Abstract
BACKGROUND AND OBJECTIVES:
A low risk of gastrointestinal disorders in the adult population has long been linked to consuming a Mediterranean diet (MD). The study aims to evaluate the effects of the Mediterranean diet educational program on employee’s knowledge regarding functional gastrointestinal disorders.
MATERIALS AND METHODS:
A quasi-experimental study design of two study groups (pre-test and post-test) was carried out at four colleges in the University of Baghdad, Iraq of the period between January 10, 2022 and May 31, 2022. A purposive (non-probability) sample was used with a sample size of (160) employees divided into two groups (80 employees each). The study group of 80 employees was exposed to the Mediterranean Diet educational program while the control group with was not.
RESULTS:
The results showed a positive effect of the Mediterranean diet educational program on the employees’ functional gastrointestinal disorders (FGIDs) knowledge in the study group. The study results indicated that there are highly significant mean differences between the study and control groups in the pre-test and the post-test in the specific and general knowledge area of employees’ functional gastrointestinal disorders (t = 17.002, df = 158; t = 24.19, df = 158; P value ≤ 0.01). Findings indicated that there were no significant statistical relationships between the level of knowledge of functional gastrointestinal disorders and demographic characteristics except employees’ level of education with a high significant association P value ≤ 0.01).
CONCLUSION:
The Mediterranean diet educational program effectively improves the employees’ knowledge of functional gastrointestinal disorders. These results support the benefit of establishing educational programs for adult employees on the Mediterranean diet to improve individuals’ knowledge about the gastrointestinal diseases.
Keywords: Educational program, employees, gastrointestinal disorders, knowledge, Mediterranean diet
Introduction
The fundamental predictor of gastrointestinal health has historically been thought to be diet. The minimally processed plant-based foods that represent the majority of the Mediterranean diet (MD) with high in monounsaturated fat from olive oil but low in saturated fat, meats, and dairy products, which is an ideal dietary pattern for gastrointestinal diseases health.[1] Functional Gastrointestinal Disorders (FGIDs) are gastrointestinal conditions caused by motility disturbance, visceral hypersensitivity, changed mucosa and immunological function, altered gut microbiota, and altered central nervous system processing.[2] Furthermore, the progressive degradation of the environment, and the quality of food and medications overused, lead to FGIDs.[3] However, the epidemiological causes of FGIDs and the factors that contributed to it are still unknown.[4] These functional gastrointestinal disorders have been associated with lower health-related quality of life (HRQOL), greater use of medical services, and lower work productivity.[5] There is a growing interest in employing complementary and alternative therapies as a result of the frequency of FGIDs and the scarcity of efficient pharmaceutical treatments.[6] Long-term management of chronic diseases such as FGIDs is largely based on lifestyle modifications such as diet.[7] The Mediterranean diet has several positive effects, one of which is unquestionably a decrease in mortality for all causes.[8] Mediterranean diet has been shown to prolong life and improve psychological wellness as well as perceived health status.[9] It can also lower the risk of mortality and the occurrence of some of the most serious disease states.[10] Adhering to a Mediterranean diet by individuals with FGIDs such as irritable bowel syndrome (IBS) significantly reduced disease activity and inflammation-related indicators by diet.[11] The role of quality of food is evidenced by the Middle Eastern countries, where FGIDs used to be uncommon.[12] The effects of the Mediterranean diet and related knowledge of employees/workers with FGIDs are not well understood. This study aims to evaluate the effects of the Mediterranean diet educational program on employee’s knowledge regarding functional gastrointestinal disorders.
