Effect Of Gender And Age On Nutrition Knowledge Education Essay

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The results will be discussed and compared with available literature in context with the study aims. For the purpose of discussion, major findings related to the three hypothesis of the research are commented upon separately in the first three parts. The fourth and fifth parts deal with the effect of gender and age on nutrition knowledge respectively. The sixth section deals with the student teachers' nutrition knowledge before and after the two-day workshop. In the seventh section, comparison of nutrition knowledge among the intervention, control and comparison groups is presented.

Hypothesis 1

Nutrition knowledge will increase in all students irrespective of the teaching tool

The highly significant increase found in the mean number of correct answers from baseline to post intervention and through follow-up in both study groups supports the first hypothesis of the present study and confirms that nutrition education intervention was successful in increasing the nutrition knowledge of children.

School-based nutrition education intervention provides an opportunity to inculcate healthy eating habits in children. Eating habits developed in early childhood continue to persist into adulthood (Kelder et al, 1994). Consequently, unhealthy eating habits acquired in childhood lead to chronic diseases in later life. Evidence supports that lack of nutrition knowledge is a key factor in different choices in diet; more healthy eating habits are associated with individuals with more nutrition knowledge (Lino M 1998; Blay lock 1999). Nutrition education should not only provide the children information about healthy foods but also focus on transforming this knowledge into practice.

The significant increase in nutrition knowledge, found in the present study, as a result of nutrition education intervention is in accord with other studies done regarding nutrition education intervention. Many such school-based interventions developed and assessed around the world, have demonstrated beneficial effects. (Brit I. Saksvig et al 2005, Contento I.1995). Lister-sharp, in a review of 32 reviews of health promotion in schools, reported that knowledge gain was achieved in all such interventions (Lister-sharp et al 1999).

The present study observed 3.70 mean increase in nutrition knowledge from baseline to post-intervention. This finding was consistent with the findings of Subha Rao, Elena L Serrano and N. Gupta, who reported 3.91, 5.26 and 7.51 mean increase in nutrition knowledge of the respondents respectively 7,20,29. The observed mean increase could be attributed to the fact that Pakistani primary schoolchildren had never been exposed to such a motivating and interesting learning methodology and environment before.

Adequate implementation period for the intervention is necessary to demonstrate significant changes in children's' knowledge regarding nutrition. The available literature suggests that 10-15 hours were needed to demonstrate noteworthy changes in knowledge gain (Bergen D, 1993). In the present study, the time allocated was five lessons comprising of 45 minutes each for duration of two weeks. Hence, by engaging children in as few as two hours and 25 minutes of the intervention, the study demonstrated a considerable increment in the nutrition knowledge of children. Contento et al (1995), in a review reported eight studies with nutrition education intervention. The intervention time in these studies ranged from eight lessons in as many weeks to 24 lessons in six months. All studies reported increase in nutrition knowledge. Although, the intervention time in all eight studies was greater than the present study yet it also demonstrates the same result.

Hypothesis 2

Nutrition knowledge will be higher in the group using computer - based nutrition education materials in addition to non computer-based materials as compared to the group using only non computer-based materials at post-intervention and three months follow up.

The study did not find significant difference in the nutrition knowledge from baseline to post-intervention between the intervention and control groups. This finding did not support the second hypothesis proposed in the study. Hence, suggesting that the computer-based tool did not support additional learning in children. Although nutrition knowledge in children of both groups (intervention and control) increased, however, children in the intervention group attained more scores.

This result is consistent with the results reported in literature (Munguba et al 2008; Katrin 2001). In a study done in Brazil, on 200 children of 8-10 yrs old, Munguba et al, upon comparing the effects of two interactive games (Video game and board game) based on the food pyramid, reported that the children in both groups demonstrated increase in learning of nutritional concepts. The study proposed the use of both videogame and board game in nutrition education. Katrin (2001) also reported no significant difference in mean number of correct answers between control (traditional methods) and intervention (computer-based) groups at post intervention and follow-up. This study also reported significant increase in both groups instead.

