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UNIT
HST3501 HEALTH RESEARCH PROJECT
NAME OF STUDENT
SCHWARTZKOPFF TRISTAN
STUDENT ID
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10330671
NAME OF LECTURER DR DIANNE HAWK DUE DATE
9/11/2014
Topic of assignment SOCIAL HEALTH RESEARCH STUDY: PILOT STUDY AND REPORT WRITING
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1
HST3501: A quantitative look at the Western Australian public’s knowledge of
Australian Dietary Guidelines and how this affects weekly red meat consumption
Tristan Schwartzkopff
10330671
Edith Cowan University
HST3501: Health research project
Dr Dianne Hawk
2/11/2014
2
Table of contents
Introduction 4
Literature review 4
Australian Dietary Guidelines 5
Recommendations for red meat intake 6
Red meat consumption 6
Health outcomes related to consumption of red meat 7
Conclusion 8
Research questions and Sub-questions 9
Research aim 9
Main research question 9
Research sub-questions 9
Definition of key concepts 10
Research design 10
Research methodology 11
Ethics 13
Pilot study 14
Processes and procedures 14
Reflection 15
Study results 16
Descriptive statistics 16
Red meat intake 18
Understanding of the ADG 20
Health outcomes related to red meat intake 22
Discussion 23
Objective 23
Weekly red meat intake 24
Understanding of the ADG 24
Knowledge of health outcomes related to red meat intake 25
Strengths and limitations 26
Reflection 27
References 28
Appendix 1: Data collection instrument 31
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Introduction
The purpose of this study is to gain an understanding of what level of
knowledge Western Australian adults have of the current guidelines for red meat
intake, and whether this understanding influences their weekly red meat intake. This
paper will begin with a review of current literature relating to the Australian Dietary
guidelines and red meat consumption before stating the research question and sub-
questions. The paper will then define and describe the measurement of key
concepts, outline the research design and methodology, before discussing the
ethical considerations that were made before, during and after the implementation of
the study. Finally the methods used to administer the pilot study will be discussed
along with the pilot study results and a discussion and reflection section.
Literature review
With the recent increase in the promotion of a variety of diets throughout
social media, a certain level of confusion and misunderstanding regarding diets and
nutrition can be expected in the general public (Williams, Anderson, Rawson, 2013).
While a change in eating habits may be beneficial to many individuals, particularly
due to the high prevalence of overweight and obesity (Australian Bureau of Statistics
(ABS), 2010), it is important to plan and implement diets correctly so as to not
damage health further (Williams et al. 2013). Of particular concern is the
consumption of red meat, with some diets removing red meat completely, while
others promote an increase in protein and red meat consumption. To assist in
providing sound nutritional information to the general public, the Australian
government has published a list of diet recommendations aimed at providing eating
guidelines for all foods including red meat. These recommendations are titled The
Australian Dietary Guidelines.
This literature review will systematically examine current Australian Dietary
Guidelines and review current literature related to the public’s understanding of
nutrition related guidelines. It will then examine what the current level of red meat
consumption is, followed by what health issues can arise from both the under-
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consumption and over-consumption of red meat. Current literature will be reviewed
under the themes of the Australian Dietary Guidelines, recommendations for red
meat intake, red meat consumption and the health outcomes related to red meat
consumption.
Australian Dietary Guidelines
The Australian Dietary guidelines (ADG) are recommendations published by
the Australian government and are developed using the best available scientific
evidence (NHMRC, 2013). They are intended to promote health and wellbeing,
reduce the risk of chronic disease and can be applied to all healthy Australians. As
they have been developed to promote health to all healthy Australians, any benefits
to the population can only be achieved if the population knows and understands the
guidelines (NHMRC, 2013). However research into nutrition related government
guidelines suggests that public understanding of nutrition guidelines is limited (Brown
et al. 2011; Keenan, Abusabha, Robinson, 2002).
Studies looking into nutritional guideline knowledge have been performed in
both America and England, however minimal quality research has been undertaken
in Australia. Separate surveys in America looking at knowledge of dietary guidelines
reported 58% (Brown et al. 2011), and 45% (Keenan et al. 2002) of participants
knew of the guidelines. While similar studies in England showed knowledge of food
group pyramid recommendations was as high as 75% (Brown et al. 2011). It is
important to note however, that the food group pyramid is a visual aid which depicts
current dietary guidelines (Brown et al. 2011). Therefore its visual appeal may
explain the increased recognition among the study group. Similarly the public’s
knowledge of the food group pyramid may also be considered as understanding of
the dietary guidelines.
However these figures represent individuals who knew the guidelines exist.
Further surveys showed that as little as 27% of Americans used guidelines when
selecting food and as few as 13% could correctly describe specific guidelines (Brown
et al. 2011). Similar studies involving open ended questions requiring respondents to
repeat guidelines found many responses were not part of the guidelines; for example
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when asked to describe a dietary guideline, 52 of 400 respondents reported a diet
low in meat as a recommendation when no such guideline exists (Keenan et al.
2002).
Further issues highlighted in these American based studies included a lack of
knowledge regarding serving sizes. When asked what difficulties they had with
recommendations, a common response from participants was a lack of
understanding of what a portion size was and how large a cup size is (Brown et al.
2011; Keenan et al. 2002).
