Effectiveness of a Pilot Healthy Eating and Lifestyle Promotion ...

Effectiveness of a Pilot Healthy Eating and Lifestyle

Promotion Program for Hong Kong Middle-aged Women

PAU King-man

A Thesis Submitted in Partial Fulfillment

P \ \

of the Requirements for the Degree of

Master of Philosophy

in

Food and Nutritional Sciences

©The Chinese University of Hong Kong

October 2001

The Chinese University of Hong Kong holds the copyright of this thesis. Any

person(s) intending to use a part or whole of the materials in the thesis in a proposed

publication must seek copyright release from the Dean of the Graduate School.

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W v ~ i » R S i T Y 1 $ ) ^gvLIBRARY SYSTEM/^/

Acknowledgements

I would like to express my most sincere gratitude to my supervisor, Professor

Georgia S. Guldan, for her guidance, encouragement, patience and inspiration for my

works during the past two years. Her professional experience boosted my interests

in research work.

I am especially thankful to Ms Kwong Yuet Sum and Ms Chan Sau Wan, who are the

chairladies of the two women centres, for their assistance in recruiting the

participants, arranging the venues and materials for my research. Many thanks wish

to be given to the women who participated in the health promotion program and the

assessments.

I would also like to thank Mr Chui Kwan Ho Kenneth, technician of Department of

Biochemistry of the CUHK, for his invaluable advice during the analysis of the

results.

Last but not least, I would like to express my warmest gratitude to my parents, my

brother, my relatives and my friends for their love and their support throughout my

work.

i

ABSTRACT

Unbalanced diet and inadequate physical activity contribute to serious health

problems, with overweight and the disease of obesity a common outcome. Local

data indicated that Hong Kong middle-aged women (aged 30-50 years) have a low

awareness of the importance of healthy diet and regular physical activity, though they

showed high rates of cardiovascular risk factors. However, no health programs

have been undertaken to promote healthy lifestyle for them in Hong Kong.

Therefore, a pilot program aimed at promoting healthy eating and lifestyle was

organized among middle-aged women. A two-group pre-post design with a six-

month follow-up was used to assess the effects of the program, and to test the

hypothesis that the Education Group will improve their knowledge, attitudes and

behavior significantly more than the Control Group.

A questionnaire, three-day dietary record, weight, height, percent body fat and total

blood cholesterol levels were used to measure the program impacts. Results

showed that the Education Group ( , 8 1 ) increased significantly the mean Nutrition

Knowledge Score between the Pre- and Posttests (7.4 Vs 9.8, respectively; P<0.001).

Significant increases were also found in the proportion of women in the Education

Group only who had heard of saturated fat (from 46 to 83%; PO.OOl)，the food

pyramid (from 79 to 100%;尸<0.001), and those who correctly matched all the food

groups with their corresponding level of the food pyramid (from 32 to 56%;

P<0.001). Moreover, only the Education Group showed significant increases in the

mean Physical Activity Knowledge Score (5.9 Vs 8.9, respectively;尸<0.01) and in

the proportion of women who had heard of the physical activity pyramid (from 14 to

79%;尸<0.001), and those who correctly matched all the physical activity groups

ii

with the corresponding level of the physical activity pyramid (from 2 to 21%;

P<0.001). The Control Group (A^-103) showed no significant changes in any

knowledge variables between the Pre- and Posttests. The Education Group

maintained all these nutrition and physical activity knowledge variables at six

months after the program (the Follow-up).

A significant improvement (P<0.01) was seen for only the Education Group in their

awareness of decreasing saturated fat intake at the Posttest. Additionally,

significant improvements (P<0.05) were found for the Education Group in their

awareness of increasing fruit and vegetable intakes at the Follow-up. However, no

significant improvements were observed in anthropometric measurements or eating

and physical activity behavior in either the Education or Control Group.

These findings clearly showed that this program successfully increased the nutrition

and physical activity knowledge among the middle-aged women, as well as their

awareness of decreasing saturated fat and increasing fruit and vegetable intakes.

This study also demonstrated that health behavior change among the local middle-

aged women is a challenge for local health promotion. Therefore, further

development and expansion of effective health promotion programs emphasizing

behavior change for Hong Kong middle-aged women are needed

Keywords: healthy eating, lifestyle, middle-aged women, physical activity, health

promotion

iii

一項有關香港中年婦女健康飮食及運動推廣活動的硏究及其成效

論文摘要

不均衡和不足夠的運動會引致嚴重的健康問題’而過重及肥胖是較爲常見的後

果°根據本地數據顯示’香港中年婦女〔年齡介乎30至50歲〕有高比率的心

血管病危險因素’可是她們對於健康飲食及定時運動的重要性卻只有很低的意

識。然而，香港沒有舉辦過針對中年婦女健康生活的推廣活動°故此’ 一項有

關香港中年婦女健康飮食及運動的推廣活動便舉行°爲了評估這項活動的成

效’硏究的設計爲對教育組和對照組兩組於活動前、後’及六個月後的評估結

果作出比較。是次硏究的假說是教育組相比對照組無論在知識’意識或行爲上

均會有較明顯的改善。

量度是次活動成效的工具包括問卷，三天的飮食記錄，體重，身高’身體脂肪

百分比和血液的總膽固醇含量。研究的結果顯示教育組〔斤二81〕於推廣活動後

明顯增加了平均的營養知識分數〔從7.4到9.8 ； P<0.00\〕o教育組中曾聽過

飽和脂肪的比例〔從46到83% ； P<0.001〕和食物金字塔的比例〔從79到

100% ； P<0.001〕亦出現明顯的增加。教育組中能夠正確知道食物金字塔每一

層是甚麼食物的比例亦有明顯的增加〔從32到56% ； ^<0.001〕O另一方面’

教育組於推廣活動後明顯增加了平均的運動知識分數〔從5.9到8.9 ；

？<0.001��教育組中曾聽過運動金字塔的比例出現明顯的增加〔從14到

79% ； PC0.001��教育組中能夠正確知道運動金字塔每一層是甚麼運動的比例

亦有明顯的增加〔從2到21% ； P<0.001〕。相反，對照組〔"=103〕在這段期

間並沒有在任何營養或運動的知識上有明顯的改變°在六個月後的追蹤硏究

中，教育組能夠維持所有的營養或運動知識°

只有教育組於推廣活動後在減少進食飽和脂肪的意識上有明顯的改善

〔P<0.01〕。另外，在六個月後的追蹤硏究中，亦只有教育組能夠在增加進食

生果和蔬菜的意識上有明顯的改善〔P<0.05〕。可是，無論是教育組或對照組’

人體測量的結果以及飮食和運動的行爲於推廣活動後或六個月後的追蹤研究中

均沒有明顯的改善。

硏究的結果淸楚顯示是次推廣活動能夠成功增加中年婦女的營養和運動知識，

以及減少進食飽和脂肪，增加進食生果和蔬菜的意識。硏究亦顯示對於健康推

廣活動而言，要改變本地中年婦女飮食和運動的行爲是一項挑戰。故此，香港

是需要更多針對改變本地中年婦女健康行爲的推廣活動。

要詞：健康飮食，生活方式’中年婦女’運動，健康推廣

iv

Table of Contents

Page

Acknowledgements i

Abstract ii

Abstract (Chinese version) iii

Table of Contents iv

List of Figures xii

List of Tables xiii

List of Abbreviations xxiv

CHAPTER ONE: INTRODUCTION

1.1 Women's Overweight and Obesity Prevalence and Trends 1

1.2 Etiology of Overweight and Obesity 2

1.3 Health Consequences of Obesity in Women 4

1.4 Dietary and Physical Activity Recommendations for Good Health for 6

Adults

1.5 Health Behavior Change Theories 8

1.6 Weight Control/Loss Interventions for Women 10

1.7 Weight Loss Risks 11

1.8 Health Promotion Programs for Women 12

1.9 General Situation and Population Trends Among Hong Kong Middle- 15

aged Women

1.10 Nutrition-related Morbidity and Mortality Among Hong Kong Women 16

1.11 Diet Composition of Hong Kong Middle-aged Women 20

1.12 Physical Activity Patterns of Hong Kong Middle-aged Women 21

1.13 Education and Health in Hong Kong Middle-aged Women 23

1.14 Attitudes Toward and Beliefs About Diet and Health of Hong Kong 24

Middle-aged Women

1.15 Common Weight Loss Methods Among Hong Kong Middle-aged 25

Women

1.16 Sources of Health Information Among Hong Kong Middle-aged 25

Women

XV

17 Summary 26

1.18 Study Purpose and Objectives 26

CHAPTER TWO: METHODOLOGY

2.1 Recruitment of Participants 29

2.2 Focus Groups 29

2.3 Survey Instrument 30

2.3.1 Questionnaire 30

2.3.2 Three-day Dietary Record 35

2.3.3 Anthropometric and Cholesterol Measurements 35

2.4 Intervention 37

2.5 Evaluation 39

2.5.1 Process Evaluation 39

2.5.2 Outcome Evaluation 40

2.6 Data Management 40

2.7 Statistics 4Q

2.8 Data Analysis 41

2.8.1 Physical Activity Patterns 41

2.8.2 Dietary Patterns 44

2.8.3 Nutrition Knowledge Score 45

2.8.4 Physical Activity Knowledge Score 46

2.8.5 Blood Total Cholesterol 46

2.8.6 Body Mass Index 47

2.8.7 Percent Body Fat 47

2.9 Ethics 47

CHAPTER THREE: RESULTS

3.1 Focus Group Results 43

3.1.1 General Description of Participants 48

3.1.2 Perceived Values and Views on 'Health' 50

3.1.3 Perceived Values and Views on 'Healthy Lifestyle' 51

vi

1.4 Perceived Values and Views on ‘Healthy Eating' 52

3.1.5 Perceived Values and Views on 'Physical Activity' 53

3.1.6 The Factors Motivating the Women to Adopt a Healthy 53

Lifestyle

3.1.7 Sources of Information About Healthy Eating and Physical 55

Activity

3.1.8 Suggestions for the Type and Content of Activities in a Health 55

Promotion Program

3.2 Participation Rate in the Study 56

3.3 Pretest 57

3.3.1 General Participant Sociodemographic Description 57

3.3.2 Anthropometry 59

3.3.3 Health Conditions Reported 60

. 3.3.4 Meal Patterns 61

3.3.5 Nutrient Supplements Practices 62

3.3.6 Cooking Practices 63

3.3.7 Food Removal Behavior 65

3.3.8 Food Label Reading 65

3.3.9 Dietary Intake 66

a. From the Three-day Dietary Records 66

b. From the Food Frequency Questionnaire 68

3.3.10 Nutrition Knowledge 59

3.3.11 Physical Activity Habits 72

3.3.12 Physical Activity Knowledge 73

3.3.13 Intention and Confidence in Changing Behavior 76

3.3.14 Perceived Difficulties in Changing Behavior 77

3.3.15 Perceived Methods Facilitating Behavior Change 79

3.3.16 Health Information Desired 80

3.3.17 Areas of Health the Women Would Like to Improve 81

3.3.18 Summary Profile of the Women at Pretest 82

3.4 Outcome Evaluation 35

3.5 Posttest g^

vii

5.1 General Participant Sociodemographic Description 85



3.5.4 Meal Patterns 88





3.5.9 Dietary Intake 93






3.5.13 Analysis the Changes by Education Level 102

3.5.14 Analysis the Changes by Age Group 104






3.5.20 Summary Profile of the Women at Posttest 112

3.6 Participants' Evaluation of the Intervention Program 113

3.7 Follow-up 118

3.7.1 General Participant Sociodemographic Description 118



3.7.4 Meal Patterns 121





viii

7.9 Dietary Intake 127







3.7.14 Analysis the Changes by Education Level 142

3.7.15 Analysis the Changes by Age Group 143





3.7.20 Summary Profile of the Women at Follow-up 150

CHAPTER FOUR: DISCUSSION

4.1 Implications of Findings 154

4.1.1 Current Situations in Diet and Physical Activity of Hong Kong 154

Middle-aged Women

4.1.2 Overall Effects of the Program 161

a. Changes in Knowledge 161

b. Changes in Awareness and Intention 163

c. Changes in Behavior 164

d. Changes in Anthropometery 166

4.2 Strengths and Limitations of the Study 167

4.3 Implications and Recommendations for Meeting the Challenges of 169

Improving Hong Kong Middle-aged Women's Nutrition and Physical

Activity Habits

4.4 Suggestions for Future Research 170

CHAPTER FIVE: CONCLUSIONS 172 ix

Page

References 173

Appendices

A Consent form (Chinese version) 182

B Consent form (English version) 183

C Questionnaire (Chinese version) 184

D Questionnaire (English version) 196

E Photos for food amount quantities and household measures (Chinese 210

version)

F Photos for food amount quantities and household measures (English 213

version)

G Sample of dietary record (Chinese version) 216

H Sample of dietary record (English version) 217

I Three-day dietary record (Chinese version) 218

J Three-day dietary record (English version) 221

K Pamphlets for health talks (Chinese version) 224

L Pamphlets for health talks (English version) 236

M Pamphlets for physical activity demonstration (Chinese version) 248

N Pamphlets for physical activity demonstration (English version) 253

O Process evaluation questionnaire (Chinese version) 258

P Process evaluation questionnaire (English version) 260

Q Overall evaluation questionnaire (Chinese version) 262

R Overall evaluation questionnaire (English version) 263

S Focus group questionnaire (Chinese version) 264

T Focus group questionnaire (English version) 265

U Focus group question guides (Chinese version) 266

x

Page

V Focus group question guides (English version) 268

W The food consumption patterns of women in the Education and 270

Control Groups

xi

List of Figures

Page Figure 1.1 A social marketing wheel 9

Figure 1.2 Percentages of Hong Kong females in specific age groups 18

classified as overweight and obese according to an Asian

definition (overweight as BMI=23.6-30.0 kg/m2 and obesity as

BMI >30.0 kg/m2)

Figure 1.3 Proportion of Hong Kong males and females with blood 19

cholesterol >5.2 mmol/L and >6.2 mmol/L

Figure 1.4 The study design of the pilot nutrition and health promotion 27

program

Figure 1.5 The conceptual framework of the study 28

Figure 3.1 Changes in Nutrition Knowledge Score between Pretest, Posttest 132

and Follow-up in the Education and Control Groups

Figure 3.2 Changes in Physical Activity Knowledge Score between Pretest, 137

Posttest and Follow-up in the Education and Control Groups

xii

List of Tables

Page Table 1.1 The secular trends of obesity by gender in selected countries 2

Table 1.2 The leading causes of death by age group among Hong Kong 17

females in 1997 (%)

Table 1.3 Age-specific hip fracture incidence rates in Hong Kong women 20

per 100,000 population in 1966, 1985 and 1991

Table 1.4 Physical activity frequency of male and female participants by 22

age group

Table 1.5 Education level of Hong Kong adults and their BMI & WHR 24

Table 1.6 Percentages of women in specific age group who obtain health 26

information from the three most common sources

Table 2.1 The list of physical activities under different categories 31

Table 2.2 Topics and objectives for each class/activity 37

Table 2.3 The intensity codes for the physical activities 42

Table 2.4 The frequency score, the duration score and the factor for each 43

index score

Table 2.5 Estimation of oil for cooking/consuming 45

Table 2.6 The marking scheme for calculating the Nutrition Knowledge 45

Score

Table 2.7 The marking for calculating the Physical Activity Knowledge 46

Score

Table 2.8 Proposed classification of BMI in adult Asians 47

Table 3.1 Date, duration and number of women participating in each focus 48

group

Table 3.2 Focus group participants' demographic characteristics (n=42) 49

Table 3.3 Number of women participating in each activity of Pretest, 56

Posttest and Follow-up

Table 3.4 Demographic characteristics of women in the Education and 58

Control Groups

xiii

Page Table 3.5 Physical measurement data, distributions of BMI levels 60

according to Asian definition, percent body fat levels and fasting

total blood cholesterol levels of women in the Education and

Control Groups

Table 3.6 Number (%) of self-reported cases of six health conditions in the 61

Education and Control Groups

Table 3.7 Number (%) of women rating their own health in different 61

categories in the Education and Control Groups

Table 3.8 Mean number of days 士 S.D. per week of having breakfast, 62

lunch, dinner and mean number 士 S.D of snacks per day in the


Table 3.9 Number (%) of women who had breakfast every day, skipped 62

breakfast every day or had lunch every day in the Education and

Control Groups

Table 3.10 Number of supplements the women taken in the Education and 63

Control Groups

Table 3.11 Number (%) of women in taking the following types of 63

supplements in the Education and Control Groups

Table 3.12 Number (%) of women in using the following oils in the 64


Table 3.13 Number (%) of women in using the following cooking methods 64

for fish, pork/beef, poultry and vegetables in the Education and

Control Groups

Table 3.14 Number (%) of women reported removing fat from meat and 65

removing skin from poultry in the Education and Control

Groups

Table 3.15 Number (%) of women reported reading the food labels with 66

different frequencies in the Education and Control Groups

Table 3.16 Number (%) of women reported different degrees of clarity of 66

the food labels in the Education and Control Groups

Table 3.17 Energy and nutrient intake data of the women in the Education 67

and Control Groups from the three-day dietary records

xiv

Page

Table 3.18 Number (%) of women exceeding the recommended percent 67

energy from total fat, SFA, PUFA and MUFA in the Education

and Control Groups

Table 3.19 Number (%) of women who met the recommended intake levels 68

of selected nutrients in the Education and Control Groups

Table 3.20 Number (%) of women who reported never/rarely consuming 69

specific dairy products in a typical week in the Education and

Control Groups

Table 3.21 Number (%) of women who reported consuming specific high 69

fat or unhealthy food two times or more in a typical week in the


Table 3.22 Mean Nutrition Knowledge Score 士 S.D and the number (%) of 70

women reported having heard of saturated fat or the food

pyramid, and who correctly matched all four food groups with

their corresponding level of the food pyramid in the Education

and Control Groups

Table 3.23 Responses to the ten additional nutrition knowledge questions 71

between the Education and Control Groups

Table 3.24 Mean 土 S.D. reported daily energy expenditure (kcal/day), 72

summary physical activity index and number of flights of steps

climbed up per day in the Education and Control Groups

Table 3.25 Mean time (mins) 土 S.D. spent per day spent on the top ten most 73

frequent physical activities reported by the women in the


Table 3.26 Mean Physical Activity Knowledge Score 土 S.D. and the 73

number (%) of women reported having heard of the physical

activity pyramid, and correctly matched all four physical activity

groups with their corresponding level of the physical activity

pyramid the Education and Control Groups

Table 3.27 Comparison between the number (%) of correct responses to the 75

nine additional physical activity knowledge questions between

the Education and Control Groups

XV

Page Table 3.28 The stages of change of behavior in the Education and Control 77

Groups

Table 3.29 Difficulties reportedly encountered preventing different 78

behavioral changes in the Education and Control Groups

Table 3.30 Methods suggested by the women in the Education and Control 79

Groups for facilitating different behavioral changes

Table 3.31 Topics about which the women would like to learn more in the 81


Table 3.32 Aspects of health the women would like to improve in the 82


Table 3.33 Comparison between physical measurement data, distributions 87

of BMI levels according to Asian definition, percent body fat

levels and fasting total blood cholesterol levels of women

between Pre- and Posttests in the Education and Control Groups

Table 3.34 Comparison between the number (%) of self-reported cases of 88

six health conditions between Pre- and Posttests in the


Table 3.35 Comparison between the self-rated health relative to that of 88

peers between Pre- and Posttests in the Education and Control

Groups

Table 3.36 Comparison between the mean number of days 士 S.D. per week 89

of having breakfast, lunch and dinner, and the mean number of

snacks 土 S.D per day between Pre- and Posttests in the


Table 3.37 Comparison between the number (%)of women who had 89

breakfast every day, skipped breakfast every day or had lunch

every day between Pre- and Posttests in the Education and

Control Groups

Table 3.38 The types of supplements taken in Pre- and Posttest in the 90


xvi

Page

Table 3.39 Comparison between the number (%) of women reported 91

removing fat from meat and removing skin from poultry



reading the food labels with different frequencies between Pre-

and Posttests in the Education and Control Groups

Table 3.41 Comparison between the distribution of the number (%) of 92

women citing different degrees of clarity of the food labels


Table 3.42 Comparison between the energy and nutrient intake data 93


Table 3.43 Comparison between the number (%) of women exceeding the 94

recommended percent energy from total fat, SFA, PUFA and

MUFA between Pre- and Posttests in the Education and Control

Groups

Table 3.44 Comparison between the number (%) of women who met the 94

recommended intake levels of selected nutrients between Pre-

and Posttests in the Education and Control Groups

Table 3.45 Comparison between the number (%) of women who reported 95

never/rarely consuming specific dairy products in a typical week


Table 3.46 Comparison between the mean Nutrition Knowledge Score 土 96

S.D. and the number (%) of women reported having heard of

saturated fat or the food pyramid, and who correctly matched all

four food groups with their corresponding level of the food

pyramid between Pre- and Posttests in the Education and

Control Groups


ten additional nutrition knowledge questions between Pre- and

Posttests in the Education and Control Groups

xvii

Page

Table 3.48 Comparison between the number (%) of women correctly 98

matched the specific food group in the food pyramid between

Pre- and Posttests in the Education and Control Groups

Table 3.49 Comparison between the mean 士 S.D. reported daily energy 99

expenditure (kcal/day), summary physical activity index and

number of flights of steps climbed up per day between Pre- and


Table 3.50 Comparison between the mean Physical Activity Knowledge 100

Score 士 S.D. and the number (%) of women reported having

heard of the physical activity pyramid, and correctly matched all

the physical activity groups with their corresponding level of the

physical activity pyramid between Pre- and Posttests in the






matched the specific physical activity group in the physical

activity pyramid between Pre- and Posttests in the Education

and Control Groups

Table 3.53 Comparison between the mean Nutrition and Physical Activity 104

Knowledge Scores 士 S.D.’ and the number (%) who had heard

of saturated fat, the food pyramid and the physical activity

pyramid of Education Group's women of different education

level between Pre- and Posttests


Knowledge Scores 士 S.D., and the number (%) who had heard


pyramid of Education Group's women of different age group

between Pre- and Posttests

Table 3.55 Comparison between the stages of change of behavior between 106


xviii

Page

Table 3.56 Comparison between the difficulties reportedly encountered 108

preventing different behavioral changes between Pre- and


Table 3.57 Comparison between the suggested methods for assisting 109

different behavioral changes between Pre- and Posttests in the


Table 3.58 Comparison between the interested topics which the women 111

would like to learn more between Pre- and Posttests in the


Table 3.59 Comparison between the aspects of health to improve between 112


Table 3.60 Reasons for participating the program (n=63) 114

Table 3.61 Reasons for attending (n=16)/not attending (n=47) all the 114

activities

Table 3.62 Ideas on the different aspects of the program (n=63) 114

Table 3.63 Information the women had told others (n=52) 115

Table 3.64 Reasons for not telling information to others (n= 11) 115

Table 3.65 Information the women had learnt from the program (n=63) 116

Table 3.66 Reasons for recommending others to join future health 116

promotion program (n=63)

Table 3.67 Improvements for the program (n=63) 116

Table 3.68 Behavioral changes after the program (n=63) 117

Table 3.69 Reasons for not changing behaviors (n=63) 117

Table 3.70 Comparison between physical measurement data, distributions 120

of BMI levels according to Asian definition, percent body fat

levels and fasting total blood cholesterol level levels of women

between Pretest, Posttest and Follow-up in the Education and

Control Groups

Table 3.71 Comparison between the self-rated health relative to that of 121

peers between Pretest, Posttest and Follow-up in the Education

and Control Groups

xix

Page

Table 3.72 Comparison between the mean number of days 土 S.D. per week 122

of having breakfast, lunch and dinner, and the mean number of

snacks 士 S.D. per day between Pretest, Posttest and Follow-up

in the Education and Control Groups

Table 3.73 Comparison between the number (%) of women who had 122

breakfast every day, skipped breakfast every day or had lunch

every day between Pretest, Posttest and Follow-up in the


Table 3.74 The types of supplements taken in Pretest, Posttest and Follow- 123

up in the Education and Control Groups

Table 3.75 Comparison between the number (%) of women in using the 123

following oils between Pretest, Posttest and Follow-up in the


Table 3.76 Comparison between the number (%) of women in using the 125

following cooking methods for fish, pork/beef, poultry and

vegetables between Pretest, Posttest and Follow-up in the



removing fat from meat and removing skin from poultry


Control Groups


reading the food labels with different frequencies between

Pretest，Posttest and Follow-up in the Education and Control

Groups

Table 3.79 Comparison between the distribution of the number (%) of 127

women citing different degrees of clarity of the food labels


Control Groups

Table 3.80 Comparison between the energy and nutrient intake data 128


Control Groups

XV

Page Table 3.81 Comparison between the number (%) of women exceeding the 129

recommended percent energy from total fat, SFA, PUFA and

MUFA between Pretest, Posttest and Follow-up in the Education

and Control Groups

Table 3.82 Comparison between the number (%) of women who met the 129

recommended intake levels of selected nutrients between

Pretest, Posttest and Follow-up in the Education and Control

Groups

Table 3.83 Comparison between the number (%) of women who reported 130

never/rarely consuming wheat bread and specific dairy products

in a typical week between Pretest, Posttest and Follow-up in the


Table 3.84 Comparison between the number (%) of women reported having 132

heard of saturated fat or the food pyramid, and who correctly

matched all four food groups with their corresponding level of

the food pyramid between Pretest, Posttest and Follow-up in the



ten additional nutrition knowledge questions between Pretest,

Posttest and Follow-up in the Education Group


ten additional nutrition knowledge questions between Pretest,

Posttest and Follow-up in the Control Group


matched the specific food group in the food pyramid between


Groups

Table 3.88 Comparison between the mean 土 S.D. reported daily energy 136

expenditure (kcal/day), summary physical activity index and

number of flights of steps climbed up per day between Pretest,


xxi

Page Table 3.89 Comparison between the number (%) of women reported having 137

heard of the physical activity pyramid, and correctly matched all

the physical activity groups with the corresponding level of the

physical activity pyramid between Pretest, Posttest and Follow-




Pretest, Posttest and Follow-up in the Education Group



Pretest, Posttest and Follow-up in the Control Group


matched the specific physical activity group in the physical

activity pyramid between Pretest, Posttest and Follow-up in the


Table 3.93 Comparison between the stages of change of behavior between 141


Groups


Knowledge Scores 土 S.D., and the number (%) who had heard


pyramid of Education Group's women of different education

level between Pretest, Posttest and Follow-up


Knowledge Scores 土 S.D.，and the number (%) who had heard


pyramid of Education Group's women of different age group

between Pretest, Posttest and Follow-up

Table 3.96 Comparison between the difficulties reportedly encountered 145

preventing different behavioral changes between Pretest,


xxii

Page Table 3.97 Comparison between the suggested methods for assisting 146

different behavioral changes between Pretest, Posttest and

Follow-up in the Education and Control Groups

Table 3.98 Comparison between the interested topics which the women 148

would like to learn more between Pretest, Posttest and Follow-


Table 3.99 Comparison between the aspects of health to improve between 149


Groups

Table 4.1 Comparison of the mean intake of the women in the present 159

study and the Hong Kong Adult Dietary Survey 1995

xxiii

List of Abbreviations

BMI Body mass index

CHD Coronary heart disease

MUFA Monounsaturated fatty acid

N/A Not applicable

N/S Non-significant

PUFA Polyunsaturated fatty acid

SD Standard deviation

SFA Saturated fatty acid

WHO World Health Organization

WHR Waist-to-hip-ratio

\

xxiv

CHAPTER ONE: INTRODUCTION

1.1 Women's Overweight and Obesity Prevalence and Trends

Unhealthy lifestyles, which include unbalanced diets composed of high fat,

cholesterol and protein but low in fibre, together with low levels of physical activity,

contribute to undesirable health outcomes, with overweight and the disease of

obesity common outcomes. Other chronic diseases such as certain kinds of cancers

(colon, breast etc), diabetes mellitus, hypertension, stroke, dyslipidemia, coronary

heart disease and osteoporosis may also result.

Overweight and obesity are increasingly common global health problems. Between

1985 and 1990, the prevalence of overweight in Canada increased from 19% to 27%

in men and 14% to 18% in women aged 18 years and over (Macdonald et al., 1997).

A US national survey showed that in 1988 to 1991, 33% of adults aged 20 years or

above were overweight, which had increased from 25% in 1976 to 1980 (Kuczmarski

etal., 1994).

The obesity prevalence in women has been shown to be higher than that for men in

some other countries, along with an increase in its prevalence for both genders in

recent years, as appear in the WHO'S statistics shown in Table 1.1.

• 1

Table 1.1 The secular trends of obesity by gender in selected countries Country Year Age (years) Men (%) Women (%)

Brazil 1975 25-64 3 8 1989 6 13

China 1989 20-45 0.3 0.9 1991 0.4 0.8 1992 1 2

East Germany 1989 25-65 13 21 1992 21 27

England 1980 16-64 6 8 1986/7 7 12 1991/2 13 15 1995 15 17

Japan 1982 >20 1 3 1987 1 3 1993 2 3

United States 1973 20-74 12 16 1978 12 15 1991 20 25

Source: [WHO, 1998]

1.2 Etiology of Overweight and Obesity

Obesity is a multi-factorial disease caused by the interaction of genetic, metabolic

and environmental factors. Bouchard et al found from a study of 1,698 members

from 409 families that biological inheritance accounted for only five percent of the

variance for subcutaneous fat and BMI, and 20 to 30 percent for the percent body fat,

fat mass, fat-free mass, and fat distribution. These results suggest that nongenetic

influences are important in determining the amount and distribution of body fat in the

population (Bouchard et al., 1988).

Metabolic factors also play a role in obesity. Total energy expenditure includes

resting energy expenditure (REE), thermogenesis of food and energy expended from

physical activity. Weinsier et al reviewed numerous studies and found that REE

had a small impact on body weight although it represents about 60% of daily energy

expenditure. According to his pair-matched study of 48 Caucasian females aged

49-67 years, 24 postmenopausal and moderately obese women were compared with

• 2

24 never-obese women of comparable age and body composition. There was no

significant difference between the obese and control women in REE after adjusting

for fat mass and fat free mass (Weinsier et al., 1995). Similar findings have been

seen in children. Goran et al demonstrated that the initial REE level did not predict

changes in fat mass in 75 children followed up annually for four years (Goran et al.,

1998).

Dietary intake and physical activity, the environmental factors, have been widely

studied to elucidate their associations with body weight. Samaras et al studied 436

healthy female twins of mean age 58 years and found that there was no relationship

between dietary fat and body fat in these women, controlled for genetic and

environmental factors (Samaras et al, 1998).

In contrast, studies have shown that physical activity has a vital role in the

development of obesity. Martinez-Gonzalez et al studied 15,239 men and women

aged 15 years or above in 15 member states of the European Union. They found

that the adjusted prevalence odds ratio for obesity was 0.52 (P<0.001) for people in

the upper quintile of physical activity, defined as greater than 30 metabolic

equivalents (METS), compared with people in the most physically inactive quintile

(<1.75 METS). Therefore, they concluded, obesity and higher body weight are

strongly associated with a sedentary lifestyle and lack of physical activity in the adult

population (Martinez-Gonzalez et al., 1999).

In summary, there is no single factor that leads to overweight or obesity. To prevent

overweight and obesity, modifiable factors, including diet and physical activity

should be the focus. Although research has shown that dietary factors had a

3

relatively lower effect than physical activity on the development of obesity, a

combination of healthy diet and active lifestyle are of no doubt the key means to

achieve and maintain a healthy weight, and prevent weight gain. The maintenance

of a healthy weight is essential because obesity may lead to other chronic diseases.

1.3 Health Consequences of Obesity in Women

Obesity, a disease itself, is associated with or else is a risk factor for many other

diseases such as coronary heart disease, diabetes mellitus, hypertension, stroke, some

forms of cancer and sleep apnea. Many studies have demonstrated the association

of obesity with these chronic diseases in women. A US cohort study which

included 82,473 female nurses aged 30-55 years with follow-up every two years

since 1976 showed that an increase in BMI of 1 kg/m2 in mid-life was associated

with a 12% increase in risk for hypertension, while an increase in BMI of 1 kg/m2 at

age 18 years was associated with an eight percent increase in risk. A 1-kg increase

in weight was associated with a five percent increase in risk (Huang et al., 1998).

BMI is not only associated with hypertension in women, but also with colon cancer

and breast cancer. Excess body weight is a risk factor for colon cancer as shown by

a US survey that included 7,914 women aged 25 years or over. Using BMI <22

kg/m2 as reference, the hazard ratios were 2.03, 2.17, 2.49, 3.64 and 2.74 for BMI

22-<24, 24-<26, 26-<28, 28-<30 and >30 kg/m2 respectively (Ford, 1999).

BMI was also found to be directly associated with breast cancer in postmenopausal

women, as shown by an Italian case-control study of 5,157 females at age 20-74

years in 1991-1994. The attributable risk for breast cancer (in this case, the

percentage of breast cancer cases attributable to overweight) in the postmenopausal

• 4

women was 10.2% for overweight (BMI>26.6 kg/m2) (Mezzetti et al., 1998).

Women with a higher BMI were also found to be at higher risk of stroke, diabetes

and arthritis. A health study of 116,759 US nurses aged 30-55 years in 1976 with

16 years follow-up found that women with a BMI >27 kg/m2 in mid-life were 1.7

times more likely to suffer ischemic stroke, while those with a BMI >32 kg/m2 were

2 times more likely than women with BMI <21 kg/m2. Women who gained 11.0-

19.9 kg were 1.7 times more likely to suffer ischemic stroke, while those who gained

20 kg or more were 2.5 times more likely than women who maintained a stable

weight at age 18 years (Rexrode et al, 1997). The same study also reported that

among the women with BMI >29 kg/m2, 70% of the CHD cases (including nonfatal

myocardial infarction and fatal coronary heart diseases) were due to obesity.

Overall 40% of the CHD cases were attributable to obesity (Manson et al., 1990).

In addition, an Italian national survey in 1983 involving 37,497 women aged >15

years showed that the age-adjusted relative risk of diabetes was 1.6 and 2.4 for

overweight (BMI 25-29.9 kg/m2) and obese (BMI >30 kg/m2) women respectively

(Negri et al” 1988).

With regard to a US study among 3,617 women done by Sahyoun et al, women with

BMI>29.0 kg/m2 and 25.0-28.9 kg/m2 had a relative risk of 1.44 and 1.14

respectively of developing arthritis compared with those with BMI 19.0-21.9 kg/m2.

These results showed that BMI was significantly associated with arthritis

susceptibility (Sahyoun et al., 1999).

Diverse negative effects of obesity or overweight in women, therefore, have been

demonstrated from many studies. This implies obesity and overweight are serious

5

problems with grave consequences requiring substantial attention and efforts to

decrease this burden.

1.4 Dietary and Physical Activity Recommendations for Good Health for

Adults

The American Heart Association (AHA) has recently published updated healthy

dietary guidelines for adults (American Heart Association, 2000). These ten

guidelines, when followed, may help their adherents improve heart rate, and also,

reduce the chance of getting diabetes, osteoporosis and certain kinds of cancers.

The dietary guidelines are as follow:

1) Eat a variety of fruit and vegetables. Choose five or more servings per day.

2) Eat a variety of grain products, including whole grains. Choose six or more

servings per day.

3) Include fat-free and low-fat milk products, fish, legumes (beans), skinless poultry

and lean meats.

4) Choose fats with two grams or less saturated fat per serving, such as liquid and tub

margarine, canola oil and olive oil.

5) Balance the calories that you eat with the calories that you use each day.

6) Maintain a level of physical activity that keeps you fit and matches the calories

you eat. Walk or do other activities for at least 30 minutes on most days. To

lose weight, do enough activity to use up more calories than you eat every day.

7) Limit your intake of foods high in calories or low in nutrition, including foods like

soft drinks and candy that have a lot of sugars.

8) Limit foods high in saturated fat, trans fat and/or cholesterol, such as full-fat milk

products, fatty meats, tropical oil, partially hydrogenated vegetable oils and egg

yolks.

• 6

9) Eat less than six grams (2,400 mg of sodium) of salt per day.

10) Have no more than one alcoholic drink per day if you are a woman and no more

than two if you are a man.

A public health recommendation on the types and amounts of physical activity

needed for health promotion and disease prevention was issued by the Centers for

Disease Control and Prevention and the American College of Sports Medicine (Curry

et al., 1992). The expert panel suggested that adults, both men and women, should

accumulate 30 minutes or more of moderate-intensity physical activity on most,

preferably all, days of the week. The recommended 30 minutes of activity can be

accumulated in short bouts of activity, for example, walking up the stairs instead of

taking the elevator, walking instead of driving short distances, doing calisthenics, or

pedaling a stationary cycle while watching television. Gardening, housework,

raking leaves, dancing, and playing actively with children can also contribute to the

30-minute-per-day total if performed at an intensity corresponding to brisk walking.

Those who perform lower-intensity activities should do them more often, for longer

periods of time, or both.

Additionally, the panel advises that people may also choose to walk or participate in

more vigorous activities, such as jogging, swimming, or cycling for 30 minutes daily.

Sports and recreational activities such as tennis can also be chosen. Those who do

not engage in regular physical activity should begin by incorporating a few minutes

of increased activity into their daily lives, building up gradually to 30 minutes per

day. Whereas those who are active on an irregular basis should adopt a more

consistent activity pattern.

• 7

1.5 Health Behavior Change Theories

Health behavior theories and models were developed to predict behavior change and

maintenance, and also assist the design and evaluation of health promotion

interventions. Although these theories are numerous, three of the most commonly

applied models are the (1) Health Belief Model, (2) Transtheoretical Model, and (3)

Social Marketing. The Health Belief Model (HBM) was developed by a group of

social psychologists in the US Public Health Service in the 1950s (Rosenstock, 1974).

The HBM was initially used to understand the widespread failure of people to accept

disease preventives or screening tests for the early detection of asymptomatic

disease.

The HBM consisted of several components: perceived susceptibility (one's opinion

of chances of getting a condition), perceived severity (one's opinion of how serious a

condition and its sequelae are), perceived benefits (one's opinion of the efficacy of

the advised action to reduce risk or seriousness of impact), perceived barriers (one's

opinion of the tangible and psychological costs of the advised action), cues to action

(strategies to activate one's readiness) and self-efficacy (one's confidence in one's

ability to take action) (Shumaker et al., 1998).

The Transtheoretical Model uses stages of change to integrate processes and

principles of change from across major theories of intervention, hence the name

'Transtheoretical'. One of the constructs is the stages of change, which represents

behavior change as a process, consisted of five stages. Precontemplation is the

stage in which people have no intention to take action. Contemplation is the stage

in which people are considering taking action, but they have no confidence to do it.

Preparation is the stage in which people intend to take action, and they have the

• 8

confidence to prepare to do it. Action is the stage in which people have changed a

specific behavior for less than six months. Maintenance is the stage in which

people have changed a specific behavior for six months or more (Shumaker et al.,

1998).

Social marketing is defined by Andreasen as the application of commercial

marketing technologies to the analysis, planning, execution, and evaluation of

programs designed to influence the voluntary behavior of target audiences in order to

improve their personal welfare and that of their society. The marketing process

includes six sequential stages, summarized in a 'social marketing wheel' (Figure 1.1)，

as a framework for health communication programs (Glanz et al., 1996).

2) Selecting channels

1) Planning and 3) Developing materials

strategy and pretesting

Y

6) Feedback to refine 4) Implementation

program

X , . . / ^ \ 5) Assessing effectiveness ^

Figure 1.1 A social marketing wheel

Source: [Glanz et al, 1996]

• 9

1.6 Weight Control/Loss Interventions for Women

As the consequences of obesity are well established, many weight

reduction/maintenance programs have been carried out to tackle this problem.

Three methods, which differ in their emphasis, are commonly used: (1) diet therapy,

(2) exercise and (3) a combination of diet and exercise. These three methods more

or less employ techniques of behavioral modification.

Studies have demonstrated the benefits of fat restriction in addition to or instead of

energy restriction alone. One US behavioral weight loss program for 44 obese

females with non-insulin dependent diabetes mellitus (NIDDM) and 46 obese

females with a family history of diabetes, focusing on reducing calories and dietary

fat, produced significantly greater weight loss in women with NIDDM than a

program focusing on calorie restriction alone (7.7 kg Vs 4.6 kg). The former group

maintained a significantly larger amount of weight loss (5.2 kg Vs 1.0 kg) at one year

than the latter group (Pascale et al., 1995).

Another study in Denmark also showed low-fat eating is essential to weight loss.

Two obese males and 41 obese females with BMI 27-40 kg/m2 in Danish nutrition

clinics participated in a weight loss program. Results showed that for maintenance

of weight loss, the ad lib low-fat, high carbohydrate program was superior to the one

with fixed energy intake. After two years of the intervention, 65% of the ad lib

group and 40% of the fixed energy group maintained a weight loss of more than 5 kg

(Toubro & Astrup, 1997).

Sometimes, the weight lost by either method mentioned above is due to loss of lean

body mass. However, fat mass is the target of weight loss, and one program

• 10

demonstrated a way to preserve fat free mass during weight loss. Forty-four

overweight women, aged 20-49 years, maintained their fat free mass with a loss of

body mass by 3.7 to 5.4 kg after they had participated in a weight loss program with

a moderate diet and exercise intervention (a low fat diet with mean daily calorie

intake of 1236.75±67.21kcal and exercise time 3 days per week with each session of

30 minutes) (Marks et al., 1995).

As described above, a variety of methods are used to lose weight. However, the

effectiveness of the programs depends on long term maintenance of weight without

weight regain, and this is usually the most difficult task for overweight or obese

people. Therefore, some health promotion programs have been targeted to healthy

people, as it is always true that prevention is better than cure.

1.7 Weight Loss Risks

As has been described above, some studies showed that lost weight was regained

after a short period of time. In fact, Berg found that unsafe or unsupervised weight

loss can be harmful to health for several reasons: (1) Very-low-calorie-diets may

cause emotional disturbances and eating disorders. (2) Diet pills and drugs may be

dangerous and have exaggerated claims, and people may also abuse them. (3)

Weight cycling is associated with mortality from CHD because the weight regained

is usually in the form of abdominal fat. (4) Weight loss is associated with

demineralization of bones which may bring out osteoporosis. Therefore, losing

weight may not always improve health, and more attention should be paid to how

weight is lost and maintained (Berg, 1995).

• 11

1.8 Health Promotion Programs for Women

Various health promotion programs conducted in community and work-site

populations produced beneficial effects among the participants. Strategies used in

health promotion programs are similar to those of weight loss programs. Promotion

of healthy eating, regular physical activity and a combination of these are the most

popular, as studies have shown that diet and exercise influence various health

parameters. Therefore, healthful behaviors with respect to diet and exercise are

essential to good health.

The composition of diet plays a crucial role in health. Low fat, low cholesterol and

high fibre diets have been shown to be healthful. This is consistent with the

findings from a meta-analysis of 395 ward experiments. The study found that

isocaloric replacement of saturated fat (equal to 10% of the total calories) by

complex carbohydrates was associated with a decrease of 0.52 mmol/L total blood

cholesterol. In addition, isocaloric replacement of carbohydrates (equal to 5% of

the total calories) by polyunsaturated fat can further decrease blood cholesterol by

0.13 mmol/L. If dietary cholesterol was reduced to 200 mg, a further decrease of

0.13 mmol/L blood cholesterol occurred (Clarke et al., 1997). In contrast, a case

control study in India, with 86 hypertensives and 79 controls aged between 30-50

years indicated that high intakes of protein and salt were risk factors for hypertension

among women (Vijayalakshmi et al, 1999).

Besides healthy eating, regular physical activity has also been proven to be healthful.

A US population-based case-control study found that long term leisure time vigorous

activity was associated with lower colon cancer risk, with the odds ratios of a high

level of activity ( >1000 calories expended per week) to a low level (1-250 calories

• 12

per week) in men and women being 0.61 and 0.63 respectively (Slattery et al., 1997).

Walking has also been found to be of benefit to women. A US cohort study of

39,372 healthy female health professionals aged 45 years or above showed that

walking was associated with lower coronary heart disease (CHD) rates. Using

those who did not walk regularly as the reference, women who walked 1-59 mins,

1.0-1.5 hours, and 2 or more hours per week, had a relative risk of 0.86, 0.49 and

0.48, respectively, adjusted for potential confounders (Lee et al., 2001).

Physical activity is also associated with higher bone density. In the US, a study of

1,703 people aged 50 years or above showed that people with strenuous exercise like

jogging and squash for at least 15 minutes per session have hip bone density 6.5%

higher than those with mild (easy walking)/less than mild exercise of the same

duration. However, the study found no association between exercise and

osteoporotic fracture (Greendale et al, 1995).

As dietary fat intake influences health, several interventions involving a reduction of

percent dietary energy from fat have shown success and should be noted. For

example, a 2-year low-fat dietary intervention for 2,208 US women aged 50-79 years

of whom 28% were Black and 16% were Hispanic successfully reduced fat intake in

the intervention group from 40% of total energy to 26% after 6 months, as measured

by a food frequency questionnaire. The effect could be maintained at a 9%

reduction of percent energy from fat at 12 months and 18 months (Coates et al.,

1999).

Another program aimed at lowering fat intake was conducted in North Carolina.

• 13

This was a computer-based intervention for 378 low income women aged 18 years or

above. Results showed that the women significantly improved their nutrition

knowledge, stage of change and certain eating behaviors such as 'baked meat in

oven' and 'ate graham crackers or pretzels as snacks' (Campbell et al., 1999).

In addition to promoting lower fat intakes, increasing vegetable and fruit intake is

another goal. A health promotion intervention was organized in Maryland among

3,122 low-income women of age 18 years or above. The intervention group had

successfully increased their mean daily consumption of fruits and vegetables by 0.6土

0.1 servings, with an additional increase of 0.3± 0.1 servings after a year (Havas et

al., 1998).

Another important element of healthy lifestyle is regular physical activity. Health

promotion programs for women targeting regular physical activity have also been

shown to be successful. A weight-bearing exercise program in Australia for 19

postmenopausal women of mean age 66 years found that weight-bearing aerobic

exercise has a protective effect on lumbar and trochanteric bone mineral density

(Caplaner al., 1993).

A US lifestyle intervention also demonstrated the effect of exercise on bone density.

This program, designed for 236 premenopausal healthy women aged 44-50 years in

the US, emphasized lowering fat intake and increasing physical activity. It found

that women who increased their energy expenditure by more than 4180 kJ/wk can

reduce the rate of bone mineral density loss in their spine (Salamone et aL, 1999).

Various types of health promotion programs have been carried out among women.

• 14

The above programs illustrated that women would change their behaviors after being

given appropriate health information and skills to achieve a healthier lifestyle.