On the contrary, in a study similar to the present study, Jana et al (2010) evaluated the effectiveness of computer-based health and nutrition education tool in increasing nutrition knowledge of primary school children. A total of 138 students participated in the intervention. During the two-week intervention, control groups were provided nutrition information through traditional education materials including books and worksheets. The experimental group used a website, provided on CDROM. The nutrition knowledge questionnaire was administered at baseline, after intervention and after 3 months. The study found increase in both groups. However, it reported that the control group attained more scores as compared to the experimental group. In this study, students in the experimental group only used CD ROM, where as the intervention children in the present study worked both with CD ROM and worksheets. In line with this comparison, it can be rightly inferred that using computers in combination with traditional teaching methods is a more productive strategy than using only computers. Computer-based tools should be used to enhance the effectiveness of traditional methods rather than replacing them.

Similarly, Raghunatha et al (2007) also found the traditional method more effective in increasing the nutrition knowledge of students as compared to the CD ROM. The study further reported that the attention of respondents was considerably high during the intervention 1 (traditional method) as compared to intervention 2 (the CD ROM) and regarded it a contributing factor of low increment of nutrition knowledge in intervention 2. However, the low attention of children in intervention 2 could be attributed to the fact that the same respondents participated in intervention 1 and intervention 2. Due to the repetition of the information over the limited time period they lost interest. Therefore, they did not find the information provided in the intervention 2 very informative and challenging, irrespective of the different teaching method. It further strengthens the abovementioned proposition that an amalgam of computer-based tools and traditional methods brings more fruitful results than using these methods in isolation.

On the contrary, there are other studies that reported beneficial effects of computer-based tools on learning regarding nutrition and healthy eating habits as compared to traditional methods (Kim Sun, 2006; Elena LS,2004; Valadez A, 2004; Turnin Mc,2001).

The mixed results found in literature about the effectiveness of computer-based tools regarding increase in nutrition knowledge may be ascribed to the variations in the study designs. The studies that reported significant increase in nutrition knowledge of the computer-based group, either evaluated it vis-à-vis teacher-led strategy or vis-à-vis the group which did not receive nutrition education (Kim Sun, 2006; Elena LS, 2004; Valadez A, 2004; Turnin Mc, 2001). On the other hand, the studies that compared the computer-based group with the one that received nutrition education through specifically developed worksheets, cards, boards and video games, reported no significant differences between the nutrition knowledge of the computer-based group and the control group (Munguba MC, 2008; Katrin K, 2004; Susan MG,2000). This shows that other creative mediums also confer equal positive influence on nutrition learning. Other factors such as animation, colour and sound effects of the computer-based tools, and time allocated to explore the computer-based tools also influence the variations.

Supporting the said argument, Vernadakis 2008 argued that the research is ambivalent in establishing the comparative effectiveness of computer-based tools alone over traditional methods. However, it suggests that more in-depth research is required to explain the prevailing discrepancies in the literature.

In short, the increase in nutrition knowledge achieved by worksheets and board games in the present study found similar to the computer- based tool, suggests that computer-based tools do not support additional learning regarding nutritional concepts in children. It is suggested that by employing interactive and innovative strategies in teaching nutrition to the children, when they are involved in learning at their own pace, similar advantages can be attained.

Hypothesis 3

Nutrition knowledge and Indicators of Socio Economic Status

3a. Nutrition knowledge is associated with indicators of children's socioeconomic status.

The literature proposed several ways to measure the Socio Economic Status of children. In general, parental education, parental occupation and the parent's income are considered the three main determinants of Socio Economic Status (Konstantinos, 2009; Robert H, Robert F, 2002; Baer and Baldi, 2003). Given that Socio Economic Status is a multidimensional concept, it has been suggested to incorporate different socio economic measures to fully comprehend its influence on health (Konstantinos, 2009). Therefore, in the present study, two indicators of SES were used. One based on occupational level of father and mother, and the other, non-occupational i.e., Family Affluence Scale (FAS) developed by Currie.