Recommendations for red meat intake
The Australian Dietary Guidelines recommend consuming one serve of lean
meat, fish, poultry nuts or legumes daily to provide protein and essential vitamins
and minerals (AIHW, 2012; NHMRC, 2013), the guidelines also define a serving size
as being between 65 to 100 g (NHMRC, 2013). Due to the high nutrient content of
red meat, the National Health and Medical Research Council recommends that 3 to
4 serves of red meat should be consumed each week (2013). These findings are
supported by several sources including the Cancer Council of Australia (2009), and
in a study undertaken by Wyness et al. (2011), which states that red meat
consumption within recommendations is beneficial to health.
With a common consensus that red meat intake among developed countries
is too high (Wang & Beydoun, 2009; Williams & Droulez, 2010; World Cancer
Research Fund, 2014; Wyness et al. 2011), research also suggests that simply
reducing intake to within recommendations will increase the overall health of the
population (White, 1998; World Cancer Research Fund, 2014; Wyness et al. 2011).
Red meat consumption
Red meat is a common staple in modern western diets and includes beef,
veal, pork and lamb (Williamson, Foster, Stanner, Buttriss, 2005). While the
influence of vegetarianism and veganism has lowered overall meat intake in the
past, a thorough longitudinal study completed in 2004 has shown a decline in the
number of vegetarians and an increase in meat consumption from 1993 to 2004
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(Beardsworth, Bryman, 2004), this corresponds with a 1995 Australian study
reporting daily intakes of 45 g and 56 g for metro and rural areas respectively (AIHW,
2012).
More recent studies investigating red meat consumption of the Australian
population have reported consumption levels at the higher end or above the current
recommendations of 195 g to 455 g per week (NHMRC, 2013). Multiple Australian
dietary intake surveys report male adult consumption at 53g per day or 371g per
week (Wang & Beydoun, 2009; Williams & Droulez, 2010), with Williams and Droulez
also stating that older individuals (41 to 68 years old) consumed more at 63g per day
or 441g per week. However, a study by Wong, Selvanathan and Selvanathan (2013)
recorded far higher intakes, reporting an annual intake of 67kg per person, or 1288g
per week. This figure may be influenced by several factors, the most notably being
the data collection method. While other researchers estimated intake using dietary
analysis surveys (Wang & Beydoun, 2009; Williams & Droulez, 2010), Wong et al.
(2013) estimated consumption by analysing annual red meat sales, therefore it is
unknown how much of this was consumed by humans.
Several other studies failed to provide data for daily red meat intake, yet still
reported consumption levels above recommendations. These studies advised that
intakes of red meat should be reduced (Henson, Blandon, Cranfield, Herath, 2010;
White, 1998). Also reporting intakes at or above recommendations was a study of
10561 women aged 50 to 55 years old, which reports that 92% of participants
consumed the minimum recommended number of red meat serves, however; as
total intake was not determined, the number of participants who over-consumed is
unknown (Ball, Mishra, Thane, Hodge, 2004).
Health outcomes related to consumption of red meat
The health effects of red meat in the diet are well researched and widely
published, with both high intakes and low intakes having their own risks. The
consumption of red meat above recommended levels has been linked with several
health outcomes, particularly Bowel and colon cancer (Burki, 2012; Cancer Council
of Australia, 2009; Cancer Council of Australia, 2014; World Cancer Research Fund,
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2014). While the link between red meat and cancer is well published, many sources
report that the lack of intervention studies into this association means a direct link
between red meat and cancer is not possible (Cancer Council of Australia, 2009;
Williamson et al. 2005).
Dietary red meat has also been linked to increased adipose tissue due to its
high levels of dietary fat when compared to other meats (Wang & Beydoun, 2009;
Wyness et al. 2011), while Williams and Droulez (2010) agreed that red meat
contributed to adipose tissue, it disagreed with its contribution to dietary fat stating
that only 17% of dietary fat was provided by red meat. Williams and Droulez state
further that over-consumption of red meat is a greater predictor of obesity rather than
red meat alone (2010).
The positive aspects of dietary red meat are also well documented with most
sources agreeing that from a biomedical perspective, red meat is a vital source of
several nutrients, including; protein, iron, zinc, vitamin B12, fatty acids and vitamin D
(Cancer council of Australia, 2009; NHMRC, 2013 Williamson et al. 2005). These
sources agree that individuals consuming red meat below current ADG
recommendations may be at risk of developing nutrient deficiencies in one or more
of these essential nutrients.
Conclusion
Current guidelines for red meat intake recommend the consumption of three
to four, 65-100g serves of red meat each week. This recommendation has been
developed provide adequate amounts of essential nutrients, while minimising the risk
of obesity and certain cancers related to red meat intake.
However, public confusion remains as to what the guidelines are and how to
use them. American and British studies have shown a general lack of understanding
of guidelines and the current lack of similar Australian studies highlights the need for
further research into the Australian public’s level of knowledge. Without correct
understanding of red meat guidelines it is possible that the current overconsumption
of red meat by members of the Australian population, particularly older Australians,
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may be caused by a lack of nutrition related education. This lack of public knowledge
and understanding may be increasing the health risks related to the
overconsumption of red meat, such as obesity and certain cancers.
Research questions and sub-questions
Research Aim:
The aim of this study is to determine what level of understanding Western
Australian adults in 2014 have of current Australian dietary recommendations
for red meat intake. The study will also examine any links between knowledge
of dietary recommendations and red meat intake, and how gender affects
both knowledge and consumption levels.
Main research question:
What level of understanding do Western Australian adults aged 18 and over,
have of current red meat intake guidelines and does their understanding
correspond to their average weekly intake of red meat? Does this differ by
gender?
Research sub questions:
What level of knowledge do Western Australian adults aged 18 and over have
of the current Australian guidelines for red meat consumption in 2014? Does
this differ by gender?