1.9 General Situation and Population Trends Among Hong Kong Middle-aged

Women

Statistics show that Hong Kong's population is an expanding but aging one. The

population is estimated to increase from 6,292,000 in mid-1996 to 8,205,900 in mid-

2016, while the percentage of the population aged 65 years or above will increase

from 10% to 13% at the same time (Census & Statistics Department, 1997). The

expected life at birth of males is expected to increase from 74.4 in 1988 to 78.1 in

2016, while that of females is expected to increase from 79.9 to 83.4 in the same

period (Census & Statistics Department, 1997) (Census & Statistics Department,

1998).

Although Hong Kong has experienced positive economic growth as its per capita

Gross Domestic Product (GDP) increased from HK$134,357 in 1992 to HK$ 192,290

in 1998 (Census & Statistics Department, 1998), health problems are still a

significantly large burden to the society. For instance, the number of

Comprehensive Social Security Assistance (CSSA) cases with ill health maintained

at a steady proportion of about 11% of total cases from '91/92 to ‘97/98 (Census &

Statistics Department, 1998). Total expenditures on medical and health services

increased from $4,520,000 in ‘87/88 to $24,122,000 in '96/97 (Census & Statistics

Department，1998).

In addition, health problems usually accompany aging and become more serious at

the same time. It is estimated that 25.9% of the elderly aged 70 years or over will

• 15

have hypertension in 2001, while prevalence rates of cardiac disease, bone fracture

and diabetes mellitus are estimated to be 14.3%, 12.0% and 7.9% respectively (Woo

et al., 1997). Several of these diseases are associated with obesity, a chronic

disease itself, and a forerunner to many others. Therefore, primary prevention of

obesity is the best way to reduce the prevalence of all these diseases.

From the Hong Kong population pyramid in mid-97, females aged 30-34 years and

35-39 years occupied the two highest proportions among all the females (Census &

Statistics Department, 1997). The estimated mid-year population of females aged

30-44 years increased from 638,900 in 1988 to 966,600 in 1997 (Census & Statistics

Department, 1998). To view with in a long-term perspective, a large number of

elderly females will be the outcome several decades later.

1.10 Nutrition-related Morbidity and Mortality Among Hong Kong Women

Overweight or obesity，common health problems in many developed countries, have

also emerged in Hong Kong, not only among the younger generation, but also among

adults, particularly the women. Other countries' health sectors, notably the US,

Canada and Britain, have health promotion and disease prevention programs,

objectives and guidelines in place to grapple with obesity. But in Hong Kong, such

efforts are minimal. Nutrition surveys and interventions in Hong Kong are not

unheard of among children, adolescents or the elderly. But usually, adults are an

almost neglected group as they are assumed to be a group with relatively few health

problems. In fact, adults also require adequate health knowledge and skills because

they make up the majority of the population and are also the major working group of

the society. They will face many years of life ahead which should be lived more

productively and without suffering preventable morbidity.

• 16

Table 1.2 presents prevalence of causes of mortality among three age groups of Hong

Kong women in 1997 (Hostpital Authority of Hong Kong, 1998). It shows that

cancer remains the top killer among Hong Kong females irrespective of their age.

Heart disease becomes the second highest killer in the middle and old ages, while

diabetes remains at the same rank in all age groups. Concern about the increasing

proportion of deaths from heart disease and diabetes is necessary because most of

these cases are preventable. Much of the cancer may also be preventable.

Table 1.2 The leading causes of death by age group among Hong Kong females in 1997 (%)

Age Group (years) Rank 15-44 45-64 >64 " 1 ~ C a n c e r (43) Cancer (53) Cancer (24)

2 Injury and Poisoning (30) Heart disease (11) Heart disease (18) 3 Pneumonia (4) Cerebrovascular disease (9) Pneumonia (17) 4 Heart disease (4) Injury and Poisoning (7) Cerebrovascular disease (13) 5 Cerebrovascular disease (3) Pneumonia (4) Nephritis, Nephrotic

syndrome and Nephrosis (4) 8 Diabetes Mellitus (0.4) Diabetes Mellitus (1) Diabetes Mellitus (2)

Source: [Hospital Authority Statistical Report, 97/98]

The Cardiovascular Risk Factor Prevalence Study conducted in 1995-1996 with

2,876 adults aged 25-64 years showed that there was a general increasing percentage

of women classified as overweight from the ages 35-39 years to 70-74 years, when

using an earlier Asian definition (overweight as BMI=23.6-30.0 kg/m2 and obesity as

BMI >30.0 kg/m2). The prevalence of obesity as shown in Figure 1.2 at the older

ages is more than double that of the younger ages (Janus, 1997).

• 17

45 40 7 , � � - 乂 z \ \ 3 5 \ \ - 一 ^

^ 3 0 7 —

W / 昏 25 — 7 ^ overweight -g 20 z ^ 1 - - _ - obesity _ » -v ,•‘ - t^ _ _

^ 1 S 7Z

^ 10 Z z ——

5 … Q 1 1 1 1 1 I I I I

2 5 - 2 9 3 0 - 3 4 3 5 - 3 9 4 0 - 4 4 4 5 - 4 9 5 0 - 5 4 5 5 - 5 9 6 0 - 6 4 6 5 - 6 9 7 0 - 7 4

Age group (years)

Figure 1，2 Percentages of Hong Kong females in specific age groups classified as

overweight and obese according to an Asian definition (overweight as BMI=23.6-

30.0 kg/m2 and obesity as BMI >30.0 kg/m2)

Source: [Janus, 1997].

That study also revealed that the proportions of people with blood cholesterol > 5.2

mmol/L and > 6.2 mmol/L in women were both lower than the rates for men at early

ages, but, as in other populations studied, this is reversed at later ages. The

proportions increased dramatically from young women to mid-life and then dropped

a little among the oldest women studied, as is shown in Figure 1.3.

• 18

80 n

70 — m a l e • - . , .——

一 60 一 female 一

邕 50 � 7 Z s ^ z y “‘ >5.2mmol/L & 40 z — r^ 扫 / y , . V S 30 T z . - •• / I 20 Z .. ^ ^ Z — — Ph “ — “ /

• • 一 •- 〜〜 —一〜、〜 ‘ 1 n * ^ . Z Z - , -……..… • • - � . � . . . . ...••••-••••

1VJ • _ -

0 _ ； " " ' , >6.2mmol/L

25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

Age group (years)

Figure 1，3 Proportion of Hong Kong males and females with blood cholesterol >5.2

mmol/L and >6.2 mmol/L

Source: [Janus, 1997].

Compared with the Cardiovascular Risk Factor Prevalence Study, even larger

proportions of Hong Kong adults (aged >20 years) were found to have blood total

cholesterol levels higher than ideal in a lipid screening survey conducted in 1991，but

that survey was not population-based. Thirty-two percent of females had a total

cholesterol concentration between 5.2 and 6.2 mmol/L. Twenty-one percent of

females (n=407) had a total cholesterol concentration >6.2 mmol/L (Fong et al.,

1994).

It was shown in 1990 that aging and obesity are the major determinants of metabolic

syndrome (the clustering of hyperglycemia, hypertension, hypertriglyceridemia and

hyperinsulinemia) in 1,513 Hong Kong Chinese aged 30-65 years (Chan et al., 1996).

Therefore, the prevention of obesity is one of the primary strategies for preventing

other chronic diseases and should be the focus of health promotion programs among

Hong Kong adults.

• 19

The Cardiovascular Risk Factor Prevalence Study gives a more detailed description

of diabetes. It found that diabetes prevalence in females aged 35-44 years was 3%,

but it jumped to 29% in those aged 65-74 years. In addition, Impaired Glucose

Tolerance prevalence increased from 14% to 26% in the same age groups (Janus,

1997).

The age-adjusted incidence of hip fracture in Hong Kong women is increasing and is

also associated with age. Below the age of 60 years, there was not much change in

the incidence rate from 1966 to 1991. But above the age of 60 years, there was a

general increasing trend, particularly for the women above age of 70 years, as is

indicated in Table 1.3. Relative risk for hip fractures was significantly decreased

among women who performed walking outdoors, upstairs, uphill or with a load daily,

compared with those who performed these activities less than once a day (Lau,

1995).

Table 1.3 Age-specific hip fracture incidence rates in Hong Kong women per

100,000 population in 1966, 1985 and 1991 Rates (per 100,000 population)

Age Group (years) 1966 1985 1991 40-49 7 11 6 50-59 22 32 26 60-69 54 135 122 70-79 173 501 581 ^80 716 1521 1916

Adapted from [Lau, 1995]

1.11 Diet Composition of Hong Kong Middle-aged Women

From the Cardiovascular Risk Factor Prevalence Study, the proportions of females

aged 25 to 64 years having a diet comprising less than 30% fat, less than 10%

saturated fat as total energy and less than 300 mg cholesterol were only 60%, 86%

and 64% respectively (Janus, 1997). More than one-third of the females studied

• 20

had fat and cholesterol intakes higher than the recommended levels. Moreover, the

mean intakes of fat, saturated fat, cholesterol and percent energy from fat decreased

with increasing age in the women, showing that the need to promote healthy low-fat

eating among Hong Kong women should be started at an early ages.

1.12 Physical Activity Patterns of Hong Kong Middle-aged Women

A Women's Health Survey conducted in 1992 among 1,183 females aged 15-60

years revealed that only about 35% of the middle-aged (30-49 years) women had

physical activity at least once per week, and half of them had performed physical

activity only less than once in six months (The Family Planning Association of Hong

Kong, 1993). Within these age groups, half of them preferred moving or stretching

exercises, walking, morning walking or mountain hiking as their physical activities.

About one third of the middle-aged women who had performed physical activity at

least once in three months (38% in 30-39 years, 32% in 40-49 years) only performed

the activities for a duration of 15 minutes or less for each session.

With reference to the marital status of all respondents in that study, half of the

married women had performed physical activity less than once in six months, and

only 37% did it at least one per week. Among single women, only 23% had

performed physical activity less than once in six months, and 52% had performed

physical activity at least one per week. Married women preferred moving or

stretching exercises and walking, morning walking or mountain hiking while single

females preferred badminton, squash, tennis or swimming. However, 32% of the

married and 19% of the single females performed the activities for a duration of only

15 minutes or less for each physical activity session.

• 21

Similar findings have been revealed in other studies. Among those studied in the

Cardiovascular Risk Factor Prevalence Study, more than half of the middle-aged (30-

44 years) female respondents indicated they had had no exercise within the last

month (Janus, 1997).

In another study of 887 adults aged 18-60 years, among those respondents reporting

participating in any form of physical activity, females had a generally higher

frequency of participation than males (Table 1.4) (Fu et al., 1998). Older women

had a higher frequency of participation than the younger women, as is shown by the

figures that 43% females aged 31-40 years had physical activity with a frequency

less than once per week, with the proportion decreasing to 3% in women aged 51-60

years.

Table 1.4 Physical activity frequency of male and female participants by age group Age-gender group

18-30 years 31-40 years 41-50 years 51-60 years M F M F M F M F

Physical activity ~ % % % % % % % frequency

< 1 per month 27 35 21 22 10 10 10 0 2-3 per month 27 25 27 21 25 15 15 3 Once per week 27 15 28 31 25 22 27 10 2-3 per week 16 15 10 21 25 32 22 46 > 3 per week 4 10 13 6 15 32 27 42

Source: [Fu et al, 1998]

The above findings indicate that a certain proportion of Hong Kong middle-aged

women are extremely inactive, and the physical activity frequency among them is far

below the recommended level (30 minutes moderate-intensity activity on most,

preferably all, days of the week) even for those regularly participating in exercise.

• 22

1.13 Education and Health in Hong Kong Middle-aged Women

Almost one-third (31%) of Hong Kong females aged 30-34 years have attained an

education level only up to lower secondary education. This proportion rises to 49%

and 63% in age groups 35-39 years and 40-44 years respectively (Census & Statistics

Department, 1996).

As in other health surveys revealing associations between higher education and better

health, evidence if this relationship is also appearing among Hong Kong adults.

The data from the Cardiovascular Risk Factor Prevalence Study showed that a higher

educational level is associated with a healthier diet (P<0.01) and lower prevalence of

overweight (/^0.001) in Hong Kong women (Woo et al., 1999). An earlier smaller

telephone interview survey found that education level was positively associated with

nutrition knowledge (尸<0.001) (Ko et al., 1995).

In the Cardiovascular Risk Factor Prevalence Study, women but not men with higher

education levels also had a lower mean BMI and WHR, as shown in Table 1.5.

Women with higher education levels also had higher fruit consumption per week.

Single women had lower consumption of vegetables and fish per week, and had a

lower BMI. Therefore, about half of the Hong Kong middle-aged women, those

with lower educational levels, may have less nutrition knowledge and a higher BMI

and WHR, if these results can be generalized to the entire women's population.

• 23

Table 1.5 Education level of Hong Kong adults and their BMI & WHR Tertiary Secondary Primary Total

~ M F M F M F M F (n=79) (n=55) (n-311) (n=244) (n=110) (n二210) (n-500) (n=509)

BMI 24.3±2.8 22.0士2.9 24.3±3.3 23.1±3.4 24.4±3.7 25.6±4.1 24.3±3.324.0±3.9*** (kg/m2)

WHR 0,87±0.06 0.76±0.07 0.89土0.23 0.78±0.07 0.91±0.08 0.84±0.08 0.89±0.19 0.81i0.08***

***P<0.001 Source: [Woo etal, 1999]

1.14 Attitudes Toward and Beliefs About Diet and Health of Hong Kong

Middle-aged Women

The Women's Health Survey conducted in 1992 among 1,183 females aged 15-60

years found that 25% of women aged 30-39 years and 24% of those aged 40-49 years

said they paid no attention to diet (The Family Planning Association of Hong Kong,

1993). Additionally in that survey it was found that married females paid more

attention to diet than single females, with 75% of married women reporting that they

paid some or a lot of/much attention to diet, compared with only 65% of single

respondents. When asked 'Do you usually pay attention to your physical health?',

13% of women aged 30-39 years and 7% of those aged 40-49 years said they paid no

attention to physical health. Again, married females paid more attention to physical

health than single females. Thirty percent of the married females responded that

they paid much attention, compared with only 17% of the single women.

Proportions of females reporting paying attention to diet were much lower than those

reporting paying attention to physical health, suggesting that there is a general

interest in physical health among Hong Kong females. Additionally, in The Hong

Kong Adult Dietary Survey 1995, more than half (54%) of the females of ages 25-64

years reported they eat almost everything, showing that they paid little concern for a

healthy diet (Leung et al, 1997).

• 24

These findings showed that about one-third of the middle-aged females paid no

attention to diet. These women apparently have a very low awareness of the

benefits of adopting a healthy eating habit.

1.15 Common Weight Loss Methods Among Hong Kong Middle-aged Women

Nearly half of the women (46% in the age 30-39 years and 43% in the age 40-49

years) in the women's health survey reported using dieting as the way to achieve

ideal weight. Single women more commonly than married women were using

dieting (55% Vs 43%) and exercise (40% Vs 34%) as the ways to achieve ideal

weight (The Family Planning Association of Hong Kong, 1993).

The Hong Kong Adult Dietary Survey 1995 also revealed that 20% of females of

ages 25-64 years, had tried weight reduction diet occasionally in the past, showing

there is an interest in dieting among the females (Leung et al., 1997). However, as

already mentioned, dieting alone is not the best way to lose weight, because dieting

without supervision may be risky as it can cause nutrient deficiency, weakness and

eating disorders. Women, therefore, should acquire proper knowledge about

reasons, appropriate methods and consequences of weight loss.

1.16 Sources of Health Information Among Hong Kong Middle-aged Women

Table 1.6 shows that the three most popular sources of middle-aged women's health

information are TV/radio, newspapers/magazines and friends (The Family Planning

Association of Hong Kong, 1993). However, not all the messages delivered

through these channels are scientific and accurate, and some claims maybe

exaggerated or questionable. It is therefore necessary to have additional sources,

such as an organized program directed by health professionals to bring out

• 25

interesting, useful and correct and sound information and skills to women as well as

motivate them to apply the information and change their health behavior toward a

healthier direction.

Table 1.6 Percentages of women in specific age group who obtain health information

from the three most common sources Source Age group (years)

30-39 (%) 40-49 (%) TV/Radio 80 7 6 ~ Newspaper/Magazines 76 73 Friends 65 70

Source: [Report on Women's Health Survey, 1993]

1.17 Summary

The information about Hong Kong middle-aged women clearly demonstrates that a

certain proportion of them have a low awareness of diet and physical activity. This

may explain why some of them also have an unhealthy lifestyle. The middle-aged

Hong Kong women also were found to exhibit high prevalences of overweight and

obesity, and risky BMI and WHR levels. Therefore, the health picture emerging

from the above findings indicates that Hong Kong middle-aged women should be a

group targeted for nutrition and health promotion.

1.18 Study Purpose and Objectives

This paper describes a pilot study aimed at promoting a healthy lifestyle to middle-

aged women. Reasons for choosing the middle-aged women were that: they usually

purchase and prepare food for the family, they are not a highly educated group, and,

in spite of their low levels of health awareness, they are nevertheless probably very

concerned about the health of themselves and their families. The promotion of a

healthy lifestyle should not only benefit the women, but also their household

members. Hopefully, participating women can bring the healthy lifestyle messages

• 2 6

to their family members and act as a role model for their children.

This pilot study used a two-group pre-post approach with a six-month follow-up to

evaluate the longer-term effectiveness of the health promotion program. The goal

of this pilot program was to develop an effective program of primary prevention of

obesity for Hong Kong middle-aged women aged 30-50 years through healthy diet

and regular physical activity. Its objectives were to: (1) improve their awareness of

the benefits of healthy eating and physical activity behavior, (2) improve

participating women's intentions to change less healthy eating and physical activity

behavior, and (3) enable skills for participating women to eat healthier and become

more physically active. The study design and the conceptual framework are shown

in Figures 1.4 and 1.5, respectively.

Education Group

Month 1 Months 3-4 Month 5 Month 11

Baseline ^ Intervention ^ Posttest ^ 6-month

survey Follow-up

Control Group

Month 1 Month 5 Month 11

Baseline ^ Posttest ^ 6-month

survey Follow-up -

Figure 1.4 The study design of the pilot nutrition and health promotion program

• 27

Socio-demographic factors

Age, Education level, Marital status

Income level, Employment status

5

Attitudes, intentions,

knowledge, and skills

towards healthy lifestyle

• i

Low level of ~ , . , . . Unbalanced diet physical activity

T ± Overweight and Obesity

I t Undesirable health outcomes

Coronary heart disease, Stroke, Diabetes, Hypertension, Hypercholesterolemia, Some types of cancer (colon, breast etc), Dyslipidemia, Osteoporosis

Figure 1.5 The conceptual framework of the study

• 28

CHAPTER TWO: METHODOLOGY

2.1 Recruitment of Participants

Invitation letters were sent to ten women's centres in the New Territories and finally

two adjacent-district centres, 'Centre One，and 'Centre Two', agreed to participate in

the study, with Centre Two willing to be the control centre. Centre One has about

1,700 members from 30 to 50 years old and Centre Two has about 680 members

within this age range. Centre One women in this age group were invited to

participate in three health assessments and a health promotion program while Centre

Two women were invited to participate in three health assessments only. As an

incentive to attend all sessions, the women in the Education Group paid a small fee

for the classes, but were told they would receive their payment back if they attended

all six activity sessions. Informed consent (see Appendices A and B) was given to

all participants during their first visit, in which the study purpose and nature were

explained. Centre One and Centre Two recruited 81 and 103 women, respectively.

2.2 Focus Groups

A focus group is a qualitative research technique, in which a group of people,

recruited on the basis of similar demographics, and led by a group moderator, can

share their views, attitudes and feelings about a particular topic in a non-threatening

environment (Greenbaum, 2000). Simultaneous to the recruitment of the women in

the Education and Control Groups, four focus groups with New Territories women of

similar age and background to those who would participate in our program were

conducted prior to conducting the Pretest survey, in order to obtain information

useful to the design and conduct of the rest of the program.

• 2 9

The objectives of the focus groups were:

1) To elicit women's ideas on 'health', 'healthy lifestyle', 'healthy eating' and

'physical activity'.

2) To elicit the factors motivating them to adopt a healthy lifestyle.

3) To elicit their knowledge and attitudes towards a healthy lifestyle.

4) To elicit their ideas on the type and content of activities they would prefer in a

health promotion program.

2.3 Survey Instrument

A self-administered questionnaire and a three-day dietary record were designed to

obtain information about the women's lives and lifestyles as well as to evaluate the

effectiveness of the health promotion program. The questionnaire and the dietary

record were pre-tested among 40 middle-aged women from outside the program

districts in three separate pretests before they were finalized. During the Pretest, the

Posttest and the Follow-up, each participant completed the questionnaire, the three-

day dietary record and the measurements of height, weight, percent body fat and

fingertip fasting blood total cholesterol level.

2.3.1 Questionnaire

The questionnaire (see Appendices C and D) consisted of seven parts. These

included dietary habits; physical activity habits; intentions, attitudes and confidence

in changing behaviors; nutrition knowledge; physical activity knowledge; a food

frequency questionnaire and demographic characteristics.

The first part queried the dietary habits by asking the general dietary practices of the

women. Some of the questions were adopted and modified from The Hong Kong

• 30

Adult Dietary Survey in 1995 (Leung et al., 1997), the others were specially

designed for this study. It had 13 questions asking about the mean days per week of

having breakfast, lunch and dinner; the number of snacks eaten per day; the taking of

nutrient supplements; fat removal behavior when eating meat and poultry; household

responsibilities for cooking and buying food; oil(s) used for cooking and eating;

common cooking methods for fish, pork/beef, chicken/duck and vegetables; food

label reading habits and perceived clarity of food labels.

To estimate the women's mean daily energy expenditure and to understand their

awareness and behaviors regarding physical activity, the second part queried physical

activity habits and contained a list of common physical activities in four categories:

work, caregiving, recreation and exercise. These activities were modified from a

previous study assessing the physical activity level among US older adults (Dipietro

et al, 1993). The activities are listed in Table 2.1. The women were asked to state

the duration in minutes of each physical activity session and the number of session(s)

per week they spent doing each physical activity in a typical week (defined as ‘a

week when you had no illness, and your working level was normal for you').

Table 2.1 The list of physical activities under different categories Category Examples

Work Buying food, shopping, stair-climbing, walking while carrying a load, laundry, light and heavy housework, food preparation, food service, dishwashing, light and heavy home repairs and computer work

Caregiving Lifting/pushing wheelchair or stroller and running with children when playing

Recreation Leisurely/morning walking, needlework, dancing, bowling, playing golf, playing mahjong, watching TV, reading newspaper/magazine/book and eating

Exercise Brisk/hill walking, pool exercise, stretching, yoga, taichi and Iiu tong quen, doing aerobics, cycling, rope skipping, swimming, running, playing badminton or table tennis and playing tennis, volleyball or basketball.

• 31

Additionally, a summary index was calculated from five additional separate

questions concerning the time the women spent on five types of physical activities

(vigorous, walking, moving, standing and sitting) to indicate the general physical

activity level of the women. Vigorous activity was defined as activity lasting at

least ten minutes and causing a large increase in heart rate. Walking was defined as

walking at least ten minutes or more without stopping which was not strenuous

enough to cause a large increase in heart rate. Moving was defined as moving

around on foot while doing things (Dipietro et al., 1993).

The women were also asked to state the number of flights of steps (about 10 steps)

they climb each day. Additionally, they were asked to compare their physical

activity level in the study season with the other three seasons. For example, the

Pretest survey was carried out in the spring, so the women needed to compare their

physical activity level in spring with that of summer, fall and winter. A Likert scale

('Much less', 'Little less', 'Same', 'Little more' and 'Much more') was used to

indicate the difference in activity level.

Part Three asked their intentions, attitudes and confidence toward changing

behaviors. Stages of change questions were adopted from a US study assessing

stages of dietary fat reduction among 1,241 adults aged 18 years or more (Curry et

al., 1992). These questions were modified for the four behaviors targeted in the

present study: reducing intake of saturated fat, increasing intake of fresh fruits,

increasing intake of vegetables and doing more physical activity. For decreasing

saturated fat intake, the women were firstly asked whether they had heard of

saturated fat. If they had not, they did not need to answer the stages of change

question regarding decreasing saturated fat intake. Two additional questions were

• 32

added for each of the four behaviors in order to find out the women's difficulties

when trying to change their behavior and the most appropriate methods they could

suggest to facilitate their behavioral change.

Part Four queried their nutrition knowledge. Ten true-false nutrition knowledge

questions about saturated fat, fibre, cholesterol, protein, frozen food, diabetes, blood

vessel hardening and colon cancer. These questions were adopted from two studies

assessing nutrition knowledge among adults (Parmenter & Wardle, 1999) (Sapp &

Jensen, 1997). Women were required to state 'True', 'False' and 'Don't know' for

each question. Additionally, the women were asked whether they had heard of the

food pyramid. If they had, they needed to place each of the four food groups

(vegetables and fruits; oils, fats, salt and sugar; cereals; meats and dairy products) in

the appropriate food pyramid layer in order to assess their understanding of the food

pyramid. All of the above nutrition knowledge was to be covered in the health

promotion program.

Part Five queried their physical activity knowledge. Nine true-false physical

activity knowledge questions about fitness in general, physical activity

recommendations, aerobic physical activity, the relationships between physical

activity and disease prevention, and cardiovascular fitness were asked. These

questions were designed specially for this study. The women were required to state

'True', 'False' and 'Don't know' for each question. As with the nutrition

knowledge, the women were asked whether they had heard of the physical activity

pyramid. If they had, they needed to place each of the four physical activity groups

(exercise for flexibility and muscular strength, aerobic and active sports, lifestyle

physical activities and rest/inactivity) in the appropriate physical activity pyramid

• 33

layer in order to assess their understanding of the physical activity pyramid. All of

the above physical activity knowledge was to be covered in the health promotion

program.

Part Six was the food frequency questionnaire, which focused on weekly and daily

food consumption patterns. Sixty common food items were listed to elicit the

women's general food consumption pattern. The food items were adopted mainly

from The Hong Kong Adult Dietary Survey in 1995 (Leung et al., 1997). The

food items included foods from different food groups, such as dairy products (cheese,

yogurt, low fat yogurt, whole milk and skim milk etc), grains/cereals (white bread,

whole wheat bread, sushi, fried rice, plain rice and red/brown rice etc), fibre (fruit

and vegetable), meats (fried egg, boiled egg, fried fish and steam fish etc) and snacks

(hamburger, filet-O-fish，egg tart, french fries, fried dim sum, steam dim sum). The

women were asked to state their weekly and daily consumption frequency

('never/not consumed', 'once per week', 'twice per week', 'three to four times per

week', 'five to six times per week', 'once a day' or 'two to three times per day') in a

typical week for each food item. If the women consumed a particular food on a less

than weekly basis, the frequency was classified to be 'not consumed'. This

frequency classification was modified from a previous Hong Kong research study

(Cheung, 1998).

Part Seven consisted of seven questions asking the women's demographic

characteristics such as age, education level，marital status, employment status,

number of household members, total monthly household income and personal

monthly income. Four additional questions queried health-related concerns. They

were asked to state if they had diabetes, hypertension, high blood triglycerides, high

• 34

blood cholesterol, bone/joint pain and anemia. The women were also asked to rate

their health when compared with women of similar age, as indicated by Likert scale

response options ('Far worse', 'Worse', 'About the same', 'Better' and 'Far better').

Moreover, two questions were designed to understand their interest in health by

inquiring about topics about which they would like to learn more and the areas of

their health they would like to improve.

2.3.2 Three-day Dietary Record

A set of photos (see Appendices E and F) and a sample dietary record (see

Appendices G and H) were used to teach participants how accurately to estimate

their portion sizes and correctly fill in the dietary record at the first assessment. The

women were requested to record all foods and beverages they consumed on two

weekdays and one weekend day (see Appendices I and J).

2.3.3 Anthropometric and Cholesterol Measurements

Height was measured using a measuring tape fixed vertically on a wall. The

women wore light clothing without shoes and hats, standing straight and with heels

and feet together, and heels, buttocks, shoulder blades and the back of the head in

contact with the wall. Their eye level was kept horizontal, and their arms hung

loosely at their sides, with their palms facing the thighs, and their shoulders relaxed.

A measuring aid was put on the crown of the head of the women, and then their

height was measured by the investigator to the nearest 0.1 cm.

Weight and percent body fat were measured by a TANITA4j Body Composition

Analyzer (TBF-300GS, serial no: 00040005, Tokyo, Japan). The women wore

light clothing, were barefoot and stood erect so that their body weight was evenly

• 35

distributed over both feet. Their weight and percent body fat were measured to the

nearest 0.1 kg and 0.1% respectively.

Fasting total blood cholesterol level was measured by an Accutrend® GC Meter

(serial no: 01155016/429 and 01155299/429). The finger-tip blood samples were

collected when the women were seated. A softclix® II lancet (Roche Diagnostics

GmbH, D-68298 Mannheim, Germany) was used to take the first drop of the

forefinger-tip blood sample which was then discarded. Then, a Reflotron® capillary

tube was used to collect 32 jul of blood. The blood sample was then dropped on the

application zone of the test strip for measuring total cholesterol, and the strip was put

into the measuring chamber of the meter. The value of the total cholesterol was

shown after 180 seconds. The detection range of the meter was 3.88 to 7.75

mmol/L. To ensure the measurement quality of cholesterol, the meter was

calibrated with a lot-specific code strip each time when a new lot of test strips was

used. In addition, the meter was tested with Accutrend® Control CH 1 standard

before each day of assessment. The Accutrend® GC Meter was proven to be

reliable for measuring total cholesterol. When compared with the cholesterol

oxidase/p-aminophenazone (CHOD-PAP) method, the Accutrend® GC Meter showed

highly comparable results (r二0.911 to 0.922) (Gottschling et al., 1995). All

measurements were performed twice and the average was taken for data analysis,

except for the cholesterol level which was measured only once.

• 36

2.4 Intervention

Based primarily on the focus group results, five tailored weekly 1.5- to 2-hour

education classes and a healthy cooking demonstration were designed and held on

consecutive Saturday afternoons in a secondary school hall. In addition, a physical

activity demonstration and voluntary practice together with five minutes of

supervised fast walking within the hall were included as a break midway throughout

each of the five classes. Information taught from the talks, the cooking and

physical activity demonstrations were included in pamphlets (see Appendices K

through N), which were given to the women. An additional voluntary mid-week

fast walking/jogging activity was organized once per week in a nearby sports ground.

Table 2.2 lists the topics and objectives for each intervention activity.

Table 2.2 Topics and objectives for each class/activity

Talk 1: Diet, Physical Activity, Healthy Weight and Health.

After the class, participants should be able to

1. Correctly fill in the food groups according to the food pyramid

2. Correctly identify the importance of healthy diet and regular physical activity on

health, as measured by the true-false nutrition and physical activity knowledge

questions.

3. Define healthy weight by using BMI.

4. Give reasons why many women are on diets but not losing weight.

5. Apply healthy eating and regular physical activity in maintaining healthy weight.

6. Know the conditions that need to take nutrient supplements.

7. Increase their intention, as mentioned by stages of change statements, to change

unhealthy behaviors, such as consumption of a diet high in saturated fat but low in

fruits and vegetables and low participation in physical activity. The intention is

measured by stages of change statements.

8. Move forward, according to stages of change statements, in changing some of the

above unhealthy behaviors.

• 37

Talk 2: Food Choice, Cooking and Eating Out.


1. Describe how the cooking method affects the fat content of food.

2. Identify common healthy food choices when buying food and eating out.

3. State the ways to eat less fat and cholesterol when eating out.

4. State some ways to eat more fibre when eating out.

5. State some ways to eat more calcium when eating out.

6. Identify components of a nutrition label, especially fat, saturated fat, cholesterol

and fibre contents.

7. Establish ways to overcome the barriers to healthier eating, as measured by their

responses to questions about whether they have such barriers and their own ways

to overcome them.

Talk 3: Genetically-modified Food, Food Safety and Food Hygiene.


1. Define genetically-modified food.

2. Describe the effects of genetically-modified food on health.

3. Identify some common local genetically-modified food.

Healthy Cooking Demonstration

After the demonstration, participants should be able to practice low-fat cooking

methods, as measured by their reported common cooking methods for common food

items.

Talk 4: Physical Activity and Your Health


1. Correctly fill in the types of physical activities according to its position in the

physical activity pyramid.

2. Describe the recommendations of physical activity for adults.

3. Explain the benefits of physical activity.

4. Establish ways to overcome barriers to having more physical activity, as measured

by their responses to questions about whether they have such barriers to doing more

physical activity and their own suggestions as to how to overcome them.

5. Be able to draw up a physical activity plan/schedule that they can follow for the

coming month.

6. Describe some myths or beliefs about different weight loss methods.

• 38

Physical Activity Demonstration

After the demonstration, participants should be able to

1. Practice some simple physical activities for flexibility, cardiovascular endurance

and muscle strength and endurance.

2. Build confidence in doing physical activity. The confidence is measured by stages

of change statements.

Talk 5: Healthy Lifestyle and Disease Prevention


1. Identify the trends in the occurrence of obesity, diabetes, coronary heart disease,

hypertension, stroke, osteoporosis and some cancers in Hong Kong.

2. State some risk factors for each of these diseases.

3. Explain the importance of healthy lifestyle for the prevention of these conditions,

as measured by the true-false nutrition and physical activity knowledge questions.

4. Adopt healthier eating and regular physical activity behaviors, as measured by

stages of change statements.

2.5 Evaluation

Evaluation provided feedback to monitor and modify the program. In this pilot

study, two types of evaluation were used, process and outcome evaluations.

2.5.1 Process Evaluation

After each activity, a short evaluation questionnaire (samples in Appendices O and P)

was delivered to the participants to gather their comments on the corresponding

activity. Their responses acted as the direct feedback to the program, which was

continuously modified based on their comments.

At the end of the program, an additional evaluation questionnaire (Appendices Q and

R) was used in the Education Group to gather the women's ideas about the overall

program.

39

2.5.2 Outcome Evaluation

All the women in both the Education and Control Groups were re-assessed

immediately after the intervention and six months later. Except for some evaluation

questions for the Education Group only, all assessments were identical in the Pretest

and the two assessments. The results of these two assessments were then compared

with the Pretest results to determine any improvements in knowledge, attitudes,

health behavior and anthropometric and physiological measurements for the

Education Group, in order to determine the extent of success of the program.

2.6 Data Management

After each round of data collection, the questionnaires and the dietary records were

checked for clarity, and if necessary follow-up telephone calls were carried out for

clarification. The questionnaires and the dietary records were then coded and

entered into the computer with Statistical Package for Social Sciences Data Entry

Builder (SPSS Data Entry Builder Release 1.0.4, SPSS Inc., Chicago, the United

States) with double punching for verification. Finally the overall data set was

analyzed using the Statistical Package for Social Sciences (SPSS for windows,

version 9.0; SPSS Inc., Chicago).

2.7 Statistics

Comparisons of the variables between the Education and Control Groups in the

Pretest were conducted by using independent sample Mests and Chi-square tests.

Comparisons of variables between the Pre- and Posttests and the Follow-up within

the groups were conducted by using paired sample /-tests and Chi-square tests.

Significance levels of 95%, 99% and 99.9% were used in this study, with significant

changes then indicated by the 尸-values less than 0.05, 0.01 or 0.001.

4 0

2.8 Data Analysis

2.8.1 Physical Activity Patterns

Mean daily energy expenditure was calculated from each respondent's list of her

physical activities and the reported duration. The energy expenditure for each type

of activity was calculated by multiplying the duration in min/week and the intensity

code (kcal/min). This method was adopted from the previously mentioned study

assessing the physical activity level among adults (Dipietro et al., 1993). Then, the

energy expenditures for all activities were summed, and finally divided by seven

resulting in the mean daily energy expenditure. The energy expenditure level was

derived from the common physical activities of the women, thus estimating the

amount of energy the women expended in their daily lives. Table 2.3 lists the

intensity code assigned to each kind of activity.

41

Table 2.3 The intensity codes for the physical activities Type of activities Intensity code

(kcal/min) Work

Buying food 3.5 Shopping 3.5 Stair-climbing while carrying a load 8.5 Walking flat while carrying a load 3.5 Laundry (time loading, unloading, folding only) 3.0 Light housework: tidying, dusting, sweeping, collecting trash in home, 3.0

polishing, indoors gardening, ironing. Heavy housework: vacuuming, mopping, scrubbing floors and walls, 4.5

moving furniture, boxes or garbage cans. Food preparation: chopping, stirring, moving about to get food items, 2.5

pans. Food service : setting tables, carrying food, serving food. 2.5 Dishwashing : clearing table, washing/drying dishes, putting dishes 2.5

away. Light home repair: small appliance repair, light home maintenance/ 3.0

repair. Heavy home repair: painting, carpentry, washing/polishing car 5.5 Computer work, clerical work, typing. 1.5

Care giving Lifting, pushing wheelchair 5.5 Lifting, carrying, pushing stroller 4.0 Chasing children during playing 4.0

Recreational activities Leisurely walking, morning walk 3.5 Needlework: knitting, sewing, needlepoint, craft work 1.5 Dancing (moderate/fast) 5.5 Bowling 3.0 Golf 3.0 Playing Mahjong 2.0 Watching TV 1.3 Reading newspaper, magazine, book 1.2 Eating (total time for the 3 regular meals) 1.5

Exercise Brisk walking or hill walking 6.0 Pool exercises, stretching, yoga, taichi, Liu Tong Quan 3.0 Vigorous calisthenics, aerobics 6.0 Cycling, exercycle 6.0 Rope Skipping 10.0 Swimming 6.0 Running 8.0 Badminton, Table Tennis 7.0 Tennis, Volleyball, Basketball 7.0 Source: [Dipietro et al, 1993]

42

A summary index was calculated from the five types of physical activity, to indicate

the general physical activity level of the women. Each individual index score was

calculated by multiplying frequency score by duration score by a factor. Table 2.4

lists the frequency score, the duration score and the factor for each index score.

Table 2.4 The frequency score, the duration score and the factor for each index score Index Frequency score Duration score Factor

Vigorous activity O = no activity 1 = 10-30 mins 5 1 = 1-3 times per month 2 = 31 -60 mins 2 = 1 - 2 times per week 3 = >60 mins 3 = 3-4 times per week 4 = >5 times per week

Walking 0 = no activity 1 = 10-30 mins 4 1 = 1-3 times per month 2 = 31 -60 mins 2 = 1 - 2 times per week 3 = >60 mins 3 = 3-4 times per week 4 = >5 times per week

Daily Moving N/A 0 = not moving at all 3 1 = <1 hour per day 2 = 1 to less than 3 hours per day 3 = 3 to less than 5 hours per day 4 = 5 to less than 7 hours per day 5 = >7 hours per day

Daily Standing N/A 0 = not standing at all 2 1 = <1 hour per day 2 = 1 to less than 3 hours per day 3 = 3 to less than 5 hours per day 4 = 5 to less than 7 hours per day 5 = >7 hours per day

Daily Sitting N/A 0 = not sitting at all 1 1 二 <3 hours per day 2 = 3 to less than 6 hours per day 3 = 6 to less than 8 hours per day 4 = >8 hours per day

Source: [Dipietro et al, 1993]

43

2.8.2 Dietary Patterns

The nutrient composition of the three-day dietary record was analyzed by the

Nutritionist IV Diet Analysis software program (First Data Bank, San Bruno, Ca.)

with some local foods added to it. In addition, fifteen local foods were added to the

database especially for this study. Kilocalories, carbohydrate, protein, fat, SFA,

MUFA, PUFA, cholesterol, dietary fibre, calcium, iron and vitamins A, C and E were

estimated for each of the three days. The mean values were then taken for analysis.

The percent energy from carbohydrates, protein, fat, SFA, MUFA and PUFA were

calculated as follows:

Percent energy from carbohydrate = carbohydrate (g) *4 kcal / energy (kcal)* 100%

Percent energy from protein = protein (g) *4 kcal / energy (kcal)* 100%

Percent energy from fat = fat (g) *9 kcal / energy (kcal)* 100%

Percent energy from SFA = SFA (g) *9 kcal / energy (kcal)* 100%

Percent energy from MUFA = MUFA (g) *9 kcal / energy (kcal)* 100%

Percent energy from PUFA = PUFA (g) *9 kcal / energy (kcal)* 100%

4 4

The amount of oil used for cooking/consuming was estimated by a reference method

from The Hong Kong Adult Dietary Survey 1995 (Leung et al., 1997), as is shown in

Table 2.5.

Table 2.5 Estimation of oil for cooking/consuming

Foods Oil estimated (Tablespoon) Butter spread for 50 g bread 0.5 200 g fried noodle 0.5 100 g boiled vegetable with oil added 0.2 100 g stir fried vegetable 0.5 100 g steam fish, no sauce 0.3 100 g steam fish, with sauce 0.5 100 g fried fish 0.8 50 g fried meat 0.5 50 g deep fried meat 1.5 240 ml soup 0.3

Source: [Leung et al, 1993]

2.8.3 Nutrition Knowledge Score

An additive Nutrition Knowledge Score was calculated to indicate the nutrition

knowledge level, from the questions concerning heard of saturated fat and the food

pyramid, together with the ten additional true-false questions, and the knowledge of

the food groups and food group layers. The marking scheme is shown in Table 2.6.

The maximum achievable score was 16.

Table 2.6 The marking scheme for calculating the Nutrition Knowledge Score Nutrition knowledge questions Marks assigned Heard of saturated fat? One mark for ‘ Yes’, zero mark for 'No' . Heard of food pyramid? One mark for ‘Yes，，zero mark for 'No' . Matching each food pyramid One mark for each correct response for the four

layer with its food group corresponding levels of the food pyramid. Ten additional nutrition One mark for each correct response, zero for incorrect or

knowledge questions ‘Don,t know' response.

4 5

2.8.4 Physical Activity Knowledge Score

An additive Physical Activity Knowledge Score was calculated to indicate the

physical activity knowledge level from the questions concerning heard of the

physical activity pyramid, together with the nine additional true-false questions, and

the knowledge of the physical activity groups and physical activity pyramid layers.

The marking scheme is shown in Table 2.7. The maximum achievable score was

14.

Table 2.7 The marking for calculating the Physical Activity Knowledge Score Physical activity knowledge questions Marks assigned Heard of physical activity pyramid? One mark for 'Yes', zero mark for ‘No’. Matching physical activity pyramid One mark for each correct response for the

layer with its physical activity group four corresponding levels of the physical activity pyramid.

Nine additional physical activity One mark for each correct response, zero knowledge questions for incorrect or ^Don't know, response.

2.8.5 Blood Total Cholesterol

According to the guidelines issued by the National Cholesterol Education Program in

2001 (National Cholesterol Education Program, 2001), blood total cholesterol was

classified as 'desirable' if under 5.20 mmol/L. Levels between 5.20 and 6.19

mmol/L were 'borderline-high', and a level of 6.20 mmol/L or greater is "high"

blood cholesterol. This classification was identical to that adopted by The Hong

Kong Cardiovascular Risk Factor Prevalence Study 1995-1996 (Janus, 1997), and

also was adapted for use in the present study.

4 6

2.8.6 Body Mass Index

The BMI was calculated as weight in kilograms divided by the square root of height

in meters. According to the Asia-Pacific Steering Committee on Obesity (Asia-

Pacific steering committee, 2000), the newly proposed BMI classification for adult

Asians shown in Table 2.8 was used to classify overweight and obesity among the

subjects.

Table 2.8 Proposed classification of BMI in adult Asians

Classification BMI (kg/m2) Underweight <18.5 Normal 18.5-22.9 Overweight 23.0-24.9 Obese >25.0

Source: [Asia-Pacific Steering Committee on Obesity, 2000]

2.8.7 Percent Body Fat

As indicated by the TANITA® manufacturer, the desirable range of percent body fat

for Asian females aged over 30 years is 20-27%.

2.9 Ethics

This study received ethical approval from The Clinical Research Ethics Committee

of The Chinese University of Hong Kong.

4 7

CHAPTER THREE: RESULTS

3.1 Focus Group Results

3.1.1 General Description of Participants

Four focus groups among a total of 42 women were conducted in February 2000,

each taking about 1 to 1.5 hours. The number of women in each group ranged from

six to sixteen, as is shown in Table 3.1.

T^blg 3.1 Date, duration and number of women participating in each focus group Group Date Number of women Duration (hours)

1 23-2-2000 12 1.5 2 23-2-2000 16 1.5 3 23-2-2000 6 1.0 4 24-2-2000 8 1,25

A brief self-administered short questionnaire (see Appendices S and T) was used to

elicit their demographic characteristics, and the data are presented in Table 3.2.

About 93% of them were 30-49 years old, and all were married. About 83% of

them were housewives. Three-quarters of them had attained primary or lower

secondary (Form one to three) education, and three-quarters of them had three to five

household members. Half of them had monthly household income below $15,000

while another half were above that level.

48

Table 3.2 Focus group participants' demographic characteristics (n=42)

Demographic variables Number of women (%) Age group

25-29 1 (2) 30-34 3 (7) 35-39 7 (17) 40-44 17(40) 45-49 12(29) 5 0 ^ 4 2_(5)

Marital status Married 42 (100)

Working status Full time 2 (5) Part time 4 (10) Housewife 35 (83) No work 1 (2)

Education level No formal schooling 2 (5) Primary 15(36) Lower secondary (Form 1-3) 17 (40) Upper secondary (Form 4-7) 7 (17) Post secondary 1 (2)

Household member 2 1(2) 3 6(14) 4 18(43) 5 8(19) 6 3(7)

Missing 6 (14) Household income

$5,001-$10,000 5 (12) $ 1 0 ， 0 0 1 - $ 1 5 , 0 0 0 1 5 ( 3 6 )

$15,001420,000 8 (19) $20,001425,000 7 (17) $ 2 5 ， 0 0 1 - $ 3 0 , 0 0 0 1 ( 2 )

>$30,000 4 (10) Missing 2 (5)

The overall atmosphere of the focus groups was lively and open. Most of the

women were willing to express their views and opinions and enjoyed discussing with

others. They seemed interested in health issues and would like to know more about

healthy eating and physical activity because they all hoped to become healthier.

The focus groups mainly discussed several aspects: Their views on 'health', 'healthy

4 9

lifestyle', 'healthy eating' and 'physical activity'; factors motivating healthy lifestyle;

sources of health information and ideas for a health promotion program.

3.1.2 Perceived Values and Views on 'Health'

During each session, 24 questions (see Appendix U and V) were raised to initiate the

discussion about health issues. The first one was 'What comes to your mind when

you think of health?'. All groups replied that they would think about balanced diet

(飮食均衡 ‘yam sik gwan hang') and physical activity (做運動 ‘cho wan dung').