The present study found a significant difference in children's nutrition knowledge (mean number of correct answers) with regard to mother's occupational level. Children's nutrition knowledge with regard to father's occupational level did not differ at baseline however differed significantly at post intervention and follow-up. The nutrition knowledge differed significantly between scores of FAS at baseline, post- intervention and follow-up.

Nutrition knowledge differed significantly between scores of FAS at baseline, post-intervention and follow-up. This result is consistent with the findings of R Hakeem. In a study conducted in Karachi, Pakistan, she reported a similar trend. She found significant low nutrition knowledge scores in individuals belonging to low income group in comparison to middle and higher income groups (R. Hakeem, 2004).

A strong association between the socioeconomic status and healthy eating habits has been documented in literature (John Convey, 2004). Many studies reveal that individuals from the higher/middle socioeconomic status demonstrate higher nutrition knowledge, habits and healthy lifestyles as compared to individuals from lower socioeconomic status (Räsänen M, 2003; Jane Wardle, 2003; Parmenter K.2000; Judith L Buttriss 1997

The present study found a significant difference in children's nutrition knowledge (mean number of correct answers) with regard to mother's occupational level. It was found that children whose mothers' occupational level was "very high", "high" and "medium" had more nutrition knowledge as compared to children whose mothers' occupational level is "very low", "low" and "non-categorizable".

In contrast to the present study result, a study in Korea, analyzing the effect of parents' occupational and educational level on nutrition knowledge and dietary behaviour of their children was carried out. It demonstrated that mothers' employment status had no significant effect on children's nutrition knowledge, dietary behaviour and nutrition attitude. However, it reported better nutrition knowledge and dietary behaviour as mothers' education level increased (Eun-Sui Choi, et al., 2008).

Considering that parental education is evince of parental occupation (Matthais Richter 2009), that both measures are interconnected (Galobardes, et al., 2001; R. Gnavi, 2000), and that parental education is a strong determinant of parenting knowledge (Rodolfo, 2005), a possible explanation of the study in Korea may be the female literacy rate, which is approximately 94% (Shelley S, 2000). The educated mother, whether she works outside or stays at home, in both circumstances is able to provide her children better information related to hygiene, nutrition and health (Francesco Burchi, 2009; Steven A. Block, 2007). In Pakistan, female literacy rate is….. . Illiterate or less educated mothers not only work in low status jobs but also possess little knowledge about nutrition and healthy eating (Darren A. DeWalt, 2009; R Hakeem, 2004). Consequently, they are not as effective in teaching their children about healthy foods and healthy behaviours compared to women with higher education level, who enjoy higher occupational jobs and are more informed about healthful diets (R Hakeem, 2004). These women are able ransfer this knowledge to their children more successfully. This finding corroborates the ideas of R Ganvi (2000) who also made a similar proposition. In his study, he found no difference in the rate of obesity with regard to parental occupation while he was able to find differences in the rate of obesity with regard to the education level of the parents. He regarded occupational status as disposable income and education as a cultural resource i.e., being able to determine lifestyles behaviour.

The study found that at baseline, nutrition knowledge of children did not differ with regard to occupational level of fathers while it varied significantly with regard to the occupational level of mothers. A possible explanation of this variation is that mothers, particularly in Pakistan, are predominantly more engaged in selection, preparation and serving of food and in determining the nutrition-related behaviours of their children as compared to fathers (Helen Madden, 2010; R Hakeem, 2004 ; Moisio, et al., 2004). Furthermore, as a large number of mothers are homemakers and children spend more time with their mothers, therefore, it is more likely that the mother's beliefs, values and model behaviour regarding nutrition may influence children's nutrition knowledge more likely. Thus, explaining the variation in nutrition knowledge with regard to the occupational level of the mother and the father. Although, significant variation was found in nutrition knowledge of children within the occupational levels of mothers, it could be conceivably be deduced that even less educated Pakistani mothers are quite ingenious regarding issues about nutrition and are more capable of transmitting this knowledge to their children as compared to the fathers, who are more educated but are naive in this aspect (Rodolfo and Nayga, 1997).

