사회인지론과 행동변화단계 모델을 적용한 소비자 대상 나트륨 섭취 줄이기 영양교육 프로그램 개발 및 교육효과 평가 :Development and evaluation of nutrition education program to reduce sodium intake for consumers based on social cognitive theory and stage of behavior change model

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자료유형: 학위논문

저자정보: 안소현 (가톨릭대학교, 가톨릭대학교 대학원)

지도교수: 김혜경

발행연도: 2013

저작권: 가톨릭대학교 논문은 저작권에 의해 보호받습니다.

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이 논문의 연구 히스토리 (4)

2022

주부대상 나트륨 섭취 줄이기 영양교육 프로그램 개발 및 효과 평가: 사회인지론과 행동변화단계모델 적용

안소현 , 권종숙 , 김경민 외 1명 Journal of Nutrition and Health 2022.02 학술저널

2015

사회인지론에 근거한 나트륨 섭취 줄이기 소비자 영양교육 프로그램의 효과 평가

안소현 , 권종숙 , 김경민 외 2명 대한지역사회영양학회지 2015.12 학술저널

2014

사회인지론 모델을 적용한 나트륨 섭취 줄이기 소비자 영양교육 프로그램 개발 : 포커스그룹 인터뷰에 기초하여

안소현 , 김혜경 , 김경민 외 2명 대한지역사회영양학회지 2014.08 학술저널

2013

사회인지론과 행동변화단계 모델을 적용한 소비자 대상 나트륨 섭취 줄이기 영양교육 프로그램 개발 및 교육효과 평가

안소현 식품영양학과 영양학 전공 2013.01 학위논문

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본 연구는 포커스그룹 인터뷰에 근거하여 사회인지론을 적용한 소비자 대상 나트륨 섭취 줄이기 영양교육 프로그램, 교육 자료 및 평가도구를 개발하고 그 교육 효과를 평가하는 한편, 우리나라 소비자들의 나트륨 섭취 줄이기 실천에 대한 행동단계의 실태를 파악하여 향후 교육자료 개발을 위한 기초자료 제공을 목적으로 하였다.

연구1. 나트륨 섭취 줄이기 영양교육 프로그램 개발
사회인지론은 환경적 요인과 인지적 요인, 행동적 요인의 끊임없는 상호작용이 개인의 행동변화에 영향을 미친다는 이론으로, 사회인지론을 모델로 한 영양교육 프로그램 개발을 위해 소비자단체회원 30명을 대상으로 2회에 걸쳐 포커스그룹 인터뷰(FGI)를 실시한 후 이를 토대로 영양교육 프로그램 및 교육자료를 개발하였다. FGI에서는 교육요구도 및 나트륨 관련 인지적?환경적?행동적 요인 조사를 실시하였는데 인지적 요인 조사 결과 준비과정, 요리법의 제한, 맛 등이 ‘부정적 결과 기대’로 언급되었고 가족의 질병, 주변의 권유 등은 ‘자아효능감’을 높이는 요인으로, 주변의 낮은 호응, 직장 회식, 입맛의 둔화, 식습관 변화의 어려움 등은 나트륨 섭취 줄이기에 대한 자아효능감을 낮추는 요인으로 작용하였다. 환경적 요인 조사 결과 주로 매스컴을 통해 저나트륨식에 대해 인지하는 경우가 많았고, 영양정책, 사회적 지원, 영양표시 등에 대한 인식은 다소 낮았다. 요구도 조사에서 행동수행력 향상을 위한 구체적인 정보, 실질적인 조리법, 자기관리 요령 등의 교육을 희망하였다.
FGI에서 도출된 내용을 바탕으로 주부, 학부모, 직장인 대상 나트륨 섭취 줄이기 일회 영양교육 프로그램을 개발하고 이에 대한 평가 및 검증을 실시하였다. 공통적으로 도입부에서는 긍정적인 결과기대와 결과가치 상승, 중반부에서는 행동수행력 향상 및 사회적 지원, 주변 인식, 모델링에 초점을 두고 후반부에서는 자아효능감 상승과 자기조절에 초점을 두었다. 행동수행력 향상을 위해 영양지식과 기술적 측면에서 식품 구매, 조리, 식사, 외식의 단계로 구분하여 교육 프로그램을 구상하여 주부용은 식품 구매와 조리에, 학부모용은 아이들의 먹거리와 관련한 조리와 식사에, 직장인용은 영양표시 활용 및 외식에 초점을 맞추어 내용을 구성하였다.
실제 조리를 담당하고 가정내 구매력과 영향력을 가진 주부를 대상으로 행동변화단게별 실천용이도 특성을 고려한 나트륨 섭취 줄이기 심화 교육 프로그램을 개발하였다. 나트륨 섭취를 줄이기 위한 식생활 지침의 기본 원리 및 실제 조리에서의 요령, 천연조미료와 저나트륨 건강식사의 소개 및 상차림 방법 등으로 행동수행력을 높이고자 하였으며 행동단계나 유지단계 대상자를 위한 모니터링, 행동조절 요령 등에 대한 부분을 포함하였다.
개발된 영양교육 프로그램 및 자료는 교육 대상자 집단, 교육자 집단, 영양학 및 교육학, 소비자학 전공 교수로 구성된 전문가 집단의 평가와 검증을 거쳐 이해도를 높이고 내용의 통일성, 사회인지론과의 연결성을 높이는 방향으로 수정 보완하였다.

