Participatory cooking demonstrations: A distinctive learning approach towards positive health

ABSTRACT

Background:

Participatory cooking demonstration is a unique and effective way to teach nutritional concepts and basic cooking skills in a community setting. The present study attempted to develop the same in 4^th-year nursing students through the intervention for a better nutritional health outcome. The objectives are to introduce and train nursing students on participatory cooking demonstrations in community households, evaluate the improvement of knowledge and self-efficacy of the participants, and assess the feedback of the study participants towards the intervention.

Methodology:

An educational intervention was carried out among BSc Nursing students in a tertiary healthcare institute from April to June 2019. A sample of 66 students were subjected to pre- and post-tests along with a self-efficacy evaluation and feedback survey.

Results:

Out of all, 91.1% were between 21 and 30 years, 77.8% belonged to rural areas, and 82% were in the lower–middle socioeconomic class. The knowledge was improved, and it was found to be statistically significant (P < 0.0001). The self-efficacy evaluation showed an enhancement of knowledge and awareness. The majority either strongly agreed or agreed that participatory cooking demonstrations helped them learn healthy cooking practices (80%), analyze specific nutritional problems (95.6%), and get hands-on experience in nutritional care (86.4%). The themes that emerged from qualitative data were discussed under liked, disliked aspects, challenges faced, and solutions offered.

Conclusion:

The hands-on sessions on participatory cooking demonstrations were successfully introduced and the knowledge and self-efficacy of the participants was improved. All participants were satisfied with the intervention as perceived by the participants.

Background

Participatory cooking demonstrations are a unique and effective way to teach nutritional concepts and basic cooking skills in a community setting which can improve confidence in the kitchen, cooking skills, and the promotion of healthier food into the diet.[1] Moreover, learning nutrition counselling skills along with an understanding of the social determinants of health through culinary education in a community setting was well received by students.[2]

Participatory cooking demonstrations involving community nutrition and health workers, mother leaders, and peer counsellors to ensure mothers of malnourished children get adequate knowledge and skills to prepare nutritionally balanced food was an important strategy to tackle malnutrition.[3]

Another study has shown incorporating cooking demonstrations as part of nutrition education is effective in inculcating healthy eating practices and changing self-reported eating habits in a short term among the general population in a primary healthcare setting.[4]

The present study intends to introduce and train nursing students on participatory cooking demonstrations in community households, evaluate the improvement of knowledge and self-efficacy of the participants, and assess the feedback of the study participants towards the intervention.

Materials and Methods

Study design: An educational intervention study.

Study population: BSc Nursing students

Study setting: A tertiary healthcare institute of Srikakulam, AP

Study duration: April to June 2019

Sample size: 66

Sampling method: Complete enumeration

Inclusion criteria: All students, posted under the Department of Community Medicine, gave consent for participation.

Exclusion criteria: Those students who were absent in any of the sessions.

The nursing students were posted in field practice areas of the Department of Community Medicine in 3 consecutive batches of 25 each, which is a part of the nursing curricular guidelines. During their posting of 15 days, the first 7 days were for surveying the houses and the next 7 days were for identifying families and performing participatory cooking demonstrations as per their nutritional needs (children under 5, pregnant mothers, post natal mothers, adolescents, and geriatric population) and the presence of specific diseases. (like Diabetes Mellites, Hypertension, Chronic Kidney Diseases, Acute Peptic Disorders, Cardiovascular Diseases). A pre-designed, pre-validated questionnaire and module with details on the process and implementation of cooking demonstrations targeting specific diseases were utilized. After sensitization, a pre-test was conducted to assess the knowledge of nutritional importance among the students. Then, the students were assigned to perform participatory cooking demonstrations in identified specific households as a part of an intervention where they need to plan, prepare and perform according to the presence of disease/pathological or physiological conditions in the house, followed by a faculty visit and interaction between the faculty, student, and the family members along with clarifying doubts and giving feedback during the whole discussion. After completion of the postings, a post-test was conducted to evaluate the change in knowledge. The retrospective pre- and post-self-efficacy evaluation was conducted among the students along with feedback on the learning experience and implementation of the module. The approval of the institutional ethics committee was obtained for the study. (21/IEC/GEMS&H/2021).