However, these findings must be interpreted cautiously keeping in view that the children were the proxy informants about the occupational level of their parents and there was no other option to confirm the accuracy of the responses provided by children. Many studies consider taking information about parental occupation as complicated (Currie et al, 2008; Molcho M, 2007). Furthermore, the results of the present study indicated a small number of children whose parents belonged to very high occupational level. It is recommended for future studies to include measure of parental education for identifying a more robust nexus between parental occupation and nutrition knowledge of children.

To summarize, the results of the present study affirms the hypothesis that both indicators of Socioeconomic status i.e. Family Affluence Scale and mothers' occupational level are concordant with the nutrition knowledge of the children. While, on the other hand the results did not support the second part of the third hypothesis that gain in nutrition knowledge of children is associated with indicators of Socio Economic Status. This suggests that gain in nutrition knowledge is tantamount to the various level of Socio Economic Status. Furthermore, no difference was detected in nutrition knowledge with regard to different levels of mother and father occupation and Family affluence scale between intervention and control groups. This suggests that computer-based tool did not

Gender and nutrition knowledge

The comparison of nutrition knowledge found a significant difference in mean number of correct answers between girls and boys at 3 months follow-up. The result is consistent with the study result of Michelaine D Salgado (2005). In this study, she investigated the impact of nutrition education program on food and nutrition knowledge of 283 elementary school students. The study design comprised of four stages including pre-test, post-test, re-test 1 and re-test 2. No difference was detected between nutrition knowledge of girls and boys at pre-test and post-test. However, significant difference was found at 3 month's re-test.

A possible explanation for this significant difference in retention of nutrition knowledge between girls and boys could be associated to the fact that in Pakistani society the male and female domains and roles are clearly distinct. The woman's role is primarily defined within the home. Therefore, girls found nutrition knowledge more relevant to their future prospective role as homemaker and caretakers. Hence, they showed high retention as compared to boys who did not find nutrition knowledge of much relevance to their future adult life pattern. Furthermore, the result is in affirmation with the universal trend of women having better nutrition knowledge than men (Alice Grønhøj, 2007; Ingrid Kiefer, 2005; Parmenter k.2000; Judith L Buttriss, 1997). Richard Lynn (2005) in a study, investigated sex differences in general knowledge and reported that women's gained higher scores in nutrition knowledge in comparison to men's who gained higher score in sport, finance and science. He also suggested women's higher interest in nurturing as a possible explanation for the observed variation.

Age and nutrition knowledge

The result showed that younger children (8-9 years) remember more at follow up as compared to older children (10-11 years), indicating that the intervention material may have been more suitable for the younger children. Children's age seemed to have a strong influence on the retention of the learned material. Mashid Pirouza (2001) in his reported the similar findings. The younger children's retention of nutrition knowledge could be associated to their better comprehension of the intervention material and/or student-teachers of this age group incorporated the intervention more advantageously. Furthermore, it indicates that the nutrition intervention is more advantageous when started at an early age (Perez-Rodrigo C, Aranceta, 2001; Johnson CC, 1994; Koivisto HU-K, 1999).

Nutrition knowledge comparison among intervention, control and comparison groups

The results of the comparison group show an increase in mean number of correct answers from baseline to post-intervention and at three months follow up. However, the increase is not statistically significant. The repetition of the same questionnaire at post-intervention and follow-up without any intervention may be a possible factor responsible for the increase in the nutrition knowledge. A similar finding was also reported by Sara E Benjamin (2007), Hewitt (2001) and Hemalainen and, Keinanen-kiukaanniemis (1992).