Physical health (身體健康 ' s an tai gin hong'), adequate rest (有足夠休息 ' y au

chuk gau yau sik') and having an open mind/always be happy (快樂 ' f a a i Iok' or

開朗 ‘hoi long') were mentioned by women in three groups. Most of the

participants agreed that these six items were the most common things related to

health. Other items such as family health (家庭要健康 ‘ka ting yiu gin hong'),

beauty (親 ‘leng，)，keep fit and free of illnesses (無病無痛 ‘ m o ban mo tung') were

given by some participants.

When asked which of the above was the most important, a variety of responses was

observed. Some of the women said physical activity and diet were equally

important (運動同飮食同樣係重要 ‘wan dung tong yam sik tong yeung hai jui

chung yiu'). The rest felt that physical activity, diet or healthy mind individually

was the most important to their health ( 重要思想健康，開心 ‘jui chung yiu si

seung gin hong, hoi sum，，做多啲運動至重要 ‘cho doh d wan dung chi gan yiu' or

重要飮食，可以 fit 啲 ‘jui chung yiu yam sik, hak yee fit d').

Most of the women said their own health was just average or had no health problems,

however, they stated that they did not always pay attention to physical activity, diet

50

or both (我誌ok啦，有時唔係好注意飮食同少做運動 ‘ngo Ium ok la, yau si ng

hai ho chu yee yam sik tong siu cho wan dung'). Women in all groups said that in

order to improve their health, they should do more physical activity or start doing it

and pay more attention to their diet, and always keep these thoughts in their mind (要

成日誌住做多d運動先得，同埋要睇吓食咗啲乜‘yiu shing yat Ium chu cho doh d

wan dung sin tak, tong mai yiu tai ha sik joh d mut'). Some said if they could have

enough rest or keep relaxed, this could also improve their health.

3.1.3 Perceived Values and Views on 'Healthy Lifestyle，

Most women had similar views on 'Healthy lifestyle' and 'Health'. They regarded

'Healthy Lifestyle' as having more physical activity (做運動 ‘doh wan dung'),

balanced diet (飮食要健康 ‘yam sik yiu gwan hang'), and regular mealtime (定時

飮食 ‘ting shi yam sik'). Some mentioned adequate rest (睡眠要充足 ‘sui min

yiu chung chuk'), healthy thoughts (有健康思想 ‘yau gin hong si seung' and family

health (家庭都要健康 ‘ka ting dou yiu gin hong'). About half of the women

thought they had a healthy lifestyle as they had already achieved most of the above

criteria such as regular physical activity and balanced diet (我有做運動嫁，都算健康

掛 ‘ngo yau cho wan dung ka, duo suen gin hong gaar' or 我都有注意飮食嗦 ' n g o

do yau chu yee yam sik ka'). The other half felt that they did not have a healthy

lifestyle, as some barriers such as lack of health knowledge and constraints from

their families and friends prevented them from achieving a healthy lifestyle. For

example, there were limited healthy food choices when eating out (出街食野唔健康

‘chut gaai sik ye ng gin hong’ or 出街好難有健康選擇 ‘chut gaai ho naan yau gin

hong suen jaak'). If their friends chose some unhealthy/fatty food, the women said

it was difficult to refuse eating these foods (同朋友出街食飯，人地叫咗啲唔健康或

者肥嘅餸，有時好難話唔食 'tong pang yau chut gaai sik faan, yan dei giujoh d ng

51

gin hong waak je fei ge song, yau si ho naan wa ng sik').

3.1.4 Perceived Values and Views on 'Healthy Eating'

Most of the women agreed that healthy eating means using less oil during cooking

(用少P的油嚟煮餸 'yung siu d yau lei chu song'), eating more vegetables and fruit

but less meat (食多啲菜，少啲肉 ' s ik doh d choi, siu d yuk' or 食多啲水果 ‘sik

doh d shu gwoh'). Some said healthy eating implied eating everything in a

balanced way (食得均衡啲 ‘sik tak gwan hang d' or 乜都食，自我控制 'mu t do

sik, chi ngo hung chai，). About half of them said they already have had a healthy

eating habit. But some said they did not know what is healthy eating. Some

mentioned they tried to eat healthily, such as using canola oil instead of peanut/corn

oil, steaming the food rather than frying/deep frying, using more lean meat, eating

more vegetables and fish, using less sugar/salt/oil when cooking or seasoning.

For those who regarded themselves as having healthy eating habits, nearly all of

them replied' they would like to become more healthy, not only themselves but also

their whole families (想健康啲 ‘ s eung gin hong d' o r全家人都可以健康啲

'chuen ka yan do hak yee gin hong d'). Most of them said they should be healthy

because they need to take care their family members (我要照顧家人‘我要身體健

康’唔可以病 ' n g o yiu jiu koo ka yan, ngo yiu san tai gin hong, ng hak yee ban,).

Some said healthy eating could prevent diseases such as diabetes, high blood

pressure and stroke (防止疾病，好似糖尿病，高血壓，中風啦‘fong chijat ban, ho

chi tong Iiu ban, go huet aat, chung fung la'). In addition, some said healthy eating

is a way to prevent weight gain because they were afraid of being fat, or they thought

they were a bit fat (我怕肥’所以要食得健康口的 kngo pa fei, sho yee yiu sik tak gin

hong d' or ‘我覺得自己有啲月巴，想減肥 ngo gaau tak chi gei yau d fei, seung gaam

52

fei').

3.1.5 Perceived Values and Views on 'Physical Activity'

About half of the women regarded themselves as having regular physical activity,

usually two to three times per week. However, most of their activities were less

vigorous although they performed about 20-60 minutes for each session. Different

kinds of activities, ranging from some less vigorous types such as tai-chi; yoga;

morning walk; Iiu tong quan and social dance to some more vigorous such as

badminton; swimming and aerobic dance were mentioned. Most of them performed

more than one kind of physical activity. When asked the reasons for doing physical

activity, most of the women replied that hoped to become healthier and prevent

diseases, some would like to lose weight and keep fit (我想健康昍勺'ngo seung gin

hong d\ “想防止有病，就做運動 seung fong chi yau ban, jiu cho wan dung' or 我

想減月巴'ngo seung gaam fei'). Some said that physical activity enabled them to

move their joints and muscles, which was healthier than being inactive (有P動吓筋骨

同關節，總好過口吾有'yuk tong ha gan gwat tong gei yuk, chung ho gwoh ng yuk').

3.1.6 The Factors Motivating the Women to Adopt a Healthy Lifestyle

For women who already had healthy eating habits, they said these were not difficult

to achieve because they were responsible for choosing the cooking method and

deciding what food to be purchased (唔難做到，因爲我負責煮飯同買餸‘ng naan

cho do, yan wei ngo foo jaak chu faan tong mai song’). Some said they prevented

their children from eating unhealthy food by limiting the frequency of eating out (我

好少俾細路出街食野，啲野食唔健康‘ngo ho siu bei sai Io chut gaai sik ye, d ye

sik ng gin hong'). Overall, they agreed that family support and family acceptance

were very important in adopting healthy eating (我家人好支持我’呢樣係好緊要

53

'ngo ka yan ho chi chi ngo, lei yeung hai ho gan yiu' or 全家合作，可以一齊健康

'cheun ka hap jok, hak yee yat chai gin hong').

However, some women expressed that it was difficult to achieve healthy eating,

because it was easier said than done, especially when eating out, in which it was

difficult to control the healthiness of the food eaten (講就易’要做就難 ‘kong jau

yee, yiu chojau naan’ or出街食野好難控制’啲野唔係我煮 ‘chut gaai sik ye ho

naan hung chai, d ye ng hai ngo chu’). Some also said that they had to fry or deep

fry the food in order to fulfill their children's taste preferences (我有時要煎吓，炸吓

啲食物，如果唔係啲細路唔食飯‘ngo yau si yiu chin ha, cha ha d sik mat, yue

gwoh ngo hai d sai Io ngo sik faair), Furthermore, some said they lacked adequate

knowledge about nutrition and healthy eating, so it was difficult for them to achieve

healthy eating.

With regard to physical activity, the active women said it was already a habit to do

physical activity (我依家有習慣做運動 ' ngo yi ging yau chap gwaan cho wan

dung’）. Most of them agreed that they had more free time as their children had

grown up, so they could have time to participate in various physical activities (口的糸田

路大咗，我有多啲時間 ‘d sai Io dajoh, ngo yau doh d si gaan’).

Nevertheless, all inactive women said' they were lazy about doing physical activity

(我好懶，無恆心做 kngo hao laan, mo hang sam cho), but some said they had no

time because they needed to work or spent most of their time on housuework and

taking care of their young children (我要返工’無時間 ‘ngo yiu faan gong, mo si

gaan' o r要做家務同照顧細路’無時間 ‘ y i u cho ka mo tong jiu goo sai lo, mo si

gaan,). Lack of companions (都無人陪 ‘dou mo yan pui') and cold weather were

54

also mentioned by a few women.

3.1.7 Sources of Information About Healthy Eating and Physical Activity

Almost all women said that the mass media (including television, radio, newspapers

and magazines), chatting or discussion with peers were the most common sources of

health information. Some women pointed out that the women's centre, health talks,

books and doctors were other sources. Although they acquired the information

from various sources, more than half of the women doubted the reliability of this

information, with some said that information from doctors were more reliable than

others.

3.1.8 Suggestions for the Type and Content of Activities in a Health Promotion

Program

When the women were asked what health information they were interested in

learning, most of the women wanted to know something about women's diseases,

especially those common at their age (同我地年紀有關嘅病 ‘tong ngo tei nin ki yau

gwan gei ban'). Osteoporosis, cancer, blood vessel blockage and heart disease were

mentioned by them (想知骨質疏鬆’癌症’血管硬化’心臟病嘅野‘seung chi gwat

chat soh sung, ngaam ching, huet goon ngaang fa, sam chong ban gei ye'), and they

wanted to know the causes and the prevention of these conditions (預防呢啲病嘅方

法 cyue fong lei d ban gei fong faat'). More than half of the women wanted to

know basic knowledge about diet and nutrition, nutrient content of common food,

and suitable types of physical activity for their ages (食啲乜野健康啲 ‘sik d mer ye

gin hong d’，有啲乜運動啱我地做 ‘yau d mer wan dung arm ngo tei cho' or 食物

嘅營養成份 ‘sik mat ger ying yeung shing fair). Some would like to know about'

food preservatives and genetically modified food (食物嘅防腐劑對身體嘅影響 ‘sik

55

mat gei fong fu chai dui san tai ger ying heung，or邊啲係基因改造食物，食卩左會點

'bin d hai ger yan goi cho sik mat, sik joh kooi dim’).

With regard to the activities of the health promotion program, nearly all women

suggested talks, cooking and physical activity demonstrations and a body check for

blood cholesterol level, blood triglyceride level, blood pressure, blood glucose and

body fat.

Most of the women responded that they would join the health program if they had

time, and they suggested Saturday afternoon would be a suitable time. They

emphasized that if they knew more about healthy lifestyle, they could bring the

health information to their family members and become a role model for their

children as well.

3.2 Participation Rate in the Study

Table 3.3 shows the number of women who returned the questionnaire, the three-day

dietary record, and participated in body measurements in the Pretest, the Posttest and

the Follow-up.

Table 3.3 Number of women participating in each activity of Pretest, Posttest and

Follow-up Education Group Control Group

Pretest Posttest Follow-up Pretest Posttest Follow-up Questionnaire 81 63 51 103 65 50 Three-day dietary record 75 58 43 72 49 33 Body measurements 80 53 39 100 62 39

56

3.3 Pretest

3.3.1 General Participant Sociodemographic Description

Eighty-one women participated in the Pretest in the Education Group and 103

women in the Control Group. Their demographic characteristics are listed in Table

3.4, and no significant differences were found between the two groups. The mean

age of the Education Group and the Control Group was 42.7 years and 42.4 years,

respectively. About 60% in both groups had finished primary or lower secondary

education level, while 20% below that level. Over 90% of the women were married

and 70% of them were housewives. Although more than half of the women

reported having four household members, about 80% of them had at least that many.

About 50% of them had monthly household income $10,001-$20,000 with 20%

below that level and 30% above. Over 70% of the women had no personal income.

Compared with the Hong Kong middle-aged women's population (aged 30-49 years)

(Census & Statistics Department, 1996), more women in the present study had

primary or lower secondary education (81% Vs 46%), more of the women in this

group women were married (95% Vs 80%), and more were housewives (71 % Vs

37%). Similarly, 32% of the women in the Census but 57% in the present study

reported having four household members. In the Census, 35% of women compared

to 49% in the present study had monthly household income in the $10,001 to

$20,000 range. However, more women in the present study reported no personal

income (72% Vs 41%). Therefore, the demographic characteristics of the middle-

aged women in the present study were quite different from those in the whole Hong

Kong population. This group appeared to be less educated, with larger households,

with a higher proportion of housewives and with lower household income than the

Hong Kong middle-aged women's population at large.

57

Table 3.4 Demographic characteristics of women in the Education and Control Groups Demographic variables Education Group Control Group Significance

(n=81) (n=103) Mean 士 S.D.

Age (years) 42.7 ± 5.2 42.4 ±5.5 N/S Number (%)

Education level Never O (0) 2 (2) N/S Incomplete primary 16 (20) 20 (19) Complete primary 16 (20) 31 (30) Lowersecondary 32 (40) 34 (33) Upper secondary 15(18) 16(16) University 2_(2) 0_(0)

Marital status Single 3(4) 2(2) N/S Married 74 (91) 100 (97) Divorced 4 (5) 0 (0) Widowed 0_(0) l_(lj

Working status No work 6(7) 3(3) N/S Full time 8(10) 13 (13) Part time 10(13) 13 (13) Housewife 57 (70) 74 (71)

Household member 2 3(4) 1(1) N/S 3 14(17) 12(12) 4 40 (49) 64 (62) 5 17(21) 17(16)

^6 7_(9) 9_(9) Household income

<$5,000 4 (5) 4 (4) N/S $5,001-$10,000 13 (16) 17 (16) $10,001-$15,000 20 (25) 31 (30) $15,001-$20,000 17 (21) 23 (22) $20,001-$25,000 12 (15) 11 (11) $25,001-$30,000 9 (11) 8 (8) >$30,000 6 (7) 8 (8) Missing 0_(0) 1_(1)

Personal income None 60 (74) 73 (71) N/S $1-$ 1,000 1(1) 4 (4) $1,001-$2,000 2 (3) 6 (6) $2,001-$3,000 1 (1) 5 (5) $3,001-$4,000 5 (6) 1(1) $4,001-$5,000 1(1) 2 (2) $5,001-$10,000 7 (9) 7 (7) $10,001-$15,000 2 (3) 2 (2) >$15,000 2_(3) 3_(3)

58

3.3.2 Anthropometry

Eighty and 100 women completed body measurements in the Education and Control

Groups respectively. Their mean body weight, mean body height, mean BMI

(calculated by body weight in kilograms divided by square of body height in meters),

mean percent body fat and mean fasting blood cholesterol level (excluding those

with a ‘low’ (n=36) or�high , (n=l ) readings outside the range of the equipment) are

all shown in Table 3.5. There were no significant differences in the mean values of

any body measurements between the two groups. The mean BMI, the mean percent

body fat and the mean fasting blood cholesterol level was 23.5 kg/m2, 31.5% and 4.7

mmol/L respectively in the Education Group compared with 23.2 kg/m2, 30.8% and

4.5 mmol/L in the Control Group.

According to the Asian classification of BMI (overweight as BMI=23.0-24.9 kg/m2

and obesity as BMI >25.0 kg/m2), 28% and 12% of the Education and Control

Groups, respectively, were classified as overweight. The prevalences of obesity

were 26% and 32% in the Education and Control Groups respectively. More than

70% of the Education Group and about 60% of the Control Group had percent body

fat exceeding the desirable range (20-27%). Only 21% and 35% of the Education

Group and the Control Group had percent body fat within the desirable level.

Most of the women, 80% in the Education Group and 90% in the Control Group, had

normal (less than 5.2 mmol/L) fasting total blood cholesterol level. Only 16% and

9% of the Education Group and the Control Group women were within the

borderline range (5.20-6.19 mmol/L), and very few of them were classified as high

(> 6.2 mmol/L).

59

Table 3.5 Physical measurement data, distributions of BMI levels according to Asian

definition, percent body fat levels and fasting total blood cholesterol levels of women

in the Education and Control Groups Mean 士 S.D.

Measurement n Education n Control Significance Group Group

Weight (kg) 80 57.2 ± 7 . 6 " " " 1 0 0 5 6 . 1 ±9.2 N/S Height (cm) 80 156.2 ± 5.3 100 155.4 ±4.9 N/S BMI (kg/m2) 80 23.5 ±2.9 100 23.2 ±3.7 N/S Percent body fat (%) 80 31.5 ± 6.3 100 30.8 ±7.1 N/S Fasting total blood 68 4.7 ± 0.6 75 4.5 ± 0.6 N/S

cholesterol level (mmol/L) Number (%)

BMI levels n=103 Underweight 2(3) 5(5) N/S Normal weight 35 (44) 51 (51) Overweight 22 (28) 12 (12). Obese 21 (26) 32 (32)

Percent body fat levels n=81 n=103 Below range 2(3) 2(2) N/S Desirable range 17 (21) 35 (35) Above range 61 (76) 63 (63)

Fasting total blood n=81 n=103 cholesterol levels

Desirable 64 (80) 90 (90) N/S Borderline 13 (16) 9(9) High 3_(4) W )

3.3.3 Health Conditions Reported

There were no significant differences in the number of self-reported diabetes,

hypertension, high blood cholesterol, high blood triglycerides, bone/joint pain,

anemia and other diseases between the two groups (Table 3.6). About one-third of

the women in both groups reported they had bone/joint pain, and 16 to 17% of the

women had anemia. Table 3.7 shows that about half of the women said their health

was the same as the other women while one-third of them rated their health

better/much better than their peers.

60

Table 3.6 Number (%) of self-reported cases of six health conditions in the Education

and Control Groups Diseases Education Group Control Group Significance

(n=81) (n=103) Diabetes u j ) 0^0) Hypertension 9(11) 10(10) N/S High blood cholesterol 7 (9) 4 (4) N/S High blood triglycerides 2 (2) 2 (2) N/S Bone/joint pain 24 (30) 37 (36) N/S Anemia 14(17) 16(16) N/S

Table 3.7 Number (%) of women rating their own health in different categories in the

Education and Control Groups Rating of health Education Group Control Group Significance

(n=81) (n-103) Much worse 3~(4) 0^0) N/S Worse 20 (25) 18 (18) Same 35 (43) 49 (48) Better 20 (25) 32 (31) M u c h better 3 J 4 ) 4_(1)

3.3.4 Meal Patterns

Table 3.8 shows the mean number of days of having breakfast, lunch and dinner of

the women in the two groups. In both groups, breakfast was the most commonly

skipped meal while dinner was the least. There were no significant differences in

the mean number of days per week of the three regular meals between the two groups.

About 30% of the women in both groups reported never having snacks. Even so,

the mean frequency among the snack eaters in the Education Group and the Control

Group was 2.3 and 1.8 times/day respectively. There were no significant

differences in the data concerning snacks between the two groups.

61

Table 3.8 Mean number of days 土 S.D. per week of having breakfast, lunch, dinner and mean number 土 S.D of snacks per day in the Education and Control Groups Meal Education Group Control Group Significance

(n=81) (n=103) Breakfast (d/wk) 5.8 ±2.2 6.0 ± 1.8 N/S Lunch (d/wk) 6.4 ± 1.5 6.4 ± 1.3 N/S Dinner (d/wk) 7.0 ± 0.2 7.0 ± 0.0 N/S Snacks (per day) 2.3 土 1.9 1.8 士 1.3 N/S

Additionally, only about 70% of women in both groups replied they had breakfast

every day, and about 80% of them had lunch every day, as is presented in Table 3.9.

Breakfast skipping was somewhat common in both groups only, with about two-

thirds of the women reporting eating breakfast daily, and 7% and 5%, respectively, in

the Education Group and the Control Group reporting never having breakfast. No

significant differences between the two groups were seen in any of these findings.

Table 3.9 Number (%) of women who had breakfast every day, skipped breakfast

every day or had lunch every day in the Education and Control Groups Education Group Control Group Significance

(n二81) (n=103) Ate breakfast daily 54 (67) 71 (69) N/S Never ate breakfast 6(7) 5(5) N/S Ate lunch daily 66(81) 79 (77) N/S

3.3.5 Nutrient Supplements Practices

There was a significant difference (尸<0.001) in the number of women who took

supplements regularly between the two groups (Table 3.10). Twenty-seven percent

of the Education Group compared to 6% of the Control Group reported taking

nutrient supplements. In the Education Group, it was obvious that most of the

supplement takers (17%) took one supplement only. The most common type of

supplement taken was vitamin E, followed by unspecified vitamin(s), calcium and

vitamin C. The types of supplements taken are listed in Table 3.11.

62

Table 3.10 Number of supplements the women taken in the Education and Control

Groups Number of supplements taken Education Group Control Group Significance

(11=81) (n 二 103) None 59 (73) 97 (94) P<0.01 One 14(17) 2(2) Two 5 (6) 2 (2) Three 0(0) 1(1) Four 3_(4) U l )

Table 3.11 Number (%) of women in taking the following types of supplements in

the Education and Control Groups Type of supplement Education Group Control Group Total

(11=22) (n=6) (n=28) ^ V i t a m i n E 9 (41) 3 (50) 12 (43)

Vitamin(s) (unspecified) 7 (32) 1 (17) 8 (29) Calcium 6 (27) 1 (17) 7 (25) Vitamin C 4(18) 2(33) 6(21) Vitamin B 2(9) 3 (50) 5 (18) Fishoil 3(14) 0(0) 3 (11) Manganese 1(5) 1 (17) 2(7) Protein powder 1 (5) 0 (0) 1 (4) Traditional Chinese 1 (5) 0 (0) 1 (4)

Medicine Others 2_(9) IJVJ) 3 (11)

3.3.6 Cooking Practices

Almost all (97%) of the women in both groups were responsible for cooking at home.

More than half of them used corn oil for cooking and about half of them used peanut

oil as is shown in Table 3.12. The Education Group had significantly higher

proportion who reported using butter/margarine (尸<0.05), canola oil (尸<0.01) and

safflower oil (P<0.05).

63

Table 3.12 Number (%) of women in using the following oils in the Education and

Control Groups Types of oil Education Group Control Group Significance

(11=81) (11=103) Corn oil 47 (58) 56 (55) N/S Peanut oil 36 (44) 49 (48) N/S But te r /Margar ine 36 (44) 29 (28) 尸<0.05 Canola oil 36 (44) 25 (25) ？<0.01 Sa f f lower oil 4 ( 5 ) 0 ( 0 ) 尸<0.05 Olive oil 3J4) 1_(1) N/S

When asked the common cooking methods for fish, the three most common methods

were steaming, frying and boiling. Steaming was also the most common method

for cooking poultry, followed by boiling and grilling. Stir frying was used most

frequently for cooking pork/beef and vegetables, the results are listed in Table 3.13.

Table 3.13 Number (%) of women in using the following cooking methods for fish,

pork/beef, poultry and vegetables in the Education and Control Groups Food item Cooking methods Education Group Control Group Significance

(11=81) ( n : 1 0 3 ) Fish

Steaming 76 (94) 98 (95) N/S Frying 71 (63) 53 (52) N/S Boiling 18 (22) 28 (28) N/S

Pork/Beef Stir frying 49 (61) 65 (63) N/S Boiling 37 (46) 47 (46) N/S Steaming 35 (43) 38 (37) N/S

Poultry Steaming 52 (64) 67 (65) N/S Boiling 34 (42) 34 (33) N/S Grilling 32 (40) 31 (30) N/S

Vegetables Stir frying 70 (86) 88 (86) N/S Boiling 58 (72) 56 (54) P<0.05

64

3.3.7 Fat Removal Behavior

Over 60% of the women in both groups removed some fat from meat before eating.

About 31% of the Education Group and 25% of the Control Group removed all fat

from meat before eating. Regarding poultry, over 50% of women removed some

skin before eating in the two groups. About 36% of the Education Group and 25%

of the Control Group removed all skin before eating. There was no significant

difference between the two groups in these practices, with results shown in Table

3.14.

Table 3.14 Number (%) of women reported removing fat from meat and removing

skin from poultry in the Education and Control Groups Food Fat/skin removal Education Group Control Group Significance item (n=81) (n=103) Meat

Not remove any fat 1 (1) 12(12) N/S Removed some fat 53 (65) 63 (61) Removed all fat 25 (31) 26 (25) Never consume meat 2 (3) 2 (2)

Poultry Not remove any skin 8(10) 18(18) N/S Removed some skin 43 (53) 58 (56) Removed all skin 29 (36) 26 (25) Never consume poultry 1(1) 1(1)

3.3.8 Food Label Reading

Almost all (94%) of the women in both groups were responsible for buying food for

their families. Also, 93% of the women reported reading food labels when buying

pre-packed food for the first time, however, only half of them read it each time or

usually do so (Table 3.15). For those who read food label, only 5% of the

Education Group and 11% of the Control Group replied that the food label is

clear/very clear to them with Table 3.16 showing the results.

65

Table 3.15 Number (%) of women reported reading the food labels with different

frequencies in the Education and Control Groups Frequency Education Group Control Group Significance

(n二81) (n=lQ3) Never 6~{T) 6^6) N/S Usually 37 (46) 50 (49) Always 18 (22) 27 (26) Each time 20 (25) 20(19)

Table 3.16 Number (%) of women reported different degrees of clarity of the food

labels in the Education and Control Groups Clarity Education Group Control Group Significance

(n=75) (n=97) ^ V e r y unclear f(T) 2(2) N/S

Unclear 10(13) 10(10) So-So 60 (80) 74 (76) Clear 4(5) 10(10) Very clear 0^0) 1_(1)

3.3.9 Dietary Intake

a. From the Three-day Dietary Records

The three-day dietary record provided information about the general energy and

nutrient intakes of the women, with these data presented in Table 3.17. In the

Education and Control Groups, 75 and 72 women, respectively, returned the dietary

records. Significant differences (尸<0.05) were seen in the mean intakes of energy,

fat and vitamin C, in which the intakes in the Education Group were lower than those

of the Control Group.

66

Table 3.17 Energy and nutrient intake data of the women in the Education and Control Groups from the three-day dietary records

Mean 土 S.D. Diet component Education Group Control Group Significance

(n=75) (n=72) Energy (kcal) 1853.4 ± 4 0 7 . 3 2 0 3 5 . 8 ± 606.5 ^<0.05 Carbohydrate (g) 232.3 土 59.2 250.1 ± 74.7 N/S Protein (g) 74.2 ± 20.9 79.8 ± 27.8 N/S Fat (g) 73.8 ± 23.1 83.0 ± 3 1 . 7 尸<0.05 SFA (g) 14.8 ±6.4 16.0 ±6.7 N/S PUFA (g) 14.5 ±6.3 16.8 ±9.0 N/S MUFA (g) 22.6 ± 9.2 25.9 ±11.3 N/S Cholesterol (mg) 232.6 土 128.8 236.5 士 156.8 N/S Fibre (g) 9.0 ±5.4 10.1 ±5.8 N/S Calcium (mg) 504.7 ± 280.5 515.8 ±213.1 N/S Iron (mg) 15.7 ±13.8 15.6 ±7.5 N/S Sodium (mg) 1807.8 ± 810.0 1924.9 ± 1314.6 N/S Vitamin A (RE) 859.5 ± 1074.1 1008.3 土 809.0 N/S Vitamin C (mg) 153.8 ± 83.4 184.5 ±102.1 尸<0.05 Vitamin E (mg) 8.9 ±7.1 11.5 ±10.6 N/S

Over 80% of the women in both groups had percent energy from total fat >30% and

more than half had percent energy from MUFA >10%, greater than the recommended

intake (Table 3.18). Moreover, nearly all of them had insufficient fibre intake

(Table 3.19). Low calcium intakes were also found among the women, as less than

10% of them met the recommended intake level. Additionally, about 40% had

insufficient iron intake, as well as one-fourth of them having cholesterol intakes that

exceeded the recommended amount.

Table 3.18 Number (%) of women exceeding the recommended percent energy from

total fat, SFA, PUFA and MUFA in the Education and Control Groups Percent of women Education Group Control Group Significance

(n=75) (n=72) With energy from total fat >30% 62 (83) 61 (85) N/S With energy from SFA >10% 9(12) 4(6) N/S With energy from PUFA > 10% 7(9) 7(10) N/S With energy from MUFA >10% 38(51) 47 (65) N/S

67

Table 3.19 Number (%) of women who met the recommended intake levels of selected nutrients in the Education and Control Groups Nutrient Education Group Control Group Significance

(n=75) (n=72) Protein >70 g 41 (55) 45 (63) Cholesterol <300 mg 58 (77) 52 (72) N/S Fibre >25 g 0(0) 1(1) N/S Calcium >800 mg 7(9) 6(8) N/S Iron >12 mg 44 (59) 45 (63) N/S Vitamin A >800 RE 29 (39) 37 (51) N/S Vitamin C >60 mg 67 (89) 66 (92) N/S Vitamin E >12 mg 13(17) 18(25) N/S

b. From the Food Frequency Questionnaire

The use of the food frequency questionnaire in this study was to understand the

general food consumption patterns of common local food items among the women.

The consumption frequencies of all the sixty food items in the questionnaire are

shown in Appendix W. Among all the food items, only five of them showed a

significant difference (?<0.05) between the Education and Control Groups. They

were whole milk, tofu skin, potato crisps, chocolate and salad dressing. The

Control Group had higher consumption frequencies of these five food items than did

the Education Group.

Moreover, it was revealed that dairy product consumption was uncommon among the

women. More than half of them never or rarely consumed dairy products such as

cheese, yogurt or skim milk, etc, in a typical week (defined as 'during which you

have no illness, and your working level was normal to you，)，as is shown in Table

3.20. However, some of the high fat or less healthy food such as dim sum, fried

eggs, fried pork etc, were consumed frequently among the women, as is shown in

Table 3.21, and ice-cream was the most frequently consumed of the dairy products

queried.

68

Table 3.20 Number (%) of women who reported never/rarely consuming specific

dairy products in a typical week in the Education and Control Groups Food item Education Group Control Group Significance

(n二81) (n=lQ3) Cheese 56 (69) 68 (66) N/S Yogurt 67 (83) 84 (82) N/S Low-fat yogurt 67 (83) 84 (82) N/S Whole milk 71(88) 70 (68) 尸<0.05 Skim milk 57 (71) 67 (65) N/S High-calcium low-fat milk 41 (51) 61 (59) N/S Ice-cream 42 (52) 44 (43) N/S

Table 3.21 Number (%) of women who reported consuming specific high fat or

otherwise 'less healthy' food two times or more in a typical week in the Education

and Control Groups

Food item Education Group Control Group Significance (11=81) (n=103)

Steam dim sum 43 (53) 51 (50) N/S Fried pork 40 (49) 54 (52) N/S Fried egg 39 (48) 41 (40) N/S Chicken wing 36 (44) 39 (38) N/S Fried fish 30 (37) 39 (38) N/S Fried dim sum 24 (30) 29 (28) N/S Fried noodles 23 (28) 29 (28) N/S Fried beef 20 (25) 25 (24) N/S Ham 17(21) 21 (20) N/S Cup noodles 15 (19) 18 (17) N/S Soft drink 13 (16) 25 (24) N/S Sausage 12(15) 21 (20) N/S

3.3.10 Nutrition Knowledge

No significant difference in the mean Nutrition Knowledge Score between the

Education and Control Groups was found. About half (51%) of the women in the

Education Group reported they had heard of saturated fat, compared to only 35% in

the Control Group (P<0.05). About 80% and 70% of the Education Group and the

Control Group, respectively, reported they had heard of the food pyramid, however,

only 35% and 27% of the Education Group and Control Group women, respectively,

were able to correctly matched all the food groups with their corresponding level of

the food pyramid, as is shown in Table 3.22.

69

Table 3.22 Mean Nutrition Knowledge Score 士 S.D and the number (%) of women

reporting having heard of saturated fat or the food pyramid, and who correctly

matched all four food groups with their corresponding level of the food pyramid in

the Education and Control Groups Nutrition knowledge questions Education Group Control Group Significance

(n=81) (11=103) Nutrition Knowledge Score 7.7 ±3.6 6.7 ±3.4 N/S Hadheard of saturated fat 41(51) 36 (35) 尸<0.05 Had heard of the food pyramid 64 (79) 72 (70) N/S Correctly matched food pyramid 28 (35) 28 (27) N/S levels

No significant differences were seen for the ten additional nutrition knowledge

questions between the Education and Control Groups (Table 3.23). In both groups,

about 80% of the women knew that fibre can help prevent colon cancer, and 82% and

72% of the Education and Control Group, respectively, correctly replied that whole

wheat bread has more fibre than white bread. However, less than 10% of the

women in both groups correctly stated that the hardening of blood vessels is not

mainly caused by too much dietary cholesterol. Additionally, only around 10% of

the women knew that high cholesterol food has a smaller effect than high saturated

fat food on raising blood cholesterol level.

70

Table 3.23 Responses to the ten additional nutrition knowledge questions in the Education and Control Groups Nutrition knowledge questions Education Group Control Group

(n二81) (n-103) Egg white has more saturated fat Correct 46 (58) 47 (46) than egg yolk. Incorrect 9 (11) 15(15)

Don’t know 26 (32) 41 (40) Skim milk has more saturated fat Correct 51 (64) 55 (53) than whole milk. Incorrect 8(10) 14(14)

Doirt know 22 (27) 34 (33) Some foods contain a lot of fat Correct 19 (24) 19(18) but no cholesterol. Incorrect 35 (43) 43 (42)

Don't know 27 (33) 41 (40) High cholesterol food has a Correct 9 (11) 12(12) greater effect than high saturated Incorrect 31 (38) 29 (28) fat food on raising blood Don't know 41 (51) 62 (60) cholesterol level. White bread has more fibre than Correct 66 (82) 74 (72) whole wheat bread. Incorrect 9(11) 10(10)

DoiVt know 6(7) 19(18) Whole milk contains more Correct 31 (38) 35 (34) protein than skim milk. Incorrect 24 (30) 29 (28)

Doirt know 26 (32) 39 (38) Frozen foods have the same Correct 45 (56) 39 (62) nutrients as fresh foods. Incorrect 20 (32) 19 (30)

Doirt know 8(13) 5 (8) Eating a lot of sugars will cause Correct 19 (24) 21 (20) diabetes. Incorrect 54 (67) 65 (63)

DoiVt know 8 (10) 17(17) The hardening of blood vessel is Correct 4(5) 7(7) mainly caused by too much Incorrect 68 (84) 79 (77) cholesterol in your diet. Don't know 9(11) 17(17) A high fibre diet can help Correct 65 (80) 79 (77) prevent colon cancer. Incorrect 4 (5) 2 (2)

DoiVt know 12(15) 22 (21)

71

3.3.11 Physical Activity Habits

The mean reported daily energy expenditure calculated by group from each woman's

list of activities was not significantly different (Table 3.24). However, the

Education Group had a significantly (P<0.05) higher summary physical activity

index (indicating the level of physical activity from five types of activities: vigorous

physical activity, walking, moving, standing and sitting) than the Control Group.

More than half (58% and 54% in the Education and Control Groups, respectively) of

the women reported no daily stair climbing. Among those who did, the number of

flights was 3.0 flights per day in the Education Group and 3.7 flights per day in the

Control Group, not a significant difference. About 60% of women in both groups

replied that there were no seasonal differences in their activity level.

Table 3.24 Mean 土 S.D. reported daily energy expenditure (kcal/day), summary

physical activity index and number of flights of steps climbed per day in the

Education and Control Groups Education Group Control Group Significance

(n:81) (n-103) Daily energy expenditure (kcal/day) 1444.6 土 632.6 1656.7 土 786.5 N/S Summary physical activity index 31.9 ± 19.0 25.7 土 15.4 尸<0.05 Number of flights of steps climbed 3.0 士 2.7 3.7 土 5.2 N/S

per day

Among the top ten most frequent physical activities performed by the women, all of

them were sedentary activities which were not vigorous enough for gaining health

benefits. Data revealed that the women spent about 2 hours per day watching

television and about 1.5 hours having meals, as is shown in Table 3.25. No

significant differences were noted between the two groups in the mean time they

performed the top ten most frequent physical activities, which were the same in both

groups.

72

Table 3.25 Mean time (mins) 土 S.D. spent per day spent on the top ten most frequent physical activities reported by the women in the Education and Control Groups Top ten frequent Education Group Top ten frequent physical Control Group physical activities (n=81) activities (n=103) Watching television 123.5 士 122.7 Watching television 115.2 士 86.9 Eating 91.3±58.8 Eating 108.0± 103.2 Reading newspaper, 49.1 土 43.5 Food preparation 55.7 土 59.7

magazines and books Food preparation 42.6 土 44.9 Reading newspaper, 49.8 土 45.4

magazines and books Light housework 37.4 士 33.3 Light housework 41.0 土 38.1 Shopping 31.5 ±29.9 Shopping 35.6 ± 30.0 Leisurely walking 27.4 士 30.3 Buying food 32.0 士 20.5 Buying food 27.2 ± 18.4 Playing Mahjong 31.2 土 49.9 Laundry 19.6 ±17.7 Heavy housework 25.0 土 33.6 Dishwashing 19.5 士 15.5 Dishwashing 23.8 ± 19.1

3.3.12 Physical Activity Knowledge

There was no significant difference in the mean Physical Activity Knowledge Score

between the two groups (Table 3.26). About 17% and 21% of the Education and

Control Group women, respectively, reported that they had heard of the physical

activity pyramid. However, only a few women (about 2% of the Education Group

and 4% of the Control Group) could correctly match all the physical activity groups

with their corresponding level of the physical activity pyramid.

Table 3.26 Mean Physical Activity Knowledge Score 土 S.D. and the number (%) of

women who reported having heard of the physical activity pyramid, and correctly

matched all four physical activity groups with their corresponding level of the

physical activity pyramid the Education and Control Groups Physical activity knowledge Education Group Control Group Significance questions (n=81) (n=103) Physical Activity Knowledge Score 6.0 ± 2.2 5.6 ±2.7 N/S Had heard of the physical activity 14(17) 22 (21) N/S

pyramid Correctly matched physical activity 2 (2) 4 (4) N/S

pyramid levels

73

Regarding the nine additional physical activity knowledge questions, a significant

difference (P<0.05) between the Education and Control Groups was seen in one

question only, which is about the relationship between physical activity and diabetes,

more women in the Control Group than the Education Group did not know how to

answer this question (Table 3.27). Most of the women (83% and 73% in the

Education and Control Groups, respectively) correctly stated that regular physical

activity decreases the chance of osteoporosis. Moreover, 73% and 76% of the

Education and Control Groups, respectively, replied correctly that physical activity

need not be hard enough to require more exertion than normal to produce gains in

health-related fitness. Nevertheless, only about 20 to 25% of the women in both

groups correctly responded to either of the two questions concerning the

recommendations for physical activity.

74

Table 3.27 Comparison between the number (%) of correct responses to the nine

additional physical activity knowledge questions between the Education and Control

Groups Physical activity knowledge Education Group Control Group questions (n=81) (n=103) Regular physical activity decreases Correct 50 (62) 55 (53) the chance of adult-onset diabetes* Incorrect 12 (24) 7(7)

Dorft know 19(15) 41 (40) Regular physical activity increases Correct 62 (77) 69 (67) the chance of hypertension. Incorrect 8(10) 16(16)

Dorft know 11 (14) 18(18) Regular physical activity decreases Correct 67 (83) 75 (73) the chance of osteoporosis. Incorrect 4(5) 11 (11)

Dorft know 10(12) 17(17) Both continuous (one 30-min Correct 46 (57) 50 (49) session) and intermittent (three 10- Incorrect 4 (5) 13 (13) min sessions) aerobic physical Doirt know 31 (38) 40 (39) activity can build cardiovascular f i tness. Aerobic physical activities are the Correct 62 (77) 77 (75) most effective ones in developing Incorrect O (0) 2 (2) cardiovascular fitness. Don't know 19 (24) 24 (23) Aerobics is one kind of aerobic Correct 63 (78) 67 (65) physical activity. Incorrect 2 (3) 7 (7)

DoiVt know 16(20) 29 (28) The recommended duration for Correct 14(17) 18(18) each session of physical activity is Incorrect 53 (65) 66 (64) lOmins. Don’t know 14(17) 19(18) The recommended frequency for Correct 22 (27) 26 (25) physical activity is at least once Incorrect 46 (57) 58 (56) per week. Doirt know 13 (16) 19 (18) Physical activity must be hard Correct 59 (73) 78 (76) enough to require more exertion Incorrect 9(11) 8(8) than normal to produce gains in DoiVt know 13 (16) 17(17) health-related fitness. * 尸 < 0 . 0 5

75

3.3.13 Intention and Confidence in Changing Behavior

The stages of change situation for the behaviors of decreasing saturated fat intake,

increasing fruit intake, increasing vegetable intake and doing more physical activity

in the two groups are listed in Table 3.28. There was a significant difference

(尸<0.01) in the stages of change distribution for decreasing saturated fat intake

between the two groups, in which the Education Group had greater proportion who

were currently decreasing the intake than did the Control Group. In the Education

Group, 53% of them were in the precontemplation stage whereas in the Control

Group, 69% in this stage. In contrast, the total percentage of women in the action

and the maintenance stages in the Education Group was three times that of the

Control Group (40% Vs 13%).

Moreover, there was a significant difference (尸<0,05) in the stages of change

distribution for increasing vegetable intake between the two groups. The Education

Group again showed that they had higher intention and confidence in this behavior

than the Control Group as well, as there were only 11% of them in the

precontemplation stage compared with 24% in the Control Group. There were no

significant differences between the two groups in the stages of change for increasing

fruit intake and doing more physical activity. About one-third and one-fifth of the

women in the two groups were in the precontemplation stage for increasing

vegetable intake and increasing physical activity, showing that many had low

awareness about changing their behavior in these two areas.

76

Table 3.28 The stages of change of behavior in the Education and Control Groups Number (%) of women

Behavior Education Group Control Group Significance (n-81) (n-103)

Decreasing saturated fat intake 尸 < 0 . 0 1

Precontemplation 43 (53) 71 (69) Contemplation 2 (3) 6 (6) Preparation 4(5) 13 (13) Action 16 (20) 5 (5) Maintenance 16(20) 8_(8)

Increasing fruit intake N/S Precoiitemplation 22 (27) 34 (33) Contemplation 3 (4) 6 (6) Preparation 18(22) 15 (15) Action 15 (19) 12 (12) Maintenance 23 (28) 36 (35)

Increasing vegetable intake 尸 < 0 . 0 5

Precontemplation 9 (11) 25 (24) Contemplation 6 (7) 2 (2) Preparation 10(12) 12 (12) Action 19(24) 12(12) Maintenance 37 (46) 52 (51)

Doing more physical activity N/S Precontemplation 14 (17) 23 (23) Contemplation 8 (10) 12(12) Preparation 15 (19) 24 (24) Action 17 (21) 18(18) Maintenance 27 (33) 25 (25)

3.3.14 Perceived Difficulties in Changing Behavior

Only about 10% of the women in either group reported they had difficulties in

changing their eating behavior, whereas 38% of the Education Group and 22% of the

Control Group reported having difficulties in doing more physical activity.

Resisting the attraction of food was the most common difficulty faced when the

women tried to decrease saturated fat intake. The top three barriers to doing more

physical activity were laziness, makes me feel tired, too vigorous and no time.

Table 3.29 lists all the difficulties reported by the women in eating less saturated fat,

eating more fruit, eating more vegetable and doing more physical activity.

77

Table 3.29 Difficulties reportedly encountered preventing different behavioral

changes in the Education and Control Groups Number (%)

Behavior and difficulties Education Control Group Total Group (n=81) (n=103) (n=184)

Eating less saturated fal No difficulties reported 72 (89) 96 (93) 168 (91) Attraction of food 7 (9) 3 (3) 10 (5) Pressure from families/ friends 1(1) 2 (2) 3 (2) Feel hungry/no energy/ 1(1) 2(2) 3(2)

Uncomfortable Eating more fruit

No difficulties reported 75 (93) 101 (98) 176 (96) No time 2(2) 0(0) 2(1) Lazy 2(2) 0(0) 2(1) Can't eat when feel full 1(1) 1 (1) 2 (1) Feel discomfort 1 (1) 1 (1) 2 (1) Cannot have food in some 1(1) 0(0) 1(1)

occasions Fear to be fat 1(1) 0(0) 1(1) Afraid of fertilizers 1(1) 0(0) 1 (1) Others \_{\) 0_(0) 1 (1)

Eating more vegetables No difficulties reported 78 (95) 101 (98) 179 (97) Dislike the texture/taste 2 (2) 2 (2) 4 (2) Afraid of fertilizers 2(2) 0(0) 2(1) Don't know how to cook them 1_(1) Q (0) 1 (1)

Doing more physical activity No difficulties reported 50 (62) 80 (78) 130 (71) Laziness 13 (16) 6(6) 19 (10) Feel tired because too vigorous 8(10) 9(9) 17(9) No time 7(9) 7(7) 14(8) Health problems 2 (2) 1 (1) 3 (2) No company 1(1; 1 (1) 2 (1) Can't perform some physical 1(1) 0(0) 1(1)

activities Others 3^(4) 0_(0) 3 (2)

78

3.3.15 Perceived Methods Facilitating Behavior Change

Although not many of the women reported barriers to changing their behaviors, more

of them reported already knowing some methods for supporting their change, as are

shown in Table 3.30. Most commonly, the women pointed out that having a healthy

eating habit was a way to decrease saturated fat intake. Buying more fruit,

developing a habit of eating fruit and choosing their favorite fruit were the popular

ways to increase fruit intake. Buying/cooking more vegetables, eating less

meat/dishes and thinking of the benefits of vegetables were the most common

methods for increasing vegetable intake among the women. Thinking of the

benefits of physical activity, joining more physical activities and self encouragement

were cited by most of them as the methods for increasing physical activity.