The pre–post-test questionnaire included 15 multiple-choice questions (MCQs) on food and nutrition (5), its relation to health (5) and cooking practices (5). The retrospective pre–post-self-efficacy form consisted of 8 questions on the effect of the intervention on self, on a scale of 1–5, where 1 is very low and 5 is extremely high. Likewise, the feedback questionnaire consisted of 6 MCQs on demographic details (maintaining anonymity) and 10 questions on the perception of students towards the intervention and implementation process on Likert’s scale, 4 open-ended questions on various aspects they liked, disliked, challenges faced and suggestions for improvement. All questionnaires were validated by an expert in the field and the reliability was checked by Cronbach’s alpha, which was found to be 0.84 which is considered acceptable.

The quantitative data were analyzed in terms of percentage, proportions, paired t-test using the SPSS statistical software package and qualitative data by thematic analysis manually.

Results

Out of all participants, the majority (91.1%) were between 21 and 30 years of age group; all were female students; 77.8% belonged to rural areas, 86% practiced Hinduism, 68% were hostellers, and 82% were in the category of lower–middle socioeconomic class.

The improvement in knowledge was assessed by comparing the pre–post-test mean scores using the paired t-test, and it was found to be extremely statistically significant (P < 0.0001) [Table 1].

Table 1.

Comparison of pre–post-test mean scores before and after the intervention (n=66)

	Before	After	P
Mean test score	6.86	11.86	t=22.0794, df=65, standard error of difference=0.226
SD	1.05	1.70
SEM	0.13	0.21

The analysis of retrospective pre–post self-efficacy evaluation data showed that the importance of the topic, knowledge, awareness, competency in nutritional counselling skills, confidence, communication, competency in dietary planning and skills of demonstrating healthy practices of cooking has enhanced after the intervention as perceived by the study participants, which were found to be statistically significant [Table 2].

Table 2.

Retrospective pre- and post-self-efficacy evaluation (n=66)

Self-efficacy attributes	Mean pre-score	Mean post-score
Importance	3.3	4.2
Knowledge	2.6	3.8
Awareness	3.6	4.8
Competency in nutritional counselling	2.4	3.6
Confidence	2.1	3.9
Communication skills	3.2	4.6
Competency in prescribing a diet	2.2	4.2
Skills of demonstrating healthy practices of cooking	2.8	4.6

Feedback analysis revealed that the majority either strongly agreed or agreed that participatory cooking demonstration (intervention) to families, whereas community postings helped them learn healthy cooking practices (80%), analyze specific nutritional problems (95.6%), and gave a hands-on experience of nutritional care of the patient at home (86.4%); it also made them more confident in providing nutritional counselling (94.6%) and prescribing diet to a person according to the age, sex and physiological state or the presence of pathological disease (82.2%) [Figure 1]. Similarly, the majority agreed or strongly agreed to appropriate module content (94%), planning of activities (94%), adequate pace of the sessions (89%), effective process of implementation (96%) and overall satisfaction through the intervention (98.6%) [Figure 2].

Figure 1.

Perception of students towards the intervention

Figure 2.

Perception of students towards the module

The qualitative data obtained from open-ended questions were analyzed by thematic analysis. The themes that emerged were discussed under four categories. (1) Various aspects of the intervention liked by the study participants were direct interaction with family members, hands-on experience in effective cooking practices and nutritional care, planning individual diet, and fun learning of nutritional facts. (2) When asked about the aspects disliked, the majority has nothing to submit except the interference by other family members sometimes while cooking demonstrations and hesitancy to share the kitchen. (3) Likewise challenges faced were non-cooperation, unawareness, ignorance, illiteracy, and time constraint. (4) The solutions offered were to create awareness among surveyed family members, effective communication, adequate time and space utilization, prior orientation of students towards individual family needs and supply, a system to follow-up and availability of handouts or booklet of recipes for persons involved in cooking in the family, a web portal/support group to answer their specific query and provision of appropriate referral. All of them enjoyed the sessions and stated that it should be made a mandatory activity for all students involved in health care [Figure 3].

Figure 3.

Thematic analysis of qualitative data on the process of intervention

Discussion

The present study revealed that participatory cooking demonstrations in the community households as a part of the nursing curriculum were successfully implemented through the structured module which increased the knowledge of participants. The importance, awareness and competencies of nutritional care and communication skills of the participants were also improved as perceived by the participants themselves through pre–post-retrospective self-efficacy evaluation. Similarly, a systemic review of 30 studies with culinary interventions concluded that although it was not associated with a significant change in cardiometabolic risk factors but has improved attitudes, self-efficacy and healthy dietary intake in adults and children.[5]

