N14003: The development of interventions to improve the diet of girls and young women from populations at risk of low birthweight

Study Duration: September 2003 to March 2005

Contractor: University of Surrey

Anecdotal evidence suggests that the likelihood of having a low birth weight baby is substantially greater for mothers in specific ethnic groups and confounded by low income compared with those in higher socio-economic groupings and of white ethnicity.

The limited published evidence of the use of peer-led educators in promoting healthy eating indicates that it can be effective, particularly with hard-to-reach groups, such as adults on low incomes, ethnic minority communities and young women from areas at high risk of producing low birth weight babies.

This project will address the physiological and psychological basis on which young women make food choices. It will target young women from low income and minority ethnic communities at risk of low birth weight.

This project aims to:

• investigate factors which may inhibit dietary choices in girls and young women
• pilot cost-effective interventions using a holistic and culturally appropriate, sustainable approach
• provide both qualitative and quantitative information on the effectiveness of engaging community participation

The project builds on existing knowledge gained from the cook and eat project 'CookWell' (Agency project N09011). A community development approach will be used to tailor these tools to the specific needs of each group.

Interventions and evaluations will be piloted with the aim of improving diet and general nutrition of women from three different minority ethnic communities and a low income group. The women's knowledge, beliefs and attitudes towards food choices will be assessed pre- and post-intervention.

An assessment of the cost effectiveness and sustainability of this holistic and culturally appropriate approach will be made available.

The overall aim of the project was to develop, implement and evaluate, transferable community-based interventions to improve the diet of girls and young women from populations at risk of low birth weight.

Initial focus groups suggested that a cooking intervention would be welcomed by many of the girls and young women interviewed.

Of the 41 subjects initially recruited, 41 (24 intervention and 17 controls) completed the T1 (baseline) assessments. At T2 (immediately post-intervention) a total of 36 (20 intervention and 16 controls) completed some or all of the assessments.

The quantitative results were difficult to interpret due to small numbers. However, the results of dietary evaluations suggest an increase in fruit, vegetable and fibre consumption in two of the ethnic groups. The feasibility of carrying out food intake and behavioural measurements in these groups of women was established and tools piloted. Further work needs to be done to continue the investigation of foods consumed within ethnic groups and to develop nutritional composition tables that reflect the diversity of food intake within this group.

Over 50% of the respondents reported spending between £10 and £20 per person on food and drink, not including alcohol, per week. This was consistent between T1 and T2 and between the intervention group and the control group, although some variation was seen between the different communities.

Qualitative results showed that the respondents had learned new skills from the course, or at least had existing skills they had learned at school in Home Economics reinforced. The Caucasian girls in Dundee mentioned preparing and cooking a variety of new dishes, including: carrot cake, spaghetti bolognese, stovies, tuna pasta bake and biryani. They also indicated learning how to prepare fresh vegetables.

The average cost of implementing the seven-week CookWell course was £160 per person.
Information from this research was used to produce a second edition of the CookWell Tutor's Manual. It contains revised versions of the original cooking sessions plus additional recipes and sessions developed by the Universities of Dundee and Surrey for FSA research project N14003. This project looked at how CookWell could be adapted for use by different ethnic and age groups (British, Pakistani, Bangladeshi, Somali and Zimbabwean women and young girls. The new sessions included in the second edition allow for substitution due to cultural practices or taste preferences or for the course to be lengthened to more than seven sessions.

Barton KL, Wrieden WL, Devlin E, MacAskill S, Lawrence JM, Raats M. (2005) The impact of 'CookWell' on assisting dietary change in Asian young women at risk of having low birth-weight babies: qualitative findings. Proceedings of the Nutrition Society, 64: OCA/B, 27A. Poster based on this abstract presented at the Scottish Section of the Nutrition Society meeting in Dundee in March 2005.

The development of 'CookWell II' a cooking intervention for use with ethnic minority communities at risk of having low birth-weight babies: qualitative findings. By J.M. Lawrence¹, M. Kelly¹, M. Chinouya¹, M. Raats¹, K, E. Devlin², S. MacaskillL², K.L. Barton³, W.L. Wrieden^{3 1}University of Surrey, GU2 7XH, ²University of Stirling, FK9 4LA, ³University of Dundee, DD1 9SY.

Abstract for presentation at the 6th National Nutrition & Health Conference in November 2005.
Related abstract published in Nutrition & Health 6 Ed.Tanya Carr and Koen Descheemaeker.

Article for publication in Journal of Human Nutrition and Dietetics; further details to be added on publication.

Article published in 'The African Drum' Magazine, July 2005

The final report is available from the Agency's Information Centre.
To obtain a copy, please contact the Enquiry Desk, Information Services, Food Standards Agency (tel: 020 7276 8181/8182 or email: infocentre@foodstandards.gsi.gov.uk)

• Lawrence, JM., Devlin, E., Macaskill, S., Kelly, M., Chinouya, M., Raats, MM., Barton, KL., Wrieden, WL., Shepherd, R. (2007) Factors that affect the food choices made by girls and young women, from minority ethnic groups, living in the UK Journal of Human Nutrition and Dietetics 20 (4), 311-319.

Contact: For any enquiries concerning this research project, please contact the relevant Programme contact or email: science@foodstandards.gsi.gov.uk