연구2. 영양교육 프로그램 평가도구 개발
연구 2에서는 사회인지론의 개념을 바탕으로 교육평가를 위한 설문지를 개발하여 검증을 실시하였다. 평가항목으로는 행동변화단계 평가 문항, 인지적 요인(자아효능감, 인식, 긍정적 결과기대와 부정적 실천 장애요인)과 환경적 요인(주변환경에 대한 인식 및 구매 특성), 행동적 요인(나트륨 섭취를 높이는 식행동, 나트륨 섭취를 낮추기 위한 영양지식, DFQ 15) 및 교육 프로그램에 대한 만족도 평가를 포함하였다. 개발된 평가도구는 교육대상자 집단, 교육자 집단, 전문가 집단의 사전검증을 거친 후 내적 일관성 분석을 통해 신뢰도 검증을 실시하였다. 개발된 평가도구를 실시하는데 걸린 시간은 사전설문지 5~10분, 사후 설문지가 3~6분 정도였고, 내적 일관성 분석 결과 Cronbach ?는 0.72~0.78로 일치도가 높은 편으로 분석되어 평가도구로써 신뢰할만한 것으로 판단되었다.

연구3. 영양교육 실시와 효과 평가
영양교육 프로그램의 효율적인 수행을 위해 전문강사(30명)와 미각판정 요원(120명)을 대상으로 사전교육을 실시한 후 한국소비자단체협의회의 지역 네트워크를 통해 총 121회의 나트륨 섭취 줄이기 영양교육 프로그램을 실시하였다(주부교육(SH) 95회, 학부모교육(P) 11회, 직장인교육(O) 15회, 주부 대상 심화교육 15회). 교육 과정 중 총 8회 현장 모니터링을 실시하였고, 이를 반영하여 진행 절차를 개선하였다.
본 연구의 교육 대상자는 4,652명이었고, 이중 4,525명을 분석에 활용하였다(SH 3,256, P=646, O=623). 전체 대상자들의 행동변화단계 분포는 유지단계(M)가 29.5%, 행동단계(A)가 19.6%, 행동전단계(P)가 50.9%였다. 교육대상자들의 초기 평가 결과 식습관 조사에서 O의 외식빈도가 높았고, P는 나트륨 섭취 줄이기 관련 교육, 캠페인 등 정부, 학교, 소비자단체, 대중매체의 노력에 대해 인식하고 있는 비율이 더 높았으며(73.9%) 가공식품의 영양표시에 대해 인식하고 있는 비율도 더 높았다(23.4%). 저나트륨 식품 구매 경험도 대체로 P가

ABSTRACT

This study was performed to develop nutritional education program(NEP) for reducing sodium intake based on Social Cognitive theory(SCT) and evaluate the effect of the program after nationwide consumer education. Also, another purpose of this study was to investigate consumer status of Stage of Change(SOC) for sodium reduction in Korea and to provide a basis for the further study.

Chapter 1. The development of nutritional education program to reduce sodium intake for consumers
SCT was selected as a education model because of the recent increase of surrounding environmental effect with increasing eating-out or catering, working couples. Focus group interview(FGI) based on SCT was conducted twice with 30 members of Consumer Organizations to investigate their perceptions, experience of education, the level of knowledge and ability to practice, and environmental awareness related to reducing sodium intake as a preliminary research. The barriers to reducing sodium intake were inconvenient cooking, bad taste, low affinity and difficulty to change habits. Frequent eating-out and low adherence of family were related to low efficacy. They were much influenced by TV or media and hoped the education program to increase practical skills for reducing sodium intake with detailed information, recipe and self-control tips.
We developed one-time NEP mainly targeted to the Senior Housewives(SH), the Parents(P), and the Office workers(O), considering their ripple effect and great influence on other people and surroundings. Nutrition education materials were Power Point(ppt) materials for instruction, Manuals for educators, pamphlet, booklet, family letters from school, leaflets and posters. The contents of materials were individualized to each targeting group, reflecting the awareness, perceptions of each group and the needs of education through the FGI. Common themes were ''Salt intake and health'' to raise positive outcome expectation as a introduction part, and ''Dietary guidelines to reduce sodium intake'' to help self-regulation as a last part. In the middle part, contents were selected to raise cognitive and environmental factors related to detailed ability to practice. We heavily focused on ''cooking'' and ''food purchasing'' in education for SH, while we emphasized on ''purchasing or selection of low-sodium food with children'', ''Sodium content of eating-out food and snacks'' and ''recipes of low-sodium snacks'' for P. Also we highlighted ''how to choose the low-sodium foods when eating out'' with suggesting sodium content of each dish, and ''how to read nutrition labeling'' to make wise choices. Activity-sheets with pamphlet, and booklet with low-sodium recipes were developed to motivate participants and Manuals for educators were developed to suggest more detailed description of educational contents.
Also, we developed intensive NEP for SH who were caretaker in home cooking with buying power based on SCT and pilot study of practicability of methods for reducing sodium intake. In intensive NEP, we heavily focused on ‘practical skill’ to cooking with purchasing and preparing tips, such as comparison the meal sample of general diet vs low-sodium healthy diet, to increase their behavioral capability and included the contents of self-control and monitoring methods. This nutrition education program and materials would be available to utilize for community education and provide basis for further targeted education program to reduce sodium intake.