How many grams of red meat are consumed each week by Western
Australian adults aged 18 and over in 2014? Does this differ by gender?
What do Western Australian adults aged 18 and over in 2014 know about the
health outcomes of red meat consumption? Does this differ by gender?
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Definition of key concepts
• Australian dietary guidelines (ADG): These are the guidelines published by
the NHMRC (2013).
• Red meat: includes beef, veal pork and lamb (Wyness et al. 2011).
• Recommended levels of red meat consumption as per ADG: 3-4 serves per
week, each serve is 65-100g in size. This is the level recommended by the
NHMRC (2013).
• Weekly red meat consumption of Western Australian adults: The number of
grams of red meat the respondent consumes on average each week, to be
determined by food frequency questionnaire (Wang & Beydoun, 2009).
• Health outcomes related to red meat consumption: The benefits of red meat
consumption as described in the Australian Dietary Guidelines (NHMRC,
2013), and negative health outcomes such as increased risk of obesity and
certain cancers (Lea & Worsley, 2001).
Research design
For the purpose of this study we have utilised a quantitative approach. The
aim of the study was to investigate how understanding of guidelines influences red
meat consumption, this required the collection of measurable data on the level of
understanding and red meat intake, favouring a quantitative approach (Bryman,
2012). This approach is also a form of objective ontology as we investigated the
single truth that understanding the guidelines determines intake (Bryman, 2012). In
order to investigate this issue we needed to assume the role of a positivist
researcher by participating in objective observation in attempting to explain and
measure outcomes (Bryman, 2012).
We have used a cross-sectional study rather than a longitudinal study.
Longitudinal studies are typically expensive and time consuming due to the need for
follow up interviews (Bryman, 2012). In contrast the cross-sectional design allowed
for virtually simultaneous data collection (Bryman, 2012). As we investigated whether
individuals understand and follow current dietary guidelines, rather than evaluated a
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new campaign, simultaneous data collection was sufficient. Similarly; cross-sectional
designs are also useful for collecting quantitative data and participants could be
selected as to give a true representation of the population (Bryman, 2012).
The study is explanatory rather than descriptive as it was aimed at
understanding the effect that the public’s knowledge of current red meat intake
guidelines has on dietary intake. For the purpose of the study the public’s level of
knowledge was considered the independent variable, while weekly red meat intake
was the dependent variable. While the study was predominantly explanatory,
descriptive statistics were also collected to accurately describe the study group
providing external validity (Bryman, 2012).
Research methodology
The data collection method was a self-administered questionnaire. This
method is well suited to the cross sectional research style and quantitative approach
of the study due to the convenience to the respondent, cheap cost and speed in
which surveys could be administered (Bryman, 2012). Both understanding of dietary
guidelines and weekly red meat intake was determined by quantitative, close ended
questions. Pilot surveys were administered in person, however, future surveys will be
administered via post due to the cheap cost and minimal time taken to administer the
surveys (Bryman, 2012).
Study participants needed to represent the theoretical population of Western
Australian adult population. The key factors were an approximate even number of
males and females (ABS, 2012), and also a variety of age groups over the age of 18.
Other important factors included a range of socio-economic groups and a range of
ethnicities to represent Western Australia’s diverse population, minimising sampling
error (Bryman, 2012).
The unit of analysis for the study was individuals. For the purpose of the pilot
study our accessible population was close friends and classmates. However for
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future studies our accessible population will be the Perth metropolitan population,
this is due to the easy accessibility of the Perth metropolitan area and as it provides
a representative sample of our population, including a variety of socio-economic
groups, ethnicities, gender and a variety of ages. The sampling frame for future
studies will be the electoral role, providing names and postal addresses of all
enrolled voters in the Perth metropolitan area. To select participants we implement
multiple sampling techniques. First, stratified random sampling, separating males
and females to ensure an equal number of each is selected. Next we will use
systematic sampling, first using a random number sheet to select the initial
participant, then selecting every nth individual throughout the list (Bryman, 2012). As
there is no order to the electoral role except for alphabetical, there is minimal
sampling bias and the list will provide an accurate representative sample (Bryman,
2012).
For the purpose of the pilot study the sample size was 16. However for the full
study there are several factors to be considered. First a power calculation is
implemented to determine a minimum number of respondents required to provide a
statistically significant result (Bryman, 2012). An estimate of non-responses and
invalid surveys due to respondent error will be factored in and a minimum sample
size will be determined. Sample size is important as sampling error is decreased as
sample size increases (Bryman, 2012). This concept is important as minimal
sampling error produces a study more generalizable to our population (Webb and
Bain, 2011).
Participants will be selected from the sampling frame which provides names
and contact information, respondents will then be contacted via post. Follow up
letters and surveys will be sent one month after the initial letters to non-respondents
to maximise participation and minimise non response error (Bryman, 2012).
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Ethics
There are several ethical considerations required before undertaking any
research project. Ethical conduct is important in research to minimise potential harm
to participants, researchers and ensure research will benefit society (Hawk, 2014).
Before undertaking this research study, efforts were made to follow the 4 ECU
ethical principles.
ECU’s 4 major ethical principles include merit, beneficence, respect and
justice (ECU, 2010). Merit states that the researcher must demonstrate a genuine
intention to seek and share knowledge, also that the potential research outcomes
and benefits must outweigh any potential harm to both the researchers and
participants (ECU, 2010). Similarly beneficence and non-maleficence ensure the
research must benefit the public, while minimising harm and/or exploitation of
participants (ECU, 2010).