The children may have discussed the questionnaire content with their peers and families, which may have resulted in their increased in nutrition knowledge. A similar finding also reported by Mery et al, described that children who discussed the nutrition topics with their parents had achieved significantly higher scores as compared to those who did not. (Mery W et al, 2008). In another study in Tehran M. Abdollahi reported parents and media as two important sources of acquisition of nutrition knowledge for children aged 6-11 years (M Abdollahi et al, 2008)

Focus group discussions

According to the evaluation questionnaires received from the intervention group, sixty-one percent children ranked the computer-based tool as very good, 23 % as good and only 2.3% as not good at all. Thirty-three percent children judged their computer skills as good and only 5.6% as very good. On the other hand, 40.7 % judged as not so good and 20.3 % as not good at all. Eighty-five percent children would like to continue using computers in the classroom. However, only 15% said no.

The overall response of the children (Control and Intervention) and student teachers about the drill was very good. The focus group (n=3) with Intervention children revealed that the use of computer as a medium of learning was new to them. Therefore, initially, they faced difficulties in operating them. Despite difficulties, the children regarded learning through computers as interesting and entertaining.

The evaluation questionnaire for student teachers of Intervention group was filled out by all STs (n=8). The focus group discussion (n=3) with student teachers revealed that it was the first time they had used the computer as a teaching tool. At the same time, they were amazed by the immense interest and involvement of the children in computers. Some student teachers hinted that children regarded the computer as a thrilling and entertainment device instead of an educational tool. Some of them also mentioned that, in the first few lessons, they had not felt comfortable and confident in using computers as a teaching tool, because they were not used to working with computers themselves. Many student teachers showed eagerness to work in a computer-based system in the future. However, they highlighted the prospective problems facing computer-based education in Pakistan, including frequent power breakdowns, lack of computer-related skills of children and teachers, lack of support from school administration and lack of computer equipment.

All of them agreed that nutrition education should be included in the school curricula. In this regard, many of them highlighted the time constraints for integrating nutrition education as a separate subject and suggested its incorporation in subjects being taught currently in schools.

To conclude, the present study found that children enjoyed learning nutrition concepts through use of computers. Furthermore, it highlights many important factors that need to be taken into account in order to successfully integrate computer-oriented education in Pakistani primary schools.

Comparison of results between Lahore study and Vienna Study

The purpose of the study was to evaluate the potential effectiveness of computer-based tool in increasing the nutrition knowledge of children of Lahore. The study also looked to compare the present study results with the Vienna study results.

The investigator seeks to understand whether the computer-based nutrition education program i.e., Cool Food Planet Kidz and materials designed for children in developed countries could be effectively implemented and whether they would be appropriate for children in developing countries. Taking up this framework, the following main directions are considered to commence the comparison: (a) to explore similarities if there are any, (b) to determine line of fraction and (c) to propose suggestions.

First part deals with the similarities found between the nutrition knowledge of children in Lahore and Vienna. In the second part, the differences in the effects of computer based tool on the nutrition knowledge of children of both studies are discussed. The third part compares the effect size of the intervention found in both studies.

Similarities

The Vienna study reported a significant increase in nutrition knowledge from baseline to post-intervention and at follow up in both study groups (computer-based and traditional method). The Lahore study also found similar results, confirming that intervention was also effective in increasing the nutrition knowledge related to healthy eating habits in children of Lahore. Table : Shows nutrition knowledge as the mean number of correct answers of Vienna children and Lahore children at baseline, post intervention and follow up.

This strengthens the view that nutrition education improves knowledge about diet and develops awareness about healthy eating habits, considered to be first step towards modification of behaviour irrespective of the cultural variations.

Table : Comparison of nutrition knowledge (mean number of correct answers) at baseline, post intervention and follow-up between children of Vienna and Lahore.