Materials and Methods
Study design and setting
A quasi-experimental (pre- and post-test) design was conducted between January 10, 2022 and May 31, 2022 in the University of Baghdad, Baghdad, Iraq. The study recruited participants from four colleges at the University of Baghdad included: the College of Education-Ibn-Rushd for Humanitarian Sciences, College of Islamic Sciences, College of Languages, and College of Arts. The University of Baghdad is the largest in Baghdad, the capital city of Iraq, offering both academic teaching and scientific research services in various specialties. It has two main campuses, with a range of colleges subspecialties colleges including education, medicine, nursing, languages, arts, and many other colleges. The University of Baghdad is operated by the Ministry of Higher Education and Scientific Research in Iraq; it provides teaching services to students and accepts them from different high schools under specific regulations. Approximately 5,000 employees from different educational backgrounds and working in several colleges in the university.
Study participants and sampling
A purposive (nonprobability) sampling was utilized among non-academic employees during their managerial working hours in four colleges at the University of Baghdad. Participants were purposively allocated to either study or control groups. The university non-academic employees who have FGIDs for a minimum of three months, with different educational levels, and who agreed to participate in the study were recruited.
Data collection tools and technique
The questionnaire contained questions regarding knowledge questionnaire about the Mediterranean diet regimen and FGIDs for employees consisting of 45 questions. The knowledge questionnaire was developed by the researcher based on the existing resources to assess the knowledge of employees regarding the concept of the functional gastrointestinal disorders and the Mediterranean diet. Section one: Sought for information on socio-demographic data. Section two is divided into three domains: The first domain consists of (20) items on the knowledge about the functional gastrointestinal disorders. The second domain consists of (13) items about the knowledge of the Mediterranean diet regimen. The third domain consists of (12) items on knowledge about the effect of Mediterranean diet regimen on functional gastrointestinal disorders. Respondents’ knowledge of FGIDs was ranked according to its score. Two points were awarded for a correct response, while a wrong response received one point. This gives a minimum score of ‘45’ and a maximum score of (90) points. The use of closed-ended questions by reviewing of literature by researcher. The questionnaire was translated first into Arabic language to assess the level of employees’ knowledge about the Mediterranean diet regimen for functional gastrointestinal disorders and their needs. For this purpose, it is translated into Arabic by forward-backward translation by the researcher, and then it is translated from Arabic into English by a specialized bilingual translator. This compiler was not aware of the original tool. Then, the translated Arabic and English texts were compared.
Mediterranean diet educational program
The Mediterranean diet program consists of a lecture presentation using PowerPoint slide presentations, films, and brochures. The entire session was programmed for 60 minutes in the lecturing hall in the College of Art. On the first day of the program, employees in the study group were greeted and given an explaination of the purpose of the study and an overview of FGIDs, causes symptoms, laboratory tests, and treatments. By the end of the first session, clarification and interactions were involved between the researcher and participants. On the second day of the program, the researcher supported employees by gaining knowledge and open discussion with the study group on the topic of Mediterranean diet. These involved an introduction to the Mediterranean diet regimen, the main aspects of a diet, and health benefits and scheduling. At the end of the day, interactive session doubts were clarified. On the third day, intensified participants’ knowledge and discussed the effect of the Mediterranean diet on FGIDs. This included the dietary guidelines for employees with FGIDs and their Mediterranean diet list. Next, each participant got extra sessions with details of the contents of the program and motivated participants to read and apply them frequently. Finally, participants were informed that after one month, a post-test questionnaire would be given to assess their knowledge of both FGIDs and Mediterranean diet.
Data analysis
A descriptive analysis was performed utilizing a statistical package for social science (SPSS) version 26. Data were analyzed using descriptive and inferential statistics to summarize the results. A paired t-test to analyze the mean difference between pre- and post-test and an independent-sample t-test to examine the mean difference between the study and control groups. A level of significance was set at 0.05.
Ethical consideration
Approval was obtained from the Scientific Research Ethical Committee in the College of Nursing, University of Baghdad for the conduct of the study. Permission was obtained from the deans of the four involved colleges to carry out the study. Informed written consent was obtained from the participating employees and they were completely voluntary. Participants were free to withdraw from the study at any time. The researcher maintained the confidentiality of the collected data. The researcher approached and clearly explained the aims of the study to the employees and obtained verbal consent from them.