Respect includes both informing participants of the nature, purpose and
potential consequences of the research (ECU, 2010), while respecting autonomy
and ensuring the participants thoroughly understand the risks and benefits before
agreeing to participate (ECU, 2010). Finally, justice requires the researcher to
ensure an equitable distribution of the benefits, risks and costs of the research
throughout the research process (ECU, 2010).
As researchers the 3 ethical practices we engaged in while conducting
research included completion of the ethics approval process, informing participants
and ensuring confidentiality.
The ethics approval process is a formal process overseen by the ECU ethics
committee (ECU, 2010). Approval is only provided if the benefits of the proposed
research outweigh any risks and also ensures that the researcher will do no harm
when undertaking the research, as judged by the ECU ethics committee (ECU,
2010).
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As researchers we were required to inform participants of the aim, methods
and potential consequences of research before obtaining documentable consent,
indicating they freely and willingly agreed to participate (NHMRC, 2007). It was also
important to inform participants that they could withdraw from the study at any time
(NHMRC, 2007). This was achieved by providing participants with an information
letter upon recruitment and providing participants an opportunity to ask any
questions before completing the survey (Hawk, 2014). Participants were also asked
to sign a consent form before starting the questionnaire (Hawk, 2014).
Finally it was vital to ensure confidentiality. For the purpose of this study
consent forms and completed questionnaires were kept in separate locked drawers,
with all documents to be destroyed upon completion of HST3501 in December 2014
(Hawk, 2014). Similarly, no data raw data was shared with groups or individuals not
involved in the research process (NHMRC, 2007).
Pilot study
Processes & Procedures
The pilot study was completed by 16 individuals, 7 male and 9 female. All
participants were HST3501 classmates. Classmates were approached during an on-
campus lecture held for the purpose of completing surveys. Participants were
approached, introduced, and informed of the study and the ethical considerations
before filling out a consent form to ensure informed consent was gained. Participants
were also supplied with an information sheet outlining the study, providing contact
details should they have any questions, and informing them that participation was
optional and they may remove themselves from the study at any time. Upon
completion of the survey the consent form and completed questionnaire were
separated and stored separately to ensure confidentiality was maintained.
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Reflection
Several insights were gained from the piloting process including improved
instructions, possible changes to the design of the questionnaire, and questions that
should be included in future studies.
The initial insight from the pilot study was due to individuals failing to complete
the questionnaire correctly. Instructions informed participants to circle the number
corresponding to the correct response, however several individuals instead chose
place a tick next to the answer. While this did not affect the overall process, it may
indicate that participants skipped the instructions completely, possibly ignoring other
important information or instructions for the questionnaire.
The use of a tick rather than circling may also show a preference in the way
the questionnaire is designed. For future questionnaires it may be beneficial to utilise
a tick box rather than asking respondents to circle the number. This may remove any
confusion related to filling out the questionnaire.
Improvements can also be made regarding the questions included. Questions
were used to estimate weekly red meat intake and included asking for the
participants estimated average red meat size in grams. While this question worked
well, in future a question asking the participants to estimate the weight in grams of a
steak shown in a photograph of certain dimensions may be useful to gauge if the
participant can reliably estimate their own red meat serving sizes and improve the
overall rigour of the data collection instrument (Bryman, 2012).
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Study results
Descriptive statistics
Table 1: Number of participants
n %Males 7 44Females 9 56Total 16 100Of the 16 respondents, 7 were male and 9 were female.
Table 2: Current age of respondents
Age Malesn %
Femalesn %
Totaln %
18-34 7 100 8 89 15 9435-54 0 0 1 11 1 655-74 0 0 0 0 0 075+ 0 0 0 0 0 0Total 7 100 9 100 16 100100% of male respondents (n=7) were between the ages of 18 and 34. Of the female
respondents, 89% (n=8) were aged 18 to 34, while 11% (n=1) were aged 35 to 54.
Table 3: Current marital status
Malesn %
Femalesn %
Totaln %
Never married 7 100 5 56 12 75
Married/de facto
0 0 4 44 4 25
Divorced 0 0 0 0 0 0
Widowed 0 0 0 0 0 0
Other 0 0 0 0 0 0
Total 7 100 9 100 16 100
100% of males (n=7) have never been married, 56% (n=5) of females have also
never been married, while 44% (n=4) of females are currently married or in a de
facto relationship.
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Table 4: Number of males and females representing each education level
Malesn %
Femalesn %
Totaln %
Did not finish year 12
0 0 0 0 0 0
Year 12 5 71 5 56 10 62
Vocational training/TAFE
0 0 2 22 2 13
University undergraduate
2 29 2 22 4 25
University postgraduate
0 0 0 0 0 0
Total 7 100 9 100 16 100
71% (n=5) of male respondents reported finishing year 12 as the highest education
level currently achieved, with 29% (n=2) of males completing university
undergraduate degrees. 56% (n=5) of females state finishing year 12 as their current
highest level of education completed, with 22% (n=2) having completed university
undergraduate courses.
Table 5: Number of males and females representing each level of employment
Malesn %
Femalesn %
Totaln %
Part time 4 57 3 33 7 44Full time 0 0 1 12 1 6Retired 0 0 0 0 0 0Unemployed 1 14 2 22 3 19Other 2 29 3 33 5 31Total 7 100 9 100 16 10057% (n=4) of males and 33% (n=3) of females are currently working part time. 14%
(n=1) of males and 22% (n=2) of females are unemployed. Only 12% (n=1) of
females are currently working full time, while there are no males currently employed
in full time work. 29% (n=2) of males and 33% (n=3) of females selected other, with
all 5 respondents stated working on a casual basis.
