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Running Header: Nutrition Intervention in Lao Nadi 1

Nutrition Intervention in Lao Nadi

Lucy Aranda, Mackenzie O’Brien, Elsa Weltzien, Veronica Thao, and Michael Marino

Khon Kaen University

Introduction

Basic health and nutrition research was conducted in the railroad slum community of Lao

Nadi, located in Khon Kaen, Thailand. Lao Nadi is comprised of 151 households and has a


population of 238 people. Data gathered from 30 semi-structured interviews was used to guide

the development of a health and nutrition intervention in the community. Based on previous data

collection in Lao Nadi it was found that diabetes, hypertension, and obesity are among the most

common diseases that affect adults. In our research proposal we posed the following questions:

(1) What are the top five dietary trends among the Lao Nadi community; (2) How do they affect

villagers’ nutritional status; (3) What are some factors in diet that contribute to hypertension,

diabetes, and obesity? We hypothesized that excessive consumption of unhealthy sugar, salts,

and fats contribute to their poor health. After sampling 30 participants from Lao Nadi, aged 30

years or older, we made three significant conclusions that answer our proposed research

questions. First, the top five foods and drinks consumed by the community are white rice, sticky

rice, stir-fried dishes, noodles/soups, and “3-in-1” instant coffee drink. Second, we believe that

these foods may have an affect on the high rates of hypertension, diabetes, and obesity in the

community. To be exact, 14 of the 30 participants are currently diagnosed with hypertension,

diabetes, and/or heart disease. Third, we discovered that nutritional information is either limited

or not available to community members. Due to these issues the intervention will consist of a

one-hour information session that focuses on the top 5 consumed foods, portion control,

alternative food options, hypertension/diabetes/heart disease, the Thai Nutritional Flag, and meal

planning. The Thai Food based Dietary Guidelines and Nutritional flag, developed by the Food

and Agricultural Organization and World Health organization, will be used as guides throughout

this session. The information session will be funded by the CIEE organization, details of the

budget will be discussed in the budget session below. The goal of the information session will be

to provide the Lao Nadi community with a nutritional health session that is informative and

interactive. Ultimately, it should encourage community members to find solutions to improve


the nutritional health status of their community. To assess the success of the intervention,

researchers will conduct a post-intervention follow-up focus group.

Data Results

The results obtained through the semi-structured research interviews highlight several

unhealthy nutrition trends in the Lao Nadi community. The participants interviewed were

selected at random and each individual was at least 30 years old. The average age of the

participants was 49.4 years old. Overall, 10 males and 20 females were interviewed for a total of

30 participants. The researchers did not set a cap on the number of males and females they

wanted to participate in the interviews. This allowed numerous individuals to participate and data

was collective of the whole community.

To begin, participants were asked, “Where do you purchase your food ingredients?” The

responses to this question, shown in Figure 1, indicate that 71%, the vast majority, of Lao Nadi

villagers purchase their food at the downtown market, named “Thalad Ban Lampoo”. Villagers

indicated that they sometimes purchased pre-prepared food to eat at meal times, in addition to the

fresh cooking ingredients available. The second most common place to buy food items was the

Tesco Lotus supermarket. In order to better understand the food options available to villagers as

well as the associated costs at “Thalad Ban Lampoo”, the researchers took a trip to the market.

The market had a plethora of food items for sale ranging from fresh fish, turtles, and pork to

bitter melon, sticky rice, and tamarind. Drawing upon the researchers’ prior knowledge of certain

food costs, the ingredients were deemed to be inexpensive at around 30 Baht for fruits,

vegetables, rice, and fish. After the trip to the market, the researchers concluded that the villagers

do have access to an incredible variety of healthy food options, however the unhealthy cooking


methods prominent in Lao Nadi likely undermine the potential health benefits of the raw

ingredients.

FIGURE 1. Common food purchasing markets.

Next, results indicate that the top three health problems in Lao Nadi are hypertension

affecting 27% of participants, diabetes affecting 10% of participants, and heart disease affecting

10% of participants. Research done by Taechangnam et al. (2008) emphasizes that a balanced

diet is essential for maintaining good health and highlights a connection between nutrition and

chronic illnesses (p. 1). A successful intervention focused on proper nutrition could potentially

cut down on the rates of disease in current and future generations of Lao Nadi community

members.