In another study, the three steps of the participatory cooking demonstration were adapted from FAO (2017). The first step was the preparatory stage, where they were to identify the issues on complementary feeding of caregivers in the community and arrange the venue, ingredients, and utensils to be used. The second step was to do the actual participatory cooking demonstrations while delivering key messages on complementary feeding or clarifying misperceptions of caregivers, food tasting, and scheduling of succeeding sessions. The final step was to conduct follow-through activities for the dissemination of information through the promotion of key messages on optimal feeding practices. They observed that the participants found it useful, and the steps were easy to follow. There was also increased knowledge acquisition, but it was not as profound as food preparation skills and confidence observed in the report.[6]

Studies have found a positive impact of cooking demonstrations on African Americans and Hispanic families which include a potential decrease in comorbidities associated with obesity. Brief cooking programmes are modestly effective in increasing confidence to perform skills that improve some aspects of food literacy and those relevant to cooking meals (preparation). Thus, sessions on food preparation can influence children to try new food and change their food habits.[7,8]

Classroom learning facilitates critical thinking but does not necessarily provide a platform for hands-on learning, whereas planning and executing community-involved cooking demonstrations can give students the opportunity to connect content learned in the classroom to professional practice.[1]

In the present study, it was observed that participants positively perceived the intervention which helped them learn healthy cooking practices and analyze specific nutritional problems and gave a hands-on experience of nutritional care to patients; it also made them more confident in providing nutritional counselling and prescribing the diet for a person as per the requirement. A similar study in Onga, using cooking demonstrations to improve infant and young child feeding practices, is proven to be working where communities from the Maluwa village were able to prepare nutritious meals from the locally available food in their community. Studies have shown that providing more opportunities for hands-on practice in the demonstrations may reinforce gained knowledge and skills and lead to a greater likelihood of the participants using them on a regular basis. Participants had a largely positive reaction to food preparation demonstrations, and many had incorporated the same in their own homes. Likewise, nutrition impact and positive practice (NIPP) circles a GOAL-initiated project to address malnutrition in a preventative way through behavioural change while rehabilitating a malnourished child through supplemental feeding via cooking demonstrations which has come to play an important role in mother and child health activities in GOAL-supported clinics and GOAL’s community-based programmes.[9,10,11]

Another study found incorporating cooking demonstrations as part of nutrition education is effective in inculcating healthy eating practices and changing self-reported eating habits in the short term. At 6 months of follow-up, 84% of the participants reported positive changes in their dietary habits.[4]

Experiential cooking and nutrition education programs led by chef instructors may be effective ways to improve nutrition in low-income communities.[12]

The current study revealed few challenges like interference by other family members while cooking demonstrations and hesitancy to share the kitchen, non-cooperation, unawareness, ignorance, illiteracy, and time constraint. Similarly, studies have found that although cooking programs positively influence children’s food-related preferences, attitudes, and behaviours, few gaps needed to be addressed such as ideal program length, long-term effects, usefulness of parent engagement, tasting lessons, and other intervention components.[13]

However, in a study where hands-on cooking classes were compared to cooking demonstrations, it was observed that participants displayed positive shifts on attitude scales in the first group. Participants also displayed positive but not statistically significant, shifts in knowledge and some behaviours.[14]

Another study has found that cooking classes tailored to college students with limited access to cooking facilities, equipment, and ingredients that can be purchased on campus were effective in improving knowledge of nutrition, confidence in cooking, and ability to prepare a complete meal with readymade ingredients and dishes from basic ingredients. Despite participants’ reports that their diets were healthier after the cooking classes, there was no significant change in the frequency of choosing healthier foods detected via survey assessments.[15]

Conclusion

The hands-on sessions on participatory cooking demonstrations by 4^th-year nursing students were successfully introduced in the community households through the structured module recommended in nursing curricular guidelines with the collaboration of the Department of Community Medicine. The knowledge of health and nutrition was improved after the intervention and was found to be extremely statistically significant. The self-efficacy of participants was also improved as evaluated by themselves retrospectively. Similarly, all of the participants enjoyed and felt satisfied with the intervention, suggesting it to be a mandatory component in the curriculum of all healthcare professionals.

Limitations

Time constraint was a concern; only nursing 4^th-year students’ perception was considered. The study could be replicated in a larger population and other health professional students. There is a scope for taking the perception of members of the community involved in the process apart from students, which could be planned for further study.

Take Home Message: Participatory cooking demonstrations could be an effective way to learn nutritional concepts by students in the health profession and equally effective in the practice of cooking skills in terms of planning, preparing a healthy diet as per the need and requirements of the person, and providing nutritional care and counselling effectively.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.