Results
Socio-demographical and clinical characteristics of employees in the study and control groups
Table 1 shows that the majority of employees were female 70.0% and 55.0%, respectively, in age group (40-49 years) for the study group and (30-39 years) for the control group. The mean pre-test age scores of employees in the study group and control group were 2.93 ± 0.938 and 2.55 ± 0.884, respectively. Married participants were the highest in both study and control groups (76.3% and 31.3%, respectively). Employees with diploma qualifications recorded a high percentage in both study and control groups (46.3% and 58.8%), respectively. Regarding employees’ clinical data, a high percentage of the study group (58.8%) was diagnosed with irritable bowel syndrome [Table 1].
Table 1.
Comparison of the samples by sociodemographic characteristics of the study and control groups
| Demographic Variables | Study group (n=80) |
Control group (n=80) |
|||
|---|---|---|---|---|---|
| Groups | F. | % | F. | % | |
| Gender | Male | 24 | 30.0 | 36 | 45.0 |
| Female | 56 | 70.0 | 44 | 55.0 | |
| Age | 20-29 | 6 | 7.5 | 9 | 11.3 |
| 30-39 | 20 | 25.0 | 30 | 37.5 | |
| 40-49 | 28 | 35.0 | 29 | 36.3 | |
| 50-above | 26 | 32.5 | 12 | 15.0 | |
| MS±SD=2.93±0.938 | MS±SD=2.55±0.884 | ||||
| Educational level | Primary school | 4 | 5.0 | 21 | 26.3 |
| Tertiary school | 6 | 7.5 | 4 | 5.0 | |
| Secondary school | 10 | 12.5 | 7 | 8.8 | |
| Diploma | 37 | 46.3 | 47 | 58.8 | |
| Bachelor and above | 23 | 28.8 | 1 | 1.3 | |
| Marital status | Single | 11 | 13.8 | 5 | 6.3 |
| Married | 61 | 76.3 | 25 | 31.3 | |
| Widowed | 2 | 2.5 | 22 | 27.5 | |
| Divorced | 5 | 6.3 | 5 | 6.3 | |
| Separated | 1 | 1.3 | 23 | 28.8 | |
| Living arrangement | Own a house | 68 | 85.0 | 59 | 73.8 |
| Rent a house | 12 | 15.0 | 21 | 26.3 | |
| Free accommodation | 0 | 0 | 0 | 0 | |
| Physical exercises | Yes | 38 | 47.5 | 41 | 51.2 |
| No | 42 | 52.5 | 39 | 48.8 | |
| How often you have exercises | Daily | 21 | 26.2 | 9 | 11.2 |
| Weekly | 13 | 16.2 | 18 | 22.5 | |
| Monthly | 4 | 5.0 | 14 | 17.5 | |
| How long in minutes you do your exercises | Less than 30 minutes | 22 | 27.5 | 16 | 20.0 |
| 30-60 minutes | 10 | 12.5 | 21 | 26.3 | |
| More than 60 minutes | 6 | 7.5 | 4 | 5.0 | |
F=Frequency, %=Percentage, No=Number
The level of employees’ knowledge of functional gastrointestinal disorders, the Mediterranean diet, and the effect of the MD on FGIDs in study and control groups
The pre-test results demonstrated that areas were within poor levels of Knowledge in the study group for functional gastrointestinal disorders, with a mean of (1.19), and a fair level of knowledge for the control with a mean score of (1.23). The Mediterranean diet for both the study and control group results showed a poor level, the mean score (1.16, 1.14), respectively, and a poor level for the effect of the Mediterranean diet on FGIDs (1.14) as regarded before implementation of the program. Also, this table shows results after applying the program for the study group illustrated a good level for all areas of knowledge in FGIDs and the Mediterranean diet as follows (1.74, 1.68), respectively, while a fair level of Knowledge on the effect of the Mediterranean diet on FGIDs, their means of the score as a group (1.61). The control group shows a poor level of knowledge for all areas of knowledge as follows (1.15, 1.14, and 1.14), respectively [Table 2].