17
Table 6: Number of males and females representing each ethnicity
Malesn %
Femalesn %
Totaln %
Australian 4 58 6 67 10 61
Aboriginal/TSI 0 0 0 0 0 0
Asian/Pacific Islander
1 14 1 11 2 13
UK & Ireland 1 14 1 11 2 13
African 1 14 1 11 2 13
European 0 0 0 0 0 0
American 0 0 0 0 0 0
Other 0 0 0 0 0 0
Total 7 100 9 100 16 100
58% (n=4) of males and 67% (n=6) of females are of Australian ethnicity. For males
other ethnicities include; Asian/Pacific Islander (n=1), UK & Ireland (n=1) and African
(n=1). Similarly for females other ethnicities include; Asian/Pacific Islander (n=1), UK
& Ireland (n=1) and African (n=1).
Red meat intake
Table 7: Weekly red meat consumption level
Malesn %
Femalesn %
Totaln %
Under consume
1 14 3 33 4 25
Healthy consumption
1 14 5 56 6 38
Over consume
5 72 1 11 6 38
Total 7 100 9 100 16 100
Respondents were asked to state how many times they consumed red meat each
week and their average red meat serving size. Weekly red meat intake was
determined by multiplying weekly serves by average serving size. Weekly red meat
intake was then categorised as over-consumption, under-consumption and healthy
consumption levels. Under-consumption is considered as below 195 g per week as
18
per the ADG recommendations (NHMRC, 2013), over-consumption is considered as
above 455 g per week as per the ADG (NHMRC, 2013), healthy consumption is
considered between 195 g and 455 g per week. 72% (n=5) of males reported
consuming red meat above recommended levels compared to 11% (n=1) of females.
Only 14% (n=1) of males were within recommended consumption levels while 56%
(n=5) of females consumed red meat within recommendations. 14% (n=1) of males
under-consumed while 33% (n=3) of females under-consumed.
Table 8: Self-reported under consumption, healthy consumption and over
consumption of red meat
Malesn %
Femalesn %
Totaln %
Under-consumed 1 14 3 33 4 25
Healthy consumption
5 72 6 67 11 69
Over-consumed 1 14 0 0 1 6
Total 7 100 9 100 16 100
Respondents were asked to rate their own red meat intake as over-consuming,
under-consuming or healthy. 72% (n=5) of males and 67% (n=6) of females reported
that they believed their weekly red meat consumption was within recommendations.
14% (n=1) of males and 33% (n=3) of females believed they under-consumed red
meat, while only 14% (n=1) of males believed they over-consumed red meat.
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Table 9: Reasons for consuming red meat
Malesn %
Femalesn %
Totaln %
Health 2 29 5 56 7 37
Enjoyment/taste 5 71 4 44 9 47
To feel full 0 0 1 11 1 5
Don’t eat red meat
0 0 2 22 2 11
Other 0 0 0 0 0 0
Total 7 100 12 100 19 100
Respondents were asked why they chose to consume red meat. Of the respondents
29% (n=2) of males and 56% (n=5) consumed red meat for health, 71% (n=5) of
males and 44% (n=4) of females consumed red meat due to enjoyment/taste, with a
further 11% (n=1) of females consuming red meat to feel full. 22% (n=2) of females
reported not eating red meat.
Understanding of the Australian Dietary Guidelines
Table 10: Number of respondents who have heard of the Australian Dietary
Guidelines
Malesn %
Femalesn %
Totaln %
Yes 7 100 8 89 15 94No 0 0 1 11 1 6Total 7 100 9 100 16 100Respondents were asked if they have heard of the Australian Dietary Guidelines. Of
the respondents; 100% (n=7) of male respondents and 89% (n=8) of females had
heard of the Australian dietary guidelines. Only 11% (n=1) of females had not heard
of the Australian Dietary Guidelines.
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Table 11: Respondents who believe they understand the Australian Dietary
Guidelines
Malesn %
Femalesn %
Totaln %
Yes 4 57 6 67 10 62No 1 14 1 11 2 13Unsure 2 29 2 22 4 25Total 7 100 9 100 16 100Respondents were asked whether they understood the guidelines, 57% (n=4) of
males reported understanding the Australian Dietary Guidelines along with 67%
(n=6) of females. 14% (n=1) of males and 11% (n=1) of females report not
understanding the guidelines. 29% (n=2) of males and 22% (n=2) of females are
unsure.
Table 12: Knowledge of Australian Dietary guidelines and red meat consumption
UC
M(n) M(%) F(n) F(%)
H
M(n) M(%) F(n) F(%)
OC
M(n) M(%) F(n) F(%) T(n) T(%)Good knowledge
0 0 0 0 1 100 3 60 0 0 0 0 4 25
Some knowledge
1 100 0 0 0 0 1 20 3 60 1 100 6 38
Lack of knowledge
0 0 3 100 0 0 1 20 2 40 0 0 6 38
Total 1 100 3 100 1 100 5 100 5 100 1 100 16 100
Respondents were asked a variety of questions designed to test their knowledge of
the guidelines. Questions included identifying current guidelines, stating
recommended serving sizes and weekly recommended intakes, and identifying
sources of red meat. Respondents were given a score out of 14, scores of 12 and
above were classified as having a good knowledge of the guidelines, a score of 9 to
11 was classified as having some knowledge of the guidelines, while a score of 8 or
below was classified as having a lack of knowledge. Scores were compared to the
respondents weekly red meat intake (over-consumption, under-consumption and
healthy consumption). Of the respondents who under-consumed red meat, 100%
(n=1) of males had some knowledge of dietary guidelines while 100% (n=3) of
females lacked knowledge of the guidelines. For respondents who had a healthy
level of red meat intake, 100% (n=1) of males and 60% (n=3) of females had a good
level of knowledge of the guidelines, 20% (n=1) of females had some knowledge and
20% (n=1) lacked knowledge. For respondents who over-consumed red meat 60%
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(n=3) of males and 100% (n=1) of females had some knowledge while 40% (n=2) of
males lacked knowledge.