Studies

Count

Mean

SD

Min

Max

Correct answers baseline

Lahore Study

303

10.05

3.00

2

17

Vienna study

271

11.29

3.25

1

20

Correct answers post intervention

Lahore Study

303

13.76

3.46

5

21

Vienna study

271

13.86

3.43

3

21

Correct answers at Follow up

Lahore Study

303

13.09

3.22

4

21

Vienna study

271

13.55

3.31

2

21

Fig : Comparison of nutrition knowledge (mean number of correct answers) at baseline, post intervention and follow up between children of Vienna and Lahore.

Related to the second hypothesis, the Vienna study reported that using the computer-based tool combined with traditional tools did not prove effective in increasing knowledge. The present study also found no additional beneficial effects of the computer-based tool. Both groups demonstrated significant increase in nutrition knowledge. Mean number of correct answers of intervention groups in both studies was higher as compared to control groups. However, the increase was not statistically significant. The descriptive statistics for the Vienna and Lahore study is presented in the table .

Table : shows nutrition knowledge as the mean number of correct answers at baseline, post intervention and follow up between intervention and control children of Vienna study and intervention and control children of Lahore.

Studies

Group

Count

Mean

SD

Min

Max

Correct answers baseline

Lahore

Study

Intervention

147

10.01

3.01

2

17

Control

156

10.08

3.01

2

17

Vienna

Study

Intervention

145

11.50

3.25

5

20

Control

126

11.04

3.25

1

20

Correct answers

post-intervention

Lahore

Study

Intervention

147

13.99

3.48

5

21

Control

156

13.54

3.42

5

21

Vienna

Study

Intervention

145

14.07

3.41

3

21

Control

126

13.61

3,44

4

21

Correct answers at follow-up

Lahore

Study

Intervention

147

13.47

3.22

5

21

Control

156

12.74

3.19

4

20

Vienna

Study

Intervention

145

13,59

3.44

2

21

Control

126

13.51

3.17

3

21

Fig : shows nutrition knowledge as the mean number of correct answers at baseline, post intervention and follow up between intervention and control children of Vienna study and intervention and control children of Lahore.

The Vienna study did not report significant difference in mean number of correct answers between control and intervention group at the three months follow-up, hence supporting the view that the computer-based tool did not exert additional influence in retaining the gain in nutrition knowledge. Similarly, in the Lahore study, no significant difference was found in mean number of correct answers between control and intervention groups at the three months follow-up. Both in the Vienna study and Lahore study, mean number of correct answers of intervention group was higher as compared to control group at follow-up. However, the difference was not large enough to be considered as statistically significant.

This is in accordance with other studies. In order to assess the retention effects Pisapia and Perlman (1993) in a review of five studies with follow-up intervals of 2 to 6 months, reported that in four of them retention effects of computer-based as compared to control groups were not large enough to be considered statistically significant. This result supports the findings that knowledge imparted through innovative and creative mediums, irrespective of the mode of delivery, has longer effects on retention which is the foremost and fundamental aim of teaching.

Effect Size

The Vienna study reported an effect size of d=0.134 (there was no statistically significant difference between the groups). The present study yielded an effect size d= 0.130 (there was no statistically significant difference between the groups), which is highly compatible in magnitude to the Vienna study. According to Cohen 1988, interpretation of effect sizes, the effect size below 0.2 is reported as small, 0.5 as medium and 0.7 as large. (Cohen 1988). An effect size in both studies was small d <0.2. An average effect size of 0.130 replicated in the present study indicated that the computer-based tool also had a very small effect on Lahore children's learning of nutrition knowledge.

Differences

The comparison further revealed that at baseline, nutrition knowledge (mean number of correct answers) of Vienna children was higher as compared to the Lahore children, indicating that Pakistani children are short of important nutrition knowledge. Prior to the present study, there is no data available about the nutrition knowledge level of Pakistani children, especially in comparison with children of developed countries. However, the poor level of nutrition knowledge found in this study is consistent to the prevalent trend of low level of nutrition knowledge in south Asia region. In studies from India Subha Rao et al and Mahtab S also reported nutrition knowledge of Indian children as poor (Subha Rao et al, 2006; Mahtab S, 2006). The low nutritional knowledge of children of Lahore study indicates that the parents, school and media are unable to deliver sufficient and effective nutrition-related messages and develop healthy eating habits in the children.

