Background and Aims: Nutrition education emphasizing permanent lifestyle changes is an important component of primary and secondary prevention of coronary artery disease and is an important facet of Cardiac Rehabilitation (CR). Nutrition workshops (NW) are widely used to deliver nutritional education to both patients and family members. Workshop methods often combine strategies for enhancing self-efficacy and promoting positive behavior change in the context of healthy eating. Evaluating a NW is important to ensure that workshop objectives are being met and that the strategies employed and the method of delivery optimize participant learning and behavior change. Information obtained from evaluations is used to improve programs. This pilot study evaluated a heart healthy NW, offered at the XXX, using a Stages of Change Model.
Methods and Materials: Sixty participants (80% male, mean age 59 +/- 10.5), of which 49 (82%) were CR participants, completed the evaluation questionnaire (EQ) that included basic demographic variables, nine questions assessing recent changes in eating habits, beliefs and perceived self-efficacy, and 12 questions regarding key dietary behaviors based on the stages of change model. Participants completed the EQ at baseline (prior to the NW) and at a 3-month follow-up (FU).
Results: Forty-seven participants (78%) completed the FU. At baseline, descriptive statistics indicated that 93% of participants felt they needed to change their eating habits to make them healthier and had made previous attempts to change their diet with moderate success. Paired sample t-tests were performed to assess changes between baseline and FU. Results indicated improvements in feelings of healthier eating (t(46) = 5.55, P < .000), knowledge regarding healthier food choices (t(46) = 7.19, P < .000), the meaning of healthy eating (t(45) = 5.66, P < .000), and perceptions of a more supportive environment (t(46) = 2.912, P < .01). Furthermore, stages of change improvements were noted for consumption of fruits (t(42) = 2.65, P < .01), fish (t(39) = 2.79, P < .01), salt (t(42) = 3.31, P < .01) and fast/canned/convenience foods (t(41) = 3.10, P < .01). Most participants were already eating healthier oils, whole grains, lower-fat dairy products, vegetables and regular meals. At FU 78% reported that NW improved their understanding of healthy eating.
Conclusions: Patients attending a CR NW appear to be motivated to engage in healthier eating behaviors, likely due to having a recent cardiac event. The results of our evaluation indicate that the NW may have contributed to participants' knowledge and positive beliefs associated with heart healthy eating, as well as in increased readiness to make healthy dietary behavior changes. Clinically, it is important that the CR participants engage in heart healthy eating, and the NW can play a valuable role in ensuring that confidence and positive behavioral change is achieved through knowledge and understanding of why behavior modification needs to take place. Future directions in this area need to consider using alternative assessment tools, a larger sample size, a control group, and a longer FU time.