Health outcomes related to red meat intake
Table 13: Over-consumption of red meat contributes to obesity
SAn %
An %
Nn %
Dn %
SDn %
Male 0 0 4 57 2 29 1 14 0 0Female
1 11 4 45 3 33 1 11 0 0
Total 1 6 8 50 4 25 2 13 0 0Respondents were asked whether they agree or disagree with the comment;
“Obesity can be linked to consuming red meat above recommended levels”. 57%
(n=4) of males agree that over-consumption of red meat contributes to obesity, while
14% (n=1) disagree with 29% (n=2) being neutral. For females 11% (n=1) strongly
agree with the statement while 45% (n=4) agree and 11% (n=1) disagree. 33% (n=3)
of females were neutral
Table 14: Over-consumption of red meat may increase the risk of developing bowel
cancer
SAn %
An %
Nn %
Dn %
SDn %
Male 1 14 1 14 4 57 1 14 0 0Female
2 22 5 57 1 11 1 11 0 0
Total 3 19 6 38 5 31 2 13 0 0Respondents were asked whether they agree or disagree with the comment; “Bowel
cancer can be linked to consuming red meat above recommended levels”. 14%
(n=1) of males and 22% (n=2) strongly agree that over-consumption of red meat
increases the risk of developing bowel cancer. Similarly, 14% (n=1) of males and
57% (n=5) agree with the statement. On the other side are 14% (n=1) of males and
11% (n=1) of females who disagree. 57% (n=4) of males and 11% (n=1) of females
are neutral.
22
Table 15: Over-consumption of red meat may increase the risk of developing colon
cancer
SAn %
An %
Nn %
Dn %
SDn %
Male 1 14 1 14 4 57 1 14 0 0Female
2 22 5 57 2 22 0 0 0 0
Total 3 19 6 38 6 38 1 6 0 0Respondents were asked whether they agree or disagree with the comment; “Colon
cancer can be linked to consuming red meat above recommended levels”. 14%
(n=1) of males and 22% (n=2) of females strongly agreed that over-consumption of
red meat may increase the risk of developing bowel cancer. 14% (n=1) of males and
57% (n=5) of females agree with the statement, while only 14% (n=1) of males
disagree. 57% (n=4) of males and 22% (n=2) of females were neutral.
Table 16: Red meat is necessary for muscle mass
SAn %
An %
Nn %
Dn %
SDn %
Male 1 14 4 57 1 14 0 0 1 14Female
3 33 6 67 0 0 0 0 0 0
Total 4 25 10 63 1 6 0 0 1 6Respondents were asked whether they agreed or disagreed with the comment; “red
meat in the diet is essential for muscle mass”. Both males and females perceived red
meat as being necessary for muscle mass with 14% (n=1) of males and 33% (n=3)
strongly agreeing, and 57% (n=4) of males and 67% (n=6) of females agreeing with
the statement. 14% (n=1) of males strongly disagreed while 14% (n=1) of males
were neutral.
Discussion
Objective
This study was designed to establish what level of understanding Western
Australian adults have of current Australian Dietary Guidelines (ADG), and whether
that level of understanding is related to the amount of red meat consumed each
week. This level of knowledge and weekly red meat intake was compared between
23
males and females. It was assumed individuals with a good understanding of the
ADG would have a weekly red meat intake within current recommendations.
Weekly red meat intake
Weekly red meat consumption was categorised as under-consuming, over-
consuming and healthy consumption. Generally speaking males appear to over-
consume with 72% of respondents consuming above 455 g (table 8), while females
on average had a healthier level of consumption with 69% consuming between 195 g
and 455 g of red meat each week (table 8).
These results are in line with current reports by the NHMRC (2013) which
state that the Australian population typically consumes red meat at the higher end or
above recommendations. Other studies also agree that males typically consume
more red meat than women with Wang & Beydoun (2009) reporting male weekly
consumption at 371 g per week, with females typically consuming 196 g per week.
While these figures are below our weekly red meat intake figures, they agree with
our findings that males typically consume more red meat than females.
Understanding of ADG
Although 100% of males and 89% of females had heard of the ADG (table
10), only 57% of males and 67% of females believed they had a good understanding
of the ADG (table 11). Similar studies have shown that 75% of English respondents
(Brown et al. 2011) and between 45% Keenal et al. 2002) and 58% (Brown et al.
2011) of American respondents have heard of the guidelines. While our results show
a higher percentage of respondents have heard of the guidelines, the number of
respondents who had a good understanding of the guidelines was similar. Our study
reports that 14% of males and 33% of females had a good understanding of the
guidelines, in comparison, only 13% of Americans surveyed were reported as
understanding the guidelines (Brown et al. 2011).