Table 3.30 Methods suggested by the women in the Education and Control Groups

for facilitating different behavioral changes

Number (%) Behavior and methods Education Control Total

Group Group (n=184) (n-81) (n=103)

Eating less saturated fat No methods suggested 47 (58) 86 (83) 133 (72) Have healthy eating practices 23 (28) 5 (5) 28 (15) Co-operate with family 3 (4) 3 (3) 6 (3) Buy/cook fatty food less frequently 3 (4) 2 (2) 5 (3) Self control/self remind 3 (4) 2 (2) 5 (3) Pay attention to eating habits and food 2 (1) 0 (0) 2 (1)

composition Others 0_(0) 5 (5) 5 (3)

Eating more fruit No methods suggested 33 (41) 59 (57) 92 (50) Buy fruit more frequent 12 (15) 7(7) 19(10) Choose favorite/different types of fruit 7 (9) 9 (9) 16 (9) Develop a habit of eating fruit 8(10) 7(7) 15 (8) Have fruit as snacks 9(11) 2 (2) 11 (6) Eat less meat/dishes 3 (4) 8 (8) 11 (6) Remember the benefits of eating more 3 (4) 3 (3) 6 (3)

fruit Eat salad/assorted fruit basket 1(1) 1(1) 2(1) Others 5 (10) 7(7) 12(7)

79

Number (%) Behavior and methods Education Control Total

Group Group (n=184) (n=81) (n-103)

Eating more vegetables No methods suggested 36 (44) 63 (61) 99 (54) Buy/cook vegetables more frequent 15(19) 9(9) 24 (13) Eat less meat/dishes 10 (12) 9 (9) 19 (10) Remember the benefits of eating more 6 (7) 9 (9) 15 (8)

vegetables Develop a habit of eating vegetables 5 (6) 4 (4) 9 (5) Use a healthy cooking method 5 (6) 4 (4) 9 (5) Choose favorite vegetables 3 (4) 5 (5) 8 (4) Others H U 0(0) 1 (1)

Doing more physical activity No methods suggested 33 (41) 55 (53) 88 (48) Remember the benefits of doing 10 (12) 13 (13) 23 (13)

physical activity Self encouragement/More wi 11 power 8 (10) 10(10) 18(10) Join more physical activities 6 (7) 9 (9) 15(18) Save more time for doing physical 7(9) 5(5) 12(7)

activity Have company 9 (11) 2 (2) 11 (6) Try to incorporate physical activity in 3 (4) 5 (5) 8 (4)

daily activities/in different occasions Build an interest in doing physical 2(1) 3 (3) 5 (3)

activity Other internal factors 2(1) 3 (3) 5 (3) Others U l j 3_(3) 4(2)

3.3.16 Health Information Desired

When asked what kind of health information they would like to learn more about, a

variety of topics were mentioned, with the most commonly cited interesting topic

being nutrition-related diseases (16% in the Education Group and 10% in the Control

Group). All the topics are listed in Table 3.31. However, only 32% and 16% of

the Education and Control Groups, respectively, responded to this question.

80

Table 3.31 Topics about which the women would like to learn more in the Education and Control Groups

Number (%) Health topics Education Group Control Group Total

(n=81) (n=103) (n=184) No topics suggested 62 (77) 90 (87) 152 (83) Nutrition-related diseases 13(16) 10(10) 23 (13) Nutrition information 9(11) 2(2) 11(6) One's health status 5 (6) 6 (6) 11 (6) All-rounded information 5 (6) 2 (2) 7 (4) Organ's functioning 2 (2) 2 (2) 4 (2) Other diseases 2(2) 1(1) 3(2) Women's health 1(1) 1(1) 2(1) Dieting/weight control methods 2 (2) 0 (0) 2(1) Physical activity information 2(2) 0(0) 2(1) Others 2_(2) 0_(0) 2(1)

3.3.17 Areas of Health the Women Would Like to Improve

When asked what aspects of health they would like to improve, only 69% and 62%

of the Education and Control Groups, respectively, responded to this question.

About one-fourth of all women mentioned their physical activity habits (27% in the

Education Group and 21% in the Control Group) and one-sixth of them mentioned

eating habits (21% in the Education Group and 13% in the Control Group). Other

aspects mentioned included losing weight; relieving joint/bone pain and

strengthening their health etc, all listed in Table 3.32.

81

Table 3.32 Aspects of health the women would like to improve in the Education and

Control Groups

Number (%) Aspects of health Education Group Control Group Total

(n=81) (11=103) (n=184) No improvements mentioned 36 (44) 58 (56) 94 (51) Physical activity habits 22 (27) 22 (21) 44 (24) (unspecified) Eating habits (unspecified) 17(21) 13 (13) 30(16) Lose weight 9(11) 13 (13) 22(12) Strength physical health 6 (7) 5 (5) 11 (6) Improve mental health 7(9) 1(1) 8(4) Relieve joint/bone pain 3 (4) 5 (5) 8 (4) Benefit a parts of the body 3 (4) 4 (4) 7 (4) Improve osteoporosis 4 (5) 1(1) 5(3) Gain weight 0 (0) 3 (3) 3 (2) Improve hypertension 1(1) 2(2) 3(2) Improve high blood cholesterol 2 (2) 1(1) 3(2) Get more rest 0 (0) 2 (2) 2 (1) Others 5(6) 4 (4) 9 (5 )

3.3.18 Summary Profile of the Women at Pretest

The Pretest provided a basis for evaluating the impact of the program. Among all

the variables measured in the Pretest, only few of them showed significant

differences between the Education and Control Groups. The few relatively small

differences revealed were those in nutrient supplements taking; physical activity

habits; intention/confidence in changing saturated fat and vegetable intakes;

proportion of them who had heard of saturated fat; energy, fat and vitamin C intakes

and consumption frequencies of whole milk, tofu skin, potato crisps, chocolate and

salad dressing.

The Pretest also revealed that about two-third of the total surveyed women had

complete primary or lower secondary education level. Most (70%) of them were

housewives, and more than 90% of the women were responsible for cooking at home.

The prevalence of overweight and obesity was 18% and 29% respectively, and about

82

70% of the women exceeded the desirable range of percent body fat. A better

situation prevailed for the fasting total blood cholesterol level, in which 86% of the

women had a normal level.

About 70% and 80% of the women ate breakfast and lunch daily, respectively, in

both groups, and less than 10% of them never ate breakfast. One-third of the

women in both groups reported never having snacks. The frequency of snack

eating among the eaters was twice per day. Taking supplements was more common

in the Education Group than the Control Group (27% Vs 6%;尸<0.05), and vitamin E

was the most popular supplement taken in both groups.

The women mainly used either corn oil or peanut oil for cooking. Regarding their

cooking methods, steaming was the most common for fish (95%) and poultry (65%),

while stir frying was the most popular for pork/beef (62%) and vegetables (86%).

About 30% of the women removed all the fat/skin before they eating meat or poultry.

About half of the women replied they sometimes read the food labels, only 8%

indicated that the labels were clear or very clear.

The three-day dietary records showed that about 80% of the women's percent energy

from fat was greater than the recommended level (less than 30%), mainly come from

the fried food such as fried meat, chicken wing, fried dim sum and fried noodles.

Fibre intake needed some attention because almost none of the women met the

recommended intake levels, because vegetables consumption was low among the

women. Calcium and vitamin E intakes were another concern, as less than 10% of

the women achieved the recommended intake level for calcium, and only one-fifth of

them had sufficient vitamin E intake. Additionally, from the food frequency

83

questionnaire, the women rarely consume the dairy products, except for ice-cream.

Half and one-third of the Education and Control Groups, respectively, reported they

had heard of saturated fat. More women had heard of the food pyramid, in which

80% of the Education Group and 70% of the Control Group responded they had

heard of it, however, only about 30% from both groups could correctly match all the

food groups with the corresponding levels of the food pyramid.

Stair climbing was not common among the surveyed women as more than half of

them did no daily stair climbing. The physical activity on which the women spent

the most time was watching television (two hours per day), followed by having

meals (one and a half hours per day). Not many of the women (20% in both groups)

had heard of the physical activity pyramid, and only less than 5% of the women

could correctly match all the physical activity groups with their corresponding levels

of the physical activity pyramid.

Sixty-one percent of the total surveyed women had no awareness about decreasing

their saturated fat intake, revealed from the stages of change question. The

proportion of women who had no awareness to increase fruit intake, increase

vegetable intake and do more physical activity was 30%, 18% and 20% respectively.

The women reported more difficulties when they tried to do more physical activity

than when they tried to eat less saturated fat or eat more fruit and vegetables.

Laziness and feeling tired were the top two barriers for doing more physical activity

among the surveyed women. To facilitate their behavior change, some of the

women did mention various methods, however.

84

Less than one-third of the women seemed interested enough in various health

information topics, in which nutrition-related diseases was the most attractive one to

them. Among the total surveyed women, only 24% and 16% replied they would

like to improve their physical activity and eating habits respectively.

In summary, the Pretest showed that a certain proportion of the surveyed middle-

aged women had unhealthy lifestyles in various aspects, such as diets with high

saturated fat, low fibre, vitamin E and calcium intakes, as well as frequently

participating in sedentary activities such as watching television, eating and reading.

These findings further support the development of a health promotion program

emphasizing healthy eating and regular physical activity as necessary for local

middle-aged women such as these.

3.4 Outcome Evaluation

To evaluate the effectiveness of the program, both the Education and Control Groups

were assessed twice after the program: immediately after the program (the Posttest),

and six months later (the Follow-up). The assessments were the same as in the

Pretest, and comparisons were made from these two assessments to determine if any

aspects of their knowledge, attitudes and behavior underwent any significant change.

3.5 Posttest


About two-thirds of the women, 63 women in the Education Group (78% of the

Pretest) and 65 women in the Control Group (63% of the Pretest), participated in the

Posttest. There were no significant differences in any of the demographic

characteristics between the two groups. There were also no significant differences

85

in the demographic characteristics between the dropouts and those remaining at the

Posttest in the two groups. Therefore, the nature of the subjects was not strongly

affected even though some dropped out from the Pre- to Posttest. All the

comparisons between Pre- and Posttests were based on those who had completed

both assessments, that is, 63 women in the Education Group and 65 women in the

Control Group.

3.5.2 Anthropometry

Only 53 and 59 women completed both body measurements in the Pre- and Posttests

in the Education Group and the Control Group respectively. None of the body

indices were changed significantly in the two groups, except that the mean fasting

blood cholesterol level which increased significantly both in the Education Group

(from 4.7 to 5.0 mmol/L,尸<0.01) and the Control Group (from 4.6 to 4.8 mmol/L,

尸<0.05). No significant changes were observed in the distributions of women in

different categories of BMI, percent body fat and fasting total blood cholesterol level

(Table 3.33).

86

Table 3.33 Comparison between physical measurement data, distributions of BMI levels according to Asian definition, percent body fat levels and fasting total blood cholesterol levels of women between Pre- and Posttests in the Education and Control Groups

Mean 士 S.D. Education Group (n=53) Control Group (n=59)

Measurement Pretest Posttest Pretest Posttest W e i g h t (k§) 58.2 ± 7.2 57.4 1 7.9 55.9 ± 10.0""55.4 ± 10.8 Height (cm) 155.8 ±4.9 155.7 ±5.1 155.3 ±4.8 155.4 ±4.6 BMI (kg/m2) 24.0 ±2.9 23.7 ± 3.2 23.2 ±4.0 23.0 ±4.4 Percent body fat (%) 32.8 ± 6.2 33.9 ± 7.3 30.7 ± 7.7 30.6 ± 7.5 Fasting total blood 4.7 ± 0.7 5.0 ±0.8** 4.6 ± 0.5 4.8 ± 0.6*

cholesterol level (mmol/L) ~ Number (%)

BMI levels Underweight 1(2) 2(4) 5(9) 7(12) Normal weight 20 (38) 17 (32) 29 (49) 26 (44) Overweight 16 (30) 18 (34) 6 (10) 9 (15) 0 b e s e 16 (30) 16 (30) 19 (32) 17 (29)

Percent body fat levels Below range 1 (2) 1 (2) 2 (3) 2 (3) Desirable range 7 (13) 5 (9) 21 (36) 20 (34) Above range 45 (85) 47(89) 36 (61) 37 (63)

Fasting total blood cholesterol levels D e s i r a b l e 40 (76) 35 (66) 53 (90) 51 (86) Borderline 11 (21) 15 (28) 5(9) 7(12) H i g h 2_(4) 3_(6) \ J2) 1 (2)

* 尸 < 0 . 0 5 * * 尸 < 0 . 0 1


About the same number of women reported having the same six conditions in the

two groups between the Pre- and Posttests, as is shown in Table 3.34, no significant

changes were noted in either group. About one-third of the women claimed that

they had bone/joint pain, while the prevalence of the other diseases/conditions were

not high among the women.

87

Table 3.34 Comparison between the number (%) of self-reported cases of six health conditions between Pre- and Posttests in the Education and Control Groups

Number (%) Education Group (n=63) Control Group (n=65)

Disease/condition Pretest Posttest Pretest Posttest Diabetes f (2 ) i~(2) 0^0) 0^0) Hypertension 8 (13) 6 (10) 7(11) 5 (8) High blood cholesterol 5(8) 11 (17) 3(5) 2(3) High blood triglycerides 1 (2) O (0) 2 (3) 1 (2) Bone/joint pain 19 (30) 18 (29) 25 (38) 23 (35) Anemia 8 (13) 5J8) 9(14) 8(12)

The percentage of women who rated their health as worse or much worse than that of

their peers dropped from 29 to 15% in the Education Group while the percentage was

maintained at 19% in the Control Group (Table 3.35). The change in the Education

Group corresponded to an increase in the number who rated their health as the same

as their peers. However, none of these changes were significant.

Table 3.35 Comparison between the self-rated health relative to that of peers between



Rating of health Pretest Posttest Pretest Posttest Much worse 3^5) 1 (2) oTO) 0 ~ ( 0 ) ^ Worse 15 (24) 8(13) 12(19) 12(19) Same 26 (41) 38 (61) 33 (51) 37 (57) Better 17 (27) 13 (21) 20 (31) 15 (23) Much better 2_(3) 3_(5) 0(0) 1 (2)

3.5.4 Meal Patterns

Breakfast remained the most commonly skipped meal among the women while

dinner was the least. There were no significant changes in the meal patterns in

either the Education Group or the Control Group. There were also no significant

changes in the number of women having breakfast or lunch every day or skipping

breakfast daily (Tables 3.36 and 3.37). No significant changes was also seen in the

88

percentage of women who reported that they never had snacks, remaining at about

30%.

Table 3.36 Comparison between the mean number of days 土 S.D. per week of having breakfast, lunch and dinner, and the mean number of snacks 土 S.D per day between Pre- and Posttests in the Education and Control Groups

Education Group (n=63) Control Group (n=65) Meal Pretest Posttest Pretest Posttest

Breakfast (d/wk) 5.7 ± 2.2 5.8 ± 2.0 6.1 土 1.8 5.9 ±2.1 Lunch (d/wk) 6.6 ±1.1 6.4 ±1.3 6.5 土 1.3 6.6 ±1.1 Dinner (d/wk) 7.0 士 0.0 6.9 士 0.5 7.0 土 0.0 7.0 土 0.2 Snacks (per day) 1.5±1.7 1.1 ± 1.2 1.3±1.5 1.4±1.3

Table 3.37 Comparison between the number (%) of women who had breakfast every

day, skipped breakfast every day or had lunch every day between Pre- and Posttests

in the Education and Control Groups

Education Group (n^63) Control Group (n=65) Pretest Posttest Pretest Posttest

Ate breakfast daily 42 (67) 36 (57) 45 (69) 42 (65) Never ate breakfast 4 (6) 3 (6) 4 (6) 5 (8) Ate lunch daily 54 (86) 47 (75) 53 (82) 53 (82)


There were no significant changes in the prevalence of taking nutrient supplements

regularly among the women in both groups between the Pre- and Posttests. Among

those who taking supplements, vitamin E was the most common supplement in either

group in the two assessments. The types of supplements that the women took are

listed in Table 3.38.

89

Table 3.38 The types of supplements taken in Pre- and Posttest in the Education and

Control Groups


Types of supplements Pretest Posttest Pretest Posttest None 45 (71) 41 (65) 61(94) 58 (89) Vitamin E 9(14) 11 (17) 3(5) 3(5) Calcium 5 (8) 5 (8) 1 (2) 1 (2) Vitamin(s) (unspecified) 6(10) 6(10) O (0) 1 (2) Vitamin B 1 (2) 2 (3) 2 (3) 2 (3) Vitamin C 4(6) 2 (3) 1 (2) 1 (2) F ish oil 2 (3) 2 (3) O (0) 1 (2) Manganese 1 (2) O (0) 1 (2) 1 (2) Protein powder 1(2) 2(3) 0(0) 0(0) Traditional Chinese 1 (2) 2 (3) 0 (0) O (0)

Medicine Others Q (0) 2 (3) Q (0) 1 (2)


There were again no significant changes in the proportion in using each type of oil in

both groups. Corn oil remained the most common cooking oil with more than half

of them women reported using it, followed by peanut oil, used by nearly half of the

surveyed women.

Both groups maintained the same rank for the common cooking methods for fish;

pork/beef; poultry and vegetables. The three most common cooking methods for

fish were steaming, frying and boiling. However, significant increase (尸<0.05) was

found in the Education Group in the proportion of using stir frying for fish (from 0%

to 8%). While in the Control Group, significant decrease (尸<0.05) was seen in the

proportion of using boiling for fish (from 34% to 17%).

No significant changes were observed in the proportion of women using different

cooking methods for pork/beef, poultry and vegetables in both groups. Stir frying,

boiling and steaming were remained the top three common cooking methods for

90

pork/beef. The top three cooking methods for poultry were steaming, grilling and

boiling, while stir frying and boiling were still the most common methods for

cooking vegetables.


In assessing their fat removal behavior, there were no significant changes for meat

and poultry in the Education and Control Groups (Table 3.39).

Table 3.39 Comparison between the number (%) of women reported removing fat

from meat and removing skin from poultry between Pre- and Posttests in the


Education Group Control Group (n=63) (n-65)

Food item Fat/skin removal Pretest Posttest Pretest Posttest Meat

Not remove any fat 1 (2) 1 (2) 8(12) 4 (6) Removed some fat 43 (68) 39 (62) 43 (66) 40 (62) Removed all fat 17 (27) 22 (35) 12 (19) 20 (31) Never consume meat 2 (3) 1 (2) 2 (3) 1 (2)

Poultry Not remove any skin 7 (11) 3(5) 10(15) 9 (14) Removed some skin 37 (59) 36 (57) 39 (60) 35 (54) Removed all skin 18 (29) 24 (38) 15 (23) 20 (31) Never consume poultry 1 (2) Q (Q) 1 (2) 1 (2)


The Posttest revealed that there was no significant change in the proportion of

women responsible for buying food for their families, with the proportion remaining

at more than 90% of the women in both groups. No significant changes were also

found in the frequency of reading food labels in the two groups. When asked about

the clarity of the food labels, although there was a 5% increase of women who

replied these were clear/very clear in the Education Group, whereas the same

percentage was seen for the Control Group. However, this change was not

significant for the two groups between Pre- and Posttests (Tables 3.40 and 3.41).

91

Table 3.40 Comparison between the number (%) of women reported reading the food

labels with different frequencies between Pre- and Posttests in the Education and

Control Groups Education Group (n=63) Control Group (n=65)

Frequency Pretest Posttest Pretest Posttest Never 4(6) 2(3) 4(6) 7(11) Sometimes 30 (48) 36 (57) 30 (46) 30 (46) Usually 14 (22) 10 (16) 18 (28) 14 (22) Each time 15 (24) 15 (24) 13 (20) 14 (22)

Table 3.41 Comparison between the distribution of the number (%) of women citing

different degrees of clarity of the food labels between Pre- and Posttests in the

Education and Control Groups Education Group Control Group

Clarity Pretest Posttest Pretest Posttest (n-59) (n=61) (n=61) (n=58)

Very unclear 1 (2) f (2 ) U 2 ) 0(0) Unclear 6(10) 9(15) 9(15) 7(12) So-So 49 (83) 45 (74) 46 (75) 47 (81) Clear 3(5) 5(8) 5(8) 4(7) Very clear 0_(0) \ J2) 0^0) O(Q)

92


a. From the Three-day Dietary Records

Totals of 58 and 43 women returned the dietary record in both Pre- and Posttests in

the Education and Control Groups respectively. No significant changes were

observed among any of the dietary components measured in either group from Pre-

to Posttests (Table 3.42).

Table 3.42 Comparison between the energy and nutrient intake data between Pre- and

Posttests in the Education and Control Groups Mean 土 S.D.

Education Group (n=58) Control Group (n=43) Diet component Pretest Posttest Pretest Posttest Energy (kcal) 1826.0 ±404.9 1777.6 ± 399.7 2036.3 ±492.4 2089.9 ± 572.9 Carbohydrate (g) 230.0 ± 61.9 223.8 ± 53.8 250.9 ± 61.4 270.7 ± 76.3 Protein (g) 72.8 ±19.8 72.0 ±19.7 79.2 ±21.6 81.3 ±29.5 Fat (g) 72.3 ± 22.6 70.7 ± 23.5 82.1 ± 29.3 80.1 ±31.4 SFA (g) 14.0 ±5.5 14.7 ±6.5 15.4 ±6.1 15.5 ±8.2 PUFA (g) 13.8 ±6.3 13.2 ±8.2 16.7 ±8.0 15.9 ±8.8 MUFA (g) 21.7 ±8.6 21.4 ± 9.0 25.5 ± 10.5 24.8 ±12.4 Cholesterol (mg) 230.0 ± 134.9 218.1 ± 126.5 233.9 ± 170.7 237.5 ±122.1 Fibre (g) 8.3 ± 5.2 8.1 ±5.4 9.8 ± 4.5 10.7 ±4 .8 Calcium (mg) 502.6 ± 300.1 438.0 ± 158.8 477.8 ± 148.5 481.9 ±163.9 Iron (mg) 15.9 ±15.3 18.5 ±16.6 14.8 ±5.7 15.4 ±7 .9 Sodium (mg) 1799.1 ± 856.1 1781.4 ± 857.1 1713.6 ± 595.5 1945.2 ± 867.4 Vitamin A (RE) 841.5 815.0 ± 654.2 967.2 ± 675.6 997.4 土 643.4

土 1 2 0 3 . 6

Vitamin C (mg) 142.8 ± 82.5 153.0 ±117.5 176.9 ±83.3 180.6 ±79.7 Vitamin E (mg) 8.4 ± 7.3 8.2 ±9.6 11.0 ±10.5 11.1 ±9.9

There were no significant changes in the percentages of women exceeding the

recommended percent energy from total fat, SFA, PUFA or MUFA in the two groups,

as is shown in Table 3.43. There were also no significant changes in the

percentages of women meeting the recommended intakes of selected nutrients in the

two groups (Table 3.44).

93

Table 3.43 Comparison between the number (%) of women exceeding the recommended percent energy from total fat, SFA, PUFA and MUFA between Pre-and Posttests in the Education and Control Groups

Education Group (n=58) Control Group (n=43) Percent of women Pretest Posttest Pretest Posttest With energy from total fat > 3 0 % 4 6 (79) 44 (76) 35 (81) 29 (67) With energy from SFA >10% 5 (9) 8 (14) 1 (2) 4 (9) With energy from PUFA >10% 5(9) 5(9) 2(5) 5 (12) With energy from MUFA >10% 28 (48) 36 (62) 27 (63) 21 (49)

Table 3.44 Comparison between the number (%) of women who met the

recommended intake levels of selected nutrients between Pre- and Posttests in the

Education and Control Groups Education Group (n=58) Control Group (n=43)

Nutrient Pretest Posttest Pretest Posttest Protein >70 g 32 (55) 26 (45) 27 (63) 26 (61) Cholesterol <300 mg 46 (79) 49 (85) 33 (77) 30 (70) Fibre >25 g O (0) 1 (2) 0 (0) 0 (0) Calcium >800 mg 6(10) 1 (2) 0 (0) 1 (2) Iron >12 mg 34 (59) 36 (62) 28 (65) 25 (58) Vitamin A >800 RE 19 (33) 23 (40) 22 (51) 25 (58) Vitamin C >60 mg 51 (88) 47 (81) 40 (93) 41 (95) Vitamin E >12 mg 7(12) 8(14) 9(21) 10(23)


None of the food items in the food frequency questionnaire, except boiled egg,

showed significant changes. The Education Group women reported significantly

(尸<0.05) increased the frequency of consumption of boiled eggs (those who

consumed once or more per week was increased from 35 to 45%).

Also, the number of women who never consumed/not consumed dairy products such

as cheese and low fat yogurt in a typical week was decreased in the Education Group

after the intervention, implying that more women in the Education Group had tried to

consume those dairy products. While in the Control Group, the number of women

94

who never consumed/not consumed was remained nearly unchanged (Table 3.45).

Table 3.45 Comparison between the number (%) of women who reported never/rarely consuming specific dairy products in a typical week between Pre- and Posttests in the Education and Control Groups

Education Group (n=63) Control Group (n=65) Food item Pretest Posttest Pretest Posttest

Cheese 45 (71) 36 (57) 39 (60) 44 (68) Low-fat yogurt 54 (86) 48 (76) 50 (77) 53 (82) Whole milk 55 (87) 51(81) 42 (65) 49 (75) Skim milk 43 (68) 37 (59) 39 (60) 44 (68) High-calcium low-fat milk 32 (51) 22 (35) 34 (52) 35 (54)


The mean Nutrition Knowledge Score increased significantly (^<0.001) in the

Education Group, from 7.4 in the Pretest to 9.8 in the Posttest (Table 3.46). No

significant change was seen in the Control Group. The increase in nutrition

knowledge showed no association with better body measurements, such as less

weight or blood cholesterol increase.

There was a significant increase (尸<0.001) in the number of people who had heard of

saturated fat in the Education Group, which increased from 46 to 83%. However,

there was no significant increase in the percentage in the Control Group who had

heard of saturated fat. The percentage of women who had heard of the food

pyramid increased significantly (^<0.001) in the Education Group from 79 to 100%,

whereas no significant increase was observed in the Control Group. The number of

the women who correctly answered the four layers' content of the food pyramid

increased from 20 to 35 (尸<0.001), while the number remained the same in the

Control Group.

95

Table 3.46 Comparison between the mean Nutrition Knowledge Score 士 S.D. and the

number (%) of women reported having heard of saturated fat or the food pyramid,

and who correctly matched all four food groups with their corresponding level of the

food pyramid between Pre- and Posttests in the Education and Control Groups Education Group (n=63) Control Group (n=65)

Nutrition knowledge questions Pretest Posttest Pretest Posttest Nutrition Knowledge Score 7.4 ±3.3 9.8 ±3.1*** 6.8 ± 3.7 6.7 ±3.1 Had heard of saturated fat 29 (46) 52 ( 8 3 ) " * 23 (35) 24 (37) Had heard of the food pyramid 50 (79) 6 3 ( 1 0 0 ” * * 44 (68) 48 (74) Correctly matched food 20 (32) 35 (56)*** 14 (22) 14 (22)

pyramid levels * * * 尸 < 0 . 0 0 1

The Education Group improved significantly (尸<0.05 or 尸<0.001) the proportion of

correct responses in five out of the ten additional nutrition knowledge questions

while the Control Group showed no significant changes in any of the questions

(Table 3.47). The other five questions, which were about cholesterol, protein,

frozen food, blood vessel hardening and colon cancer did not show any significant

changes in either group from Pre- to Posttests.

96

Table 3.47 Comparison between the number (%) of correct responses to the ten additional nutrition knowledge questions between Pre- and Posttests in the Education and Control Groups

Education Group Control Group (n=63) (n=65)

Nutrition knowledge questions Pretest Posttest Pretest Posttest Egg white has more saturated fat Correct 31 (49) 51 (81) 34 (52) 29 (45) than egg yolk. Incorrect 8 (13) 5(8) 9(14) 7(11) (E***) Don't know 24 (38) 7 (11) 22 (34) 29 (45) Skim milk has more saturated fat Correct 38 (60) 54 (86) 40 (62) 34 (52) than whole milk. Incorrect 6(10) 4(6) 8 (12) 8 (12) (E***) Don^t know 19 (30) 5 (8) 17 (26) 23 (35) Some foods contain a lot of fat b u t C o r r e c t 16 (25) 16 (25) 13 (20) 12 (18) no cholesterol. Incorrect 25 (40) 35 (56) 25 (38) 22 (34)

Doirt know 22 (35) 12 (19) 27 (42) 31 (48) High cholesterol food has a greater Correct 6 (10) 12(19) 7 (11) 5(8) effect than high saturated fat food on Incorrect 22 (35) 32 (51) 17 (26) 18 (28) raising blood cholesterol level. Don't know 35 (56) 19 (30) 41 (63) 42 (65) (E*) White bread has more fibre than Correct 52 (83) 60 (95) 48 (74) 51 (79) whole wheat bread. Incorrect 7 (11) 3(5) 6 (9) 6 (9) (E*) Doirt know 4(6) O(Q) 11(17) 8 (12) Whole milk contains more protein Correct 23 (37) 31 (49) 21 (32) 23 (25) than skim milk. Incorrect 20 (32) 17 (27) 19 (29) 25 (39)

DoiVt know 20 (32) 15 (24) 25 (39) 17 (26) Frozen foods have the same Correct 35 (56) 39 (62) 40 (62) 37 (57) nutrients as fresh foods. Incorrect 20 (32) 19 (30) 16 (25) 22 (34)

DoiVt know 8(13) 5(8) 9(14) 6(9) Eating a lot of sugars will cause Correct 14 (22) 29 (46) 16 (25) 17 (26) diabetes. Incorrect 42 (67) 31 (49) 42 (65) 42 (65) (E*) DoiVt know 7(11) 3(5) 7(11) 6(9) The hardening of blood vessel is Correct 3 (5) 4 (6) 3 (5) 3 (5) mainly caused by too much Incorrect 52 (83) 56 (89) 53 (82) 54 (83) cholesterol in your diet. Don^know 8(13) 3(5) 9(14) 8(12) A high fibre diet can help prevent Correct 51 (81) 58 (92) 52 (80) 54 (83) colon cancer. Incorrect 4 (6) 3 (5) 2 (3) 3 (5)

DoiVt know 8 (13) 2(3) 11 (17) 8 (12) E = Education Group

* 尸 < 0 . 0 5 , * * * 尸 < 0 . 0 0 1

Significant increases (尸<0.001) were seen in the proportion of women who correctly

identified the specific position of each food group in the food pyramid for all four

food groups in the Education Group only, but not in the Control Group (Table 3.48).

97

Nearly 90% of the women in the Education Group accurately stated that oils, fats,

salt and sugar belonged at the top layer of the food pyramid after the intervention.

The proportions who correctly identified the position increased a further 23%, 26%

and 23% for meats and dairy products, vegetables and fruits, and cereals,

respectively, in the Education Group.

Table 3.48 Comparison between the number (%) of women correctly matched the specific food group in the food pyramid between Pre- and Posttests in the Education and Control Groups

Education Group Control Group Food group Pretest Posttest Pretest Posttest

(n=63) (n=63) (n=65) (n-65) Oils, fats, salt and sugar 39 (62) 55 (87)*** 36 (55) 37 (57) Meats and dairy products 33 (52) 47 (75)*** 26 (40) 26 (40) Vegetables and fruits 21 (33) 37 (59)*** 18 (28) 16 (25) Cereals 26 (41) 40 (64)*** 20 (31) 20 (31)

* * * 尸 < 0 . 0 0 1


There was no change in the mean of the reported daily energy expenditure in the

Education Group. However, the Control Group's mean daily energy expenditure

decreased about 13% (from 1644.6 to 1424.6 kcal/day), which was a significant

(尸<0.05) drop from Pre- to Posttest (Table 3.49). The summary physical activity

index, which represented the general physical activity level from the women, did not

change significantly in either groups. Even though the mean number of flights of

steps climbed per day increased 2-fold (from 1.2 to 2.3 flights) in the Education

Group though, no significant changes were found in the mean number of flights of

steps the women climbed each day in either group. However, half of the women

still reported they had no stair climbing in the two groups in the Posttest.

98

Table 3.49 Comparison between the mean ± S.D. reported daily energy expenditure (kcal/day), summary physical activity index and number of flights of steps climbed per day between Pre- and Posttests in the Education and Control Groups

Education Group (n=63) Control Group (n=65) Pretest Posttest Pretest Posttest

Daily energy expenditure 1488.8 1467.6 1644.6 1424.6 (kcal/day) ± 664.8 ± 852.0 ±669.8 ± 604.3*

Summary physical activity index 32.4±19.5 28.6 ± 15.2 25.8 ± 16.3 26.8 ±15.7 Number of flights climbed per 1.2 土 2.4 2.3 ± 5.5 1.7 ±2.0 2.0 ±5.6

d a y * 尸<0.05 between Pre- and Posttests

The ranking and the time spent on each activity of the top ten frequent physical

activities in the Posttest remained nearly the same as the Pretest in both the

Education and Control Groups. Watching television, eating meals and reading were

the top three physical activities that the women did most during the day. Women

from both groups still spent about 2 hours per day watching television and about 1.5

hours per day having meals.

！ 3.5.12 Physical Activity Knowledge

As for the mean Nutrition Knowledge Score, the mean Physical Activity Knowledge

Score increased significantly (P<0.001) in the Education Group from 5.9 to 8.9

whereas no significant increase was seen in the Control Group (Table 3. 50).

The percentage of women who had heard of the physical activity pyramid increased

significantly (尸<0.001) in the Education Group from 14 to 79%. However, there

was no significant change in the Control Group. Also, a significant increase

(尸<0.001) was noted in the number of women (from 1 to 13) who correctly answered

the content of the physical activity pyramid was observed in the Education Group.

While in the Control Group, the number decreased from three to two women,

99

although this change was not significant.

Table 3.50 Comparison between the mean Physical Activity Knowledge Score 土 S.D. and the number (%) of women reported having heard of the physical activity pyramid, and correctly matched all the physical activity groups with their corresponding level of the physical activity pyramid between Pre- and Posttests in the Education and Control Groups

Education Group Control Group (n=63) (n-65)

Physical activity knowledge Pretest Posttest Pretest Posttest questions Physical Activity Knowledge Score 5.9 ±2.1 8.9 ±2.1*** 5.7 ±2.8 6.0 ± 2.6 Had heard of the physical activity 9 (14) 50 (79)*** 13 (20) 14 (22)

pyramid Correctly matched physical activity 1 (2) 13 (21) *** 3 (5) 2 (3)

levels * * * 尸 < 0 . 0 0 1

The Education Group improved significantly (尸<0.05 or 尸<0.01) in four out of the

nine additional physical activity knowledge questions while the Control Group

showed no significant changes in any of the questions (Table 3.51). The other five I

questions, which were about diabetes, aerobic physical activity, physical activity

recommendations and fitness did not show any significant changes in the two groups

from Pre- to Posttest.

1 0 0


additional physical activity knowledge questions between Pre- and Posttests in the Education and Control Groups

Education Group Control Group (n 二 63) (n=65)

Physical activity knowledge Pretest Posttest Pretest Posttest questions Regular physical activity decreases Correct 38 (60) 48 (76) 36 (55) 34 (52) the chance of adult-onset diabetes. Incorrect 12 (19) 5(8) 6(9) 10(15)

Dorftknow 13 (21) 10 (16) 23 (35) 21 (32) Regular physical activity increases Correct 48 (76) 57 (91) 46 (71) 49 (75) the chance of hypertension. Incorrect 7(11) 6(10) 10(15) 9(14) (E*) Don^ know 8(13) O (O) 9(14) 7(11) Regular physical activity decreases Correct 51 (81) 59 (94) 43 (66) 54 (83) the chance of osteoporosis. Incorrect 4(6) 3(5) 10 (15) 4(6) (E*) DoiVt know 8 (13) 1(1) 12 (19) 7(11) Both continuous (one 30-min Correct 38 (60) 40 (64) 33 (51) 42 (65) session) and intermittent (three 10- Incorrect 2(3) 13 (21) 8 (12) 6(9) min sessions) aerobic physical Doirt know 23 (37) 10 (16) 24 (37) 17 (26) activity can build cardiovascular fitness. (E**) Aerobic physical activities are the Correct 50 (79) 62 (98) 49 (75) 49 (75) most effective ones in developing Incorrect 0(0) 0(0) 2(3) 0(0) cardiovascular fitness. Don't know 13 (21) 1(2) 14 (22) 16 (25) (E**) Aerobics is one kind of aerobic Correct 49 (78) 55 (87) 41 (63) 42 (65) physical activity. Incorrect 2(3) 0(0) 6 (9) 4 (6)

Dorf tknow 12 (19) 8 (13) 18 (28) 19 (29) The recommended duration for each Correct 9(14) 7 (11) 15(23) 10(15) session of physical activity is 10 Incorrect 41 (65) 51 (81) 41 (63) 47 (72) m i n s - DoiVt know 13 (21) 5(8) 9(14) 8 (13) The recommended frequency for Correct 16 (25) 20 (32) 18 (28) 24 (37) physical activity is at least once per Incorrect 36 (57) 39 (62) 34 (52) 34 (52) w e e k . Doirt know 11 (18) 4(6) 13 (20) 7(11) Physical activity must be hard Correct 48 (76) 54 (86) 49 (75) 53 (82) enough to require more exertion than Incorrect 5 (8) 5 (8) 5 (8) 3 (5) normal to produce gains in health- Doirl know 10(16) 4(6) 11(17) 9(14) related fitness.

E = Education Group

* 尸 < 0 . 0 5 ， * * 尸 < 0 . 0 1

Significant increases (?<0.001) were found in the proportion of women who

correctly identified the specific position of physical activity group in the physical

activity pyramid for all the four physical activity groups in the Education Group only,

101

but not in the Control Group (Table 3.52). Seventy-percent of women in the

Education Group accurately stated that rest/inactivity was in the top layer of the

physical activity pyramid in the Posttest. For the other three levels, significant

increases in the proportion of correct responses in the Education Group.

Table 3.52 Comparison between the number (%) of women correctly matched the

specific physical activity group in the physical activity pyramid between Pre- and


Education Group Control Group Physical activity group Pretest Posttest Pretest Posttest

(n=63) (n-63) (n=65) (n-65) Rest/inactivity 8 (13) 45 (69)*** 10 (15) 12 (18) Exercise for flexibility and 2(3) 15 (23)*** 5(8) 4(6)

muscular strength Aerobic and active sports 4 (6) 24 (37)*** 6 (9) 3 (5) Lifestyle physical activity 2 (3) 23 (35)*** 6 (9) 3 (5) * * * 尸 < 0 . 0 0 1

As the Education Group significantly improved their nutrition knowledge and

physical activity knowledge after the intervention, analysis was made by education 1

level and age group to investigate whether any subgroups of women had made better

improvement.

3.5.13 Analysis of the Changes by Education Level

When the Education Group was divided into four education levels (incomplete

primary; complete primary; lower secondary and upper secondary), no association

was found between the education level and any of the body parameter changes. The

mean Nutrition Knowledge Score was significantly increased (P<0.05 or P<0.01),

for all the education level groups, except for those of lower secondary level. The

women in complete primary education had the greatest increase while those in lower

secondary had the least increase (Table 3.53).

102

All the education levels increased the proportion who had heard of saturated fat.

Significant changes were seen in three education levels: complete primary ^<0.01) ,

lower secondary (尸<0.05) and upper secondary (尸<0.05). All the women, no

matter what their education level, replied that they had heard of the food pyramid in

the Posttest. Significant increases were observed in two education levels:

incomplete primary (尸<0.05) and lower secondary (尸<0.01).

Women at all the education levels had significantly increased (^<0.05, P<0.01 or

?<0.001) their mean Physical Activity Knowledge Score. The greatest increase

was found in complete primary while the least increase was seen in incomplete

primary. Moreover, significant increases (尸<0.05,尸<0.01 or �< 0 . 0 0 1 ) were

observed in all the education level groups with regard to the proportion who had

heard of the physical activity pyramid. The increase in the percentage of women

ranged from four-fold for upper secondary education (from 15% to 62%) to seven-

fold for complete primary education (from 14% to 93%). However, education level

showed no associations with the changes of proportion who could correctly fill in the

food and physical activity pyramids, and the stages of change in behavior.

103

Table 3.53 Comparison between the mean Nutrition and Physical Activity

Knowledge Scores 土 S.D., and the number (%) who had heard of saturated fat, the

food pyramid and the physical activity pyramid of Education Group's women of

different education level between Pre- and Posttests Education level Pretest Posttest Incomplete primary (n=13)

Nutrition Knowledge Score 5.7 ± 3.3 7.8 ± 2.8* Had heard of saturated fat 5 (39) 9 (69) Had heard of the food pyramid 8 (62) 13 (100)* Physical Activity Knowledge Score 5.7 土 2.0 8.0 士 2.0* Had heard of the physical activity pyramid 2(15) 10 (77)**

Complete primary (n=14) Nutrition Knowledge Score 6.6 土 2.8 10.1 土 3.0** Had heard of saturated fat 3 (21) 10(71)** Had heard of the food pyramid 13 (93) 14 (100) Physical Activity Knowledge Score 5.4 ±2.2 8.9 ±2.1** Had heard of the physical activity pyramid 2(14) 13 (93)***

Lower secondary (n:22) Nutrition Knowledge Score 7.9 ±3.6 9.6 ±3.4 Had heard of saturated fat 11 (50) 19 (89)* Had heard of the food pyramid 16 (73) 22 (100)** Physical Activity Knowledge Score 5.9 ± 2.2 8.7 ±2.0*** Had heard of the physical activity pyramid 3(14) 18 (82)***

Upper secondary (n=13) Nutrition Knowledge Score 8.8 ± 2.5 11.7 ±1.4** Had heard of saturated fat 9 (69) 13 (100)* Had heard of the food pyramid 12 (92) 13 (100) Physical Activity Knowledge Score 6.5 ±2.1 9.8 ±2.3** Had heard of the physical activity pyramid 2(15) 8 (62)*

* 尸 < 0 . 0 5 , * * 尸 < 0 . 0 1 , * * * 尸 < 0 . 0 0 1

3.5.14 Analysis of the Changes by Age Group

When the Education Group was divided into two age groups, 30-39 years and 40-50

years, no association was found between age and any of the body parameter changes.

Both age groups' mean Nutrition Knowledge Score increased significantly ( ^ 0 . 0 5

or 尸<0.001) in the Posttest (Table 3.54). Significant increases (尸<0.01) were

obtained in both age groups with respect to the proportion who had heard of

saturated fat, resulting in more than 80% of the women had heard of it. Significant

increase (尸<0.001) was only observed in age group 30-39 years in the proportion

104

who had heard of the food pyramid.

The mean Physical Activity Knowledge Score increased significantly (尸<0.001) in

both age groups. Significant (尸<0.001) and tremendous increases were observed in

both age groups in the proportion of women who had heard of the physical activity

pyramid. The proportion increased from 0 to 72% in age group 30-39 years and

from 20 to 82% in age group 40-50 years. Nevertheless, as like education level, age

group showed no effects on the changes of proportion who could correctly fill in the

food and physical activity pyramids, and the stages of change in behavior.




different age group between Pre- and Posttests Education level Pretest Posttest 30-39 years (n=18)

Nutrition Knowledge Score 8.7 ± 2.6 10.2 ±3.1* Had heard of saturated fat 7 (39) 15 (83)** Had heard of the food pyramid 16 (89) 18 (100) Physical Activity Knowledge Score 6.3 士 1.2 9.0 士 2.0*** Had heard of the physical activity pyramid Q (Q) 13 (72)***

40-50 years (n=45) Nutrition Knowledge Score 6.9 ± 3.5 9.7 ±3.1*** Had heard of saturated fat 22 (49) 37 (82)** Had heard of the food pyramid 34 (76) 45 (100)*** Physical Activity Knowledge Score 5.7 ±2.3 8.8 ±2.2*** Had heard of the physical activity pyramid 9 (20) 37 (82)***

* 尸 < 0 . 0 5 , * * 尸 < 0 . 0 1 , * * * 尸 < 0 . 0 0 1


Table 3.55 shows that significant change (尸<0.01) was found in the Education Group

only in stages of change in decreasing saturated fat consumption, in which less

women were in the precontemplation stage, resulting in more women were in the

action and maintenance stages in the Posttest. However, no significant changes in

105

stages of change in increasing fruit consumption, increasing vegetable consumption

or doing more physical activity were observed in both groups.

Education level and age did not demonstrate any association with changes in stages

of change in these behavior. Women in the maintenance stage of any of these four

behaviors had no significant differences in dietary and physical activity habits with

those in the earlier stages.

Table 3.55 Comparison between the stages of change of behavior between Pre- and

Posttests in the Education and Control Groups Number (0Zo) of women

Education Group (n=63) Control Group (n=65) Behavior Pretest Posttest Pretest Posttest Decreasing saturated fat intake (E**)

Precontemplation 35 (56) 14 (22) 46 (71) 47 (72) Contemplation 1 (2) 3 (5) 3 (5) 4 (6) Preparation 4(6) 11(17) 6 (9) 4 (6) Action 15 (24) 22 (35) 3 (5) 3 (5) Maintenance 8(13) 13 (21) 7(11) 7(11)

Increasing fruit intake Precontemplation 17 (27) 8 (13) 24 (37) 12 (19) Contemplation 3 (5) 1 (2) 3 (5) 5 (8) Preparation 15(24) 12(19) 8(12) 7(11) Action 14 (22) 20 (32) 7 (11) 12 (19) Maintenance 14 (22) 22 (35) 23 (35) 29 (45)

Increasing vegetable intake Precontemplation 8(13) 7(11) 19(29) 10(15) Contemplation 5 (8) 3 (5) 2 (3) 1 (2) Preparation 8 (13) 12(19) 5(8) 5 (8) Action 17 (27) 15 (24) 8 (12) 13 (20) Maintenance 25 (40) 26 (41) 31 (48) 36 (55)

Doing more physical activity Precontemplation 12(19) 7(11) 14 (22) 11(17) Contemplation 7(11) 6(10) 7(11) 14(22) Preparation 10(16) 14 (22) 17 (27) 14 (22) Action 11 (18) 14 (22) 13 (20) 10 (15) Maintenance 23 (37) 22 (35) 13 (20) 16 (25)

E = Education Group

* * 尸 < 0 . 0 1

106


Not many women reported difficulties in changing their behavior, except for doing

more physical activity. A slight increase in the number of people (from seven to

twelve) in the Education Group who said that they faced difficulties in decreasing

saturated fat intake was seen, as the attraction of the food was still the major problem

for the women. At the same time, the number of women who reported difficulties

in decreasing saturated fat intake in the Control Group was dropped a little (from six

to three), Table 3.56.

The number of women who reported difficulties in increasing fruit intake was nearly

the same in the Education Group while in the Control Group the number increased

from zero to six. A variety of difficulties were mentioned by the women, as is

shown in Table 3.56.

The main difficulty in increasing vegetable intake was dislike the texture/taste of

vegetables for the two groups. An increase in number was observed in the Control

Group for physical activity (from 15 to 20). Among all the difficulties, laziness was

the one most commonly mentioned by the women.