Table 2.
Comparison of employee’s level of knowledge of functional gastrointestinal disorders, Mediterranean diet, and effect of Mediterranean diet on functional gastrointestinal disorders in study and control groups
| Employees specific knowledge | Study group (n=80) |
Control group (n=80) |
||||||
|---|---|---|---|---|---|---|---|---|
| Pre-test M±SD | Level of knowledge | Post-test M±SD | Level of knowledge | Pre-test M±SD | Level of knowledge | Post-test M±SD | Level of knowledge | |
| Functional Gastrointestinal Disorders | 1.19±0.39 | Poor | 1.74±0.41 | Good | 1.23±0.40 | Fair | 1.15±0.36 | Poor |
| Mediterranean diet (MD) | 1.16±0.36 | Poor | 1.68±0.44 | Good | 1.14±0.34 | Poor | 1.14±0.34 | Poor |
| Effect of Mediterranean diet on MD | 1.14±0.35 | Poor | 1.61±0.45 | Fair | 1.13±0.33 | Poor | 1.14±0.34 | Poor |
n=Number, M±SD=Mean±Standard Deviation, Level of Assessment=1-1.33=Poor, 1.34-1.66=Fair, 1.67-2=Good
Employees’ specific knowledge in the study and control groups
Table 3 highlights that employees in the study group have a poor level of knowledge about functional gastrointestinal disorders with a mean score of 1.19 ± 0.39, while the control group has a fair level of knowledge with a mean score of 1.23 ± 0.40. There are significant differences regarding specific knowledge areas between the study and control groups of the current study before applying the educational program at a P value ≤ 0.05. There are no significant differences regarding specific knowledge areas regarding the effect of the Mediterranean diet on FGIDs between the study and control groups of the current study before applying the educational program at a P value ≤0.05. There are highly significant mean differences concerning specific knowledge areas between the study and control groups after applying the educational program in the post-test period at a P value ≤0.01. Participants’ knowledge was improved regarding FGIDs with 1.7 ± 0.41, the Mediterranean diet with 1.68 ± 0.44, and the effect of the Mediterranean diet on FGIDs with 1.61 ± 0.45 (P = 0.001) in the study group compared with the control group with (1.15 ± 0.36; 1.14 ± 0.34; and 1.14 ± 0.34), respectively.
Table 3.
Significant differences of employee’s knowledge of functional gastrointestinal disorders, Mediterranean diet, and effect of Mediterranean diet on functional gastrointestinal disorders between study and control groups
| Employees knowledge | Test period | Study group (n=80) | Knowledge | Control group (n=80) | Knowledge | Independent t test statistics |
||
|---|---|---|---|---|---|---|---|---|
| M±SD | M±SD | M±SD | M±SD | t-test | df | P | ||
| Functional Gastrointestinal Disorders (FGID) | Pre-test | 23.9±2.03 | 1.19±0.39 | 24.64±2.83 | 1.23±0.40 | 1.861 | 158 | 0.006 |
| Post-test | 34.90±4.17 | 1.7 (0.41) | 23.10±1.55 | 1.15±0.361 | 23.687 | 158 | 0.001 | |
| Mediterranean diet (MD) | Pre-test | 15.09±2.02 | 1.16±0.36 | 14.84±1.38 | 1.14±0.34 | 0.914 | 158 | 0.001 |
| Post-test | 21.83±3.08 | 1.68±0.44 | 14.88±1.20 | 1.14±0.34 | 18.750 | 158 | 0.001 | |
| Effect of Mediterranean diet on FGIDs | Pre-test | 13.76±1.65 | 1.14±0.35 | 13.60±1.73 | 1.13±0.33 | 0.607 | 158 | 0.393 |
| Post-test | 19.44±2.79 | 1.61±0.45 | 13.69±1.16 | 1.14±0.34 | 17.002 | 158 | 0.001 | |
n=Number, M=Mean, SD=Standard deviation, t=t-test, P=0.001, M±SD=Mean±Standard Deviation
Discussion
Regarding the sociodemographic characteristics in this study, the majority of the university employees, 28 (35%) in the study group and 30 (37.5%) in the control group were in the age group of 40-49 years and 30-39 years, respectively. This result is agreed with Al-Obaidy and Hassan’s[13] study who reported the majority of the sample was within the age group between 40 and 60 years old. This study results highlighted that females constitute most in both groups, 56 (70%) in the study group and 44 (55%) in the control group. This result is in agreement with[14] results that revealed that 55% of the participants were females. Furthermore, the majority (76.3%) in the study group and (31.3%) in the control group were married. This result agrees with the findings of a study carried out in General Kirkuk Hospital in Iraq with the majority of the participants (88%) being married.