Comparison of individual intakes of red meat and corresponding knowledge of
the ADG show that 100% of males and 60% of females who consumed a healthy
level of red meat each week, also had a good knowledge of the ADG (table 12). For
24
individuals who over-consumed red meat, 60% of males had some knowledge of
guidelines while 100% of females also had some knowledge of the guidelines. The
concerning result were with females who under-consumed red meat with 100%
lacking knowledge of the ADG (table 12). Interestingly, 100% of respondents who
had a good knowledge of the ADG had a healthy level of red meat consumption.
These results confirm a possible link between understanding of the guidelines and
red meat intake. While further investigation is needed to provide statistically
significant results, it appears that a good knowledge of the ADG may influence
individuals to consume a healthy level of red meat each week.
Knowledge of health outcomes related to red meat intake
There were several worrying results from the questions relating to knowledge
of the health outcomes related to red meat intake. Of particular concern was the
100% of females and 71% of males who either agreed or strongly agreed that red
meat is necessary for muscle mass (table 16). The key requirements for muscle
mass are adequate energy intake, dietary protein and the body’s ability to synthesise
muscle tissue (Williams et al. 2013). While red meat is a good source of dietary
protein (NHMRC, 2013), there are several other adequate sources of protein, these
include other meat sources such as poultry and fish, and non-meat sources such as
eggs, beans, legumes and grains (NHMRC, 2013). These non-red meat alternatives
can adequately provide the nutrients required to synthesise lean muscle tissue for all
individuals, no matter what their individual requirements are (Williams et al. 2013).
These responses to the requirements of red meat for muscle size and strength are in
line with similar studies by Lea & Worsley (2001) who reported a common response
by individuals who regularly consume red meat was the requirement for strength and
a perception of vegetarians as lacking masculinity.
Other concerns include 14% of males and 11% of females who disagree that
the over-consumption of red meat contributes to bowel cancer, while 14% of males
disagreed that over-consumption of red meat contributes to colon cancer.
Consumption of red meat below 455 g each week has been shown to be safe
(Cancer Council of Australia, 2009; Williamson et al. 2005), whereas consumption
above 455 g per week has been linked with both bowel and colon cancer (Burki,
25
2012; Cancer Council of Australia, 2009; Cancer Council of Australia, 2014; World
Cancer Research Fund, 2014). The lack of understanding of the health outcomes
related to red meat intake highlight the need for further public education of both the
positive and negative aspects of consuming red meat. Similarly, the tendency of
individuals with a good understanding of the ADG to consume red meat within
recommendations, shows the potential health related benefits of increased
promotion of the guidelines to the general public.
Strengths and limitations
The limitations of the study include the recruitment method. While the
recruitment method was convenient for piloting the study, the sample is not
representative of the population and cannot be generalised to the population
(Bryman, 2012). While the number of male and female respondents were
approximately equal, a greater spread of age groups, education level and ethnicities
should be utilised in future studies to provide a better representation of the Western
Australian population.
The sample size is also inadequate for providing a statistically significant
result (Bryman, 2012). Future studies should utilise power calculations to determine
a minimum sample size to provide statistically significant results (Bryman, 2012).
Other limitations include the use of a self-administered questionnaire. While
this form of questionnaire is useful for collecting data from large populations and for
cross-sectional studies (Bryman, 2012), the data may not be considered as reliable
due to possible misunderstanding of questions and without an interviewer to probe
for answers or clarify any confusion (Bryman, 2012).
The strengths of the study include the use of close ended questions for easy
analysis and the short duration of the questionnaire to reduce respondent burden
(Bryman, 2013). Other strengths include the use of a cross-sectional study design to
allow for cheap and easy collection of data from a large population (Bryman, 2012).
26
Reflection
There were several difficulties encountered while completing this research
project, including difficulties formulating research questions, developing the survey
and writing a thorough literature review. As this was the first research project I have
developed, most of the content was completely new to me. The thought process
involved in developing the research aim and research questions was completely
different to what I am used to and I found it far more difficult than other university
projects.
Heading in to this study I understood the difficulties associated with research
projects, however, I found the entire process far more tedious than I believed it
would be. The constant iteration was very frustrating, but the improvements this
process made to the overall project was very satisfying. In general, the actual
process was more difficult than I expected, but very satisfying when completed. I feel
like this has been the most difficult unit I have studied at university and also the most
satisfying to complete.
In the future I would like to be involved in further research projects. My plan is
to complete my undergraduate health science degree, complete my masters of
nutrition and dietetics then move into the field of sports dietetics. In this field it is my
intention to be involved in clinical sports nutrition research working with athletes to
improve performance through diet and dietary supplements.
27
References
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Australian Bureau of Statistics (2012). 3235.0 - Population by Age and Sex, Regions
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ures~Western+Australia?OpenDocument
Australian Institute of Health and Welfare. (2012). Australia’s food & nutrition 2012.
Canberra: Australian Institute of Health and Welfare
Ball, K., Mishra, G. D., Thane, C. W., & Hodge, A. (2004). How well do Australian
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Beardsworth, A., & Bryman, A. (2004). Meat consumption and meat avoidance
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Burki, T. K. (2012). End of the road for red meat? Lancet Oncology, 13(4), 147.
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Edith Cowan University [ECU]. (2010). Conduct of ethical human research.
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Hawk, D. (2014). HST2122 Lecture notes. Retrieved from Edith Cowan University,
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30
Appendix 1: Data collection instrument
Questionnaire
Thank you for participating in this research study. This questionnaire will help identify
the understanding of the Australian Dietary Guidelines and red meat consumption.
Instructions:
The following questionnaire contains a total of 22 questions spread across 4
sections entitled demographic questions, red meat weekly consumption,
understanding of Australian Dietary Guidelines and health outcomes related
to red meat consumption.