107

Table 3.56 Comparison between the difficulties reportedly encountered preventing different behavioral changes between Pre- and Posttests in the Education and Control Groups

Number of women Education Group (n=63) Control Group (n=65)

Behavior and difficulties Pretest Posttest Pretest Posttest Eating less saturated fat

Attraction of food 5 8 2 1 Pressure from families/friends 1 3 2 1 Feel hungry/no energy/ 1 2 2 1

uncomfortable Eating more fruit

No time 2 1 0 0 Cannot have food in some 1 0 0 0

occasions Lazy 2 1 0 1 Fear to be fat 1 1 0 0 Afraid of fertilizers 1 0 0 0 Can't eat when feel full 1 1 0 1 Feel discomfort 1 0 0 1 Dislike the taste 0 1 0 1 Expensive 0 1 0 1 Others 1 0 0 2

Eating more vegetables Dislike the texture/taste 0 3 1 1 Afraid of fertilizers 1 1 0 0 Feel full 0 1 0 0 Don't know how to cook 0 0 0 1

Doing more physical activity Lazy 12 13 5 3 No time 4 2 4 3 Feel tired because too 5 2 5 9

vigorous No company 1 3 1 5 Health problems 0 0 1 3 Can't perform some physical 1 3 0 3

activity actions/don't know how to do

Others 3 2 0 Q

108

3.5.17 Perceived Methods for Facilitating Behavior Change

The number of people who suggested methods for behavioral changes was not

changed greatly for any behavior, except for the number mentioning decreasing

saturated fat in the Education Group. The number in this case was increased from

16 to 36, and there were some new suggestions in the Posttest, for instance, healthy

cooking method and decreased frequency of eating out, which were new ideas were

not cited by the Control Group. Some new ideas were also seen in the Control

Group in the Posttest. The percentages of all the ideas mentioned were not changed

significantly in the two groups (Table 3.57).

Table 3.57 Comparison between the suggested methods for assisting different

behavioral changes between Pre- and Posttests in the Education and Control Groups Number of women

Education Group (n=63) Control Group (n=65) Behavior and methods Pretest Posttest Pretest Posttest Eating less saturated fat

Buy/cook fatty food less 2 5 2 2 frequently

Have healthy eating practices 16 18 4 5 Have healthy cooking practices O 6 0 0 Decrease frequency of eating out 0 3 0 0 Pay attention to eating habits and 2 1 0 0

food composition Self control/self remind 2 8 2 4 Cooperate with families 2 2 2 0 Others 0 1 3 l

Eating more fruits Buy more fruit 12 18 5 12 Have fruit as snacks 6 5 0 6 Remember the benefits of eating 1 2 1 0

more fruit Choose favorite/different types 6 4 6 4

of fruit Develop a habit of eating fruit 6 9 5 1 Eat less meat/dishes 3 2 6 3 Eat salad/assorted fruit basket 1 0 1 1 Others 4 6 2 5

109

Number of women Education Group (n=63) Control Group (n二65)

Behavior and methods Pretest Posttest Pretest Posttest Eating more vegetables

Buy/cook vegetables more 14 17 9 12 frequent

Eat less meats/dishes 8 9 7 2 Remember the benefits of eating 2 2 5 3

more vegetables Choose favorite vegetables 2 4 3 0 Develop a habit of eating 4 1 3 0

vegetables Modified cooking method 3 3 2 4 Others 1 4 0 3

Doing more physical activity Save more time for doing physical 5 7 5 5

activity Have company 6 9 2 5 Self encouragement/More will 8 9 8 5

power Develop an interest in doing 2 4 2 0

physical activity Remember the benefits of doing 8 6 8 4

physical activity Joined more physical activities 5 3 9 7 Want to lose weight 0 1 0 5 Try to incorporate physical 3 4 1 2

activity in daily activities/in different occasions

Others 3 3 5 4


More people replied that they would like to learn more about health in both groups in

the Posttest (Table 3.58). In the Education Group, an increase of the number of

women was seen in topics such as nutrition information and all-rounded information,

but a drop was seen in nutrition-related diseases. In the Control Group, increases

were observed in many topics, for example, nutrition information, all-rounded

information, women's health and nutrition-related diseases.

110

Table 3.58 Comparison between the interested topics which the women would like to

learn more between Pre- and Posttests in the Education and Control Groups Number

Education Group (n=63) Control Group (n=65) Health topics Pretest Posttest Pretest Posttest

Women's health 1 2 1 5 Nutrition-related diseases 9 2 8 11 Other diseases 2 1 1 3 Nutrition information 7 12 1 8 Dieting/Weight control 2 3 0 3 methods Physical activity information 2 1 0 1 All-rounded information 3 6 1 8 One's health status 4 4 5 3 Organ's functioning 2 0 2 2 Others 2 3 O Q


A little drop of the number of women was found in the Education Group who

reported aspects of health they would like to improve, while a little increase was seen

in the Control Group (Table 3.59). Increases in the number were observed in

'eating habits' and ‘physical activity habits' in both groups, together with a decrease

in areas such as improvements of joint/bone pain and relief of osteoporosis in the

Education Group. Other areas mentioned maintained nearly the same number of

women.

I l l

Table 3.59 Comparison between the aspects of health the women desired to improve

between Pre- and Posttests in the Education and Control Groups Number

Education Group (n=63) Control Group (n=65) Aspects of health Pretest Posttest Pretest Posttest

No improvements mentioned Eating habits (unspecified) 15 18 6 8 Physical activity habits 19 24 17 20

(unspecified) Lose weight 8 6 10 10

Get more rest 0 0 1 3 Improve mental health 4 4 1 1 Improve osteoporosis 4 1 1 0 Relieve joint/bone pain 2 1 4 5 Gain weight 0 0 2 2 Strengthen physical health 3 1 3 2 Improve hypertension 1 0 2 1 Improve high blood cholesterol 2 1 1 0 Benefit all parts of the body 3 0 4 0 Others 4 2 2 3

3.5.20 Summary Profile of Women at Posttest

The Pre- and Posttests comparisons showed that the intervention successfully

improved the nutrition knowledge and physical activity knowledge of the Education

Group. Education level and age seemed to have little association with these

changes. Nearly all the education and age groups made significant increases in the

nutrition knowledge variables.

However, increases in women's nutrition and physical activity knowledge did not

lead to a significant improvement in their eating and physical activity behavior or

their body measurements. No significant changes were seen in reported health

conditions, meal patterns, nutrient supplements, cooking practices, fat removal

behavior, food label reading, energy and nutrient intakes, stages of change in

increasing fruit and vegetable intakes, stages of change in doing more physical

activity.

112

Few significant changes were seen in both groups. Both groups increased the mean

fasting total blood cholesterol level. The Education Group increased the reported

frequency of consuming boiled eggs, and the stages of change in decreasing saturated

fat intake in which more women were classified in the action and maintenance stages

after the intervention. On the other hand, the Control Group decreased significantly

their daily energy expenditure, as revealed from a list of common physical activities.

The Posttest's findings showed that the intervention could increase knowledge

significantly in a short period of time, but behavioral changes may take more time to

do. Therefore, a Follow-up was taken after six months to observe the maintenance

of their knowledge level and to monitor any behavioral changes.

3.6 Participants' Evaluation of the Intervention Program

After the intervention, the Education Group was asked to complete an evaluation

questionnaire. Results showed that 70% of the women joined the program because

they would like to learn more about health (Table 3.60). However, only 25% of

them attended all six of the Saturday afternoon activities. One-third (38%) of them

attended five sessions, one-fifth (19%) attended four sessions, and the rest attended

either three (13%) or two (5%) sessions. Most of these women replied they had no

time to join all (Table 3.61). Sixty-eight percent of the women strongly

agreed/agreed that Saturday is the best time for organizing talks; 81% of them

strongly agreed/agreed school hall was the best venue for the talks; more than half

(60%) of them strongly agreed/agreed the slides used in talks were clear enough;

about two-thirds (65%) of them strongly agreed/agreed the layout or design of

pamphlets was good; most (87%) of them strongly agreed/agreed the content of

pamphlets was useful; and that the information given from the talks was practical

113

(87%) and easily understood (80%) (Table 3.62).

Table 3.60 Reasons for participating the program (n=63) Reasons Number (%)

To learn more about health 44 (70) To know one's health status and improve one's health 14 (22) As a women center's member to accompany friends 9(14) To obtain useful content 2 (3) No reason given 2 (3)

Table 3.61 Reasons for attending (n二 16)/not attending (n=47) all the activities Number (%)

Reasons for attending Learned more about health 11 (17) Content of the program was useful 1 (2) Enjoy group activity 1 (2) No idea/No reason 3 (5)

Reasons for not attending No time 36 (57) Other specific reasons like being sick, forgot to go, etc 11 (17)

Table 3.62 Ideas on the different aspects of the program (n=63) Number (%)

Strongly Agree Fair Disagree Strongly agree disagree

Saturday is the best time for 12(19) 31(49) 1 0 ( 1 6 ) 9 ( 1 4 ) 1 (2) organizing a series of talks

School hall was the best venue for 13 (21) 38 (60) 11 (18) 1 (2) 0 (0) delivering a series of talks

The slides used in the talks were clear 7 (11) 31 (49) 21 (33) 4 (6) 0 (0) The layout/design of the pamphlets 5 (8) 36 (57) 22 (35) 0 (0) 0 (0)

was good The content of the pamphlets was 5 (8) 50 (79) 8 (13) 0 (0) 0 (0)

useful The information given from the talks 9 (14) 46 (73) 8 (13) 0 (0) 0 (0)

was practical The information given in the talks 8 (13) 42 (67) 12 (19) 1 (2) 0 (0)

was easily understood

Eight-three percent of the women reported that they had told what they learnt to their

families and friends. Most of them had told diet information (23%) and physical

activity information (27%), other information included that about fat, saturated fat

and cholesterol (17%) and healthy eating behavior (12%) etc. Seventeen percent of

114

the women said they had not told the information to others because there was no

chance (36%) or it was difficult to express the messages (27%) etc, as is shown in

Tables 3.63 and 3.64.

Table 3.63 Information the women had told others (n=52) Information Number (0Zo)

Physical activity 16 (31) Diet 12(23) Fat, saturated fat and cholesterol 9 (17) Healthy eating behavior 6 (12) Healthy cooking demonstration 4 (8) All information 3 (6) The food pyramid 2 (4) Benefits and harms of food 2 (4) Others 3_(6)

Table 3.64 Reasons for not telling information to others (n=l 1) Reasons Number (%)

No chance 4 (36) Difficult to express 3 (27) Others 2(18) No idea/No reason 2(18)

When asked what they had learnt from the program, 25% replied information about

physical activity, 19% said information about food and nutrition, and 19% said

information about saturated, unsaturated fat, cholesterol and calories etc (Table 3.65).

All of them said they would recommend that others join similar health promotion

programs in the future because their friends can learn about health from the program

(38%), as is shown in Table 3.66.

115

Table 3.65 Information the women had learnt from the program (n=63) Topics Number (%)

Physical activity 16(25) Food and nutrition 12(19) Saturated/Unsaturated fat, cholesterol and calories 12(19) Health 7(11) Importance of healthy eating 7(11) Healthy eating behavior 7(11) Healthy eating 6 (10) Importance of physical activity 6 (10) Food pyramid 3 (5) Physical activity pyramid 3 (5) Paying attention to health 2 (3) Others 7 (11)

Table 3.66 Reasons for recommending others to join future health promotion

program (n=63) Reasons Number (%)

They can learn more health knowledge 24 (38) The program is useful 13 (21) Want others to be healthy 10 (16) No idea/No reason 16 (25)

The women were asked to give comments to improve the program. Forty-three

percent of them said there should be some improvements for the program, for

example, ten percent of them said the scheduling should be re-arranged, better not to

hold the classes on Saturday; ten percent of them pointed out that the program should

include more information; Eight percent of them said the program should be

shortened (Table 3.67).

Table 3.67 Improvements for the program (n=63) Reasons Number (%)

Better scheduling 6(10) More information/activities 6 (10) Shorten the time between sessions 5 (8) More active participation 4 (6) Reduce the number of sessions 2 (3) Others 6 (10)

116

One evaluation question asked the women if they made any changes in their eating

and physical activity behavior, and 87% of the women reported they had made

changes after the program. Thirty-seven percent of them reported reducing their

intakes of high fat/high saturated fat/high cholesterol/high sugar food, 35% of them

said they had done more physical activity and 19% had paid more attention to diet.

All of the changes are listed in Table 3.68. Thirteen percent of the women replied

they had not changed their behavior because they already followed a healthy diet and

physical activity patterns or else because it was difficult to change (Table 3.69).

Table 3.68 Behavioral changes after the program (n=63) Behavioral changes Number (%)

Ate less high fat/high saturated fat/high 23 (37) cholesterol/high sugar food

Did more physical activity 22 (35) Paid more attention to diet 12(19) Attempted to achieve healthy eating 8 (13) Ate more vegetables/fruits/cereals 6(10) Paid more attention to physical activity 5 (8)

Table 3.69 Reasons for not changing behaviors (n=63) Reasons Number (%)

Already paid attention to diet and physical activity 3 (5) Difficult to change diet/No will power to change 2 (2) No idea/No reason 3 (5)

117

3.7 Follow-up


Fifty-one women (63% of the Pretest) and 50 women (49% of the Pretest) in the

Education Group and Control Groups, respectively, attended the Follow-up

evaluation. No significant differences were found in any demographic

characteristics between the Education and Control Groups. There were also no

significant differences in the demographic characteristics between the dropouts and

the participants in the two groups, except that the mean age of those remaining in the

Education Group was significantly greater than that of the dropouts (43.8 ±5.0 years

Vs 40.2±4.7 years; ^ 0 . 0 5 ) . Comparisons were made between the Pretest and the

Follow-up evaluation, and the Posttest and the Follow-up evaluation. Analyses

were based on those who had completed the three assessments, that is, 51 women in

the Education Group and 50 women in the Control Group. However, only 43

women and 33 women in the Education Group and Control Groups, respectively,

completed the dietary record and 39 women in both groups took part in the

anthropometric measurements.

3.7.2 Anthropometry

No significant change was observed for the mean body weight in the Education

Group, while a significant increase (from 53.9 kg in Posttest to 55.4 kg in the

Follow-up;尸<0.05) was found in the Control Group. The mean BMI showed no

significant change in either group. However, a significant increase (?<0.001) was

seen in the mean percent body fat between the Pretest and the Follow-up in both the

Education and Control Groups (32.2% Vs 34.0% in the Education Group and 29.5%

Vs 31.1% in the Control Group). Additionally, significant increase was found in

the mean fasting blood cholesterol level in both groups. In the Education Group,

118

the mean value increased significantly (尸<0.05) from 4.4 mmol/L in the Pretest to

5.0 mmol/L in the Follow-up, however, the level was maintained from the Posttest to

the Follow-up. In the Control Group, however, the mean fasting blood cholesterol

level increased significantly (尸<0.001) in the Follow-up when compared with either

the Pretest or the Posttest.

Although there were changes in anthropometric parameters, there were no significant

changes in the distribution of women in different categories of BMI and percent body

fat. At the Follow-up, more than 60% and about half of the Education Group and

the Control Group respectively remained classified as overweight and obese. More

women were found to be over-fat (percent body fat greater than 27%) at the Follow-

up, a five percent and a twelve percent increase was seen in the Education and

Control Groups, respectively.

There was also no significant change observed in the distribution of women in

different fasting total blood cholesterol level categories in the Education Group only.

However, a significant change (尸<0.05) was found in the Control Group. The

percentage of women with desirable cholesterol level decreased from 92% in the

Pretest to 67% in the Follow-up, six months after the program. Table 3.70 shows

all the anthropometric data of the two groups.

119

Table 3.70 Comparison between physical measurement data, distributions of BMI

levels according to Asian definition, percent body fat levels and fasting total blood

cholesterol level levels of women between Pretest, Posttest and Follow-up in the

Education and Control Groups Mean 土 S.D.

Education Group (n=39) Control Group (n=39) Pretest Posttest Follow-up Pretest Posttest Follow-up

Weight (kg) 58.0 57.0 57.4 54.8 53.9 55.4 ±6.2 ±7.3 ±7.4 ±9.0 ±10.0* ±8.5

Height (cm) 156.0 155.7 155.9 155.3 155.3 155.4 ±4.6 ±4.6** ±4.5 ±5.0 ±5.0 ±4.9

BMI (kg/m2) 23.9 23.6 23.6 22.7 22.4 23.0 ±2.6 ±3.0 ±3.0 ±3.8 ±4.2 ±3.6

Percent body fat (%) 32.2 33.9 34.0 29.5 29.8 31.1 ± 5 . 2 * * * 土 7 . 0 ± 5 . 6 ± 7 . 2 * * * ± 7 . 7 ± 7 . 1

Fasting total blood 4.4 4.9 5.0 4.0 4.1 5.2 cholesterol level ±1.2* ±1.0 ±1.3 ± ! 2*** ± 1.4*** ±0.8 (mmol/L)

一 Number (%) BMI levels

Underweight 1(3) 2(5) 2(5) 5(13) 7(8) 3(8) Normal weight 13 (33) 11 (28) 11 (28) 18 (46) 15 (39) 18 (46) Overweight 14 (36) 13 (33) 15 (39) 5 (13) 8 (21) 8 (21) Obese 11 (28) 13 (33) 11(28) 11(28) 9 (23) 10 (26)

Percent body fat levels Below range 1 (3) 1 (3) 0 (0) 2 (5) 2 (5) 0 (0) Desirable range 5 (13) 4 (10) 4 (10) 16 (41) 15 (39) 13 (33) Above range 33 (85) 34 (87) 35 (90) 21 (54) 22 (56) 26 (67)

Fasting total blood cholesterol levels Desirable 29 (74) 26 (67) 24 (62) 36 (92)* 34 (87) 26 (67) Borderline 8 (21) 11(28) 11(28) 2 (5) 4 (10) 9 (23) High 2(5) 2(5) 4(10) 1(3) 1(3) 4(10)

* 尸<0.05 for difference between Pretest or Posttest and Follow-up by paired /-tests

** 尸<0.01 for difference between Pretest or Posttest and Follow-up by paired /-tests

*** 尸<0.001 for difference between Pretest or Posttest and Follow-up by paired l-

tests

1 2 0


No significant change was seen in the self-rated health in either the Education or

Control Group. A similar distribution of women in different rankings was observed

in the two groups (Table 3.71).

Table 3.71 Comparison between the self-rated health relative to that of peers between

Pretest, Posttest and Follow-up in the Education and Control Groups Number (%)

Education Group (n=51) Control Group (n=5Q) Rating of health Pretest Posttest Follow-up Pretest Posttest Follow-up Much worse 3 (6) 1 (2) 1 (2) O (O) O (O) O (O) Worse 10 (20) 7 (14) 8 (16) 11 (22) 9 (18) 7 (14) Same 22 (43) 31 (61) 28 (55) 25 (50) 29 (58) 30 (60) Better 14 (28) 10 (20) 13 (26) 14 (28) 11 (22) 12 (24) Much better 2 (4) 2 (4) 1 (2) 0 (0) 1 (2) 1 (2)

3.7.4 Meal Patterns

Regarding the women's eating frequencies of breakfast, lunch and dinner, no

significant changes were noted in the Education Group (Table 3.72). However, the

mean breakfast eating frequency was significantly increased (P<0.05) in the Control

Group from 6.1 士 1.8 days per week in the Posttest to 6.4 土 1.5 days per week in the

Follow-up. Lunch and dinner eating frequencies did not change significantly.

Referring to their snack eating frequency, a significant increase (尸<0.05) was noticed

in the Education Group in their mean snack eating frequency, from 1.2 times per day

in the Posttest to 1.6 times per day in the Follow-up, returning to nearly the same

level as in the Pretest. No significant change was found in the Control Group.

The proportion of women who had breakfast every day, skipped breakfast every day

or had lunch every day did not change significantly in both the Education and

Control Groups (Table 3.73).

1 2 1

Table 3.72 Comparison between the mean number of days 土 S.D. per week of having

breakfast, lunch and dinner, and the mean number of snacks 土 S.D. per day between

Pretest, Posttest and Follow-up in the Education and Control Groups Education Group (n=51) Control Group (n=50)

Meal Pretest Posttest Follow-up Pretest Posttest Follow-up Breakfast 5.6 ±2.3 5 .7±2.0 5.8±2.1 6 .2±1.6 6.1 土 6 .4±1.5 (d/wk) 1.8* Lunch 6.5 ±1 .2 6.4 ±1.3 6.5 ±1.3 6.5 ±1.1 6.6 ±1.1 6.2 ±1.8 (d/wk) Dinner 7.0 ± 0.0 6.9 ± 0.6 6.9 ± 0.8 7.0 ± 0.0 7.0 ± 0.3 7.0 ±0.1 (d/wk) Snacks 1.7±1.8 1.2±1.2* 1.6±1.7 1.6±1.6 1.5±1.4 1.5±1.7 (per day) * 尸<0.05 for Posttest and Follow-up by paired /-test

Table 3.73 Comparison between the number (%) of women who had breakfast every

day, skipped breakfast every day or had lunch every day between Pretest, Posttest

and Follow-up in the Education and Control Groups Education Group (n=51) Control Group (n:50)

Pretest Posttest Follow-up Pretest Posttest Follow-up Ate breakfast daily 34 (67) 30 (59) 31 (61) 36 (72) 33 (66) 38 (76) Never ate breakfest 3 (6) 2 (4) 3 (6) 2 (4) 2 (4) 1 (2) Ate lunch every daily 43 (84) 39 (77) 42 (82) 40 (80) 40 (80) 39 (78)


No significant change was seen in the number of women who reported taking

nutrient supplements in both groups. Vitamin E was the most common type of

nutrient supplement the women taken in each assessment period in both the

Education Group and Control Groups (Table 3.74).

122

Table 3.74 The types of supplements taken in Pretest, Posttest and Follow-up in the

Education and Control Groups Number (%)

Education Group (n=51) Control Group (n=50) Type of supplement Pretest Posttest Follow-up Pretest Posttest Follow-up None 34 (67) 25 (49) 24 (47) 42 (84) 39 (78) 36 (72) Vitamin E 6(12) 10(20) 7(14) 3(6) 3(6) 3(6) Calcium 2(4) 4(8) 6(12) 1(2) 1(2) 2(4) Vitamin(s) 3 (6) 3 (6) 4 (8) 0 (0) 1 (2) 1 (2) (unspecified) Vitamin B 1 (2) 2 (4) 0 (0) 2 (4) 2 (4) 2 (4) Vitamin C 3 (6) 2 (4) 3 (6) 1 (2) 1 (2) 1 (2) Fish oil 0 (0) 1 (2) 1 (2) 0 (0) 1 (2) 2 (4) Manganese 0 (0) 0 (0) 1 (2) 1 (2) 1 (2) 1 (2) Protein powder 1 (2) 1 (2) 2 (4) 0 (0) 0 (0) 0 (0) Traditional Chinese 1 (2) 1 (2) 1 (2) 0 (0) 0 (0) 0 (0)

Medicine Others Q (0) 2 (4) 2 (4) Q (Q) 1 (2) 2 (4)


There were no significant changes in the proportion in using each type of oil in both

groups (Table 3.75). Canola oil (51%) became the most popular cooking oil in the

Follow-up in the Education Group, followed by corn oil (49%) and peanut oil (35%).

Whereas in the Control Group, corn oil (58%) and peanut oil (58%) remained the

first two most common types of cooking oils used, followed by canola oil (30%).

Table 3.75 Comparison between the number (%) of women in using the following

oils between Pretest, Posttest and Follow-up in the Education and Control Groups Education Group (n=51) Control Group (n=5Q)

Types of oil Pretest Posttest Follow-up Pretest Posttest Follow-up Corn oil 30 (59) 27 (53) 25 (49) 24 (48) 27 (55) 29 (58) Peanut oil 20 (39) 20 (39) 18 (35) 25 (50) 26 (53) 29 (58) Canola oil 25 (49) 23 (45) 26 (51) 11 (22) 13 (27) 15 (30)

Both groups maintained the same rank for the common cooking methods for fish;

pork/beef; poultry and vegetables (Table 3.76). The three most common cooking

methods for fish were steaming, frying and boiling. Significant decrease (尸<0.05)

123

was found in the Education Group in the proportion of using frying for fish (from

73% in the Pretest to 49% in the Follow-up). In the Control Group, a significant

decrease (尸<0.05) was seen in using stir frying for cooking fish (from 14% in the

Pretest to 2% in the Follow-up).

Significant decrease (尸<0.05) was observed in the Education Group only in using

deep frying for pork/beef (from 10% in the Pretest to zero in the Follow-up). Stir

frying, boiling and steaming were remained the top three common cooking methods

for pork/beef. The top three cooking methods for poultry were steaming, grilling

and boiling. Significant decrease (尸<0.05) was found in the Education Group only

in using deep frying for pork/beef (from 18% in the Pretest to 4% in the Follow-up).

Stir frying and boiling were still the most common methods for cooking vegetables.

However, the percentage of stir frying was decreased in the Education Group from

90% in the Pretest to 77% in the Follow-up, while at the same time, the percentage of

boiling was increased from 67% to 75%, though these changes were not significant.

In the Control Group, the percentage of boiling was increased from 64% in the

Pretest to 76% in the Follow-up while the percentage of stir frying was dropped a

little from 86% to 80%.

124

Table 3.76 Comparison between the number (%) of women in using the following

cooking methods for fish, pork/beef, poultry and vegetables between Pretest, Posttest

and Follow-up in the Education and Control Groups Food item Cooking Education Group (n=51) Control Group (n=50)

method Pretest Posttest Follow-up Pretest Posttest Follow-up Fish

Steaming 47 (92) 48 (94) 49 (96) 49 (98) 50 (100) 48 (96) Frying 37 (73)* 30 (59) 25 (49) 26 (52) 23 (46) 30 (60) Boiling 9 (18) 13 (26) 10 (20) 18 (36) 10 (20) 15 (30) Stir frying 0(0) 4(8) 2(4) 7(14)* 2(4) 1(2)

Pork/Beef Stir frying 28 (55) 29 (58) 32 (63) 37 (74) 36 (72) 33 (66) Boiling 27 (53) 24 (48) 28 (55) 22 (44) 17 (34) 23 (46) Steaming 20 (39) 21 (42) 25 (49) 18 (36) 20 (40) 22 (44) Deep frying 5 (10)* 1(2) Q(Q) 1(2) 4(8) 4(8)

Poultry Steaming 33 (65) 31 (62) 33 (65) 32 (64) 36 (72) 38 (76) Boiling 22 (43) 20 (40) 15 (29) 18 (36) 16 (32) 14 (28) Grilling 20 (39) 16 (32) 30 (39) 20 (40) 20 (40) 16 (32) Frying 2(4) 9(18)* 2(4) 10(20) 5(10) 5 (10)

Vegetables Stir frying 46 (90) 42 (84) 39 (77) 43 (86) 40 (80) 40 (80) Boiling 34 (67) 35 (70) 38 (75) 32 (64) 30 (60) 38 (76)

* 尸<0.05 for Pretest or Posttest and Follow-up


In response to their fat removal behavior, no significant changes were seen in the

Education Group for meat and poultry. Similarly, no significant change was

observed in the Control Group for poultry. Unexpectedly, there was a significant

increase (尸<0.05) in the number of women in the Control Group who reported

removing all fat from meat before they consumed (Table 3.77).

125

Table 3.77 Comparison between the number (%) of women reported removing fat

from meat and removing skin from poultry between Pretest, Posttest and Follow-up

in the Education and Control Groups Food item and Education Group (n=51) Control Group (n=50) fat/skin removal Pretest Posttest Follow-up Pretest* Posttest Follow-up Meat Not remove any fat 1 (2) O (O) 1 (2) 4 (8) 2 (4) O (O) Removed some fat 33 (65) 33 (65) 31 (61) 35 (70) 31 (62) 28 (56) Removed all fat 15 (29) 17 (33) 19 (37) 11 (22) 17 (34) 22 (44) Never consume meat 2 (4) 1 (2) Q (Q) O (Q) O (Q) O (Q) Poultry Not remove any skin 7(14) 2(4) 2(4) 3(6) 3(6) 1(2) Removed some skin 27 (53) 31 (61) 38 (75) 34 (68) 28 (56) 25 (50) Removed all skin 16 (31) 18 (35) 11 (22) 13 (26) 19 (38) 24 (48) Never consume 1 (2) O (0) O (0) O (0) O (0) O (0) poultry

* 尸<0.05 for Pretest and Follow-up


No significant change was noted in either the Education or Control Group in their

habit of food label reading. Among those who read the food label, the proportion of

women who replied the label is clear was increased in the Education Group though

this was not significant. In the Control Group, there was also no significant change

regarding the clarity of the food label (Tables 3.78 and 3.79).

Table 3.78 Comparison between the number (%) of women reported reading the food

labels with different frequencies between Pretest, Posttest and Follow-up in the

Education and Control Groups Education Group (11=51) Control Group (n=5Q)

Frequency Pretest Posttest Follow-up Pretest Posttest Follow-up Never 4 (8) 2 (4) 1 (2) 3 (6) 3 (6) 3 (6) Sometimes 24 (47) 29 (57) 29 (57) 23 (46) 24 (48) 22 (44) Usually 8 (16) 7 (14) 12 (24) 15 (30) 10 (20) 13 (26) Each time 15 (29) 13 (26) 9 (18) 9 (18) 13 (26) 12 (24)

1 2 6

Table 3.79 Comparison between the distribution of the number (%) of women citing different degrees of clarity of the food labels between Pretest, Posttest and Follow-up in the Education and Control Groups

Education Group Control Group Clarity Pretest Posttest Follow-up Pretest Posttest Follow-up

(n=47) (n=49) (n=50) (n=47) (n=47) (n=47) Very unclear 1 (2) UT) 0^0) 0~(0) 0(0) 1 (2) Unclear 4(9) 7(14) 5 (10) 6(13) 6(13) 4(9) So-So 39 (83) 35 (71) 38 (76) 37 (79) 37 (79) 38 (81) Clear 3(6) 5 (10) 7(14) 4(9) 4(9) 4(9) Very clear Q (Q) 1 (2) Q (Q) Q (0) 0 (0) Q (Q)


a. From the Three-Day Dietary Records

None of the energy or nutrient intakes showed significant changes, except for the

mean total fat intake in the Education Group which significant decreased (尸<0.05)

from 72.8 g in the Posttest to 66.3 g in the Follow-up, as is shown in Table 3.80.

127

Table 3.80 Comparison between the energy and nutrient intake data between Pretest,

Posttest and Follow-up in the Education and Control Groups Mean 土 S.D.

Education Group (n=43) Control Group (n=33) Diet component Pretest Posttest Follow-up Pretest Posttest Follow-up Energy (kcal) 1809.2 1806.9 1719.1 2037.7 2150.5 1994.7

±423.4 ± 399.5 ±439.6 ± 526.7 ±617.5 ± 392.8 Carbohydrate (g) 231.5 226.1 210.5 253.0 275.6 257.1

±64.4 土 51.8 ±59.1 ±63.7 士 80.0 ±55.7 Protein (g) 71.5 72.7 75.4 78.8 84.7 84.1

±22.0 ±20.3 ±25.4 ±22.4 ±31.1 ±26.4 Fat (g) 70.6 72.8 66.3 82.4 82.7 72.8

± 2 3 . 4 ± 2 3 . 9 * ± 2 1 . 0 ± 3 1 . 7 土 3 4 . 5 ± 1 8 . 3

SFA (g) 13.2 ±5.7 14.6 ±6.5 12.9 ±5.0 14.8 ±6.1 16.1 ±9.0 13.9 ±5.2 PUFA (g) 13.2 ±6.2 13.9 ±8,9 12.3 ±5.2 17.2 ±8.8 17.2 ±9.5 15.0 ±7.8 MUFA (g) 20.6 土 9.3 21.9 土 9.2 20.7 土 8.0 24.9 土 10.6 25.7 土 13.6 22.2 土 7.9 Cholesterol (mg) 233.4 227.6 206.0 233.8 239.7 218.9

±147.3 ±138.9 ±102.7 ±191.0 ±125.9 ±112.9 Fibre (g) 8.2 ± 4.9 7.9 ±5.0 7.7 ± 4.7 9.6 士 4.3 10.7 ± 5.0 9.9 ± 4.5 Calcium (mg) 465.4 429.0 466.9 487.6 505.4 532.6

±257.8 ±149.3 ±189.8 ±156.1 ±162.8 ±236.4 Iron (mg) 16.2 19.6 15.4 14.9 16.5 17.5

±17.4 ±18.4 ±12.9 ±5.9 ±8.7 ±9.9 Sodium (mg) 1827.0 1942.6 1701.4 1681.66 1901.9 1726.7

± 897.3 ± 865.0 ±571.5 ± 584.8 ±902.3 ± 573.4 Vitamin A (RE) 835.1 772.6 870.9 999.9 956.9 1052.2

±1385.0 土 593.4 士 573.2 ± 738.0 ±561.0 ±905.8 Vitamin C (mg) 134.4 140.6 160.7 180.0 180.1 214.2

±89.8 ±113.1 ±100.1 ±84.5 士 82.1 ±130.8 Vitamin E (mg) 7.5 士 6.3 8.9 ±10.9 7.4 ±5.5 11.6 ±11.8 11.9 ±11.2 9.9 ±10.5 * 尸<0.05 for Posttest and Follow-up by paired /-test

When the women's fat intakes were classified according to the recommendation, no

significant change was seen for the total fat, SFA or PUFA in both the Education

Group and Control Groups (Table 3.81). Whereas few of them exceeded the

recommended intake amount for SFA and polyunsaturated, however, more than 70%

of the women exceeded the recommended intake amount for total fat. Moreover,

only the Education Group significantly increased (尸<0.05) the proportion of women

exceeding the recommended intake amount for MUFA between the Pretest and the

Follow-up (37% to 65%).

128

Table 3.81 Comparison between the number (%) of women exceeding the recommended percent energy from total fat, SFA, PUFA and MUFA between Pretest Posttest and Follow-up in the Education and Control Groups

Education Group (n=43) Control Group (11=33) Percent of women Pretest Posttest Follow-up Pretest Posttest Follow-up With energy from total fat >30% 32 (74) 34 (79) 34 (79) 26 (79) 21 (64) 24 (73) With energy from SFA >10% 3(7) 5 (12) 1(2) O(O) 4(12) 2(6) With energy from PUFA >10% 3(7) 5 (12) 1(2) 2(6) 4(12) 2(6) With energy from MUFA >10% 16 (37)* 28 (65) 28 (65) 20 (61) 16 (49) 14 (42)

* 尸<0.05 for Pretest and Follow-up

With regard to other nutrients, no significant changes were observed for the

proportion of women meeting the recommended intakes in the Education Group.

On the other hand, in the Control Group only, a significant decrease (/^0.05) was

found for the proportion of women having cholesterol intake less than 300 mg while

a significant increase (尸<0.05) was noted for the proportion of women meeting the

recommended intake of calcium (>800 mg) (Table 3.82).

Table 3.82 Comparison between the number (%) of women who met the

recommended intake levels of selected nutrients between Pretest, Posttest and

Follow-up in the Education and Control Groups Education Group (n:43) Control Group (n=33)

Nutrient Pretest Posttest Follow-up Pretest Posttest Follow-up Protein >70 g 21 ( 4 9 ) 2 1 ( 4 9 ) 2 4 ( 5 6 ) 2 0 ( 6 1 ) 20 ( 6 1 ) “ “ 2 3 (70) Cholesterol <300 mg 10 (23) 8 (19) 9 (21) 8 (24) 11 (33)* 4 (12) Fibre >25 g 0(0) 1 (2) 0 (0) 0 (0) 0 (0) 0 (0) Calcium >800 mg 3(7) 0(0) 2(5) 0(0)* 1(3) 5 (15) Iron >12 mg 26 (61) 29 (67) 21(49) 21(64) 22 (67) 22 (67) Vitamin A >800 RE 11 (26) 15 (35) 19 (44) 16 (49) 20 (61) 16 (49) Vitamin C >60 mg 36 (84) 33 (77) 36 (84) 31 (94) 31 (94) 33 (100) Vitamin E >12 mg 4(9) 7(16) 9(14) 7(21) 10(30) 6(18)

* P<0.05 for Pretest/Posttest and Follow-up


Among the sixty food items listed in the food frequency table, only a few of them

showed significant changes. In the Education Group, the proportion of women who

never consumed/not consumed evaporated milk in the typical week significantly

129

decreased (尸<0.05) from 77% in the Posttest to 53% in the Follow-up. Similarly,

the proportion of women who never consumed/not consumed no-cream cake

significantly decreased (?<0.05) from 67% in the Pretest to 51% in the Follow-up.

Nevertheless, the proportion of women who consumed candy and chocolate once or

more per week significantly increased 24% and 16% (尸<0.05) respectively in the

Follow-up when compared with the Pretest.

In the Control Group, significant changes were only seen for soft drinks and fried

dim sum consumption. The proportion of women who consumed soft drinks once

or more per week significantly decreased from 54% to 42% (尸<0.05) in the Follow-

up when compared with the Posttest. However, the proportion of women who

consumed fried dim sum three times or more per week significantly increased from

18% to 26% (尸<0.05) in the Follow-up when compared with the Pretest.

The Education Group increased their consumption in wheat bread together with some

of the dairy products such as cheese, low-fat yogurt, skim milk and high-calcium

low-fat milk. From the Pretest to the Follow-up, the proportions of women who

did not consumed these products in a typical week decreased, but these changes were

not significant (Table 3.83).

Table 3.83 Comparison between the number (%) of women who reported

never/rarely consuming wheat bread and specific dairy products in a typical week

between Pretest, Posttest and Follow-up in the Education and Control Groups Education Group (n=51) Control Group (n=50)

Food item Pretest Posttest Follow-up Pretest Posttest Follow-up Wheat bread 30 (59) 20 (39) 22 (43) 18 (36) 20 (40) 24 (48) Cheese 38 (75) 30 (59) 34 (67) 29 (58) 31 (62) 39 (78) Low-fat yogurt 46 (90) 40 (78) 42 (82) 38 (76) 40 (80) 44 (88) Skimmilk 36 (71) 29 (57) 31 (61) 29 (58) 31 (62) 31 (62) High-calcium low-fat milk 28 (55) 18 (35) 20 (39) 27 (54) 26 (52) 22 (44)

130


The mean Nutrition Knowledge Score (Figure 3.1) increased significantly between

the Pretest and the Follow-up in the Education Group (7.3 Vs 9.9;尸<0.001). The

score was maintained between the Posttest and the Follow-up (10.1 Vs 9.9).

Unexpectedly, the mean Nutrition Knowledge Score also increased significantly in

the Control Group between the Pretest and the Follow-up (7.4 Vs 8.2;尸<0.05) and

between the Posttest and the Follow-up (7.0 Vs 8.2;尸<0.001).

When asked if they had heard of saturated fat, a significant increase (尸<0.01) in

positive responses was found in the Education Group only, from 45% in the Pretest

to 71% in the Follow-up (Table 3.84). Concerning the food pyramid, a significant

increase was found in the Education Group only. Ninety-eight percent of the

women in the Follow-up had heard of the food pyramid, compared with about 80%

in the Pretest (尸<0.01). Besides, among those who had heard of the food pyramid,

the proportion of women who could correctly matched all the food groups with the

levels of the food pyramid also increased significantly in the Education Group only

(33% Vs 57%;尸<0.01).

131

12

驾 a

I 10 ——— ±—— W) O

rT-J (S ’ ^ ^ mi 1 ‘ ‘ -

S _ � • b,c J 4 — F = = = = ^ , : , A Education Group o

» <-H

B 2 Control Group Z

Q 1 1 1 1 1 I I I

0 1 2 3 4 5 6 7 8 9 Time (months)

a 尸<0.001 for Pretest and Follow-up by paired /-test

V<0.05 for Pretest and Follow-up by paired /-test

P<0.001 for Posttest and Follow-up by paired /-test

Figure 3.1 Changes in Nutrition Knowledge Score between Pretest, Posttest and Follow-up in the Education and Control Groups

Table 3.84 Comparison between the number (%) of women reported having heard of

saturated fat or the food pyramid, and who correctly matched all four food groups

with their corresponding level of the food pyramid between Pretest, Posttest and

Follow-up in the Education and Control Groups Nutrition knowledge Education Group (n二51) Control Group (n=50) questions Pretest Posttest Follow-up Pretest Posttest Follow-up Had heard of 23 (45)** 41(80) 36 (71) 19 ( 3 8 ) 1 7 (34) 19 (38)

saturated fat Had heard of the food 40 (78)** 51 (100) 50 (98) 38 (76) 38 (76) 42 (84)

pyramid Correctly matched 17 (33)** 27 (53) 29 (57) 12 (24) 12 (24) 11 (22)

food pyramid levels

** 尸<0.01 for Pretest and Follow-up

Responses to nine out of the ten additional nutrition knowledge questions improved

in the Education Group, in which a significant increase (户<0.05) of correct responses

occurred for one question concerning saturated fat. However, most of the women

still thought incorrectly that the hardening of blood vessel is mainly caused by too

132

much cholesterol in diet, this resulted in only 10% of the Education Group could

correctly answer this question. In the control Group, no significant changes were

observed in any of the nutrition knowledge questions (Tables 3.85 and 3.86).

Table 3.85 Comparison between the number (%) of correct responses to the ten

additional nutrition knowledge questions between Pretest, Posttest and Follow-up in

the Education Group Education Group (n=51)

Nutrition knowledge questions Pretest Posttest Follow-up Egg white has more saturated fat than Correct 26 (51) 42 (82) 40 (78) egg yolk.* Incorrect 5 (10) 3 (6) 1 (2)

Dorftknow 20 (39) 6 (12) 10 (20) Skim milk has more saturated fat than Correct 30 (59) 44 (86) 39 (77) whole milk. Incorrect 4(8) 3(6) 5 (10)

Don't know 17(33) 4(8) 7(14) Some foods contain a lot of fat but no Correct 13 (26) 12 (24) 12 (24) cholesterol. Incorrect 19 (37) 27 (53) 27 (53)

Don't know 19 (37) 12 (24) 12 (24) High cholesterol food has a greater Correct 5(10) 7(14) 11 (22) effect than high saturated fat food on Incorrect 17 (33) 27 (53) 22 (43) raising blood cholesterol level. Doirt know 29 (57) 17 (33) 18 (35)

White bread has more fibre than whole Correct 40 (78) 48 (94) 43 (84) wheat bread. Incorrect 7(14) 3 (6) 5(10)

Don't know 4(8) Q(O) 3 (6) Whole milk contains more protein Correct 16 (31) 24 (47) 27 (53) than skim milk. Incorrect 19 (37) 13 (26) 13 (26)

Don't know 16(31) 14 (28) 11 (21) Frozen foods have the same nutrients Correct 26 (51) 31 (61) 33 (65) as fresh foods. Incorrect 17 (32) 15 (29) 16 (31)

DoiVt know 8(16) 5 (10) 2(4) Eating a lot of sugars will cause Correct 11 (22) 25 (49) 21 (41) diabetes. Incorrect 33 (65) 23 (45) 23 (45)

DoiVt know 7(14) 3(6) 7(14) The hardening of blood vessel is Correct 3 (6) 4 (8) 5 (10) mainly caused by too much Incorrect 41(80) 44 (86) 43 (84) cholesterol in your diet. DoiVt know 7(14) 3(6) 3(6) A high fibre diet can help prevent Correct 39 (77) 46 (90) 45 (88) colon cancer. Incorrect 4 (8) 3 (6) 2 (4)

Don't know 8 (16) 2(4) 4(8) * 尸<0.05 for Pretest and Follow-up

133

Table 3.86 Comparison between the number (%) of correct responses to the ten additional nutrition knowledge questions between Pretest, Posttest and Follow-up in the Control Group

Control Group (n=50) Nutrition knowledge questions Pretest Posttest Follow-up Egg white has more saturated fat than Correct 29 (58) 23 (46) 33 (66) egg yolk. Incorrect 7(14) 4(8) 2(4)

DoiVt know 14 (28) 23 (46) 15 (30) Skim milk has more saturated fat than Correct 33 (66) 26 (52) 34 (68) whole milk. Incorrect 5 (10) 5 (10) 3 (6)

DoiVt know 12 (24) 19 (38) 13 (26) Some foods contain a lot of fat but no Correct 11 (22) 9 (18) 15 (30) cholesterol. Incorrect 22 (44) 20 (40) 18 (36)

Dorft know 17 (34) 21 (42) 17 (34) High cholesterol food has a greater Correct 6 (12) 4(8) 6 (12) effect than high saturated fat food on Incorrect 14 (28) 13 (26) 17 (34) raising blood cholesterol level. Don't know 30 (60) 33 (66) 27 (54) White bread has more fibre than whole Correct 38 (76) 40 (80) 43 (86) wheat bread. Incorrect 4(8) 4(8) 4(8)

Doirt know 8(16) 6(12) 3(6) Whole milk contains more protein Correct 10 (20) 19 (38) 21 (42) than skim milk. Incorrect 14 (28) 20 (40) 14 (28)

Doirt know 18 (36) 11 (22) 15 (30) Frozen foods have the same nutrients Correct 33 (66) 30 (60) 37 (74) as fresh foods. Incorrect 11 (22) 16 (32) 10 (20)

Dorftknow 6(12) 4(8) 3(6) Eating a lot of sugars will cause Correct 15 (30) 15 (30) 18 (36) diabetes. Incorrect 32 (64) 32 (64) 25 (50)

DoiVt know 3(6) 3(6) 7(14) The hardening of blood vessel is Correct 3 (6) 3 (6) 2 (4) mainly caused by too much Incorrect 43 (86) 43 (86) 45 (90) cholesterol in your diet. Doirt know 4 (8) 4 (8) 3 (6) A high fibre diet can help prevent Correct 41 (82) 43 (86) 45 (90) colon cancer. Incorrect 2 (4) 1 (2) 1 (2)

Doirt know 7(14) 6 (12) 4(8)

The proportion of correct responses for each of the four layers in the food pyramid

significantly increased (尸<0.01) in the Education Group. On the other hand, none

of the variables concerning the food pyramid showed significant changes in the

Control Group (Table 3.87).

134

Table 3.87 Comparison between the number (%) of women correctly matched the

specific food group in the food pyramid between Pretest, Posttest and Follow-up in

the Education and Control Groups Education Group (n=51) Control Group (n=50)

Food group Pretest Posttest Follow-up Pretest Posttest Follow-up Oils, fats, salt and 31 (61)** 44 (86) 43 (84) 31 (62) 29 (58) 33 (66)

sugar Meats and dairy 28 (55)** 38 (75) 37 (72) 22 (44) 21 (42) 29 (58)

products Vegetables and 18 (35)** 29 (57) 31 (61) 16 (32) 14 (28) 13 (26)

fruits Cereals 21 (41)** 31 (61) 32 (63) 17 (34) 17 (34) 18 (36) ** 尸<0.01 for Pretest/Posttest and Follow-up


Table 3.88 shows that no significant change in the mean reported daily energy

expenditure or the summary physical activity index was found in the Education

Group. However, a significant decrease was noted in the Control Group between

the Pretest and the Follow-up (1666 kcal/day Vs 1466 kcal/day;尸<0.05).