This finding further support the other studies which documented that the knowledge level of Pakistani children in many academic subjects is low (Farooq1990; Mirza and Hameed 1996; S.M Aijaz2001; saeed et al, 2005 Andrabi et al 2007). However, the low level of learning achievement is not only a Pakistan specific problem. In fact these trends are prevalent throughout the South Asian region (Das. Jishunu et al, 2006).

The Lahore study observed 3.70 mean increase in nutrition knowledge from baseline to post-intervention. This finding was consistent with the finding of Subha rao, Elena L Serrano and N. Gupta who reported 3.91, 5.26 and 7.51 mean increase in nutrition knowledge of the respondents respectively (Subha Rao et al, 2006; Elena L Serrano 2004; N. Gupta,2009). However, the observed mean increase of 3.70 in the Lahore study as compared to mean increase of 2.57 in the Vienna study could be attributed to the fact that Pakistani primary school children had never been exposed to such a motivating and interesting learning environment designed to accelerate their learning.

It was also observed, while comparing the mean nutrition knowledge scores at follow-up between the two studies, that children in the Vienna study notably retained more nutrition knowledge as compared to the Lahore children. A possible reason for retaining more nutrition knowledge of the Vienna children at three months follow-up as compared to the Lahore children could be of more opportunities to get nutrition- related information from their environment. These include media, teachers and parents thus strengthening the nutrition knowledge the children had already acquired.

On the contrary the children of the Lahore study did not have this additional advantage to support in retaining their already learned nutrition knowledge concepts. This signifies the importance of delivering health and nutrition- related messages through the help of parents, media and schools (R Hakeem, 2004). The knowledge acquired through creative and innovative tools have more chances to be retained by the children.

Study Limitations

Like many other School-based nutrition education intervention present study also faced some limitations. The schools which used worksheets for imparting knowledge to children were included in the study. Later it was disclosed that teaching children through worksheets and board games was not a general practice in some of the selected schools. During the focus group discussions children of certain control schools also mentioned and complaint about the infrequent use of worksheets in classrooms. In line with the prevailing situation it can be inferred that the children of control group enjoyed working with nutrition worksheets and learning nutrition concepts through board and card games and found them very interesting. The medium of worksheets contributed in resultant significant increase in nutrition knowledge of control group children. This could be the possible reason for the lack of observed difference between control and intervention groups.

The second limitation was that two class-rooms from each school participated in the study. Initially, in order to reduce the likely contamination effects, one class-room from each school was selected. However, due to the refusal and non adherence to study protocol, some schools were excluded from the study; as depicted in fig1. This awkward situation resulted in the selection of two classes from the same school, which possibly might have affected the tenacity of the findings.

Children in intervention group used computer-based tool in addition to the worksheets and board games. The children might not get appropriate time to explored the CDROM and learn at their on pace. Furthermore, the frequent power failure interrupted the time schedule and consequently reduced the time that children had allocated to explore the CDROM. This might have negatively affected children's learning through computers, considering that the success of the intervention also depends upon the available time to explore the CDROM. The level of computer skills is directly related to the effective use of computers. The lack of computer skills, as reported by children, might be proved a strong barrier in attaining the maximum benefit from computer-based tool.

Same amount of nutrition education was provided to the children of all classes. However, the methods and exact content differed depending upon the different strategies employed by the student teachers. This represented variation in the presentation of the nutrition education materials that children received.

The present study only included children of fourth and fifth classes due to which results could not be generalize to whole population.