Please complete all 22 questions by placing a tick in the box corresponding to
your response.
Demographic questions
1. Which gender are you? (please circle corresponding number)
1. Male
2. Female
2. Which of the following age categories represents you? (please circle
corresponding number)
1. 18-342. 35-543. 55-744. 75+
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3. What is your marital status? (please circle corresponding number)
1. Never married2. Married/de facto3. Divorced4. Widowed5. Other (Please specify):
4. What is the highest level of education have you achieved? (please circle
corresponding number)
1. Did not finish year 122. Year 123. Vocational training/TAFE4. University undergraduate5. University postgraduate
5. Employment status? (please circle corresponding number)
1. Part time2. Full time3. Retired4. Unemployed5. Other (Please specify):
32
6. Which of the following ethnicities do you identify with? (please circle
corresponding number)
1. Australian2. Aboriginal/TSI3. Asian/Pacific Islander4. UK & Ireland5. African6. European7. American8. Other (Please specify):
7. Residential post code? (please specify below)
1. _____
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Red meat weekly consumption
8. On average how many times a week do you consume red meat? (please specify
below)
1. _____
9. What is your average red meat portion size in grams? (please circle
corresponding number)
1. 0-75 g2. 76-150 g3. 151-225 g4. 226-300 g5. 301+ g6. Unknown (Please answer question 9.A below
9.A. If unknown, please circle which diagram best represents your
average red meat portion size?
1. 2.
3. 4.
(Images from San Francisco examiner. November 16, 2012)
34
10. What do you believe best describes your red meat intake? (please circle
corresponding number)
1. Under consume2. Healthy consumption level3. Over consume
11. Which of the following best describes the reasons for your red meat
consumption? (please circle corresponding number)
1. For health
2. Enjoyment/taste
3. To feel full
4. Don’t eat red meat
5. Other (Please specify):
35
Understanding of Australian Dietary Guidelines
12. Have you heard of the Australian Dietary Guidelines? (please circle
corresponding number)
1. Yes2. No
13. Would you say you understand the Australian Dietary Guidelines? (please circle
corresponding number)
1. Yes
2. No
3. Unsure
14.Which of the following are examples of current Australian Dietary Guidelines?
(please circle corresponding number for all that apply)
1. Enjoy a wide variety of nutritious vegetables of different types and colours, and legumes/beans every day.
2. Limit your intake of carbohydrates such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley.
3. Limit your intake of lean meat and poultry, fish, eggs, and/or plant based alternatives.
4. Adults should aim to consume 2.5 serves each day of milk, yoghurt, cheese, and/or their alternatives, mostly reduced fat.
5. Limit intake of foods and drinks containing added sugars such as confectionary, sugar-sweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and sports drinks.
36
15.Which of the following is the current recommendations for daily serves of lean
meat, poultry, fish, eggs and/or plant based alternatives? (please circle
corresponding number)
1. 0-1 serves2. 2-3 serves3. 4-5 serves4. 6+ serves5. Unsure
16.Which of the following is considered as red meat according to the Australian
Dietary Guidelines? (please circle corresponding number for all that apply)
1. Beef2. Chicken3. Pork4. Lamb5. Veal6. Fish7. Shellfish8. Duck9. Goat10. Kangaroo11. Turkey
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17.What is stated in the Australian Dietary Guidelines as the size of one serve of
lean red meat? (please circle corresponding number)
1. Less than 65 g2. 65 g3. 100 g4. 135 g5. 170 g6. 205+ g7. Unsure
18.What, if any, is the maximum number of serves of red meat suggested by the
Australian Dietary Guidelines? (please circle corresponding number)
1. No recommendation2. 3 serves3. 7 serves4. 11 serves5. 15 serves6. Unsure
38
Health outcomes related to red meat consumption
19. Red meat has been shown to be a good provider of which of the following
nutrients? (please circle corresponding number for all that apply)
1. Protein2. Carbohydrate3. Fatty acids4. Vitamin A5. Vitamin D6. Vitamin E7. Vitamin K8. Iron9. Niacin10. Riboflavin11. Zinc12. Vitamin B1213. Magnesium14. Calcium15. Unsure
39
Please evaluate the following statements by circling the number
corresponding to how you feel about each comment:
20. The following conditions can be linked to consuming red meat above
recommended levels:
Condition Strongly Agree
Agree Neutral Disagree Strongly Disagree
1. Obesity 1 2 3 4 5
2. Bowel Cancer 1 2 3 4 5
3. Asthma 1 2 3 4 5
4. Colon Cancer 1 2 3 4 5
6. Arthritis 1 2 3 4 5
7. Prostate Cancer 1 2 3 4 5
21.Red meat in the diet is essential for the following :
Conditions Strongly Agree
Agree Neutral Disagree Strongly Disagree
1. Muscle Size 1 2 3 4 5
2. Muscle Mass 1 2 3 4 5
3. Muscular Endurance
1 2 3 4 5
4. Brain Function 1 2 3 4 5
5. Heart Health 1 2 3 4 5
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22.The following conditions can be improved by the regular consumption of red meat
within Australian Dietary Recommendations:
Conditions Strongly Agree
Agree Neutral Disagree Strongly Disagree
1. Anaemia 1 2 3 4 5
2. Asthma 1 2 3 4 5
3. Muscle wastage 1 2 3 4 5
4. Iron Deficiency 1 2 3 4 5
5. Arthritis 1 2 3 4 5
Thank you for your time
41