Abstract
BACKGROUND/OBJECTIVES: Adolescence is an important period for developing the knowledge and skills for healthy eating. Past studies have found that declarative knowledge of food and nutrition alone is not sufficient to improve healthy behavior, but how adolescents make connections from factual knowledge to skill and behavior is less clear. Based on cognitive development theories, a new concept, "awareness as connection", was devised, and a questionnaire addressing the connection between food, nutrition, diabetes, and behavior was developed to assess the awareness of adolescents. METHODS: A lesson designed to connect food, nutrition, and local lifestyle was piloted with a group of 146 students aged 13-17 years in northern Taiwan. RESULTS: The pre- and posttest results found that students improved regarding their awareness of the association between food, nutrition, diabetes, and lifestyles (p < 0.01). The exploratory factor analysis results revealed one factor for the pre-test but two factors for the posttest, indicating growth in the students' knowledge structure. Most of the students demonstrated significant progress in the posttest, especially on the knowledge application subscale. The results reveal that students in lower grades started low and ended low but achieved greater gains than high schoolers. High-school students had better nutritional knowledge, but junior-high-school students made substantial progress on the application of this knowledge, indicating an improvement for cognitive complexity. Students with overweight started out low and achieved fewer and uneven gains than students without overweight but scored high on particular items. Gender did not have significant impact on the overall learning, but girls showed more gains in factual knowledge. CONCLUSIONS: These results suggest that awareness can be a mid-step to help link knowledge to behavior, and for some, this step may take more time.