Chapter 2. The development of evaluation tool for NEP
This study was performed to develop and verify the evaluation tool based on SCT. They were included cognitive factors(positive outcome expectation, negative barriers, perceptions and self-efficacy), environmental factors(perception for surroundings and characteristics of purchasing), behavioral factors(dietary behavior and knowledge related to sodium intake, DFQ 15) and satisfaction survey on programs as assessment items. To verify the evaluation tools, we performed the evaluation with 3 groups; subjects, educators, and professional group. The comments raised on the goup session were adopted. Cronbach ? from internal concordance analysis was 0.72~0.78, so it was considered as a reliable assessment tool.

Chapter 3. The implementation and evaluation of NEP
NEP were performed 121 times(95 times for SH, 11 times for P, 15 times for O, 15 times for intensive NEP) through the Korea National Council of Consumer Organizations’ local network after educator workshop for 30. Also, we reflected the results of the 8 on-site monitoring to improve the NEP.
Among the whole participants of this NEP(n=4,652), 4,524 were used in the analysis(SH=247, P=589, O=464) and the distribution of subjects SOC were 29.5 % of Maintenance(M), 19.6 % of Action(A), 50.9% of Pre-action(P). In the results of baseline evaluation, the response rate of eating-out was higher in O than others, and the rate to recognize for effort of governments, schools and media were higher in SH and P than O. P has higher efficacy related to sodium reduction than others. In the results of one-time education effect evaluation(n=4,265), positive outcome expectations(POE) and knowledge score were increased and negative outcome expectations(NOE) were decreased after education in all the groups(p<0.05). The behavioral capability of knowledge was also improved. Higher SOC showed the lower NOE and higher self-efficacy and knowledge score at the baseline and especially showed significant rise in scores of knowledge in the results of one-time education effect according to the SOC(n=3,492) adjusted with age, height, weight, education level, income level, residence and NEP.
In 2’nd intensive NEP, 587 participants were participated and only 387 available data were used to analysis. Environmental factors of perceptions and experience rate to purchase low-sodium foods were improved and cognitive factors of NOE were slightly attenuated

#사회인지론 #행동변화단계 #소비자 #나트륨 #식품영양

Ⅰ. 서론 ·······································································································································1
Ⅱ. 문헌고찰 ·······························································································································6
Ⅲ. 본론 ·····································································································································18
연구 1. 나트륨 섭취 줄이기 영양교육 프로그램 개발 ···············································19
1. 사회인지론에 근거한 포커스그룹 인터뷰 ··································································19
1) 연구목적 ·····························································································································19
2) 연구대상 및 방법 ···········································································································19
(1) 연구대상 및 조사일시 ································································································19
(2) 연구내용 및 방법 ··········································································································19
(3) 자료 수집 및 분석 방법 ······························································································20
3) 연구 결과 ···························································································································21
(1) 포커스그룹 인터뷰 조사 대상자들의 일반적 특성 ················································21
(2) 사회인지론에 근거한 포커스그룹 인터뷰 조사 결과 ············································23
(3) 나트륨 섭취 줄이기 영양교육 프로그램에 대한 요구도 ····································30
2. 소비자 대상 나트륨 섭취 줄이기 영양교육 프로그램 및 교육자료 개발 ········32
2.1. 나트륨 섭취 줄이기 일회교육 프로그램 및 교육자료 개발 ·····························32
1) 연구목적 ·····························································································································32
2) 연구 방법 ···························································································································32
(1) 나트륨 섭취 줄이기 일회교육 프로그램 및 교육자료 개발 ································32
(2) 영양교육 프로그램 진행 매뉴얼 ················································································33
(3) 영양교육 프로그램 및 교육자료에 대한 평가와 검증 ····································33
3) 연구 결과 ···························································································································34
(1) 나트륨 섭취 줄이기 일회교육 프로그램 개발 ························································34
(2) 나트륨 섭취 줄이기 관련 교육자료 개발 ································································47
(3) 영양교육 프로그램 및 교육자료에 대한 평가와 검증 ······································52
2.2. 나트륨 섭취 줄이기 심화교육 프로그램 및 교육자료 개발 ·····························53
1) 연구목적 ·····························································································································53
2) 연구대상 및 방법 ·············································································································53
(1) 식행동 특성 분석 및 저나트륨 식사 방법의

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