Additionally, significant increase in the summary physical activity index was

observed in the Control Group (28.0 in the Pretest Vs 37.5 in the Follow-up;尸<0.05,

27.1 in the Posttest Vs 37.5 in the Follow-up;尸<0.01), indicating that there was a

contradiction in the Control Group's physical activity level, assessed by daily energy

expenditure and summary physical activity index. There was also no significant

change in the mean number of flights of steps climbed per day in either the

Education or Control Group.

135

Table 3.88 Comparison between the mean 土 S.D. reported daily energy expenditure

(kcal/day), summary physical activity index and number of flights of steps climbed

per day between Pretest, Posttest and Follow-up in the Education and Control Groups Education Group (n=51) Control Group (n=50)

Pretest Posttest Follow-up Pretest Posttest Follow-up Daily energy 1538.5 1495.9 1379.3 1666.0 1416.0 1466.4

expenditure ± 682.9 ±915.9 ± 657.3 ± 693.7* ±618.0 ± 594.1 (kcal/day)

Summary physical 34.5 29.5 30.2 28.0 27.1 37.5 activity index ±20.5 ±15.8 ±17.0 ±17.2* ±15.6** ±20.3

Number of flights 1.3 土 2.6 2.5 ± 6.0 1.5 ±2 .5 2.1 ±3 .5 1.6 ±4 .3 1.4 ±2 .2 of steps climbed per day

* ^<0.05 for Pretest or Posttest and Follow-up by paired /-test

** 尸<0.01 for Posttest and Follow-up by paired /-test

3.7.12 Physical Activity Knowledge

The mean Physical Activity Knowledge Score (Figure 3.2) increased significantly in

the Education Group only between the Pretest and the Posttest (5.9 Vs 8.8;尸<0.001).

The score was maintained at the same level between the Posttest and the Follow-up.

When asked if the women had heard of the physical activity pyramid, a significant

increase was found in the Education Group only between the Pretest and the Follow-

up (16% Vs 82%;尸<0.001). The same proportion was maintained for those who

had heard of the physical activity pyramid between the Posttest and the Follow-up.

A significant increase was also observed in the Education Group for those who could

correctly match all the physical activity groups with the corresponding level of the

physical activity pyramid between the Pretest and the Follow-up (2% Vs 16%;

尸<0.001)，these data are shown in Table 3.89.

136

^ 10 a

1 9 ^ •

<U 8 7 —

r^ 6 - _ " _ _ ： Z： - ：

§ s 2 ) ^ 4 A Education Group '> 3 • T-H J < 2 Control Group -g 1 •I o 1 1 1 1 1 1 ‘ ‘ £ 0 1 2 3 4 5 6 7 8 9

Time (months) a 尸<0.001 for Pretest and Follow-up by paired /-test

Figure 3.2 Changes in Physical Activity Knowledge Score between Pretest, Posttest

and Follow-up in the Education and Control Groups

Table 3.89 Comparison between the number (%) of women reported having heard of

the physical activity pyramid, and correctly matched all the physical activity groups

with the corresponding level of the physical activity pyramid between Pretest,

Posttest and Follow-up in the Education and Control Groups Physical activity Education Group (n二51) Control Group (n=50) knowledge Pretest Posttest Follow-up Pretest Posttest Follow-up questions Had heard of the 8 (16)*** 42 ( 8 2 ) 4 2 ( 8 2 ) 1 2 ( 2 4 ) 1 3 (26) 15 (30)

physical activity pyramid

Correctly matched 1(2)*** 9(18) 8 (16) 3(6) 1(2) 1(2) physical activity levels

*** 尸<0.001 for Pretest and Follow-up

Among the proportion of correct responses to the nine additional physical activity

knowledge questions, three questions showed significant improved in the Education

Group. However, only 12% of the women could correctly answer that the

recommended duration for each session of physical activity is not 10 mins. On the

other hand, the Control Group showed no significant changes in either the mean

137

Physical Activity Knowledge Score or in the proportion of correct responses for each

physical activity knowledge question (Tables 3.90 and 3.91).


additional physical activity knowledge questions between Pretest, Posttest and

Follow-up in the Education Group

Education Group (n=51) Physical activity knowledge questions Pretest Posttest Follow-up Regular physical activity decreases the Correct 31 (61) 38 (75) 39 (77) chance of adult-onset diabetes. Incorrect 9 (18) 4(8) 5 (10)

DoiVt know 11(22) 9(18) 7(14) Regular physical activity increases the Correct 38 (75) 45 (88) 47 (92) chance of hypertension. * incorrect 5 (10) 6 (12) 4(8)

— Don't know 8 (16) 0 (0) Q(Q) Regular physical activity decreases the Correct 41 (80) 48 (94) 50 (98) chance of osteoporosis. * Incorrect 3 (6) 2 (4) 1 (2)

DoiVt know 7(14) 1(2) Q (Q) Both continuous (one 30-min session) Correct 30 (59) 32 (63) 31 (61) & intermittent (three 10-min sessions) Incorrect 2(4) 9(18) 15(29) aerobic physical activity can build Don't know 19 (37) 10 (20) 5 (10) cardiovascular fitness.*

Aerobic physical activities are the Correct 40 (78) 50 (98) 46 (90) most effective ones in developing Incorrect 0 (0) 0 (0) 1 (2) cardiovascular fitness. DoiVt know 11 (21) 1 (2) 4 (8)

Aerobics is one kind of aerobic Correct 39 (77) 45 (88) 41 (80) physical activity. Incorrect 1 (2) 0 (0) 3 (6)

DoiVt know 11 (22) 6(12) 7 (14) The recommended duration for each Correct 7(14) 6 (12) 6(12) session of physical activity is 10 mins. Incorrect 33 (65) 41 (80) 41 (80)

DoiVt know 11 (22) 4(8) 4(8) The recommended frequency for Correct 14 (28) 18 (35) 25 (49) physical activity is at least once per Incorrect 27 (53) 29 (57) 21 (41) w e e k . Doirt know 10(20) 4(8) 5(10) Physical activity must be hard enough Correct 36 (71) 43 (84) 40 (78) to require more exertion than normal Incorrect 5 (10) 4(8) 1 (14) to produce gains in health- Doirt know 10 (20) 4(8) 4(8) related .fitness * 尸<0.05 for Pretest and Follow-up

138


additional physical activity knowledge questions between Pretest, Posttest and Follow-up in the Control Group

Control Group (n=5Q) Physical activity knowledge questions Pretest Posttest Follow-up Regular physical activity decreases the Correct 29 (58) 28 (56) 34 (68) chance of adult-onset diabetes. Incorrect 6(12) 8(16) 8(16)

Dorftknow 15 (30) 14 (28) 8 (16) Regular physical activity increases the Correct 39 (78) 38 (76) 40 (80) chance of hypertension. Incorrect 8(16) 8(16) 8(16)

Dorft know 3 (6) 4 (8) 2 (4) Regular physical activity decreases the Correct 37 (74) 44 (88) 39 (78) chance of osteoporosis. Incorrect 8 (16) 3 (6) 6(12)

Don't know 5(10) 3(6) 5 (10) Both continuous (one 30-min session) Correct 27 (54) 33 (66) 27 (54) and intermittent (three 10-min Incorrect 7 (14) 6(12) 9 (18) sessions) aerobic physical activity can Don't know 16 (32) 11 (22) 14 (28) build cardiovascular fitness.

Aerobic physical activities are the Correct 39 (78) 38 (76) 42 (84) most effective ones in developing Incorrect 2 (4) O (0) 1 (2) cardiovascular fitness. Don,t know 9(18) 12 (24) 7(14)

Aerobic physical activity is one kind Correct 33 (66) 32 (64) 37 (74) of aerobic physical activity. Incorrect 6(12) 4(8) 1(2)

Dorftknow 11 (22) 14 (28) 12 (24) The recommended duration for each Correct 12 (24) 9 (18) 35 (70) session of physical activity is 10 mins. Incorrect 32 (64) 35 (70) 10 (20)

DonH know 6(12) 6(12) 5 (10) The recommended frequency for Correct 15 (30) 21 (42) 23 (46) physical activity is at least once per Incorrect 25 (50) 24 (48) 21 (42) w e e k . DoiVt know 10(20) 5 (10) 6(12) Physical activity must be hard enough Correct 39 (78) 42 (84) 42 (84) to require more exertion than normal Incorrect 4 (8) 3 (6) 4 (8) to produce gains in health-related Don't know 7(14) 5(10) 4(8) fitness.

Moreover, when divided the physical activity pyramid into four individual layers, the

correct responses for each layer was significantly increased (尸<0.001) in the

Education Group. In contrast, none of the variables concerning the physical activity

pyramid showed significant changes in the Control Group (Table 3.92).

139

Table 3.92 Comparison between the number (%) of women correctly matched the specific physical activity group in the physical activity pyramid between Pretest, Posttest and Follow-up in the Education and Control Groups

Education Group (n=51) Control Group (n=50) Physical activity Pretest Posttest Follow-up Pretest Posttest Follow-up group Rest/inactivity 7 (14)*** 37 (73) 37 (73) 10 (20) 11 (22) 12 (24) Exercise for 2 (4)*** 11 (22) 13 (25) 5 (10) 3 (6) 4 (8)

flexibility and muscular

strength Aerobic and active 4 (8)*** 18 (35) 17 (33) 6 (12) 2 (4) 4 (8)

sports Lifestyle physical 2 (4)*** 17 (33) 16 (32) 6 (12) 2 (4) 3 (6)

activity *** 尸<0.001 for Pretest and Follow-up


No significant change was seen in the Education Group for their intention and

confidence in decreasing saturated fat intake or doing more physical activity.

Significant change (尸<0.05) was noted in the Education Group only for increasing

fruit intake and increasing vegetable intake. The proportion of women in the

precontemplation stage for increasing fruit intake decreased significantly from 29%

in the Pretest to 6% in the Follow-up, while the proportion of women in the

maintenance stage increased significantly from 24% to 47% during the same period.

In addition, the proportion of women in the contemplation stage for increasing

vegetable intake decreased significantly from 10% in the Pretest to zero percent in

the Follow-up, together with a significant increase in the proportion of women in the

maintenance stage from 24% to 47% during the same period (Table 3.93). However,

there were no significant differences between the maintainers in increasing fruit

intake or increasing vegetable (those in the maintenance stage) and those in earlier

stages in any of the eating behavior. No significant changes were observed in the

Control Group for each of the behavior. No significant difference was also noted in

140

any of these behavior changes between women in the maintenance stage and the

earlier stages in dietary and physical activity habits.

Table 3.93 Comparison between the stages of change of behavior between Pretest,


Number (%) of women B — r Education Gro叩（n=51) Control Group (n-5Q)

Pretest Posttest Follow-up Pretest Posttest Follow-up Decreasing

saturated fat intake Precontemplation 29 (57) 13 (26) 17 (33) 34 (68) 36 (72) 31 (62) Contemplation 1 (2) 3 (6) 1 (2) 2 (4) 3 (6) 1 (2) Preparation 3(6) 8(16) 8(16) 6(12) 3(6) 5(10) A c t i o n H (22) 16 (31) 10 (20) 3 (6) 3 (6) 5 (10) Maintenance 7 (24) 11(22) 15 (29) 5 (10) . 5 (10) 8 (16)

Pretest* Posttest* Fol low-up~Pre tes tPos t tes t Follow-up Increasing fruit

intake Precontemplation 15 (29) 8(16) 3(6) 17(34) 7(14) 5 (10) Contemplation 3(6) 0(0) 5 (10) 3(6) 2(4) 3(6) Preparation 11 (22) 11 (22) 10 (20) 7 (14) 6 (12) 9 (18) A c t i o n 10 (20) 16 (31) 9 (18) 5 (10) 11 (22) 9 (18) Maintenance 12 (24) 16 (31) 24 (47) 18 (36) 24 (48) 24 (48)

Pretest* Posttest Follow-up Pretest Posttest Follow-up Increasing

vegetable intake Precontemplation 7(14) 7(14) 6(12) 15 (30) 6(12) 6(12) Contemplation 5(10) 3(6) 0(0) 2(4) 1(2) 0(0) Preparation 6(12) 7(14) 7(14) 4(8) 4(8) 5(10) Action 14 (28) 14 (28) 7 (14) 4 (8) 12 (24) 10 (20) Maintenance 19 (37) 20 (39) 31 (61) 25 (50) 27 (54) 29 (58)

Pretest Posttest Follow-up Pretest Posttest Follow-up Doing more physical activity

Precontemplation 11 (22) 5 (10) 5 (10) 10 (20) 9 (18) 7 (14) Contemplation 4(8) 4(8) 14(28) 6(12) 8(16) 7(14) Preparation 10 (20) 12 (14) 9 (18) 16 (32) 13 (26) 15 (30) Action 7(14) 10(20) 9(18) 7(14) 8(16) 9(18) Maintenance 19 (37) 20 (39) 14 (28) 11 (22) 12 (24) 12 (24)

* 尸<0.05 for Pretest or Posttest and Follow-up

When comparisons were made between the Pretest and the Follow-up, it was clear

that the Education Group had significantly improved their nutrition and physical

141

activity knowledge, together with their intention and confidence to increase fruit and

vegetable intakes. Further analysis showed that their education level and age also

influenced these changes.

3.7.14 Analysis of the Changes Education Level

When the Education Group was divided into four education levels (incomplete

primary; complete primary; lower secondary and upper secondary), no association

was noticed in the education level and any of the body parameter changes.

Additionally, it was found that women in complete primary, lower secondary and

upper secondary had significantly increased (尸<0.05 or 尸<0.01) the mean Nutrition

Knowledge Score between the Pretest and the Follow-up (Table 3.94). However’

only among the women who had complete primary education did the percentage who

had heard of saturated fat between the Pretest and the Follow-up significantly

increased (尸<0.05). Also, only among the women in incomplete primary did the

percentage who had heard of the food pyramid during the same period significantly

increased (尸<0.05). Therefore, women of all education levels had significantly

increased (尸<0.05,尸<0.01 or 尸<0.001) their mean Physical Activity Knowledge

Score, and also showed an increase in the percentage of women who had heard of the

physical activity pyramid between the Pretest and the Follow-up. Education level

showed no associations with the stages of change of behavior or the proportions of

women who could correctly fill in the food and the physical activity pyramids

between the Pretest and the Follow-up.

142




different education level between Pretest, Posttest and Follow-up Education level Pretest Posttest Follow-up Incomplete primary (Iir=I 1)

Nutrition Knowledge Score 5.7 ±3.6 7.7 ±3.1 8.5 ± 3.0 Had heard of saturated fat 4 (36) 8 (73) 5 (46) Had heard of the food pyramid 7 (64)* 11 (100) 11 (100) Physical Activity Knowledge Score 5.8 土 1.7** 7.7 士 2.0 8 6 ± 9 1 Had heard of the physical activity pyramid 2 (18)** 8 (73) 9 (82)

Complete primary (n=13) Nutrition Knowledge Score 6.7 士 3.0** 10.3 土 3.6 8.9 土 3.6 Had heard of saturated fat 3 (23)* 9 (69) 8 (62) Had heard of the food pyramid 12 (92) 13 (100) 13 (100) Physical Activity Knowledge Score 5.6 ±2.2* 8.6 ±2.1 8.2 ± 2 6 Had heard of the physical activity pyramid 2 (15)** 12 (92) 9 (69)

Lower secondary (n=16) Nutrition Knowledge Score 7.3 ±3.7* 10.3 ±2.8 10.2 ±3.0 Had heard of saturated fat 8 (50) 13 (81) 12 (75) Had heard of the food pyramid 11 (69) 16 (100) 15 (94) Physical Activity Knowledge Score 5.5 ±2.5** 9.1 ±2.1 9 2 ± 2 2 Had heard of the physical activity pyramid 3 (19)*** 15 (94) 14 (88)

Upper secondary (11= 10) Nutrition Knowledge Score 9.3 士 2.5* 11.9 ± 1 1 1 1 7 + 1 8 Had heard of saturated fat 7 (70) 10 (100) 10 (100) Had heard of the food pyramid 9 (90) 10 (100) 10 (100) Physical Activity Knowledge Score 7.0 ±1.3* 9.5 ± 2.3 9 2 ± 1 8 Had heard of the physical activity pyramid 1 (10)*** 6 (60) 9 (90)

* 尸<0.05 for Pretest/Posttest and Follow-up * * 尸 < 0 . 0 1 for Pretest/Posttest and Follow-up *** 尸<0.001 for Pretest/Posttest and Follow-up

3.7.15 Analysis of the Changes by Age Group

When the Education Group was divided into two age groups, 30-39 and 40-50, as

was found when analyzing by education level, no associations were found between

the age and body parameter changes. Also, both age groups’ mean Nutrition

Knowledge Score increased significantly (尸<0.05 or 尸<0.001) between the Pretest

and the Follow-up (Table 3.95). Significant increases (P<0.05 or 尸<0.01) were

observed in the older group only in the proportion who had heard of saturated fat or

143

the food pyramid between the Pretest and the Follow-up. Both age groups showed

a significant increase (尸<0.01 or 尸<0.001) in their mean Physical Activity

Knowledge Score and the proportion of women who had heard of the physical

activity pyramid between the Pretest and the Follow-up. Moreover, in the older

group only, a significant increase (from 40 to 70%;尸<0.01) was seen in the

percentage of women in the action and maintenance stages of increasing fruit intake

between the Pretest and the Follow-up.




different age group between Pretest, Posttest and Follow-up Education level Pretest Posttest Follow-up 30-39 years (n=l l )

Nutrition Knowledge Score 8.2 土 2.8* 10.5 士 3.1 10.4 土 3.1 Had heard of saturated fat 4 (36) 9 (82) 6 (55) Had heard of the food pyramid 9 (82) 11 (100) 10 (91) Physical Activity Knowledge Score 6.3 士 1.2** 8.7 ±1 .9 9.1 土 2.2 Had heard of the physical activity pyramid Q (Q)*** 8 (73) 8 (73)

40-50 years (n=40) Nutrition Knowledge Score 7.0 土 3.6*** 10.0 士 2.8 9.8 士 3.2 Hadheard of saturated fat 19 (48)* 32 (80) 30 (75) Had heard of the food pyramid 31 (78)** 40 (100) 40 (100) Physical Activity Knowledge Score 5.8 土 2.3*** 8.9 土 2.2 8.8 土 2.2 Had heard of the physical activity pyramid 8 (20)*** 34 (85) 34 (85)

* 尸<0.05 for Pretest/Posttest and Follow-up ** 尸<0.01 for Pretest/Posttest and Follow-up *** P<0.001 for Pretest/Posttest and Follow-up


Only a few of the women in both the Education and Control Groups reported having

difficulty when they had tried to eat less saturated fat, eat more fruit or eat more

vegetables, as revealed in the Pretest, the Posttest and the Follow-up (Table 3.96).

Doing more physical activity remained the most difficult behavioral change among

the women in the Pretest, the Posttest or the Follow-up. Laziness, no time and

144

tiredness were the three common barriers mentioned preventing them from doing

more physical activity.

Table 3.96 Comparison between the difficulties reportedly encountered preventing

different behavioral changes between Pretest, Posttest and Follow-up in the

Education and Control Groups Number of women

Education Group (n=51) Control Group (n=5Q) Behavior and difficulties Pretest Posttest Follow-up Pretest Posttest Follow-up Eating less saturated fat

Attraction of food 4 5 6 2 1 O Pressure from 1 2 2 2 1 O

families/friends Feel hungry/no energy/ 1 1 0 1 0 0

uncomfortable Don't know the cooking 0 0 0 0 0 1

method Eating more fruit

No time 1 0 1 0 0 1 Cannot have food in 1 0 0 0 1 0

some occasions Lazy 2 1 0 0 2 1 Others 3 4 4 Q 2 1

Eating more vegetables Dislike the texture/taste 0 3 1 1 1 0 Afraid of fertilizers 1 0 1 0 0 0 Feel full 0 1 0 0 0 1 Don't know how to cook 0 0 0 0 1 0 Eat less when eating out 0 0 1 0 0 0 Others Q Q Q Q Q 1

Doing more physical activity Lazy 8 9 12 5 2 2 No time 4 2 4 3 2 3 Feel tired because too 5 1 7 3 7 7

vigorous No company 0 3 0 1 5 0 Health problems 0 0 0 1 2 2 Others 2 2 1 0 2 l

3.7.17 Perceived Methods Facilitating Behavior Change

When asked for suggestions of methods facilitating their eating less saturated fat,

more women in the Education Group but not the Control Group could state some

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methods after the intervention (Table 3.97). 'Have healthy eating practices' and

'self control' or 'self reminder' were the most common methods mentioned in both

the Education and Control Groups. However, there was only little change in the

methods for increasing fruit and vegetables intakes and doing more physical activity

as revealed in both Education and Control Groups.

Table 3.97 Comparison between the suggested methods for assisting different

behavioral changes between Pretest, Posttest and Follow-up in the Education and

Control Groups Number of women

Education Group (n=51) Control Group (n=50) Behavior and methods Pretest Posttest Follow-up Pretest Posttest Follow-up

Eating less saturated fat Buy/cook fatty food less O 2 1 2 2 0

frequent Have healthy eating 12 13 18 3 2 6

practices Have healthy cooking 0 5 2 0 0 1

practices Decrease frequency 0 2 2 0 0 0

of eating out Pay attention to eating 2 1 1 0 0 2

habits and food composition

Self control/self remind 2 8 8 1 4 5 Co-operate with 2 1 0 2 0 1

families Others Q 1 2 2 1 1

Eating more fruits Buy more fruit 6 13 11 5 11 9 Have fruit as snacks 5 4 2 0 4 1 Remember the benefits 1 2 1 1 0 7

of eating more fruit Choose favorite/ 6 4 7 4 4 5

different types of fruit Develop a habit of 6 7 4 5 1 4

eating fruit Eat less meat/dishes 3 2 1 5 3 1 Eat salad/assorted fruit 1 0 1 1 1 0

basket Not being a food 0 0 0 0 0 1

picker Eat less snacks 0 0 1 0 0 0 Others 3 4 3 2 4 1

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Number of women Education Group (n=51) Control Group (n=5Q)

Behavior and methods Pretest Posttest Follow-up Pretest Posttest Follow-up Eating more vegetables

Buy/cook vegetables 12 13 9 9 12 9 more frequent

Eat less meats/dishes 6 9 2 6 2 1 Remember the benefits 1 2 5 4 3 5

of eating more vegetables

Choose favorite 2 4 3 2 0 2 vegetables

Develop a habit of 4 1 5 1 0 2 eating vegetables

Modify cooking 2 2 2 2 3 1 method

Have meals at home 0 0 2 0 0 O Choose the one easy to O O 2 0 0 0

cook Use different cooking 0 0 0 0 0 1

methods Choose different types 0 0 0 0 0 4

of vegetables Others 1 3 1 Q 4 1

Doing more physical activity Save more time for 5 7 3 5 4 8

doing physical activity

Have company 5 8 8 2 4 6 Self encouragement/ 6 6 6 7 5 2

More will power Develop an interest 2 3 1 1 0 0

in doing physical activity

Remember the benefits 5 5 3 6 4 6 of doing physical activity

Join more physical 5 3 2 8 7 1 activities

Want to lose weight 0 0 0 0 2 0 Try to incorporate 3 3 4 1 1 0

physical activity in daily activities/in different occasions

Go to the park 0 0 1 0 0 0 As a way to relax 0 0 0 0 0 1 Others 2 2 1 5 3 3

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More people reported they would like to learn health information in the Follow-up

than in the Pre- and Posttests in both the Education Group and the Control Groups

(Table 3.98). In the Education Group, an increase was seen in the number of

women who would like to learn all kinds of health information. On the other hand,

an increase was observed in the number of women who would like to know nutrition

information in the Control Group.

Table 3.98 Comparison between the interested topics which the women would like to

learn more between Pretest, Posttest and Follow-up in the Education and Control

Groups Number of women

Education Group (n=51) Control Group (n=50) Health topics Pretest Posttest Follow-up Pretest Posttest Follow-up Women's health 1 2 0 1 5 3 Nutrition-related 8 2 5 7 9 10 diseases Other diseases 2 1 1 1 1 3 Nutrition information 7 10 7 1 8 9 Dieting/Weight control 1 2 2 0 3 4

methods Physical activity 2 1 0 0 1 1

information All-rounded 1 4 16 1 5 7 information One's health status 4 3 3 5 2 4 Organ's functioning 0 0 2 1 1 0 Ways to keep healthy 0 0 1 0 0 0 Others 2 3 O Q 0 1

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When the women were asked to state which part of their health they would like to

improve, more women in the both groups responded to this question in the Follow-up

(Table 3.99). Most of them reported that they would like to improve their physical

activity habits, followed by their eating habits. However, nearly the same number

of women in the Control Group also replied with areas of their health that they would

like to improve. As with the Education Group, about half of them would like to

improve their physical activity habits.

Table 3.99 Comparison between the aspects of health to improve between Pretest,

Posttest and Follow-up in the Education and Control Groups Number of women

Education Group (n二51) Control Group (n=50) Aspects of health Pretest Posttest Follow-up Pretest Posttest Follow-up Eating habits 10 12 18 6 7 12

(unspecified) Physical activity habits 12 16 26 14 18 20

(unspecified) Lose weight 5 5 4 8 7 4 Get more rest 0 0 1 1 2 0 Improve mental health 3 3 2 1 1 2 Improve osteoporosis 4 1 1 1 0 0 Relieve joint/bone pain 2 1 1 3 4 2 Gain weight 0 0 0 2 2 1 Strengthen physical 3 1 0 3 1 2

health Improve hypertension 0 0 1 2 0 1 Improve high blood 1 1 2 1 0 0

cholesterol Benefit all parts of the 3 0 2 3 0 3 body Others 3 2 5 1 2 3

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3.7.20 Summary Profile of Women at Follow-up

In the Education Group, only older women tended to return for the Follow-up.

Except for this, none of the demographic variables were found to have significant

difference within the group or between the Education and Control Groups.

Between the Pretest and the Follow-up, both groups increased the mean percent body

fat and fasting total blood cholesterol level. In the Control Group only, significant

less women were within the desirable total blood cholesterol level in the Follow-up

when compared with the Pretest. No significant changes were observed in the

reported health conditions in the two groups.

The Education Group significantly increased the number of snacks they ate daily

between the Posttest and the Follow-up after decreasing from Pre- to Posttest, and

returned to nearly the same frequency as in the Pretest. In the Control Group, a

significant increase was seen in the mean days of having breakfast between the

Posttest and the Follow-up. No significant changes were found in the taking of

nutrient supplements in either group.

No significant changes were noted in the types of oil used for cooking in the two

groups. Significant decreases were obtained in the Education Group in using the

less healthy cooking methods such as frying and deep frying. Interestingly, the

proportion of women who reported removing all fat from meat before they consumed

it significantly increased in the Control Group, whereas no significant change were

found in the Education Group. No significant changes were observed in food label

reading.

Except that the mean total fat intake was significantly decreased in the Education

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Group between the Posttest and the Follow-up, none of the energy or nutrient intakes

showed significant changes in the two groups. However, in the Education Group

only, a significant increase was seen in the proportion with energy from MUFA

greater than the recommended intake level (>10%). Significant changes were also

found in the Control Group, and the proportion of women meeting the recommended

intake of cholesterol decreased in the Follow-up, while the proportion of those

meeting the recommended intake level of calcium increased. Some of the food

items in the food frequency assessment also showed significant changes from the

Pretest to the Follow-up. Significantly more women consumed evaporated milk,

no-cream cake, candy and chocolate in the Education Group. On the other hand,

significantly more women consumed fried dim sum and significantly less women

consumed soft drink were found in the Control Group.

No significant changes were found in the Education Group regarding to the physical

activity behavior. However, the Control Group significantly decreased their mean

daily energy expenditure between the Pretest and the Follow-up, while at the same

time significantly increasing the summary physical activity index.

The Education Group successfully maintained their nutrition and physical activity

knowledge for six months after the intervention. Only the Education Group

significantly increased their awareness of eating more fruit and vegetables.

Education level only to a small degree and age to a larger extent were found to be

associated with some of the changes of women's nutrition and physical activity

knowledge in the Education Group. Only women in complete primary significantly

increased the proportion of women who had heard of saturated fat between the

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Pretest and the Follow-up, and only women in incomplete primary significantly

increased the proportion of women who had heard of the food pyramid. When

analyzed by age group, significant increases were observed in the older group only in

the proportion who had heard of saturated fat or the food pyramid between the

Pretest and the Follow-up. Age also showed some effects on women's intention to

change their behavior. Among the older group, a significant increase was seen in

the proportion of women in the action and maintenance stages in increasing fruit

intake.

In summary, the Follow-up findings showed that most of the eating and physical

activity behavior did not change significantly in both the Education and Control

Groups, but significant changes were mainly noted in the nutrition and physical

activity knowledge level in the Follow-up when compared with the Pretest.

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CHAPTER FOUR: DISCUSSION

Understanding Hong Kong middle-aged women's attitudes towards healthy eating

and regular physical activity, their nutrition and physical activity knowledge,

together with their eating and physical activity practices is essential to the

development of a nutrition and physical activity promotion program for them. This

study described the effects of a pilot healthy eating and lifestyle promotion program,

designed with respect to the above factors, aimed at improving their awareness of the

benefits of a healthy lifestyle, improving their intentions to change less healthy

eating and physical activity behavior, and enabling skills for them to eat healthier and

become more physically active. The need for a primary prevention program for

local women is supported by Lau (Lau, 2000), who reported that many conditions

affecting women are preventable, and also, health behavior of women may influence

their family members. A study of 2,452 Lithuanian men and 3,365 Dutch men

(Bosma et al., 1995), found that men whose spouses of lower education apparently

had an increased risk of all-cause mortality, when controlled for men's education.

The relative risks (RR) were 1.57 in Lithuanian men and 2.15 in Dutch men.

Although that study referred to the women's formal education, and not just their

health education, it may be that providing health education to women may help

improve their husbands' health.

This study began by conducting focus groups to gather ideas from women about how

to effectively implement a health promotion intervention tailored to them. The use

of focus groups has been utilized in other studies, for example, Gettleman and

Winkleby used it for the implementation of a cardiovascular diseases intervention

program tailored to low-income women in California (Gettleman & Winkleby, 2000).

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Moreno et al conducted focus groups to gather relevant information for a heart

disease prevention and education campaign designed for Latinos (Moreno et al.’

1997). The focus groups in the present study suggested that health talks, cooking

and physical activity demonstrations were suitable activities for the healthy eating

and lifestyle promotion program. Based on the focus groups’ results, a healthy

eating and lifestyle promotion program was designed. The study used a two-group

Education and Control Group design with Pre-, Post- and Follow-up evaluations to

determine the effects of this program.

4.1 Implications of Findings

4.1.1 Current Situation in Diet and Physical Activity of Hong Kong Middle-

aged Women from the Pretest Survey

The Pretest survey provided insights to the women,s anthropometry, as well as their

diet, knowledge, attitudes and behavior related to healthy lifestyle. The findings

showed that the prevalences of overweight (BMI =23.0-24.9 kg/m2) and obesity

(BMI >25.0 kg/m2) among the local middle-aged women was 18% and 29%

respectively. These prevalences differed from those found in The Hong Kong

Cardiovascular Risk Factor Prevalence Study (Janus, 1997), which revealed that 22%

of women of age 30-49 years were overweight (BMI 二25.1-30.0 kg/m2) and 6% of

them were obese (BMI >30.0 kg/m2). The difference comes from the adoption of a

different BMI classification. The present study used an Asian definition, which has

been developed from various Asian studies about risk factors and morbidities (Asia-

Pacific steering committee, 2000). The use of the lower BMI cut-offs to define

obesity has also received support from a local study which found that the Hong Kong

Chinese population have a higher percent body fat for a given BMI. When using

BMI to predict percent body fat, the BMI under-estimated the value by 3.4% in

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females when compared with the value obtained from dual-energy X-ray

absorptiometry. This occurred because the prediction formula was developed from

Caucasian populations, leading the authors to recommend the newly proposed BMI

classification for Hong Kong adults (He el al., 2001). If the Asian definition were

applied to The Hong Kong Cardiovascular Risk Factor Prevalence Study, 28% of the

middle-aged women aged 30-49 years in that study would have been classified as

obese, which is consistent with the present study.

Sixty-seven percent of the women exceeded the desirable percent body fat (20-27%).

The mean percent body fat of the total surveyed women was 31.1%, which was

similar to that found in Japanese and Chinese populations, but lower than Indonesian

and Dutch populations. A Japan study of 794 women found that the mean percent

body fat was 29.1% and 32.2% for those of 30-39 and 40-49 years, respectively (Ito

et al., 2001). Another Beijing survey of 124 females of mean age 34 years, found

that the mean percent body fat was 32.1% (Wang & Deurenberg, 1996). A study

including 51 Indonesian women of mean age 35 years and 42 Dutch Caucasians of

mean age 34 years, showed that the mean percent body fat was 36.0% and 33.2%,

respectively (Gurrici et al., 1998). Additionally, only 12% and 2% of the surveyed

women had fasting total blood cholesterol level within the borderline range (5.20-

6.19 mmol/L) and high (> 6.2 mmol/L) respectively. These were lower than those

found from The Hong Kong Cardiovascular Risk Factor Prevalence Study, in which

23% and 7% of women were classified as borderline and high, respectively.

The study found that overweight or obesity and being above desirable percent body

fat were common among the local middle-aged women, although most of the women

were within desirable total cholesterol range. This phenomenon should be

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improved, because obesity has been found to be a central determinant of the

metabolic syndrome (the clustering of cardiovascular risk factors like hypertension,

glucose intolerance, high triglycerides, low HDL cholesterol, hyperinsulinemia, and

microalbuminuria) in Hong Kong adults aged 30-65 years (Chan et al., 1996).

Reduction of obesity prevalence should be a first step to reduce risk of morbidity and

mortality of these diseases among Hong Kong women.

Regarding nutrient supplement practices, 15% of the total surveyed women took

supplements, which is similar to the findings from The Hong Kong Adult Dietary

Survey 1995 (Leung et al, 1997), which revealed that 18% of females took

supplements.

Generally speaking, the common types of cooking methods for fish, poultry and

vegetables are also similar in the present study and the 1995 Dietary Survey. The

same proportion (95%) of women in the present study and of females in the 1995

dietary survey reported using steaming for fish. Steaming was also frequently used

in both the present study (65%) and the dietary survey (77%) for poultry. Eighty-

six percent of women and 91% of females in the present study and the dietary survey,

respectively, reported stir frying was the common cooking method for vegetables.

A difference, however, was noted in cooking pork/beef. Most of the women (62%)

in the present study used stir frying, whereas most of the females (88%) in the

dietary survey reported using boiling.

Twenty-eight percent of the total surveyed women in the present study reported

removing all fat from meat, which was lower than that reported by the females in the

dietary survey (35%). Instead, most of the women (63%) in that present study

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reported removing some fat, which was higher than in the dietary survey (43%).

Moreover, more women in the present study reported removing some skin from

poultry than the dietary survey (55% Vs 45%), whereas a similar proportion was

seen in both studies of removing all skin from poultry (30% and 32% in the present

study and the dietary survey, respectively.).

At the beginning of the study, 42% of the total surveyed women had heard of

saturated fat while 74% of them had heard of the food pyramid. The recent

promotion of the food pyramid via the mass media may explain why more women

had heard of it than saturated fat. However, only 30% of the women could correctly

match all the food groups with their corresponding level of the food pyramid. That

means the women are not fully understanding the content of the food pyramid, which

is intended to guide people to achieve healthy eating. As Dixon said, the food

pyramid is the foundation of the development of food guidance system to assist

consumers in the learning of key themes of the total diet, i.e., variety, moderation and

proportionality (Dixon et al., 2001). Therefore, more in-depth promotion and

education about the food pyramid are needed to help women develop a healthy eating

habit, if the food pyramid is to truly function as it is intended.

In addition, from the true-false nutrition knowledge questions, middle-aged women

showed confusion with respect to the effects of cholesterol on health. When asked

whether it is true that 'The hardening of blood vessels is mainly caused by too much

cholesterol in diet', most of the women (80%) wrongly indicated that it is true.

Another question also revealed similar pattern, when asked whether vHigh

cholesterol food has a greater effect than high saturated fat food on raising blood

cholesterol level', in which only 11% of women correctly stated that it is false and

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more than half (56%) had no idea about this. This implies middle-aged women lack

adequate understanding about relationships between dietary cholesterol, dietary

saturated fat, and hardening of the arteries, and shows that education emphasizing

these relationships is essential of them. Also, the stages of change questions in the

pretest found that with 63% of the surveyed women in the precontemplation stage,

they had low awareness about decreasing saturated fat intake, partly because some of

them do not know what saturated fat is, and partly because they do not know the

health risks of high saturated fat intake. Additionally, 30% and 18% of the women

had low awareness (being in the precontemplation stage) of increasing fruit and

vegetable intakes, respectively.

Regarding the diet composition, when compared with the findings from The Hong

Kong Adult Dietary Survey 1995 (Leung el al, 1997), the women's mean intakes of

total fat and sodium in this present study are higher while the mean intakes of

cholesterol, calcium and vitamins A are lower than the 1995 survey. The mean

intakes of energy and other nutrients are similar in both studies, as is shown in Table

4.1.

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Table 4.1 Comparison of the mean dietary intake of the women in the present study

and the Hong Kong Adult Dietary Survey 1995 Diet component Present study Hong Kong Adult

(n=147, age=30-50 years) Dietary Survey 1995 (n=133, age二35-44 years)

Energy (kcal) 1942.8 1869.9 Carbohydrate (g) 241.0 245.0 Protein (g) 76.9 89.0 Fat (g) 78.3 62.1 SFA (g) 15.4 16.9 PUFA (g) 15.6 14.4 MUFA (g) 24.2 21.5 Cholesterol (mg) 234.5 299.8 Fibre (g) 9.5 9.3 Calcium (mg) 510.1 594.7 Iron (mg) 15.6 15.4 Sodium (mg) 1865.2 1113.0 Vitamin A (RE) 932.4 1419.2 Vitamin C (mg) 168.9 179.5 Vitamin E (mg) \ 0 2 H J

Eighty-four percent of the women in the present study had percent energy from fat

>30%, which is greater than the recommended intake level. Reduction of dietary

fat intake among the women is essential because this is associated with reducing the

risk for diseases such as cardiovascular diseases (Hooper et al., 2001), type II

diabetes (Tuomilehto et al., 2001) and some kinds of cancers (Steinmaus et al., 2000)

(Weisburger, 1997). This indicates that healthy cooking methods, especially for

vegetables and pork/beef, may be introduced to the women to reduce their fat intake,

because most of the women reported they used stir frying for cooking these food.

In addition, teaching them to trim off all the visible fat from meat and all skin from

poultry is another method, because only one-third of the women reported removing

all fat or skin from meat and poultry.

On the other hand, only 13% and 9% of them achieved the recommended intake

levels of vitamin E and calcium, respectively. Few of them met the recommended

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intake levels of fibre. The insufficient intakes of these nutrients may be

problematic because they have many health benefits. For example, fibre has been

shown to reduce the risk of heart diseases (Anderson, 1995) and colon cancer

(Dwyer, 1993). Calcium can reduce the rate of bone loss (Dawson-Hughes, 1996)

(Kaufman, 1995). The low intake of calcium among the women may be because of

their infrequent consumption of dairy products such as cheese, yogurt and milk.

The Pretest also revealed that while only 20% of the women had heard of the

physical activity pyramid, and very few of them (3% of the total surveyed women)

could correctly match all four physical activity groups with their corresponding level

of the physical activity pyramid. One major reason for this situation is that the

promotion of the physical activity pyramid has not begun on a wide scale in Hong

Kong. Moreover, the additional physical activity knowledge questions showed that

the surveyed women knew little about physical activity recommendations. When

asked whether it is true that ‘The recommended duration for each session of physical

activity is 10 mins', only 17% could correctly state that it is false. Another question

is 'The recommended frequency for physical activity is at least 1 time per week',

only one-fourth of women correctly stated that it is false. In addition, 20% of

women had never thought of or tried to do more physical activity. The findings

suggested that education about the physical activity pyramid and the physical activity

recommendations is necessary for the middle-aged women, so as to help them

develop regular physical activity.

Among the top ten most frequent physical activities, most of them were not of the

vigorous type. Instead, women were found to have frequent sedentary and lifestyle

activities which required less energy. Watching television, having meals and

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reading were the top three daily physical activities on which the women spent most

of their time, with the mean time of doing these three activities totaling 4.5 hours per

day.

Along with their inadequate nutrition and physical activity knowledge, an

imbalanced diet and sedentary lifestyle, the low awareness of the local women

towards healthy eating and regular physical activity revealed from the Pretest clearly

revealed the urgent need for a health promotion for the local middle-aged women.

4.1.2 Overall Effects of the Program

a. Changes in Knowledge

The Posttest findings showed that only the Education Group significantly increased

their nutrition and physical activity knowledge immediately after the intervention,

reflected from the mean Nutrition Knowledge and Physical Activity Knowledge

Scores. Significant increases were seen in some individual nutrition knowledge

questions, too, including heard of saturated fat and the food pyramid, correct filling

of the food pyramid, and five out of ten true-false questions about saturated fat,

cholesterol, fibre and diabetes. However, almost no increase in correct responses

for two true-false questions concerning cholesterol (kSome foods contain a lot of fat

but no cholesterol，and 'The hardening of blood vessel is mainly caused by too much

cholesterol in diet') were seen. The women were found to know little about these

two questions in the Posttest, still, as the same results in the Pretest. A possible

explanation is that the idea about cholesterol is difficult to the women because it was

not taught clearly enough for them to grasp.

Similarly, some physical activity knowledge questions were significantly improved.

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However, the proportion of women who correctly answered the questions about

physical activity recommendations did not change significantly between the Pre- and

Posttests, although the health talk had focused on these recommendations.

Education level demonstrated only a minor association with the increase in nutrition

knowledge in the Education Group, but none at all with the physical activity

knowledge. Women who had incomplete primary, lower and upper secondary

showed significant increases in the mean Nutrition Knowledge Score, while no

significant change was observed among only women who had complete primary

education. Age group did not show any association with the changes in either

nutrition or physical activity knowledge in the Education Group. This showed that,

generally, women of any education level or age group could enhance nutrition and

physical activity knowledge from this health promotion program.

The Education Group maintained their increased nutrition and physical activity

knowledge for six months after the intervention. Surprisingly, the Control Group

also significantly increased their mean Nutrition Knowledge Score in the Follow-up.

This may be because after participating in the assessments in the Pre- and Posttests,

the Control Group women had increased interest and paid more attention to nutrition

information, so that improvement was then observed in the Follow-up. Another

reason is that the dropout rate in the Control Group at the Follow-up in which only

49% of the Pretest women maintained. Those women who stayed with the activity

may have been more health conscious, and therefore, their nutrition knowledge was

found to be improved.

When the Education Group was divided into four education levels and two age

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groups, both nutrition and physical activity knowledge were maintained at the

Follow-up among women of different education levels or age groups. However, the

improvements in nutrition and physical activity knowledge did not show any

associations with the changes in either anthropometric data or health behavior. This

will be discussed later.

b. Changes in Awareness

The changes of awareness toward behavior change were assessed from the stages of

change questions. The stages of change questions revealed that only the Education

Group had significantly improved in decreasing saturated fat intake between the Pre-

and Posttests. At the Posttest, more individuals reported themselves to be in the

action or maintenance stage whereas fewer individuals reported themselves to be in

the precontemplation stage. This implied the program had successfully raised the

women's awareness in decreasing saturated fat intake, and more women maintained

this behavior. This is consistent with a nutrition education program in North

Carolina which was tailored to 378 low-income women aged 18 years or above.

That program showed significant improvements in stages of change in low-fat eating,

as well as low-fat eating knowledge (Campbell et al., 1999). However, there were

no significant changes seen in the stages of change for increasing fruit or vegetable

intakes, or for doing more physical activity. Education level and age group did not

show significant differences in the stages of change for these behaviors.

At six months after the intervention, only the Education Group significantly

increased their awareness about or action toward to increase fruit and vegetable

intakes, and more of the Education Group women reported maintaining their

behavior of eating more fruit and vegetables for six months or more (in the

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maintenance stage). However, no significant changes were observed in the reported

stages of change for decreasing saturated fat intake or doing more physical activity.

The results suggested that women could change their awareness of increasing fruit

and vegetables intakes, through a period of time. Education level showed no

significant association with the stages of change in either of the behavior changes

assessed, whereas age group did demonstrate association with stage of change in

increasing fruit intake only. Only the older group (aged 40-50 years) showed

significant improvement in that behavior, in which more women reported being in

the action and maintenance stages in the Follow-up when compared with the Pretest.

As for the improvements in knowledge, the improvements in progress towards

behavior change did not demonstrate any association with their changes in health

behavior. In addition, the maintainers of behavior change (those classified in the

maintenance stage) did not show any significant differences in health behavior than

those who reported themselves being in the earlier stages. One of the possible

reasons is that the sample size in these subgroups is too small for a significant

difference to be detected. Although the consumption frequency of fruit was higher

among the maintainers than the women in the earlier stage, this difference was not

statistically significant. Another reason is that some of the women may regard their

consumption, says fruit, was adequate in the Follow-up when compared with the past,

but in fact they did not yet reach adequate consumption frequencies.

c. Changes in Behavior

Regarding their eating and physical activity behavior, only few significant changes

were observed between the Pre- and Posttests, including the daily energy expenditure.

This was maintained in the Education Group between the Pre- and Posttests, but it

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decreased significantly in the Control Group, indicating that the program could help

maintain the physical activity level of the women. The few significant changes,

perhaps, implied that behavior change takes time to occur as the Posttest was carried

out immediately after the intervention. This situation is consistent with a US

nutrition education program for 337 participants (98% female), which demonstrated

little nutrition-related behavior changes were noted immediately after the 5-class

program. The authors reported that time is required to assimilate the information,

put the information into practice, and succeed enough to report positively (Taylor et

"/.,2000).

Few of the eating and physical activity behavior in the Education Group showed

further significant improvements, also, between the Pretest and the Follow-up.

Desirable changes were observed in the Education Group only for decreasing the

consumption of cream cake. Unexpectedly, the Education Group significantly

increased their consumption frequencies of evaporated milk, candy and chocolate.

