) Continuous variable 0 = male, 1 = female 0 = low, 1 = high 0 = <12 years, 1 = 12 years 0 = unmarried, widowed, divorced; 1 = married 0 = no, 1 = yes 0 = no, 1 = yes 0 = no, 1 = yes 0 = no, 1 = yes 1.004 (0.690, 1.462) 1.291 (0.903, 1.846) 2.382 (1.683, 3.370) 1.831 (1.177, 2.849) 1.023 (0.727, 1.441) 0.984 (0.969, 1.000) 0.962 (0.946, 0.977) 1.608 (1.120, 2.309) 1.518 (1.069, 2.155) 1.270 (0.844, 1.911) 1.322 (0.918, 1.905) 2.708 (1.972, 3.718) 1.748 (1.173, 2.603) 1.577 (1.079, 2.304) 1.074 (0.759, 1.520) WM

NCDM, nutrition-related chronic disease management course; WM, weight management course. *Continuous variable (mean age 58 years; 28.5% <50 years, 37.5% 5065 years, 34% >65 years).

Low (<US$ 500/month), moderate/high (US$ 500/month). Body mass index 25 kg/m2. Systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg. Male haemoglobin: <13 g/dl; female haemoglobin: <12 g/dl.

PREDICTORS OF INTEREST AND WILLINGNESS

11

Younger participants say they are more willing to participate in NCDM than older ones (P = 0.045, OR: 0.98). Those with higher income (P < 0.001, OR: 2.4) and a higher educational level (P = 0.007, OR: 1.8) also express greater willingness to participate. Predictors of interest in NCDM courses are gender and income. Males (P < 0.001, OR: 0.54) and higher-income groups (P < 0.001, OR: 1.76) say they are more interested than their counterparts. Predictors of willingness to participate in WM courses are age, gender, income and interest in keeping normal weight and reducing fatty foods. Younger participants say they are more willing to participate than older ones (P < 0.001, OR: 0.96), females more than males (P = 0.01, OR: 1.6) and higher-income participants more than those with lower incomes (P = 0.02, OR: 1.5). Obese subjects (P < 0.001, OR: 2.7), those interested in keeping their weight (P = 0.006, OR: 1.7) and those interested in reducing their intake of fatty foods (P = 0.02, OR: 1.6) also express greater willingness to participate in WM courses. Predictors of interest in WM courses include age, gender, marital status and body mass index (BMI). Younger participants say they are more interested in the topic than older ones (P < 0.001, OR: 0.96), females more than males (P = 0.004, OR: 1.96), married participants more than non-married (P = 0.03, OR: 1.7) and obese participants more than those with normal weight (P < 0.001, OR: 3.8).

topics and willingness to participate in nutrition education courses. These results underline the need to raise the publics awareness about the link between nutrition and hidden diseases. Nutrition programmes must not only be made more attractive and consumer-oriented but spark interest and generate willingness to learn more about the subject matter. Changing social norms of healthy nutrition in general and its potential personal benefits could increase interest in nutrition topics. Our results also show that there is a need to focus more on older, low-income persons, which represent a typically neglected target group. They expressed an even greater lack of interest in nutrition topics and willingness to participate in the specific nutrition programmes compared to other population groups, even though they are more likely to have a nutrition-related disease.
What is known

Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on October 8, 2012

Predictors of the willingness to participate in nutrition programmes and interest in nutrition topics have not been studied systematically. Most published research investigates willingness to pay for health promotion or care services. No reference studies were found that investigated interest in nutrition topics and willingness to participate specifically in nutrition programmes. Some studies that investigated other health behaviours suggest that people who are affected by a condition and/or are aware of the negative consequences are more likely to seek support.6,13,14
What the study adds

Discussion
Main findings

The study results do not support the assumption that the existence of a nutrition-related health condition increases interest in nutrition topics and willingness to participate in nutrition education courses for hypertension, hypercholesteraemia, anaemia or diabetes. However, the presence of obesity and the interest in keeping normal weight and reducing fatty foods are all strong predictors for increased interest in this topic and increased willingness to participate in WM courses. Obesity is obviously a condition that affects ones appearance, which might be a reason young age, being female and having a higher income are predictors of the willingness to participate in WM courses and the interest in this topic. Jo et al. (2003) suggested that increased interest in weight management, especially among women, may be due to the influence of social norms in which a thin image is well regarded rather than due to the possible health consequences of obesity.5 As mentioned earlier, having a nutrition-related health condition is not a predictor for increased interest in nutrition

The variables interest and willingness, as discussed here, have received little attention. Thus, our study adds to the limited research. Furthermore, research using both quantitative and qualitative methods to assess the predictors of the interest in and willingness to participate in nutrition programmes is strongly recommended to support the development of effective nutrition programmes.
Study limitations

Causality cannot be inferred from the cross-sectional data. It cannot be assumed that the factors we identified are actually causal predictors of such activity. Furthermore, the structured questionnaire invites responses to a hypothetical intervention; by itself, it would not sufficiently capture the strength of subjects interest and willingness to participate were such a programme really to be offered. Additional qualitative methods could partly help interpret the results but were not included into this study because of budgetary and time constraints. However, even with qualitative methods, the likely gap between the expressed willingness and actual behaviour provides a challenge for such research.

12

JOURNAL OF PUBLIC HEALTH

Acknowledgements
Financial support for this project came from Chuncheon City, Gangwon Province, Korea (2003).

6 Stock C, Wille L, Krmer A. Gender-specific health behaviors of German University students predict the interest in campus health promotion. Health Promot Int 2001;16(2):14554. 7 Miles S, Scaife V. Optimistic bias and food. Nutr Res Rev 2003;16(1):319. 8 He KS, Yoon KA, Kim WK et al. Urban nutritional problems of Korea. Southeast Asian J Trop Med Public Health 1992;23(Suppl. 3):6976. 9 Ju JS. Nutrition in the Republic of Korea. Br J Nutr 2000;84(Suppl. 2):S195S198. 10 Park YH, de Groot LC, van Staveren WA. Dietary intake and anthropometry of Korean elderly people: a literature review. Asia Pac J Clin Nutr 2003;12(3):23442. 11 Kim DM, Ahn CW, Nam SY. Prevalence of obesity in Korea. Obes Rev 2005;6:11721. 12 Moon HK. Nutrition programs through public health centers in Korea. Biomed Environ Sci 1996;9(23):27689. 13 Lee DJ, Weatherby N. Correlates of participation and willingness to participate in anti-tobacco activities among 4th-7th graders. J Community Health 2001;26(6):44757. 14 Sheffield JK, Fiorenza E, Sofronoff K. Adolescents willingness to seek psychological help: promoting and preventing factors. J Youth Adol 2004;33(6):495507.

References
1 WHO. Diet, Nutrition and the Prevention of Chronic Diseases. WHO Technical Report Series 916. Geneva: WHO, 2003. 2 Contento I, Balch GI, Bronner YL et al. The effectiveness of nutrition education and implications for nutrition education policy, programs, and research: a review of research. J Nutr Educ 1995;27:277419. 3 Higgins MM, Barkley MC. Improving effectiveness of nutrition education resources for older adults. J Nutr Elder 2004;23(3):1954. 4 Katz DL, OConnell M, Yeh MC et al. Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep 2005;54(RR10):112. 5 Jo H, Lee S, Ahn MO et al. Structural relationship of factors affecting health promotion behaviors of Korean urban residents. Health Promot Int 2003;18(3):22936.

Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on October 8, 2012