Increment in nutrition knowledge should not necessarily mean adoption of health eating habits Future studies should also include the elements of dietary attitude and dietary behaviour and investigate the effects of computer-based tools on these.

Their level of enjoyment was influenced by their skill levels. Children were more likely to be engaged when they possessed the proper computer skills or received appropriate scaffolding from a knowledgeable adult or advanced peer. Thus, prior experience in computer use and developmental level seems to have a strong effect on an individual's capabilities and interaction with the software.

Lee, Y. (2009). Pre-K Children's Interaction with Educational Software Programs; An Observation of Capabilities and Levels of Engagement. Journal of Educational Multimedia and Hypermedia, 18(3), 289-309. Chesapeake, VA: AACE.

Retrieved from http://www.editlib.org/p/28310.

To use a CAI program, one must be able to use the computer. A minimum level of keyboard/mouse skills is required. People accustomed to using a computer may underestimate the computer-related anxiety and frustration among learners who are novice computer users. This causes two problems. Firstly, this anxiety can inhibit knowledge acquisition in some learners (anxiety is not conducive to learning, whatever the medium). Secondly, they must allocate cognitive resources to actually using the computer (for example, wondering how to select an option as opposed to considering which is the correct option). These resources are therefore not available for the processing required to learn the current topic. Toyoda (2001) found that sufficient computer literacy in students is a necessary condition for successful autonomous learning in a CALL environment. This is an important consideration in the Endangered Language context, where literacy levels may be quite low. It means that extra care must be taken with the clarity and presentation of information (e.g. sound and audio elements).

Kadijevick (2002) has identified four issues as critical to proper and effective use of computer technologies in the classrooms. Top among them is computer attitude,

followed by software selection, a proper utilization direction, and web - based professional development teachers. Studies have also, shown that omputer

anxiety, lack of confidence, and lack of enjoyment influence both the acceptance of computers and their use as a teaching and learning tool (Gressard & Loyd, 1986; Woodrow, 1991).

Computer Attitude, Ownership and Use as Predictors of

Computer Literacy of Science Teachers in Nigeria

Concerning nutrition, in a study of female first year college students, Matvienko, Lewis, and Schafer (2001) found that the subjects had insufficient baseline levels of knowledge pertaining to nutrients, food labels, dietary recommendations, and energy metabolism. As well, Kolodinsky et al. (2007) found that the college students in their study that reported consuming the recommended amounts of fruits, dairy, and protein had a higher knowledge of dietary guidelines than those that did not. Therefore, it can be assumed that if college students do not know how much physical activity they should be getting or how to manage their dietary intake appropriately, they may be less motivated to seek help or change.

http://www.fao.org/ag/humannutrition/nutritioneducation/49739/en/chl/

good for suggestions

Studies

Group

Count

Mean

SD

Min

Max

Correct answers baseline

Lahore

Study

Intervention

147

10.01

3.01

2

17

Control

156

10.08

3.01

2

17

Vienna

Study

Intervention

145

11.50

3.25

5

20

Control

126

11.04

3.25

1

20

Correct answers

post-intervention

Lahore

Study

Intervention

147

13.99

3.48

5

21

Control

156

13.54

3.42

5

21

Vienna

Study

Intervention

145

14.07

3.41

3

21

Control

126

13.61

3,44

4

21

Correct answers at follow-up

Lahore

Study

Intervention

147

13.47

3.22

5

21

Control

156

12.74

3.19

4

20

Vienna

Study

Intervention

145

13,59

3.44

2

21

Control

126

13.51

3.17

3

21

Studies

Count

Mean

SD

Min

Max

Correct answers baseline

Lahore Study

303

10.05

3.00

2

17

Vienna study

271

11.29

3.25

1

20

Correct answers post intervention

Lahore Study

303

13.76

3.46

5

21

Vienna study

271

13.86

3.43

3

21

Correct answers at Follow up

Lahore Study

303

13.09

3.22

4

21

Vienna study

271

13.55

3.31

2

21

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