Perhaps this was because the Follow-up evaluation in the Education Group was

carried out shortly after the Lunar New Year, and the consumption of candy and

chocolate may be higher in that period, although the 'typical week' criteria in the

question would have been ignored by the respondents. Or, perhaps the women in

the Education Group were now more aware of their actual consumption of these

common snack foods.

In contrast, the Control Group showed significant changes in some of their eating

and physical activity practices between the Pretest and the Follow-up. Significantly

more women met the recommended intake level of calcium and removed all fat from

meat before they ate. However, the Control Group significantly increased their

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consumption frequency of fried dim sum. Regarding physical activity, a significant

decrease was found in the mean reported daily energy expenditure from physical

activity whereas a significant increase was noted in the mean summary index.

Most of the behavior variables did not change significantly between the Pretest and

the Follow-up, demonstrating a knowledge-behavior gap about healthy lifestyle

exists among local women. This gap was also found from a local study about

diabetic patients, in which no association between diabetes knowledge and behavior

compliance was shown (Chan & Molassiotis, 1999). Rimal stated that self-efficacy

may fill this gap, as revealed from studies that knowledge-behavior correlations were

higher among participants with higher efficacy (Rimal, 2000), but self-efficacy was

not directly measured in this program. Moreover, Marcus et al pointed out that

behavior changes in diet or physical activity may be difficult because people may not

be aware that their current dietary and physical activity habits are unhealthy or the

consequences are too far away to stimulate actions toward making changes (Marcus

et al, 2000). Also, the single class and short activity breaks devoted to physical

activity and health in this program may have been too brief to have stronger impact.

d. Changes in Anthropometry

There were no significant changes in BMI or percent body fat between the Pre- and

Posttests in either the Education or Control Group. Unexpectedly, the fasting total

blood cholesterol level significantly increased in both groups. The Follow-up

showed that both the Education and Control Groups significantly increased their

mean percent body fat and mean fasting blood cholesterol level between the Pretest

and the Follow-up. The increases in percent body fat and blood cholesterol level

may be due to aging and hormonal effects (Torng et al, 2000) (O'Connor et al., 1999)

166

(Chang et al., 2000). The Education Group maintained the cholesterol level

between the Posttest and the Follow-up, whereas the Control Group significantly

increased the level during the same period. The maintenance of blood cholesterol

level in the Education Group may have been due to the increased awareness in

healthy eating among the women, which, through some undetected change in eating

or physical activity habits, may have protected them from further increase in their

blood cholesterol level. Neither education level nor age group showed any

associations with any of the changes in body measurements in either the Education or

Control Group.

4.2 Strengths and Limitations of the Study

The study is the first one that systemically organized and evaluated a health

promotion program about nutrition and physical activity for the Hong Kong middle-

aged women. This study provided information about the women's attitude,

knowledge and behavior towards nutrition and physical activity. It also monitored

the extent of changes among the women in these aspects and evaluated the feasibility

of such kind of health promotion program for the local women. Therefore, this

pilot study fills the gap in the above areas, and serves as a basis for future action and

research.

Limitations of the study should be noticed when interpreting the findings. First,

most of the findings from this study are self-reported. In the present study,

objective measures such as the percent body fat and blood cholesterol level were also

taken, however, to minimize influence of potentially exaggerated self-reported data.

Second, the generalizability of the findings has some limitations. Although the

167

study was designed for the middle-aged women, only self-selected, highly-motivated

women in the women's centre were included (5% of eligible women in Centre One

and 15% in Centre Two). Therefore, women who are not interested in health or not

members of the centre or women members who do not actively participate in the

women's centre activities were excluded. Moreover, the small sample size of this

study may not be representative enough of the Hong Kong middle-aged women's

population. This is because more housewives, with low personal income and of

lower educational level when compared with the general population of Hong Kong

middle-aged women, participated in this study. However, as this is a pilot study,

this sample size is favorable, given the available resources. Even though this group

of respondents was, in theory, a self-selected group, level of expressed interest and

awareness levels were still quite low. Whether this was due to their low education

or is a general phenomenon among Hong Kong women still needs to be established.

Finally, the dropout rate in the two groups (22% and 37% at the Posttest for the

Education and Control Groups, respectively; and 37% and 51% at the Follow-up for

the Education and Control Groups, respectively) may affect the findings because

only the more motivated or more health conscious women remained throughout the

program. This attrition problem affects many health promotion programs, and

represents a challenge to those designing health work.

168

4.3 Implications and Recommendations for Meeting the Challenges of

Improving Hong Kong Middle-aged Women's Nutrition and Physical Activity

Habits

The results indicated that Hong Kong middle-aged women can be taught basic

nutrition and physical activity knowledge, generally irrespective of their education

level and age. Women of different education levels and age can maintain the

nutrition and physical activity knowledge six months after the intervention.

According to Brownel 1, education is the primary step in dietary change because lack

of knowledge may prevent individuals from recognizing the benefits of a healthy diet

(Brownell & Cohen, 1995). After completing the program, women indicated that

they learnt nutrition and physical activity knowledge from it, and would recommend

that their friends to join similar programs in the future.

Behavior change is the most challenging aspect in such a health promotion program,

when compared with improvements in knowledge and awareness, as is shown from

this study that few of the eating and physical activity behavior had significantly

improved. According to Marcus et al, behavior is triggered by cognitive, emotional,

environmental, physical and social factors that interact with each other. The

awareness of these factors would help people to develop a plan to change behavior

(Marcus el al., 2000). Besides, behavioral skills are also important for behavior

change as Brownell and Cohen state that behavioral procedures such as self-

monitoring, stimulus control, coping skills, and relapse prevention are necessary for

programs targeting behavior change (Brownell & Cohen, 1995). Therefore, it is

recommended that future health promotion programs should understand and target

the personal, interpersonal and environmental factors, as well as incorporate

behavioral skills to yield desirable behavior changes.

169

To expand this kind of health promotion program in a larger women's population, the

continued cooperation with local women's centres is recommended because

women's centres can approach many women in the community. Additionally, they

have established linkages with community resources and experience organizing

different kinds of activities which can assist the implementation of the health

promotion program.

Another concern for a health promotion is to minimize the attrition rate. To

encourage participation for the controls, incentives such as supermarket coupons may

be used. Mail or frequent telephone reminders are also possible methods to remind

participants to attend the activities and evaluation. Both of these methods,

however, will increase the cost and/or the labor involved. Reduction of subjects'

burden is another method. Some participants may think that taking dietary record

by themselves is a burden, in this case, telephone interview or other potentially less

burdensome methods of dietary data collection can be explored to gather the

information. To encourage people to attend follow-up assessments, health checks in

additional aspects may also be provided, but it would have to be explored as to which

aspects would attract the women and also how these would add to the costs of the

intervention.

4.4 Suggestions for Future Research

More research should be done among the Hong Kong middle-aged women in order

to expand the knowledge about how to implement effective health promotion for

them. Additionally, more efforts should be paid to changing the dietary and

physical activity habits of the women. Future health promotion programs should

continue to target behavior change but focus still more on behavioral skills to

170

facilitate the changes, for example, participants should learn how to cope with

difficulties when trying to change behavior, how to choose and prepare a healthy diet,

how to set goals for behavior change. Maintaining behavior change is also

challenging, and future research is needed to investigate the best ways to prevent

relapse. In order to sustain the effects of the health promotion programs, women

may keep simple food daily checklists and physical activity daily records to monitor

their eating and physical activity patterns, respectively. Women may be encouraged

to do physical activity together by forming some small groups such as walking group

in order to maintain long-term behavior change. Moreover, competitions between

women's centres can be carried out, to encourage improvements in eating or physical

activity patterns among participants from the women's centre. In addition, future

health promotion may try to involve business sector collaboration to expand

resources, for example, a cereal product company may provide healthy breakfast to

the participants, and at the same time the company can promote their products. The

involvement of the government and Department of Health in health promotion are

also important because they have more influence in creating a health-promoting

environment. To evaluate the effects of future health promotion programs, it is

suggested that long-term follow-up evaluation such as one year or 1.5 year should be

taken because behavior change does take time to occur.

171

CHAPTER FIVE: CONCLUSIONS

It is hoped that this pilot healthy eating and lifestyle promotion program can provide

background information about the knowledge, attitudes and behavior of local middle-

aged women. It is hoped that this work will facilitate the design and development

of future similar programs. In addition, it is hoped that improvements of Hong

Kong middle-aged women's eating and physical activity behavior will be achieved

by future effective longer-term health promotion programs, in order to optimize the

health of the local middle-aged women population.

172

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1 8 1

Appendix V

香港婦女健康生活評估活動參加同意書

香港中文大學現正進行一項婦女健康習慣的調查，目的爲瞭解現時香港婦女對健

康的看法及其健康的行爲，以籌劃合適的健康推廣活動。在未來的一年，你將會

被邀請參加三次活動。每次活動將包括簡單身體檢查，如量度身高、體重、身體

脂肪百分比及血液膽固醇，塡寫有關健康習慣的問卷和飮食記錄。在量度血液膽

固醇時，需要在手指尖抽5-6滴血液，而抽取的過程是絕對安全及衛生的。如參

與是次硏究，你便能進一步知道自己的健康狀況。硏究所收集的一切資料將會絕

對保密，只作爲硏究分析之用。

本人 (參加者姓名)已經完全明白是次硏究的目的及內容，亦有機

會詢問並得到滿意的回覆。本人同意參與是次硏究。

如有任何問題，歡迎致電26035830聯絡負責人鮑敬文先生。

參加者簽名：

見證人簽名：曰期:

1 8 2

Appendix V

Women^s Healthy Lifestyle Assessment Activity Consent Form

The Chinese University of Hong Kong is now conducting research about women's

health habits. The purpose is to understand women's ideas about health and

women's health behavior, in order to plan of appropriate health promotion in future.

Over the next year, you are invited to participate three activities. Each activity will

include simple body measurements such as height, weight, percent body fat and blood

cholesterol level, a health questionnaire and a food record. For the blood cholesterol

measurement, about 5-6 drops of finger tip blood is needed with appropriate attention

to hygiene. If you participate in this research, you will learn more about your health

status. All the data will be kept confidential and will be used only for research

purposes.

I (participant's name) fully understood the research purpose and

content, and have had the opportunity to ask questions about it with satisfactory

responses. I agree to participate in this research.

If you have any questions, please feel free to contact us at 26035830.

Participant's signature:

Witness' signature: Date :

183

Appendix V

問卷編號:

香港婦女飮食及運動習慣調查

香港中文大學現正進行一項婦女飮食及運動習慣調查，目的爲瞭解現時香港婦女

對健康的看法，以籌劃合適的健康推廣活動。你的積極參與會爲是次調查提供寶

貴的資料，請仔細考慮每條問題並回答所有問題，而這裡沒有對或錯的答案。在

本問卷上塡寫的一切資料將會絕對保密，只作爲硏究分析之用。

第一部份：飮食習慣此欄不用塡寫

1. 一星期中，你有幾多日會吃早餐？日（）

2. 一星期中，你有幾多日會吃午餐？日（ )

3. 一星期中’你有幾多日會吃晚餐？日（）

4.你每日會食幾多次小食(早午晚三餐以外的食物) ？次（）

5.你有沒有定時服食營養補充劑呢？

•⑴有’是哪樣呢？ ( )

( )

• (O)沒有（）

( )

6.當你吃肉類（豬，牛，羊等）的時候，如看見脂肪在肉上，你會（）

• (0)從不吃肉類

• (1)吃前除去所有脂肪

• (2)吃前除去部分脂肪（）

• (3)不除去任何脂肪

7.當你吃家禽（雞，鴨，鵝，乳鶴等）的時候，你會

• (0)從不吃家禽

• (1)吃前除去所有皮

• (2)吃前除去部分皮（）

• (3)不除去任何皮

8.在家中，你是否負責煮飯呢？

• ⑴ 是（）

• (0)不是

184

9.你/你家人煮餸和食用時(如搽麵包) 常用的油是哪樣呢？可選超過一項此欄不用塡寫

• (O)不知道口⑶橄欖油（ ) ( )

• ⑴ 粟米油口(6)椰油（）（）

• ⑵ 花生油 [11(7)牛油或人造牛油（）（）

• ⑶ 芥花籽油 • (8)豬油或雞油（）（）

• (4)葵花籽油口 (9)其他’請註明 ( ) ( )

10.當你/你家人煮以下食物時，常用的煮食方法是哪樣呢？多選3種方法

不知道蒸灼 / 赞湯炒煎炸燉坟燒烤微波

魚 • • • • • • • • • •

豬牛肉 • • • • • • • • • •

雞鴨鵝 • • • • • • • • • •

蔬菜 • • • • • • • • • •

H.你是否爲家人買食物呢？

• ⑴ 是（）

• (0)不是

12.當你首次買或進食某一樣包裝食品時，你會閱讀食品標籤嗎？

• (0)從不1轉答後面第二部份

• ⑴ 間中

• ⑵ 經常（）

• (3)每次都會

13.你覺得食品標籤淸晰嗎？

• (0)非常不淸晰

• (1)不淸晰

• (2) 一般（ )

• (3)淸晰

• ⑷ 非常淸晰

185

第二部份：運動習慣此欄不用塡寫

以下是一些日常的工作與運動。根據近的一個典型星期〔即沒有疾病’活動

量與平時差不多〕，塡寫你用在每項的時間〔以分鐘計算〕。如你沒有做過該項

活動，貝(I在空格上塡上‘O , O

家務和工作 I 一次所用時I 一星期做多

間〔分鐘〕少次 ( 、

買餸一 ( )

購物和逛街一 ( )

手挽重物並上落樓梯一 ( )

手挽重物行平路及斜路一 ( )

手洗衣服，晾曬，摺衣服 — ( )

一般家務：如抹塵’掃地，熨衣服，執拾家中物件 — ( )

粗重家務：如吸塵，拖地，搬動傢權、一 ( )

預備食物：如洗，切，攪拌，煮食物一 (

準備碗筷，上菜 —

執枱，洗碗 — ( )

一般維修：如電器維修，少型傢ffi維修一 ( )

粗重維修：如油漆，木工，洗車 — ( )

電腦工作，文書工作，打字等 ~ ( )

其他，請註明 ( )

照顧家人 I 一次所用時I 一星期做多

間〔分鐘〕少次 ( )

搬動或推輪椅 ZZZZI ( ) 搬動，手挽或推嬰兒車 —

與小孩玩耍時一起走動 — ( )


休閒活動 I 一次所用時I 一星期做多

間〔分鐘〕少次（

）

散步’晨運 Z Z Z H ( )

手工藝：如織冷衫，插花，穿珠仔等一 ( )

跳舞〔中/快板〕 “ ( ) _保齡球 — ( )

高爾夫球 “ —

打麻雀 ““ (

-蹄電視 “ ~ ( )

1弟報紙，雜誌，書一 “ (

)

養飯（早,午,晚三餐合計） Z Z Z I I ( )

1他，請註明 ( )

1 8 6

運動 I 一次所用時 I 一星期做多 I 此欄不用塡寫

間〔分鐘〕少次

急速步行(會令你感到氣喘），行山一 ( )

瑜珈，太極，六通拳或伸展運動一 ( )

健身運動或健康舞 —

單車或健身單車

W w —

“ 一 ( )

mW ~ ( )

羽毛球，乒乓球 ~ ( )

網球，籃球，排球“ 一 ( )


1.在上個星期或上個月中’你有多少次至少十分鐘而令你心臟劇烈跳動

的運動呢？只需塡 a或 b行

a )上星期有次，每次分鐘 ( )

b)上個月有次，每次分鐘

2.在上個星期或上個月中，你有多少次連續行路至少十分鐘，但沒有令你 •

心臟劇烈跳動呢？只需塡a或b行

a )上星期有次，每次分鐘（）

b)上個月有次，每次分鐘

3.你平均每日花多少時間在需要走動的工作呢？請指出真正走動的時間

小時（）

4.你平均每日花多少時間站立？

小時（）

5.你平均每日花多少時間坐下(如食飯’睇電視’睇報紙)？ ( )

小時

6.你平均每日行多少層樓梯(1層等於10-12級樓梯)？

層（ )

7.你剛才塡寫是春天的活動量’與其他季節比較’活動量有沒有不同呢？

(1)非常少（2)較少（3)與春天差不多（4)較多（5)非常多

夏天 • • • • • ( )

秋天 • • • • • ( )

冬天 • • • • • ( )

187

第三部份：行爲上的改變此欄不用塡寫

1.你知道甚麼是飽和脂肪嗎？

•(1)知道

• (O)不知道=> 轉答第5題（）

2.以下哪一句能表達你進食飽和脂肪的行爲呢？

• (1)從無想過或試過食少些

• (2)過去有想過或試過食少些’而現在沒有，也沒有信心將來可以做到。

• (3)過去有想過或試過食少些’而現在沒有’但有信心將來可以做到。（）

• (4)現在已食少了 ’並維持了 6個月或以下。

• (5)現在已食少了，並維持了超過6個月。

3.當你嘗試食少些飽和脂肪時，有沒有遇到任何困難呢？

•⑴有，請註明 ( )

： ( )

• (0)沒有（ )

( ) 4.有甚麼方法可以幫你食少些飽和脂肪呢？

( )

( )

( ) 5.以下哪一句能表達你進食新鮮水果的行爲昵？

• (1)從無想過或試過增加食多些

• (2)過去有想過或試過食多些’而現在沒有’也沒有信心將來可以做到。

• (3)過去有想過或試過食多些’而現在沒有，但有信心將來可以做到。（）

• (4)現在已食多了，並維持了 6個月或以下。

• (5)現在已食多了，並維持了超過6個月。

6.當你嘗試食多些新鮮水果時’有沒有遇到任何困難呢？

•⑴有’請註明 ( )

( )

• (0)沒有（ )

( ) 7.有甚麼方法可以幫你食多些新鮮水果呢？

( )

( )

( )

1 8 8

8-以下哪一句能表達你進食蔬菜的行爲呢？此欄不用塡寫

• (1)從無想過或試過增加食多些

• (2)過去有想過或試過食多些’而現在沒有，也沒有信心將來可以做到。

• (3)過去有想過或試過食多些’而現在沒有，但有信心將來可以做到。（）

• (4)現在已食多了，並維持了 6個月或以下。

• (5)現在已食多了，並維持了超過6個月。

9.當你嘗試食多些蔬菜時’有沒有遇到任何困難呢？

•⑴有’請註明 ( )

( )

• (O)沒有（）

( ) 10.有甚麼方法可以幫你食多些蔬菜呢？

( )

： ( )

( ) 11.以下哪一句能表達你運動的行爲呢？

• (1)從無想過或試過做多些

• (2)過去有想過或試過做多些’而現在沒有’也沒有信心將來可以做到。

• (3)過去有想過或試過做多些，而現在沒有’但有信心將來可以做到。（）

• (4)現在已做多了，並維持了 6個月或以下。

•⑶現在已做多了，並維持了超過6個月。

12.當你嘗試做多些運動時’有沒有遇到任何困難呢？

•⑴有’請註明 ( )

• (0)沒有 ( )

13.有甚麼方法可以幫你做多些運動呢？

189

第四部份：營養知識

請指出以下句子是對或是錯’並在空格加上V，號。此欄不用塡寫

� ( O ) (2)

對錯不知道

1.蛋白比蛋黃有更多飽和脂肪。 • • • ( )

2.脫脂奶比全脂奶有更多飽和脂肪° • • • ( )

3.有些食物有大量脂肪’卻完全沒有膽固醇。 • • • ( )

4.高膽固醇食物比高飽和脂肪食物更能增加血液膽固醇。• • • ( )

5.白麵包比全麥麵包有更多食用纖維。 • • • ( )

6•全脂奶比脫脂奶有更多蛋白質。 • • • ( )

7.冷藏與新鮮肉類有相同的營養。 • • • ( )

8.食太多高糖份的食物會導致糖尿病° • • • ( )

9.血管硬化主要是飮食中的膽固醇過高。 • • • ( )

10.高纖維的飮食能幫助預防結腸癌o • • • ( )

11.你有否聽過或見過‘食物金字塔’呢？

• ⑴ 有

• (0)沒有1轉答後面第五部份 ( )

12.請將以下食物放入‘食物金字塔’的括號中？只需塡寫食物旁邊的數字在

括號內

1.蔬果類

2.油，鹽和糖

3.飯麵類

4.肉類和奶類製品

赢：：

Z LJ A ( ) 食物金字塔

190

第五部份：運動知識

請指出以下句子是對或是錯，並在空格加上7，號。此欄不用塡寫

� ( O ) (2)

對錯不知道

1.定期做運動可減少患上成人型糖尿病的機會。 • • • ( )

2.定期做運動會增加患上高血壓的機會。 • • • ( )

3.定期做運動可減少患上骨質疏鬆症的機會° • • • ( )

4.連續的有氧運動(1次做30分鐘)與分開3次做

(每次10分鐘）’同樣可以提高心肺功能。 • • • ( )

5.有氧運動是提高心肺功能的有效方法。 • • • ( )

6.健康舞是一種有氧運動° • • • ( )

7-根據建議’每次運動至少要10分鐘。 • • 口（）

8-根據建議’ 一星期至少要做1次運動。 • • 口（）

9.如要身體健康，要做比一般活動更爲劇烈的運動° • • • ( )

10.你有否聽過或見過‘運動金字塔’呢？

• ⑴ 有

• (0)沒有。轉答後面第六部份 ( )

n.請將以下運動放入‘運動金字塔’的括號中？只需塡寫運動旁邊的數字在

括號內

1.伸展運動和強化肌肉運動

2.有氧運動

3.曰常生活中的運動

4.休息或不做運動

：：

運動金字塔

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第七部份：個人資料此欄不用塡寫

1.請問你今年幾多歲呢？

歲 ( )

2.你的教育程度是：

• (1)從未接受教育/幼稚園

• (2)小學〔未完成課程〕

• (3)小學〔完成課程〕

• (4)初中〔中一至中三〕（ }

• (5)高中〔中四至中七〕

• (6)大專，大學或以上

3.你的婚姻狀況是：

• 0 )單身

• (2)已婚

• (3)離婚/分居（ )

• (4)喪偶

4.你的職業是：

•⑴沒有工作〔非家庭主婦〕

•⑵全職工作

• (3)兼職工作（ )

• (4)家庭主婦

5.你的家庭成員〔包括你在內〕共有多少人？

• ⑴ 1 人

• ⑵ 2 人

• (3)3 人

• (4)4 人（ }

• ⑶ 5 人

• (6) 6人或以上

6.你的家庭每月總收入大約畏：

• (1) $5,000 或以下

• (2) $5,001-10,000

• (3) $10,001-15,000

• (4) $15,001-20,000

• (5) $20,001-25,000 ( )

• (6) $25,001-30,000

• (7) $30,000 以上

194

7.你的個人每月總收入大約是：此欄不用塡寫

• (O)無收入

• (1) $1-1,000

• (2) $1,001-2,000

• (3) $2,001-3,000

• (4) $3,001-4,000

• (5) $4,001-5,000 ( )

• (6) $5,001-10,000

• (7) $10,001-15,000

• (8) $15,000 以上

8-你有沒有以下的疾病呢？

⑴有（0)沒有

糖尿病 • • ( )

高血壓 • • ( )

高膽固醇 • • ( )

高血脂 • • ( )

骨或關節痛 • • ( )

貧血 • • ( )

其他’請註明 • • ( )

9.與其他差不多年紀的婦女比較’你認爲自己的健康如何9

• (1)非常差

• (2)較差

•⑶跟她們差不多（ }

• (4)較好

•⑶非常好

10.你希望知道健康的資料嗎？

•⑴希望，請註明 ( )

• (0)不希望 ~ ( )

11•如你能夠改善自己的健康’會是哪方面呢？

你的名字：中文英文—

聯絡電話: 問卷完畢 ^ W ^ o

195

Appendix V

Survey ID

Hong Kong Women's Dietary and Physical Activity Survey

This survey is carried out by The Chinese University of Hong Kong. It aims at collecting information about your ideas about health so that appropriate health-improving interventions can be organized in future. Your kind cooperation will contribute much to this survey, so please answer all the questions after you have considered each one carefully. There are no right or wrong answers. All information will be kept confidential and used only for research purposes.

Part I) Dietary Habits

1. How many day(s) per week do you have breakfast? day(s)

2. How many day(s) per week do you have lunch? day(s)

3. How many day(s) per week do you have dinner? day(s)

4. How many between-meal snacks (food excluding that from regular meals) per day do you take? time(s)

5. Do you take any nutrient supplements regularly?

• (1) Yes. What kind(s)?

• (0) No

6. When you eat meat (e.g. pork, beef, lamb), if you see some fat on the meat, you would Q (0) Do not eat meat

• (1) Remove all the fat before eating

D (2) Remove some of the fat before eating

• (3) Do not remove any fat

7. When you eat poultry (e.g. chicken, duck, goose, pigeon), you would O (0) Do not eat poultry

• (1) Remove all skin before eating

D (2) Remove some skin before eating

• (3) Do not remove any skin

8. Are you responsible for cooking at home?

• (I)Yes

• (0) No

196

9. Which type(s) of oil do you/your family use for cooking and eating (e.g. spreading on bread)?

Could choose more than one.

• (0) Don't know • (5) Olive oil

• ( I )Corn oil • (6) Palm oil

• (2) Peanut oil 口 (7) Butter or Margarine

• (3) Canola oil 口 (8) Lard or Chicken oil

• (4) Safflower oil • (9) Others please specify

10. Which cooking methods do you/your family most frequently use for the following food?

丨 or each food item，maximum three cooking methods can be chosen.

Don't Steam Boil Stir fry Fry Deep fry Stew Grill Barbecue Microwave Know

F i s h • • • • • • • • • •

Pork/Beef • • • • • • •

Chicken/Duck/ Goose • 口口口 I I l ~ I l I l

Vegetable • • • • • 匚

11. Are you responsible for buying food ？

• � Yes

• (0) No

12. When you buy or eat a new packaged food, how often do you read the food label?

• (0) Never 4 Go to Part II on next page

I I (1) Sometimes

• � Usually

• (3) Every time

13. How clear is the food label to you?

• (0) Very unclear

• � Unclear

• (2) So-So

• (3) Clear

• (4) Very clear

197

Part II) Physical Activity

Here is a list of common types of physical activities. Please think carefully about each activity and

write down how much time (in minutes) you spent doing each activity during a recent typical week

(when you had no illness, and your working level was normal for you). If you have not done that

activity, please write down ‘O,.

Housework and Work ~ Minutes !Frequency per time per week

Buying food Shopping Stair-climbing while carrying a load Walking flat while carrying a load Laundry (time loading, unloading, folding only) — Light housework: tidying, dusting, sweeping, ironing, collecting trash in home. Heavy housework: vacuuming, mopping, scrubbing floors and walls, moving furniture. Food preparation: chopping, stirring, cooking food — Food service : setting tables, carrying food, serving food. Dishwashing : clearing table, washing/drying dishes, putting dishes away. Light home repair: small appliance repair, light home maintenance/ repair. Heavy home repair: painting, carpentry, washing/polishing car Computer work, clerical work, typing-Other, please specify

Care giving Minutes !Frequency

— ^ per time per week Lifting, pushing wheelchair Lifting, carrying, pushing stroller Chasing children during playing Other，please specify

198

Recreational activities Minutes !Frequency ~； per time per week Leisurely walking, morning walk Needlework: knitting, sewing, needlepoint, craftwork 一

Dancing (moderate/fast) Bowling Golf Playing mahjong Watching TV Reading newspaper, magazine, book Eating (total time for the 3 regular meals) Other, please specify

Exercise Minutes Frequency per time per week

Brisk walking (makes you feel breathless) or hill walking Yoga, Tai Chi, Liu Tong Quan, stretching exercises — Vigorous calisthenics, aerobics Cycling, exercycle Rope skipping Swimming Running Badminton, table tennis Tennis, basketball, volleyball Other, please specify

~ 11 ' I . .

199

1. About how often during the past week or month did you participate in vigorous activities that

lasted at least 10 minutes and caused a large increase in heart rate? FiU in line a or b only.

a ) times per week, minutes per time

b ) times per month, minutes per time

2. About how often during the past week or month did you walk for at least 10 minutes or more

without stopping which was n o t strenuous enough to cause large increases in heart rate? Fill in

line a or b only.

a ) times per week, minutes per time

b ) times per month, minutes per time

3. About how many hours a day do you spend moving around on your feet while doing things?

Please state only the time that you are actually moving.

hours

4. About how many hours per day do you stand?

hours

5. About how many hours did you spend sitting (such as when eating, watching television, reading etc) on an average day?

hours

6. About how many flights of steps (about 10-12 steps) do you climb each day?

flights

7. Please compare the amount of physical activity that you do during other seasons of the year with

the amount of activity you just reported. For example, do you do more or less activity than what

you reported? Check the appropriate box. Consider this survey as 'spring' activity.

(O (2) (3) (4) (5)

Much less Little less Same Little more Much more Summer • • 口

Fall • • Q

Winter 口 • 口 [

200

Part III) Changing Behavior

1. Do you know what saturated fat is?

• (1) Yes

] ( 0 ) No Go to Q5

2. Which of the following best describes vour behavior regarding saturated fat intake?

• (1) Never thought of or tried to reduce the intake.

• (2) H a v e thought or tried, but currently not reducing, and have no confidence to reduce in the future.

• � Have thought or tried, but currently not reducing, and have confidence to reduce in the future.

• (4) Currently reducing, have been limiting 6 months or less.

• (5) Currently reducing, have been limiting more than 6 months.

3. When you tried to decrease the intake of saturated fat. did you have any difficulties?

• (1) Yes, please specify

• (0) No

4. What would help you to decrease the intake of saturated fat?

5. Which of the following best describes vour behavior regarding fresh fruit intRke^

• (1) Never thought of or tried to increase the intake.

口 (2) Have thought or tried, but currently not increasing, and have no confidence to increase in the future.

• (3) Have thought or tried, but currently not increasing, and have confidence to increase in the

future.

D (4) Currently increasing, have been increasing 6 months or less. • (5) Currently increasing, have been increasing more than 6 months.

6. When you tried to increase the intake of fresh fruit, did you have any difficulties?


• (0) No

7. What would help you to increase the intake of fresh fruit?

201

8. Which of the following best describes your behavior regarding vegetables intake?

• (1) Never thought of or tried to increase the intake.

• (2) Have thought or tried, but currently not increasing, and have no confidence to increase in the future.

Zl (3) Have thought or tried, but currently not increasing, and have confidence to increase in the future.

• (4) Currently increasing, have been increasing 6 months or less. • (5) Currently increasing, have been increasing more than 6 months.

9’ When you tried to increase the intake of vegetables, did you have any difficulties?


] ( 0 ) No

10. What would help you to increase the intake of vegetables?

11. Which of the following best describes your behavior regarding doing physical activity?

• (1) Never thought of or tried to increase the frequency or duration.

• (2) Have thought or tried, but currently not increasing, and have no confidence to increase in

the future.

口 (3) Have thought or tried, but currently not increasing, and have confidence to increase in the future.

D (4) Currently increasing, have been increasing 6 months or less. • (5) Currently increasing, have been increasing more than 6 months.

12. When you tried to increase your physical activity frequency or duration, did you have any difficulties?


• (0) No

13. What would help you to increase your physical activity frequency or duration?

202

Part IV) Nutrition Knowledge

State whether the following statements are true or false. Please put a ‘,，in a box.

(1) (0) (2) T F Don't know

1. Egg white has more saturated fat than egg yolk.

2. Skim milk has more saturated fat than whole milk.

3. Some foods contain a lot of fat but no cholesterol.

4. High cholesterol food has a greater effect than high

saturated fat food on raising blood cholesterol level. • • 口

5. White bread has more fibre than whole wheat bread.

6. Whole milk contains more protein than skim milk.

7. Frozen foods have the same nutrients as fresh foods.

8. Eating a lot of sugars will cause diabetes.

9. The hardening of blood vessels is mainly caused by

too much cholesterol in the diet.

10. A high fibre diet can help prevent colon cancer.

11. Have you ever heard of or seen the food pyramid?

• (I)Yes

• (0) No => Go to Part V on next page

12. Please arrange each of the following food groups to its correct level of the food pyramid. Put the : : : � / .: � ... ：. V: • :. ::: ： • . :.. .： •：：' f :: ‘ :.: .... '：：；•••.

number only of the food group in the brackets. 1 .Vegetables and Fruits 2. Oils, Fats, Salt and Sugar. 3. Cereals 4. Meats and Dairy products

Ax Z LJ A The Food Pyramid

203

Part V) Physical Activity Knowledge

State whether the following statements are true or false. Please put a in a box.

(1) (0) (2)

丁 F Don't know

1. Regular exercise decreases the chance of adult-onset d i abe te sQ • •

2. Regular exercise increases the chance of hypertension. • • 口

3. Regular exercise decreases the chance of osteoporosis. • • 口

4. Both continuous (one 30-minute session) and intermittent

(three 10-minute sessions) aerobic exercise can build

cardiovascular fitness. 口 I ~

5. Aerobic physical activities are the most effective one in

developing cardiovascular fitness. • • [

6. Aerobic dance is one kind of aerobic exercise. • • [

7. The recommended duration for each session of physical

activity is at least 10 minutes. • • IZ

8. The recommended frequency of exercise is at least one

time per week. ~~| | ~ 9. Exercise must be hard enough to require more exertion

than normal to produce gains in health-related fitness. • • [

10. Have you ever heard of or seen the physical activity pyramid?

• ( I )Yes

• (0) No => Go to Part VI on next page

11. Please arrange each of the following physical activities to the physical activity pyramid. 1 ut the number only of the different physical activity groups in the brackets.

1. Exercise for flexibility and muscular strength

2. Aerobic and active sports

3. Lifestyle physical activity

4. Rest or Inactivity

急 '~— \

The Physical Activity Pyramid

204

Part VI) Food Frequency Table

Here is a list of common foods and beverages. Think carefully about each one and how often you

consume it in a recent typical week. Then put a ' Z, in the box under the frequency that most

closely represents your consumption frequency.

Not consume 1/wk 2/wk 3-4/wk 5-6/wk 1/day 2-3/day

(0) (1) (2) (3) (4) (5) (6)

Cheese • • • • • • •

Yogurt • • • • • • •

Low fat yogurt • • • • • • •

S c r e a m • • • • • • •

Whole milk • • • • • • •

Skimmilk • • • • • • •

High Calcium

low fat milk • • • • • • •

Chocolatemilk • • • • • • •

Condensed milk • • 口 • • • 口

EvaporatedmilkQ • • • • • •

Not consume 1/wk 2/wk 3-4/wk 5-6/wk 1/day 2-3/day (O) (1) (2) (3) (4) (5) (6)

Whitebread • • • • • 口 •

Whole wheat b r e a d • • • • • • • Sushi • • • • • • •

Fried rice • • • • • • • pIainrice • • • • • • •

Red/brown rice 口 • 口 • • 口口

noodles • • • • • • •

Noodles in soup 口 • 口 • • 口

Cup noodles/

Instant noodles • • • • • • •

205

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Part VII) Personal data

1. How old are you?

years

2. What is the highest education level you attained?

• (1) No formal schooling/ kindergarten

I I (2) Some Primary

• (3) Completed Primary

I I (4) Lower Secondary (Form 1-3)

• (5) Higher Secondary (Form 4-7)

I I (6) Post Secondary, University or above

3. What is your marital status?

• (I)Single

• (2) Married

口 (3) Divorced/Separated

• (4) Widowed

4. What is your employment status?

• (1) No work (not housewife)

• (2) Full-time

• (3) Part-time

• (4) Housewife

5. How many household members (including yourself) do you have?

• (1)1 person

• (2) 2 people

• (3) 3 people

• (4) 4 people

• (5) 5 people

• (6) 6 people or above

6. Which of the following ranges represent your total monthly household income

• (1) $5,000 or less

• (2) $5,001-10,000

• (3) $10,001-15,000

• (4) $15,001-20,000

• (5) $20,001-25,000

• (6) $25,001-30,000

• (7) More than $30,000

208

7. Which of the following ranges represent vour own monthly income?

• (0) No income

• (1)$1-1,000

• (2) $1,001-2,000

• (3) $2,001-3,000

• (4) $3,001-4,000

• (5) $4,001-5,000

• (6) $5,001-10,000

• (7) $10,001-15,000

• (8) More than $15,000

8. Do you have any of the following diseases?

(I)Yes (O)No

Diabetes 口口

Hypertension

High blood cholesterol

High blood triglycerides • •

Bone or joint diseases

Anemia

O t h e r s , please specify

9. How do you rate your health, when compared with other women of similar age?

• (1) Far worse

• (2) Worse

口 (3) About the same

• (4) Better

• (5) Far better

10. Is there anything you would like to learn about health?

] ( 1 ) Yes, please specify

• (0) No

11. If you could improve your health, what would you improve?

Your name: Chinese English

Contact no:

End of Questionnaire.

Thank You!

209

A p p e n d i x E

食物份量與器皿容量照片

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Appendix F

I Photos for Food Amount Quantities and Household Measures

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Appendix V

飮食記錄（例子）

"時間食物份量進食地點 9:00am 牛油多士 —

~ ~ 1.多士一 1 塊 —

2-牛油 1 茶匙 — —

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1.火腿半塊一

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3-什豆 — 1湯匙

熱奶茶 1杯 _ 大家樂

12:30pm 癞餃一 2 粒

燒賣 — 2粒酒 g

蓮蓉飽 1個 g g

煎腸粉 “ 3 條 — 酒樓

揚州炒飯 “ 一酒樓

1.火腿 — 1湯匙

2.雞蛋 1湯匙一

3.蝦仁一 8隻

4.飯 _ 2 酒樓碗一

4:30pm — 1 個

：維他檸檬茶250 ml 一 1包家中 —

^ O O p m 菜心炒牛肉 _ 家中

1.菜心 4條

2.牛肉一 2両

3.栗米油 2湯匙

豉汁蒸烏頭 2両 ^

1.栗米油 2 湯匙一 “

青紅蘿蔔煲豬骨湯家中 —

1.豬肉 1両

2 .湯標準碗一

2 標準碗 — 家中

i o o p m 橙(中型） U

“11 :00pm雞蛋腐竹糖水 “ 家中 —

1.雞蛋一― 1 隻一

― ― 2.腐竹糖水 1標準碗

216

Appendix H

Dietary Record (Sample) T i m e Food item Quantity/ Serving size Place

8:00am Toast with butter Cafe de Coral 1. Toast 1 piece 2. Butter 1 tea spoon

Macaroni with ham Cafe de Cora厂

1- Ham 1/2 slice 一

2. Macaroni 1 standard size bowl — 3.Mixed vegetable discs 1 table spoon

H o t t e a 1 cup Cafe de Coral—

12:30pm Shrimp dumpling 2 pieces Chinese restaurant

Siu-mai 1 piece Chinese restaurant

Lotus seed paste bread 1 bun Chinese restaurant

Fried cheung-fun 3 rolls ‘ Chinese restaurant

Fried rice in Yeung Chao Style Chinese restaurant

1 • Ham 1 table spoon ~ 2- Egg 1 table spoon 3. Shrimp 8 pieces 4- Rice 2 Chinese restaurant

bowls

Opm Egg tart 一1 item Home 一

VITA lemon tea 250ml 1 pack Home

7:30pm Stir fried Choi sum with Beef " Home 1. Choi sum 160g 2. Beef 2 taels 3. Corn oil 2 table spoons —

Steam fish with fermented soybean 4 table spoons H o m e ~ 1 • Corn oil 1 table spoon “

Chinese soup with red turnip , green Home turnip and pork bones

1. Green turnip 2 taels 2. Red turnip 2 taels ~ 3. Pork bones 1 taels 4. Soup 2 standard bowls

Rice 1 standard bowl Home

9:00pm Orange (medium) Htem Home

11:00pm Sweet soup with egg and tofu-sheet Home L Egg 1 item 2. Sweet soup with Tofu sheet 1 standard bowl

217

Appendix I

飮食胃己錄(1) 星期六或星期日

你的名字：中文問卷編號:

英文電話:

時間食物份量進食通 I T ^

218

飮食言已錄(2) 星期一至五其中一曰


英文電話:

時間食物份量進食M i T "

219

飮食記錄(3 ) 星期一至五其中一曰


英文電話:

時間食物份量進食 ^ ^

220

Appendix J

Dietary Record (1)

Saturday or Sunday Name: Chinese Survey ID ：

English

Telephone no:

T i me Food item Quantity/ Serving size Place

221

Dietary Record (2)

One day from Monday to Friday Name: Chinese Survey ID :

English

Telephone no:

Time Food item Quantity/ Serving size Place

222

Dietary Record (3)

One day from Monday to Friday Name: Chinese Survey ID :

English Telephone no:

Time Food item Quantity/ Serving size Place

223

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AB

Nat

ow

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e F

ast

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trit

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ou

nte

r.

1994

炒飯

(一

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碟）

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MSU

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4.

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使用

除

國

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脫氧

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合而

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的

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DN

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的基

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m

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MM

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q

和動物的特質。

基因

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食物

會否

影響

我們

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香港

中文

大學

>所

有基

因改

造食

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會接

受由

生產

公司

及

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ft

qp

^

mm

-h

-m

^^

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许、

止备

从:

从店

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來源

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理

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是以

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同」

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很多

移植

到農

作物

內的

DN

A片

段是

按照

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或

> 「

實質

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將原

本與

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因排

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：

行多

方面

比較

（包

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理、

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性和

營養

成

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者沒

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科學家按照某個動物或細菌基因的排序

V所

以，

現時

市場

出售

的基

因改

造食物

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會

U

比原本的食物不安全

。

婦女

健康

飮食

及運

動推

廣活

動

什麼

食物

是基

因改

造？

再移植入農作物中

黃

豆，

粟米

，芥

花籽

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茄，

馬鈴

薯，

花生

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#

$ f 二、

在香

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加工

食品

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因改

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份’

^

^ I 二

}

註：

不是

由動

物或

細菌

中直

接抽

取基

因放

入農

作包

括即

食麵

，粟

米造

的零

食’

豆腐

，贾

奶，

兒萤

^

iK

^ ^

pi

物內

的，

而是

放進

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棵植

物中

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產生

種子

作用

的苣

奶粉

等。

U

農作

物的

生產

。

在外

觀上

，大

部份

基因

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食物

與原

產品

大致

相

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ra #

、生

i ^

n

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擁有

那同

’要

分辨

的話

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只有

利用

生.物

化學

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健康

心臟

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司，

1999

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口腔

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咽喉

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體內

胰島

素分

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平衡

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孕時

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基化

合物

的食

物

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的作

用。

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第二

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第一

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小童

時期

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診斷

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礙內

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加述

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物金

字塔

泌胰

島素

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宮，

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物金

字塔

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增加

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深綠

色及

橙黃

色的

蔬菜

和水

果

上升

。大

部份

患者

(九

成以

上)是

第二

型患

者，

在成

1

.每餐

不要

進食

過散

，妝

選擇

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小食

- V選

擇一

個以

穀物

及蔬

果爲

主的

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年後

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生’

患者

的胰

臟並

沒有

受到

破壞

，只

是

1.減

少進

食脂

肪，

特別

足飽

和脂

肪

〜免果每天一•至兩個

身體

內的

細胞

不能

對胰

島素

作出

反應

，這

類糖

尿

增加

進食

含萵

纖維

食物

匆丨

跪果

’穀

類等

。

〜蔬

菜毎

天六

兩以

上

病是

可以

避免

的。

4.避

免進

负萵

熱M：

和高

糖份

的食

物如

汽水

，雪

>

減少

進食

肥腻

食物

碳水

化合

物經

過消

化和

吸收

後會

轉化

爲血

糕

，煎

炸食

物“

V選

擇企

穀類

食物

而少

食加

工食

物

糖。

糖尿

病患

者不

能將

吸收

的糖

份有

效地

轉化

塞

抖、

、魅

庇广

勺枉

由窗

〉納

各路

、減

少進

食醃

製過

的食

物或

高鹽

食物

爲我

們日

常生

活所

需的

熱量

，過

多的

糖份

積

守双

〜職

购V

^ r风

)的

厄懷

U系

V避

免用

萬年

油來

炸食

物

聚在

血液

中’

令血

糖增

高，

並經

由尿

液俳

出，

危險

因素

（不

可改

變）

危險

闪素

（可

改變

）

、維

持健

康體

重

故稱

爲糖

尿。

—+、

& @

>做

適的

運動

家

族遺

傳

吸焯

‘

\

患上

糖尿

病的

嚴重

後果

男

性

高_明

、

減少

飮酒

“

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J取

里1文

不

年齡

不

良飲

食習

惯

> 減

少進

食紅

肉，

每天

應少

於二

兩

引致

倂發

症’

例如

：

高血

脂

V適

當貯

存食

物，

以避

免細

菌的

感染

>心

臟病

缺乏

運動

>腎

病，

嚴重

者需

洗賢

ff病

二S康

剛、

冊子

，錢

公司

>丨

視力

下降

，甚

至失

明

壓力

2.食物成份表，人民衛生出版社

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w.

cc

h.

or

g.

tw

二

4.

ww

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http://www.healthbasic.com

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ly

use

dark

gr

een

vege

tabl

es.

Coo

k th

em

wit

h le

ss

oil

at

Wo

me

n's

H

ea

lth

y E

ati

ng

an

d hi

gh-t

empe

ratu

res

for

a sh

ort-

time.

Ph

ysic

al A

ctiv

ity

Prom

otio

n Pr

ogra

m

8.

Boi

l ve

geta

bles

with

sm

all

amou

nt o

f oi

l and

sal

t

Tip

s fo

r he

alth

y ea

ting

1.

Use

an

oil

filte

r to

rem

ove

exce

ss o

il fl

oatin

g on

the

sou

p

2.

Eat

les

s in

tern

al o

rgan

s, s

hrim

p's

head

s, f

ish

head

s an

d fa

tty m

eat.

Hea

lth

Tal

k (2

) 3.

E

at m

ore

oatm

eal,

whi

ch i

s ric

h in

fib

re, p

rote

in a

nd t

aste

! 4.

M

ix w

hite

ric

e w

ith r

ed o

r br

own

rice

H

ea

lt

hy

CO

Ok

il

lg

, E

at

it

tg

Ol

lt

5.