[15] Moreover, employees with diploma qualifications recorded a high percentage in both the study and control groups (46.3% and 58.8%), respectively. This result disagreed with a study carried out at Baghdad University Colleges in Bab-Almudam Iraq found that the most of participants had a doctorate education (38%).[16] Regarding employees’ clinical data, a high percentage of the study group (58.8%) was diagnosed with irritable bowel syndrome. This result is a mirror of Hassan and Najm’s[17] study findings indicating that 40% of participants have an IBS for 1-3 years.
This study found that the level of knowledge among employees before applying the MD program was poor regarding FGIDs, MD, and the effect of MD on FGIDs in both study and control groups. These results are similar to the results from Sköldstam et al.[18] who found that patients knowing about the Mediterranean diet decreased their inflammatory activity, physical function, and vitality improved. These results also agreed with the results of a study carried out at Baghdad University Colleges in Baghdad[19] demonstrated that all areas of knowledge were at poor levels in the study group. However, another study disagreed with the current study results stating that employees such as teachers have a moderate level of nutrition knowledge.[20] Nutritional education improved patients’ knowledge of nutrition, and more specifically, the Mediterranean diet.[21]
This study declared that Mediterranean diet intervention improved participants’ knowledge regarding MD, FGIDs, and the effect of MD on FGIDs. These results are supported by a study result that highlighted highly significant differences between the pre- and post-test in the study and control groups with an improvement in the knowledge of diet-related hypertension in the study group compared to the control group.[22] Similar results came from a study conducted by Naeem et al.[23] showed a high difference in the mean of participant knowledge and adherence to healthy nutrition among the study groups (P = 0.001). However, another study carried out in Iraq was the opposite arguing that there was no significant association between the sample groups regarding knowledge about hemodialysis and diet regimen in both pre-test, post-test, and post-test P > 0.05.[24]
Limitation and recommendation
The study results may not be generalizable due to recruitment from a single site with a busy employment setting where the employees were asked to fill out the questionnaires during their work hours. This may affect the attention to the questionnaires with non-accurate answers. Careful consideration should be taken when comparing the results with different employee groups.
Conclusion
The Mediterranean Diet educational program effectively improves the university employees’ knowledge towards the Mediterranean diet and functional gastrointestinal disorders. The study results sought to inform new dietary instructional approaches to improve the employees’ Mediterranean diet knowledge and hence, reduce their functional gastrointestinal disease burdens. More attention should be taken into consideration on the level of individuals’ knowledge of gastrointestinal diseases to improve their disease outcomes in addition to their medication treatment. These results support the benefit of establishing educational programs for adult employees on the Mediterranean diet to improve individuals’ gastrointestinal diseases.
Financial support and sponsorship
This research received no specific funding from any funding agency in the public, commercial, or not-for-profit sectors.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The authors would like appreciation to all employees who participated in the study.
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