Use

who

le w

heat

bre

ad i

nste

ad o

f w

hite

bre

ad s

omet

imes

H

ealt

hy f

ood

choi

ces

and

Food

Lab

els

Mor

e he

alth

y ch

oice

s L

ess

heal

thy

choi

ces

八

77

^

/;

¾

Clu

ne

se

Ric

e/N

oodl

es i

n so

up

Frie

d ri

ce/F

ried

noo

dles

/Ins

tant

noo

dles

Her

ring

fis

h pi

eces

/bal

ls

Bee

f du

inpl

ings

/Fri

ed f

ish

skin

Cong

ee/c

heun

g fa

n Y

au C

har K

wai

/Scs

ame

pufT

I

Wes

tern

Sa

ndw

ich

with

egg

and

tom

ato

Sand

wic

h w

ith e

gg a

nd h

am

yZ

i^g

R] I

Plai

n bu

n/B

read

with

jam

Fr

ench

toa

st/T

oast

with

con

dens

ed m

ilk a

nd

V^

L^

iS^

U i

i^ 工

：^

Me i

yi^

l^p

v

Sp

ag

he

tti

wit

h k

etc

hu

p

Sp

ag

hett

i w

ith

w

hil

e sa

uc

e /,

.'•

-jA

-jl^

^ /—

^^•

“磁

^^辦

纖...〜

W

ho

le w

heat

bre

ad

/Fre

nch b

read

Cro

issa

nt

Bo

rscli

/Bro

th

Cre

am

so

up

Mix

ed v

eget

able

s (n

o sa

lad

Pudd

ing/

Milk

slia

ke/I

ce-c

ream

io

|dre

ssin

g)/F

resh

fru

its

CO

I

r •

“ •

I R

ecom

men

ded

daily

int

akes

of

cho

lest

erol

and

fat

N

UT

RIT

ION

F

AC

TS

Tot

al

fat:

les

s th

an

30%

of

the

to

tal

ener

gy

NU

TR

ITIO

N F

AC

TS

(of

a x

x ch

ocol

ate)

Sat

urat

ed

fat:

les

s th

an

10%

of

th

e to

tal

ener

gy

Serv

ing

Size

l

bar

Mo

no

- an

d P

oly

-un

satu

rate

d fa

t: e

ach

less

tha

n 10

%

of

the

tota

l en

ergy

Se

rvin

gs P

er C

onta

iner

1

Cho

lest

erol

: le

ss

than

30

0 m

g F

at c

omp

osit

ion

of c

om

mo

n oi

ls

Cal

orie

s 23

0

Poly

unsa

tura

ted

fat

Mon

ouns

atur

ated

fat

Sa

tura

ted

fat

Cal

orie

s fr

om fa

t 10

0 Pe

rcen

tage

Dai

ly V

alue

s*

Pla

nt

oil

Pea

nut

32

%

46

%

17%

T

otal

Fat

12

g 18

%

C°

rn

59%

24

%

13%

Sa

tura

tedf

at

7g

36%

C

an

ol

a 2

9%

59

%

7%

Cho

lest

erol

IO

mg

3%

Oli

ve

9%

74%

14

%

Sodi

um

65m

g 3%

An

ima l

oi

l L

ard

12%

45

%

39

%

Tot

al C

arbo

hydr

ate

29g

10%

Mar

gari

ne

33

%

37

%

18%

D

ieta

ry F

iber

<

lg

3%

丨 B

utt

er

4%

3

0%

6

5%

S

ug

ars

2

4g

Pe

rc

en

t e

ne

rg

y

fr

om

fa

t/s

atu

ra

te

d

fa

t a

nd

c

ho

les

te

ro

l in

s

om

e c

om

mo

n

Pr

ot

ei

n

^S

re

sta

ur

an

t a

nd

h

om

e p

re

pa

re

d

fo

od

it

em

s V

ita

min

A

0%

Fo

od

it

em

P

ercen

t e

ne

rg

y

Percen

t en

erg

y fr

om

C

ho

lest

ero

l V

ita

min

C

0%

fro

m f

at

(%)

satu

ra

ted

fa

t (%

) (m

^)

Ca

lciu

m

6%

Fil

et-

O-f

isli

bu

rge

r 41

8 19

,5

50

il2I

} ^

Fren

ch f

ries

47

^

j() 2

0

+ Per

cent

age

Dai

ly V

alue

s ar

e ba

sed

on a

2,0

00 c

alor

ie.

Ha

mb

urg

er

31.8

IT

6 37

t>

0

0 u

lnn

Ref

eren

ces ：

1)

EN

Wli

itn

ey

& S

R R

olfe

s.

Und

ersta

ndin

g Nu

tritio

n.

1993

B

ig M

ac

46.H

/q

.q

川U

• •

c<

2) A

B N

nlow

& J

Hes

liu.

The

Fast-

Food

Nu

tritio

n Co

unte

r. 19

94

Chi

cken

Mcn

ugge

ts (

six

piec

es)

5().(

) m

”

Pizz

a (o

ne p

iece

) 56

.6

19.2

？>2

Hot

dog

81

.3

54,9

21

Frie

d ri

ce (

one

stan

dard

bow

l) 3^

4 U

64

Fr

ied

curr

ied

rice

noo

dles

沾 3

11 9

3

90

Fri

ed

eg

g

68.2

I

O

213

g iB

oile

deR

R

61.9

18

.7

__

21

3_

_

Bf"

Wh

at i

s a

gene

? ^

^^

KM

^M

A

re G

M f

ood

harm

ful t

o he

alth

? _

A

gene

is

co

mpo

sed

of

DN

A.

Dif

fere

nt

DN

A

> A

ll th

e G

M

food

are

tes

ted

and

eval

uate

d by

j^

ffl

com

posi

tion

pr

oduc

es

diff

eren

t ge

nes

whi

ch

the

prod

ucti

on

com

pany

an

d th

e ex

port

dete

rmin

e so

me

plan

t, an

imal

an

d ou

r ow

n m

onit

orin

g or

gani

zati

on

The

Chi

nese

Uni

vers

ity

of H

ong

Kon

g

char

acte

rist

ics.

>

The

ev

alua

tion

is

ba

sed

on

'Sub

stan

tial

Equ

ival

ence

' (S

E)

prin

cipl

e

Prin

cipl

e of

gen

etic

ally

-mod

ifie

d (G

M)

food

>

SE m

eans

com

pari

ng t

he o

rigi

nal

and

GM

foo

d

Man

y D

NA

fra

gmen

ts a

re t

rans

ferr

ed t

o cr

ops

from

in

di

ffer

ent

aspe

cts

(tox

icity

, al

lerg

y an

d

anim

al o

r ba

cter

ia

nutr

ient

co

nten

t).

If

ther

e ar

e no

di

ffer

ence

s W

om

en's

Hea

lth

y E

atin

g an

d

Sele

ct a

des

ired

an

imal

's o

r ba

cter

ia's

gen

es

betw

een

them

, th

e G

M

food

w

ill

mee

t th

e P

hys

ical

Act

ivit

y P

rom

otio

n P

rogr

am

U

stan

dard

.

Rep

lica

te t

he g

enes

>

The

refo

re,

the

GM

foo

d in

the

mar

ket

are

not

H

less

saf

e th

an t

he o

rigi

nal

food

Tra

nsfe

r to

the

crop

W

hat k

inds

of f

ood

are

gene

tical

ly-m

odifi

ed?

Hea

lth

Tal

k (3

) R

emar

k: T

he g

ene

is n

ot e

xtra

cted

dir

ectl

y fr

om t

he

Soyb

eans

, co

rn,

cano

la s

eed,

tom

atos

, po

tato

s an

d

anim

als

or b

acte

ria/

plan

t an

d th

en t

rans

ferr

ed i

nto

pean

uts

etc.

Abo

ut

20%

of

the

pro

cess

ed

food

in

^a

t S

afe

r a

nd

Kn

OW

M

or

e a

bo

ut

Ihc

crop

s, b

ut i

nto

a pl

ant

that

pro

duce

s se

eds

for

Hon

g K

ong

cont

ains

G

M

ingr

edie

nts,

in

clud

ing

. .

the

crop

s.

Whe

n th

e cr

ops

obta

in

the

DN

A

inst

ant

nood

les,

co

rn-b

ased

sn

acks

, to

fu,

som

e G

en

eti

ca

lly

Mo

dif

ied

Fo

od

frag

men

t, th

ey

will

ac

quir

e ce

rtai

n ge

ne

soyb

ean

mil

k,

soyb

ean

milk

po

wde

r et

c. M

ost

of

char

acte

rist

ics

such

as

an

ti-p

est,

anti

-fer

tili

zer

or

the

GM

foo

ds a

re n

earl

y th

e sa

me

as t

he

orig

inal

anti

-dro

ught

. fo

od w

ith

resp

ect

to t

heir

app

eara

nce.

B

ioch

emic

al

met

hods

ar

e th

e on

ly w

ay t

o di

stin

guis

h be

twee

n

•y

we

need

GM

foo

d?

then

, ^

1.

Incr

ease

cro

p pr

oduc

tion

, re

liev

e gl

obal

foo

d L

abel

ing

syst

em

h I

一

sho

rtag

e p

rob

lem

. U

p

to

no

w,

the

Ho

ng

K

on

g

go

ve

rnm

en

t h

as

no

^

^^

^H

fl

ff

lj

^^

2.

En

ab

le c

rop

s to

gro

w in

un

fav

ora

ble

co

nd

itio

ns

reg

ula

tio

ns

on

G

M

foo

d

lab

eli

ng

, b

ut

the

J/T

q^

^^

bR

^

3.

Impr

ove

the

nutr

itio

n co

nten

t an

d qu

alit

y of

go

vern

men

t is

co

nsid

erin

g th

e fe

asib

ilit

y of

a

food

, e.g

. in

crea

se t

he p

rote

in c

onte

nt o

f ri

ce.

labe

ling

sys

tem

, an

d ag

rees

to

have

it

2-3

year

s.

to4.

E

nabl

e th

e cr

ops

to h

ave

anti

-pes

t ab

ility

in

Una

nsw

ered

que

stio

n: T

he l

ong-

term

eff

ects

of

^ or

der

to r

educ

e th

e us

e of

pes

tici

des.

G

M f

ood

on h

ealt

h, e

nvir

onm

ent

and

agri

cult

ure?

r f Ents

afe

r ha

wke

rs

Tem

pera

ture

ind

ex f

or f

ood

safe

ty

The

fol

low

ing

food

s ar

e ea

sily

con

tam

inat

ed b

y E

nvir

onm

ent

and

Hyg

iene

bact

eria

or

toxi

n. I

f w

e ha

ndle

the

m i

mpr

oper

ly,

we

> St

ore

food

in

clea

n pl

aces

IO

O0C

: B

oilin

g, b

acte

ria

died

may

get

foo

d-bo

rne

dise

ases

. V

K

eep

all k

itche

n ut

ensi

ls i

n cl

ean

plac

es

厂'

;A

..

.

) 74

°C:

Coo

king

tem

pera

ture

�

Hig

h-r

isk

fo

od

C

on

tam

ina

ted

b

y

| A

, .

.1

Je

Sf

ls

h

or

oth

er

si

r^

ss

r,

-c

: 一

师.—

—.:,::、

：:：

Lis

teri

a

mo

no

cyto

gen

es

l^

^p

/P

^^

^P

b

acte

ria

ca

n't

re

pro

du

ce

, b

ut

are

sti

ll

彳,

：..

2.

Cru

sta

ce

a H

ep

ati

tis

A v

iru

s, C

ho

lera

ali

ve.

''' •；•

‘'

:

vir

us,

P

ara

lyti

c sh

ell

fish

C

oo

kin

g

an

d

Ea

tin

g

' I

toxi

n *

I .

3 D

eep

bay

fish

C

igue

rato

xin

‘ >

Tho

roug

hly

was

h an

d co

ok v

eget

able

s to

4

to 6

3°C

: It

's ca

lled

the

'Dan

ger

Zon

e'.

I

4. B

arbe

cued

por

k or

Sa

lmon

ella

, av

oid

food

poi

soni

ng

Food

sho

uld

not

be k

ept

at t

his

_ 1

赫

roast

ed

p

ou

ltry

S

tap

hyl

oco

ccu

s a

ure

us

y D

efr

ost

froz

en f

ood

com

plet

ely

befo

re

tem

pera

ture

ran

ge.

5. O

ctop

us, j

elly

fish

Vi

brio

par

ahae

mol

ytic

us

cook

ing

6. S

alad

or

froz

en

Liste

ria

mon

ocyt

ogen

es

, ,

,, ,

^H

IH

da

iry

prod

ucts

T

horo

ughl

y co

ok t

he f

ood

until

the

mos

t in

ner

Bel

ow 4

°C:

Chi

lling

tem

pera

ture

. M

ost

of

^V

IH

7. V

eget

able

s Pe

stic

ides

pa

rt of

the

foo

d re

ache

s 74

°C

the

bact

eria

can

't re

prod

uce,

but

^

Rf

iS

V

Tho

roug

hly

reco

ok t

he f

ood

stor

ed o

vern

ight

ar

e st

ill a

live.

^

Blr

fl

Ho

w

to p

rev

ent

foo

d-t

ran

smit

ted

dise

ases

V

C

onsu

me

food

soo

n af

ter

cook

ing

or

^^

mm

Pers

onal

ke

ep t

hem

at

a sa

fe t

empe

ratu

re (

belo

w 4

°C i

n -1

8°C

: Fr

eezi

ng t

empe

ratu

re.

Onl

y so

me

of

V

Bef

ore

prep

arin

g fo

od a

nd h

avin

g m

eal,

afte

r re

frig

erat

or o

r ab

ove

63°C

in

war

min

g th

e ba

cter

ia a

re s

till

aliv

e,

toile

t an

d ha

ndlin

g ga

rbag

e, m

ust

clea

n ha

nds

mac

hine

)

with

soa

p an

d ho

t w

ater

. V

U

se t

wo

sets

of

chop

ping

boa

rds

and

clea

vers

- 4

to 6

3°C

is

calle

d th

e 'D

ange

r Z

one'

bec

ause

the

V

Avo

idin

g ha

ndlin

g fo

od i

f hav

ing

diar

rhea

, on

e fo

r ra

w f

ood

and

the

othe

r fo

r co

oked

ba

cter

ia r

epro

duce

qui

ckly

, so

the

foo

d sh

ould

be

vom

iting

or

gast

roin

test

inal

abn

orm

aliti

es.

food

. ke

pt a

t ot

her

safe

r te

mpe

ratu

res.

y C

over

ope

n w

ound

s w

ith p

last

er t

o av

oid

V

Han

dle

raw

and

coo

ked

food

sep

arat

ely

to

cont

amin

atin

g fo

od

prev

ent

cros

s co

ntam

inat

ion

V

Kee

p ra

w a

nd c

ooke

d fo

od s

epar

atel

y, w

ith

Foo(

i so

urcc

co

oked

foo

d ke

pt o

n th

e up

per

shel

ves

of t

he

y B

uy f

ood

from

lic

ense

d an

d re

puta

ble

shop

s re

frig

erat

or.

(O

、亡

V

Do

n't

b

uy

un

co

ve

red

fo

od

o

r fo

od

fro

m i

lleg

al

^ —

4)

Alm

ond

Swee

t Po

tato

Puf

f In

gred

ient

s QB

fc "

-*5¾

^!

Swee

t po

tato

56

0 g

(14

tael

s)

The

Chi

nese

Uni

vers

ity o

f H

ong

Kon

g

Smal

l ban

ana

1 W

omen

's H

ealt

hy E

atin

g an

d G

lutin

ous

rice

flou

r 1

tbsp

s Ph

ysic

al A

ctiv

ity

Prom

otio

n Pr

ogra

m

Alm

ond

slic

es

1.5

tbsp

s ,

Suga

r 1/

4 ts

p H

ealt

hy C

ooki

ng D

emon

stra

tion

1)

Mic

row

ave

Glu

tino

us R

ice

Met

hod

Ingr

edie

nts

1. T

hinl

y sl

ice

the

swee

t po

tato

and

ste

am u

ntil

soft

(app

roxi

mat

ely

20-2

5 G

lutin

ous

rice

1.5

cups

m

inut

es).

Dri

ed m

ushr

oom

s 40

g (

Itae

l) 2.

Mas

h th

e sw

eet

pota

to,

add

suga

r an

d st

ir un

til t

he s

ugar

dis

solv

es.

Mix

D

ried

sca

llops

40

g (1

tae

l) in

glu

tinou

s ric

e fl

our

to f

orm

a d

ough

. D

ried

shr

imps

20

g (

0.5

tael

)

3. D

ivid

e th

e do

ugh

into

12

port

ions

. C

hopp

ed s

prin

g on

ions

fe

w

4. D

ice

the

bana

na i

nto

12 p

iece

s to

for

m th

e fil

ling.

5.

Fla

tten

each

por

tion

of d

ough

int

o a

roun

d an

d fil

l with

a b

anan

a fil

ling.

M

etho

d D

raw

in

the

edge

s se

cure

ly t

o fo

rm in

to a

ova

l sh

ape.

B

nish

with

wat

er

1. W

ash

and

soak

the

glu

tinou

s ric

e in

col

d w

ater

for

tw

o ho

urs.

and

spre

ad i

t with

the

alm

ond

slic

es.

Bak

e in

a to

aste

r ov

en f

or

2.

Soak

the

mus

hroo

ms

until

sof

t. R

emov

e st

ems,

drai

n an

d di

ce.

Ret

ain

appr

oxim

atel

y .te

n m

inut

es.

the

wat

er f

or la

ter

use.

3.

W

ash

and

soak

the

drie

d sc

allo

ps u

ntil

soft

. Sh

red

the

scal

lops

. R

etai

n th

e w

ater

for

late

r us

e.

4. W

ash

and

soak

the

drie

d sh

rimps

, dr

ain

wel

l.

Ref

eren

ce:

5. P

ut t

he g

lutin

ous

rice,

drie

d m

ushr

oom

s, s

hred

ded

scal

lops

, an

d dr

ied

健康

心臟新事典

，許

綺賢’皇冠出版社(香

港)有

限公

司，

1999

° sh

rim

ps i

nto

a m

icro

wav

e-us

e co

ntai

ner.

Pour

the

ret

aine

d w

ater

to

the

rice

leve

l. C

ook

in a

mic

row

ave

over

hig

h he

at f

or f

ive

min

utes

, ta

ke o

ut

and

stir

wel

l. 6.

C

ontin

ue t

o co

ok f

or f

our

min

utes

, tak

e ou

t an

d st

ir w

ell.

7. R

epea

t st

ep 6

tw

ice

for t

hree

min

utes

. St

ir in

the

chop

ped

sprin

g on

ions

ro

»o

r —

and

keep

cov

ered

for

a w

hile

. Re

ady

to s

erve

. 3)

Fi

sh C

ake

wit

h L

emon

Gra

ss

Ingr

edie

nts

2)

Chi

cken

Rol

ls

Mud

car

p fil

let

160

g (4

tael

s)

Ingr

edie

nts

Cho

pped

lem

on g

rass

2

tsps

Chi

cken

bre

ast

(fle

sh o

nly)

16

0 g

(4 t

aels

) C

hopp

ed w

ater

che

stnu

ts

2 ts

ps

Egg

whi

te

1 ite

m

Shre

dded

let

tuce

op

tiona

l

Skim

milk

3

tbsp

s Sp

ring

oni

on(c

hopp

ed)

1 st

alk

Cho

pped

red

bel

l pe

pper

1

tbsp

O

il 2

tsps

Cho

pped

gre

en p

eppe

r 1

tbsp

Seas

onin

g fo

r fis

h Se

ason

ing

for

chic

ken

Salt

1/4

tsp

Salt

1/4

tsp

Suga

r 1/

4 ts

p

Pepp

er

dash

C

ornf

lour

1.

5 ts

ps

Wat

er

1 ts

p

Met

hod

Pepp

er

Das

h

1. F

inel

y m

ince

d th

e ch

icke

n br

east

(m

ay u

se a

foo

d pr

oces

sor

or m

eat

Sesa

me

oil

Das

h

chop

per)

, m

ix w

ith a

n eg

g w

hite

to

form

a p

aste

.

2.

Gra

dual

ly s

tir i

n th

e sk

im m

ilk.

Add

the

cho

pped

pep

pers

and

sea

soni

ng,

Met

hod

mix

wel

l. 1.

Cut

the

fill

et i

nto

slic

es.

Add

sal

t an

d m

ince

the

fill

et w

ith a

cho

pper

3.

Rol

l th

e ch

icke

n pa

ste

with

foi

l and

tig

hten

bot

h en

ds.

Plac

e in

to t

he

knife

. Tr

ansf

er t

o a

mix

ing

bow

l, ad

d th

e se

ason

ing

and

stir

until

a s

ticky

refr

iger

ator

to

shap

e fo

r ab

out

30 m

inut

es.

past

e is

form

ed.

4 B

oil

four

cup

s of

wat

er i

n a

sauc

epan

. Pu

t in

the

chic

ken

rolls

and

cov

er

2. P

our

in th

e ch

oppe

d w

ater

che

stnu

ts,

lem

on g

rass

and

spr

ing

onio

n, m

ix

to c

ook

until

the

wat

er b

oils

aga

in.

Turn

off

the

heat

and

allo

w t

he

wel

l. D

ivid

e in

to e

ight

equ

al p

ortio

ns.

chic

ken

to s

oak

for

five

to s

even

min

utes

or

until

coo

ked.

Ta

ke o

ut t

o 3.

Hea

t a

non-

stic

k fr

ying

pan

and

add

the

oil.

Sh

ape

the

fish

past

e in

to

cool

and

cut

int

o 12

slic

es.

smal

l ro

unds

and

sha

llow

fry

ove

r m

ediu

m-l

ow h

eat

until

bot

h si

des

are

light

gol

den.

A

rran

ge o

n a

serv

ing

plat

e ac

com

pani

ed b

y sh

redd

ed

lettu

ce.

Serv

e ho

t.

W

J

UJ

f Ta

rget

hear

trate

durin

g Ba

lanc

ed d

iet+

^^

Ph

ysic

al a

ctiv

ity

Reg

ular

phy

sica

l ac

tivity

W

k G

ener

ally

spe

akin

g, t

he t

arge

t he

art

rate

is:

I

Low

est:

(220

-age

) x

60%

High

est ：

(220-

age)

x 90

%

The

bes

t an

d th

e m

ost

effe

ctiv

e T

he

Chi

nese

Uni

vers

ity

ofH

on

g K

ong

Exam

ple ：

40

yea

rs o

ld

wa

Y

to m

ain

tain

an

d a

chie

ve

Ta

rg

et

he

ar

t r

ate 二

Y

^f

i d

es

ira

ble

w

eig

ht

Wo

men

's H

ea

lth

y E

ati

ng a

nd

*

' Ph

ysic

al A

ctiv

ity P

rom

otio

n Pr

ogra

m

Bod

y M

ass

Inde

x (B

MI)

M

etho

d: w

eigh

t (k

g) +

hei

ght2 (

m)

r f

J. R.

P. P

angr

azi.

The

Phys

ical

Act

ivity

Py

ram

id

Top

Clin

H

ea

lt

h T

al

k (

5)

Per

cent

bod

y fa

t N"

tr “卯；“⑶：休从

J

, 2.

AC

SM

's G

uid

eli

nes

for E

xerc

ise

Test

ing

and

Pres

crip

tion

Tm

Tn

n t*

�

t

a D

esi

rab

le r

an

ge

for

wo

men

: 2

0-2

7%

5'"

ed

rl

1 I

OT

Si

JN C

W

Ce

il

tl

ir

y 3.

R.G

ingo

ld, S

ucce

ssfu

l Ag

eing

, 2nd

ed,

Oxf

ord

Uni

vers

ily

Des

irab

le p

hysi

cal

heal

th

Pres

s �9

99

p

l 9

inclu

des

three

eq

ua

lly

im

po

rta

nt

ele

men

ts:

Th

e P

hy

sic

al

Ac

tiv

ity

P

yr

am

id

Ele

men

ts

Ho

w to

ach

iev

e

1)

Co

nti

nu

ou

s p

hy

sical

acti

vit

ies

/lii

ifi^

V^

lph

ysic

al

ac

tiv

ity

Ca

rdio

resp

ira

tory

su

ch

as

fast

walk

ing

, v

igo

rou

s M

usc

le b

uil

din

g

/ \\

/\\'

i D

o

le

ss

fl

tn

es

s e

xe

rcis

e Ph

ysic

al ,

acti

Yit

y/T

^t^e

tch

ing

phys

ical

act

ivit

y 2)

Mus

cle

stre

ngth

W

eigh

t tr

aini

ng,

Wal

king

and

2-

3 ti

i^sy

W^k

V

\ ^7

,'^^

s/w

eek

and

endu

ranc

e C

limbi

ng s

tair

s w

hile

car

ryin

g _C

> ^

丨‘卜卜

X

load

“

Ae

ro

b,

c P

hy

sic

al^

^t^

^

3)

Flex

ibili

ty

Stre

tchi

ng a

nd W

arm

-up

3-6

t

im

es

//e

^M

Iphysi

ca丨

acti

vit

ies

Lif

esty

le p

W^

J^l,

ficti

yH

yi!

),

^^

\

^^

/

d^

T

\

qT：

Il

' A

m

to

I

^ 一

一_^

B

enef

its

of

ph

ysic

al

act

ivit

y T

he

Ph

ysic

al

Act

ivit

y P

yram

id

Str

etch

ing p

hys

ical

act

ivit

y —

^ Ph

ysic

al

Exa

mpl

e: S

tret

chin

g, W

arm

up

1 . M

aint

ain

wei

ght

at h

ealth

ier

leve

l ex

erci

ses

2. B

urn

exce

ss f

at a

nd b

uild

mus

cles

A

lna

cti

ye, o

hv

sic

a|

ac

tiv

itv

Freq

uenc

y: 3

-7 t

imes

per

wee

k ^

^ 3.

Im

prov

e bo

dy c

ompo

siti

on a

nd b

ody

shap

e /

^^

ph

ys

ic

al

acti

vity

D

urat

ion:

1-3

set

s, e

ach

set

abou

t 10

-60

seco

nds

Mus

cle

build

ing

/•

• \

phys

i^lH

ctiv

itV

t

.jS

tXtc

^l^

^s

ica

l ac

tivi

ty

Mu

SC

,e

bu

il

di

nS

P^

sk

al

JK

gM

Ps

ycho

logi

cal

2-3

tiim/y

v My

^ \

timfe

s/w

eek

acti

vity

1.

Bui

ld u

p se

lf-c

onfi

denc

e /

- ~

Ex

am

pl

e:

Gym

exe

rcis

es,

^m

gf

ff

iW

2.

Fe

el

rela

xe

d

Ae

ro

bl

c

ph

y^

a

^c

tiV

ity

Du

mb b

ell

IH

V

3. R

educ

e st

ress

3

-6 t

i^g

gM

Mk

^ ^

Z.

\ Fr

eque

ncy:

2-3

tim

es p

er w

eek

Lif

esty

l e

i^qt

iyif

y \

Dur

atio

n: 1

-3 s

ets,

rep

eat

mot

ions

8-1

2 ti

mes

in

/ D

aily ,：

L

^p

) \

each

se

t

Ph

ysio

log

ica

l /_

A

…

.,：..

...-

.

1. R

educ

e ch

ance

of

gett

ing

dise

ases

suc

h as

bac

k In

acti

ve p

hys

ical

ac

tivi

ty

p7

' hy

pert

ensi

H°n；

d

iSe

aS

e,

Lif

est

yle

ph

ysi

ca

l a

cti

vit

y

Wat

chin

g T

V’

驪

2 二=

i�

n

，-

t—

•二

s，

Do

in

g

^

—

^m

m

3. I

mpr

ove

bloo

d ci

rcul

atio

n ^o

usew

ork

_ j

�‘

•

-. T

Fre

qu

en

cy

: D

ail

y o

r alm

ost

d

ail

y

I W

^

^^

sm

*^

==

==

=d

讓g

P—

l a

—

Du

lon

y3

0 ,L

es

or

abov

e 1

HO

W

to

en

co

ura

ge

6.

En

ha

nc

e j

oin

t m

ove

me

nt,

re

du

ce th

e ra

te o

f I

l m

ys

elf

to

do

mo

re

ph

ys

ic

al

ac

tiv

it

y?

dege

nera

tion

. ^

Ai

1. A

cc

om

Pa

nY

frie

nd

s

7 Im

prov

e bo

dy c

oord

inat

ion,

gra

cefu

lnes

s an

d •

\\

2. J

oin

som

e sp

orts

org

aniz

atio

ns s

uch

as b

owlin

g bo

dy f

lexi

bilit

y.

Aer

ob

ic p

hysi

cal

acti

vity

J

| cl

ub,

swim

min

g cl

ub.

Exa

mpl

es:

Jogg

ing,

Aer

obic

^

SS

U

3. C

hoos

e ph

ysic

al a

ctiv

ities

tha

t yo

u ar

e in

tere

sted

^

^^

danc

e, S

wim

min

g, R

ope

^ in

and

fit

your

dai

ly s

ched

ule.

sk

ippi

ng,

Bal

l ga

mes

4.

Alw

ays

rem

ind

your

self

: 'I

will

kee

p do

ing

^^

^^

^ Fr

eque

ncy:

3-6

tim

es p

er w

eek

phys

ical

act

ivity

.’ D

urat

ion:

20

min

utes

or

abov

e 5.

Set

up

shor

t-te

rm a

nd l

ong-

term

goa

ls.

j-A

6.

Rec

ord

your

pro

gres

s an

d pr

aise

you

rsel

f. ^

Xm

_

7. P

lan

ahea

d yo

ur t

ime

for

doin

g ph

ysic

al a

ctiv

ity

jf

lH

^^

KS

^j

y -

^ an

d st

ick

to

^jr

X

L ^/

F)

^ 8.

Inc

orpo

rate

phy

sica

l ac

tivity

int

o yo

ur d

aily

life

. T

^H

^^

^^

^N

^ I

p^

y V

/ 9.

Par

ticip

ate

in a

var

iety

of

phys

ical

act

iviti

es.

Ml

k '

。+

=，

一〜

to

LM

^ r • 八，

.

Wa

ys

to p

rev

en

t o

steo

po

ro

sis

Ost

eo

po

ro

sis

, T

J

..

,…

,

r >

Hav

e su

nici

ent

inta

ke o

r ca

lciu

m e

very

day

fu

SI^n

Bon

e de

nsity

are

dec

lines

wit

h ag

ing.

If

the

bone

>

Mod

erat

e re

gula

r w

eigh

t-be

arin

g ph

ysic

al

dens

ity d

eclin

es t

oo m

uch,

it w

ould

lea

d to

bon

e ac

tiviti

es

t^o

JSfe

t^

frac

ture

and

ost

eopo

rosi

s. T

he a

nnua

l lo

ss o

f bo

ne

V

Mod

erat

e su

n ex

posu

re (

help

s pr

oduc

ing

The

Chi

nese

Uni

vers

ity

of H

ong

Kon

g de

nsity

is

1% a

fter

the

age

of

35 y

ears

. vi

tam

in D

and

sto

ring

cal

cium

)

> A

void

sm

okin

g, e

xces

sive

cof

fee,

tea

and

sal

t W

omen

's h

ealt

hy

eati

ng

. in

take

s to

pre

vent

the

los

s of

cal

cium

an

d p

hys

ical

ac

tivi

ty

Ris

k fa

ctor

s fo

r os

teop

oros

is

„ r

,.

.. �

Rec

omm

ende

d da

ily i

ntak

e of

cal

cium

pr

omot

ion

prog

ram

In

heri

tanc

e W

omen

age

d 11

-24

year

s 12

00 m

g

Fem

ale

gend

er

Wom

en a

ged

25 y

ears

or

abov

e 80

0 m

g

Lack

of

phys

ical

act

ivity

Pr

egna

nt o

r la

ctat

ing

wom

en

1200

mg

Hea

lth

talk

(6)

H

orm

onal

eff

ects

Ag

ing

Cal

cium

con

tent

in s

ome

com

mon

foo

d ^

^ .,

.

Insu

ffic

ient

int

akes

of

calc

ium

, ph

osph

orus

and

it

tms

^^

Ca

lc

iu

m

cont

ent

I^II

OW

IV

lOre

A

bO

Ut

(m^)

v

ita

min

D

Skim

jniIk

Ic

up(2

40 n

il)

316

Pr

pv

pi

it

in

a H

igh

calc

ium

milk

1

cup

(24(

) ml)

370

JT I

C V

CH

I量

IIg

L

M>

e<

l�l

�

Whole

milk

1 c

up

(24

() m

l)

290

Wh

y

do

es

os

te

op

or

os

is

us

ua

lly

o

cc

ur

Con

den

sed

milk

1

tb

sp (

15

g)

42

“

o

S

oy

a m

ilk

1 c

up (240

ml)

10

am

on

g w

om

en

? H

Uh

calic

nm s

oya

nTilT

Icn

p (2

40 m

l) 40

H

—

r^

nf

Il Q

||

V

B

one

stru

ctur

e an

d bo

ne d

ensi

ty i

n w

omen

are

Lo

w fa

t yog

urt

1 cu

p (1

50 g

) 27

4 ]

^^

;•] 丨丨

a

Ched

dar

chee

se

lsli

ce

(2 丨

g)

132

^

¾¾

! sm

all

er

than

m

en

T

of

u

""

1 sli

ce (1

60 g

) 20

0 U

^

WR

V

Pr

egna

ncy

requ

ires

a l

arge

am

ount

of

calc

ium

So

y be

an

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Appendix O

意見調查一講座

1-今日講座主要教你做些甚麼？

2.今日講座値得記住的內容是甚麼？

3.你喜歡或感興趣的內容是甚麼？

4.你不喜歡或感沈悶的內容是甚麼？

5.今日講座的內容有沒有不淸楚的地方？如有，是甚麼？

6.你有沒有其他相關的資料想知道呢？如有，是甚麼？

你認爲講者的表現如何？

•⑴非常好口⑵好口(3)普通 •⑷差口(5)非常差

8.整體來說，你滿意今日的講座嗎？

•⑴非常滿意口⑵滿意 •⑶普通口⑷不滿意 • (5)非常不滿意

9.你認爲活動有何改善的地方？

10.參加完今日的活動後’你在行爲上將會作出甚麼改變？

多謝回答

L. !!!

意見調查-煮食示範

1.從今日示範你學到甚麼？

2.今日示範値得記住的內容是甚麼？

3.你喜歡或感興趣的內容是甚麼？

4.你不喜歡或感沈悶的內容是甚麼？

5.今日示範的內容有沒有不淸楚的地方？如有，是甚麼？

6-你有沒有其他相關的資料想知道呢？如有，是甚麼？

7.你認爲講者的表現如何？

•⑴非常好•⑵好口(3)普通口(4)差口(5)非常差

8.整體來說，你滿意今日的示範嗎？

•⑴非常滿意 •⑵滿意口⑶普通 [：⑷不滿意 • (5悱常不滿意

9-你認爲活動有何改善的地方？

10.參加完今日的活動後，你將會嘗試煮哪幾個餸？(可選多過1個）

• (1)微波爐糯米飯• 香滑雞卷 • (3)香茅魚餅 • (4)番薯香蕉杏仁棗

多謝回答

259

L

Appendix P

Process Evaluation for Health Talks

1. What did the message ask you to do?

2. Was there anything that was worth remembering about the message?

3. What did you particularly like about the message?

4. Was there anything that you disliked or bothered you? If yes, please specify.

5. Was there anything in the message that was confusing? If yes, please specify.

6. Is there any relevant information about which you want to learn more? If yes, please specify.

7. How do you rate the speaker's performance?

8.

• (I)Excellent • (2) Good • � Average • (4) Bad D ( S ) P o o r

8. Overall, are you satisfied with today's talk?

• (1) Very Satisfied • (2) Satisfied 口 (3) Average 口 (4) Unsatisfied

口 (5) Very unsatisfied

9. Can you suggest any improvements for the talk?

10. After you attended today's talk, what behavior changes will you make?

Thank You

260

^ ^

Process Evaluation for Cooking Demonstration

1. What did today's demonstration ask you to do?

2. Was there anything that was worth remembering about the demonstration?

3. What did you particularly like about the demonstration?

4. Was there anything that you disliked or bothered you? If yes, please specify.

5. Was there anything in the message that was confusing? If yes, please specify.

6. Do you have any relevant information about which you want to learn more? If yes, please specify.

7. How do you rate the speaker's performance?

• (I)Excellent • (2) Good • (3) Average • (4) Bad • (5) Poor

8. Overall, are you satisfied with today's demonstration?

• � Very Satisfied 口 (2) Satisfied 口 (3) Average 口 (4) Unsatisfied

I I (5) Very unsatisfied

9. Can you suggest any improvements for the demonstration?

10. After you attended today's demonstration, which of the following dishes will you try to prepare? (can choose more than one)

• (1) Microwave Glutinous Rice 口 (2) Chicken Rolls

• (3) Fish Cake with Lemon Grass 口 (4) Almond Sweet Potato Puff

Thank You

261

Appendix V 意見調查

多謝你參加我們的健康賺活動^請仔細Hl答以下幾條問題，以助提供寶貴意見予將來同類型的活動O

1.甚麼原因驅使你參加這次活動呢？（ )

2.你是否出席所有的講座呢？

•⑴是。爲甚麼？ ( )

• (O)不是。爲甚麼？ ( )

3 - 以下每項’請以 V ’號表達你的意見。非常非常（）

同意同意普通不同意不同意

a)星期六是舉辦一系列講座的佳時間 • • • • • ( )

b)學校禮堂是舉辦一系列講座的佳地方 • • • • • ( )

c)講座所用的投影片很淸楚(包括字體、顏色、光暗）• • • • • ( )

d)小冊子的設計很合適(包括字體、顏色） • • • • • ( )

e)小冊子的內容很有用 • • • • • ( )

f )講座的資料很有實用性 • • • • • ( )

g)講座的資料很容易明白 • • • • • ( )

4-你有否將所學到的知識告訴你家人、親戚或朋友呢？（）

•⑴有。是哪些資料？ ( )

• (0)沒有。爲甚麼？ _IIZZIZIIZIIIIZIIIIZZIIIZIIZ () 5.你在整個活動學到甚麼呢？（ )

6.若將來我們在其他婦女中心舉辦同類型的活動’你會推薦朋友參加嗎？

•⑴會。爲甚麼？ ( )

• (0)不會。爲甚麼？一 ( )

7.若我們再舉辦同類型的活動，你會建議有哪些地方需作出改善呢？（）

8-參加完整個活動後，你有否在飮食或運動的行爲上作出改變呢？（）

•⑴有。是哪些行爲呢？ ( )

• (0)沒有。爲甚麼？ ^ r 、 ~ ~ — V /

你的名字：中文英文

聯絡電話: 問卷完畢’多謝合作O

262

L

Appendix R Evaluation Questions Thanks for joining our health promotion program. Here are some questions aimed at obtaining your invaluable

^formation for future programs. Please answer all questions carefully.

1. What were your the reasons of joining our program?

2. Did you attend all the classes?

• Yes. Why?

• No. Why?

Please choose the most appropriate option for the following statements.

Strongly Agree Average Disagree Strongly

Agree disagree a) Saturday's afternoons are the best time for holding a series of talks. • • • • •

b) The School hall is the most suitable venue for holding a series of talks. • • • I • 口

c) The transparencies are easy to see (i.e Font size, Color, Brightness) • • • • 口

The design of pamphlets was appropriate (i.e Font size, Color, Brightness) • • • • • e) The contents of the pamphlets are useful. • • • • •

D All the information given in the talks are practical. • • • • •

& All the contents given in the talks are easy to understand

^ Have you passed any information you learnt to your family/ relatives or friends? • Yes. What kinds?

• No. Why?

• What kinds of new information did you learnt from our program?

If we are going to hold a similar program in other women's centres, would you recommend it to your friends? • Yes. Why?

• No. Why?

If we want to hold the program again, can you suggest any improvements for it?

" — -

Have you changed any behaviors after attending the program? 口 Yes. What kinds?

� N o . Why? _ _ _ _ H Z I Z I I Z Z I Z Z Z I Z Z Z Z Z ^ Z Z I Z Z ^ I

263

1

Appendix V Focus Group Questionnaire

請塡寫以下的個人資料’所有資料將全部保密，只作爲硏究分析之用。

1.你的教育程度是：

• 1.從未接受教育

• 2.小學

• 3.初中（中一至中三）

• 4.高中（中四至中七）

• 5.大專

• 6.大學或以上

2-你的職業是：

• 1.全職工作

• 2.兼職工作

• 3.家庭主婦

• 4.沒有工作

3.你的婚姻狀況是：

• 1.單身

• 2.已婚

• 3.離婚

• 4.喪偶

4.你的家庭成員(包括你在內)共有多少人？

人

5.你的家庭每月總收入大約是：

• 1. $5,000或以下

• 2. $5,001-10,000

• 3. $10,001-15,000

• 4. $15,001-20,000

• 5. $20,001-25,000

• 6. $25,001-30,000

• 7.$30，000 以上

6-你是屬於以下哪一個年齡組別呢？

• 1.25-¾ 歲 • 4. 40-44 歲

• 2. 30-34 歲 • 5. 45-49 歲

• 3. 35-39 歲 • 6. 50-54 歲

問卷完畢，多謝合作。

264

Appendix V Focus Group Questionnaire

Please fill in the following questions, all the information will be kept confidential and used only for research purposes.

1. What is the highest education level you attained?

I I 1. No formal schooling

] 2 . Primary

] 3 . Lower Secondary (Form 1-3)

] 4 . Higher Secondary (Form 4-7)

] 5 . Post Secondary

] 6 . University or above

2. What is your employment status?

• 1. Full-time

] 2 . Part-time

] 3 . Housewife

] 4 . No work

3. What is your marital status?

• 1. Single

• 2. Married

• 3. Divorced

• 4. Widowed

4. How many household members(including yourself) do you have? people

5. Which of the following ranges represent your total monthly household income?

• I - $5,000 or less • 5. $20,001-25,000

• 2. $5,001-10,000 • 6. $25,001-30,000

• 3. $10,001-15,000 • 7. More than $30,000 • 4. $15,001-20,000

6. To which of the following age ranges do you belong?

• 1.25-29 ages

• 2. 30-34 ages

• 3. 35-39 ages

• 4. 40-44 ages

• 5. 45-49 ages

• 6- 5 0 " 5 4 ages End of Questionnaire. Thank You!

265

Appendix V

Focus Group Questionnaire Guides

早晨/午安，多謝你們的來臨°首先讓我自我介紹’我叫鮑敬文，是香港中文大

學的碩士硏究生。我現正進行一項有關香港婦女健康的硏究，而今天的小組討論

就是爲了知道一些有關健康的資料O你們的任何意見，想法或建議’對於我都是

非常重要和寶貴。以下將討論的話題是沒有對或錯的答案’請各位暢所欲言，與

其他組員分享你的見解°所有討論的內容是絕對保密’只是用作學術硏究。請問

你們有沒有任何問題？如果沒有的話’我們現在便開始。首先請輪流介紹自己’

使我們知道如何稱呼你。

1.當你想起‘健康’這兩字，你會想起甚麼呢？

2.以上提及的各方面，對你來說哪一樣是重要呢？爲什麼？

3.你會怎樣形容自己的健康呢？

4.你認爲自己可以改善健康嗎？甚麼方法？

5.當你想起‘健康生活’ ’你會想起甚麼呢？

6.你從何得知有關‘健康生活’的資料呢？

7.你認爲自己現已擁有‘健康生活’嗎？如何體現呢？

8.爲什麼你會/不會擁有‘健康生活’呢？

9.當你想起‘健康飮食’ ’你會想起甚麼呢？

10.你從何得知有關‘健康飮食’的資料呢？

11 .你認爲自己現已擁有‘健康飮食’嗎？如何體現呢？

12.爲什麼你會/不會擁有‘健康飮食’呢？

13•有些人說要在日常生活中做到‘健康飮食’是一件容易的事，但有些人卻不

認同。那麼你的看法是如何呢？

14•當你想起‘運動，，你會想起甚麼呢？

15.你從何得知有關‘運動’的資料呢？

16.你有做運動嗎？哪類運動呢？

17.爲什麼你會/不會做運動呢？

18.有些人說要在日常生活中做到‘適量運動，是一件容易的事，但有fe人卻不

認同。那麼你的看法是如何呢？

19.你曾經或現在有否在飮食上或運動上作任何改變呢？是甚麼改善呢？現在是

否仍然作此改善呢？ 20.爲什麼你會/不會作改善呢？

21 •你希望知道一些有關健康飲食的資料嗎？如有，是甚麼呢？

22.你希望知道一些有關運動的資料嗎？如有，是甚麼呢？

23.如果有一項健康飮食和運動的推廣計劃將舉行’你希望當中有甚麼活動呢？

266

24.在你們提議的活動中’你對哪一項有興趣呢？如果此項活動包含在該項推

廣計劃中，你有興趣參加嗎？

25.在討論結束前’你有沒有任何意見，睇法或問題需要補充呢？

若沒有的話’這次小組討論便到此結束’再一次多謝你們的來臨和熱烈的討論。

267

Appendix V Focus Group Questionnaire Guides

Good morning/afternoon. Thanks for coming, let me first introduce myself. My

name is Pau King Man, I'm an M.Phil, student from The Chinese University of Hong

Kong. I'm now conducting a survey about the health of Hong Kong women.

Today we will be discussing some issues about health. I'm interested in all your

comments and ideas. There are no right or wrong answers, so please feel free to

share with each other. All information will be kept confidential and only used for

research purposes. Do you have any questions? If no, we can start by introducing

yourselves. Please tell the others how you would like to be called.

1. When you think of 'Health', what comes to your mind?

2. For all mentioned aspects of 'Health', which one is the most important to you? Why?

3. How would you rate your health?

4. Can you do anything to improve your health? How?

5. When you think of 'Healthy Lifestyle', what comes to your mind?

6. How did you know something about 'Healthy Lifestyle'?

7. Do you think you have a 'Healthy Lifestyle'? In what way?

8. Why do/don't you have a 'Healthy Lifestyle'?

9. What does the word 'Healthy Eating' means to you?

10. By what means do you know something about 'Healthy Eating'?

11. Do you think you have a 'Healthy Eating, habit? In what way?

12. Why do/don't you have a 'Healthy Eating' habit?

13. Some people said it is easy to incorporate healthy eating in daily life while others said not, what is your opinion?

14. What does the word 'Physical Activity' means to you?

15. By what means do you know something about physical activity?

16. Do you do physical activity? What type(s)?

17. Why do/don't you do physical activity?

18. Some people said it is easy to incorporate physical activity in daily life while others said not, what is your opinion?

19. Have you ever made any changes in your diet and physical activity habits? What changes? Do you still do it?

20. Why do/don't you have changes? 2 1 . Would you like to learn something about healthy eating? If yes, what topics

would you like to know about?

268

22. Would you like to learn something about physical activity? If yes, what would you like to know about?

23. If a health promotion program about healthy eating and physical activity is

proposed, which activities do you recommend?

24. For those suggested activities, which one is the most interesting to you? If it is

included in the health promotion program, will you participate in the program?

25. Before we finish, do you have anything want to add?

That' s the end of the discussion, thank you for coming and discussing so

enthusiastically!

269

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5

to

UJ

CUHK L i b r a r i e s

圓圓 _ _ 0Q3TSS704

Effectiveness of a Pilot Healthy Eating and Lifestyle Promotion ...

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