Researchers proceeded to ask villagers about their daily diets to gain a better

understanding of the nutrition situation in Lao Nadi. The semi-structured interviews collected

information on what villagers ate and drank for breakfast, lunch, dinner, and snack. First, the top

four snack trends included eight participants eating fruit, seven participants eating nothing, seven

participants eating bread, and four participants eating potato chips. A high percentage of the

responses to the snack question can be placed under the category of processed foods, which are


often unhealthy. When villagers are thirsty, common drink trends included 19 participants

drinking water, six participants drinking soda, and four participants drinking coffee. SEE

FIGURE 2. Soda and coffee are not healthy drink options to quench thirst due to high amounts of

sugar.

Next, for breakfast, the top three drinks were coffee, water, and milk. The results indicate

that 50% of survey participants drink coffee for breakfast. This is of interest to researchers

because the coffee consumed is an high in sugar “3-in-1” powder mix comprised of 70% non-

dairy creamer. Researchers also discovered that 30% respondents did not eat anything for

breakfast. This is a concern for researchers because a nutritious breakfast is an essential

component of a healthy diet. In addition to “nothing,” the next two most popular responses for

breakfast food included white rice, and stir-fried vegetables.

FIGURE 2. Responses to “What do you have for snack?” and “What do you drink?” respectively.

The research was continued by asking participants what they ate and drank at lunchtime

and dinnertime. At lunchtime, the top three foods consumed include som tom, sticky rice, and

white rice, eaten by 17, 14, and 12 villagers, respectively. Vegetables are also a common

lunchtime food choice and 53.8% participants stir-fry their vegetables. Lunchtime protein

sources included pork and chicken, eaten by 47% of participants. Just like vegetables, these


meats are most commonly stir-fried. Noodle soups were consumed by 13 participants. Water was

the most common drink, consumed at lunchtime by 63% of participants, while 20% of

participants drank soda making it the second most popular drink.

The foods eaten at dinnertime were very similar to the lunchtime foods. Meals are

centered around white rice, eaten by 19 participants, and sticky rice, eaten by 14 participants.

Vegetables remained a popular response and the percentage of people who stir-fried their

vegetables drastically increased, going from 53.8% at lunchtime to 76.5% at dinnertime. 62.5%

of the pork and 37.5% of chicken consumed was stir-fried. Another 37.5% of the chicken

consumed is fried. One more popular dinnertime protein is fish, which villagers usually steam,

boil, or grill, accounting for 78% responses. Lastly, noodle soups are consumed for dinner by

30% of surveyed participants.To conclude the food-related portion of the semi structured

interviews, participants were asked about their biggest meal of the day. Breakfast was chosen by

15.4% of participants, lunch was chosen by 30.8%, and 53.8% of participants chose dinner.

In order to gauge the villager’s current knowledge about nutrition, villagers were asked

who taught them about nutrition. Of the total interviewees 16 villagers indicated that nobody has

taught them about nutrition and eight villagers said that they learned from their doctor. Often

times, the villagers taught by a doctor had to go to visit their doctor regularly because they suffer

from a chronic disease like hypertension. When asked if nutrition is taught in school, 67% of

villagers said “Yes”, 30% said “I don’t know,” and 3% of villagers responded “No.” SEE

FIGURE 3. The results from this question led the researchers to conclude that nutrition is taught

in school. It is promising that nutritional education is part of the local school curriculum.

Villagers that responded “I don’t know,” did not have children at home and the one who

responded “No”, was very elderly and perhaps did not have nutrition education when he was in


school. Further supporting the claim that nutrition is taught in school is the fact that during one

interview, the interviewee asked her child if he learned about nutrition in school and he

responded “Yes.”

Finally, villagers were asked if they learned about nutrition in Lao Nadi. The villagers

responded “no”, “yes”, and “I don’t know” at a rate of 53%, 37%, and 10%, respectively. SEE

FIGURE 3. The fact that 37% of villagers have learned about nutrition in the community

indicates that the resources are available. It could be that the 63% who said “No” or “I don’t

know” do not know how to take advantage of the nutrition information available in Lao Nadi, or

they have never tried. The researchers believe the residents of Lao Nadi could benefit from a

nutrition-related community health intervention.

FIGURE 3. Responses to “Is nutrition taught in school?” and “Do you learn about nutrition in Lao Nadi?” pictured left and right, respectively.

Intervention Plan

According to the results from the semi-structured interviews, the top 5 foods and drinks

consumed in Lao Nadi are white rice, sticky rice, soda/coffee, som tum and stir-fried dishes. The

top three chronic diseases that were prevalent among the community members interviewed were

diabetes, hypertension and heart disease. As part of the nutrition intervention to be implemented

in the community, the students plan to present their findings and address the health risks of


eating/drinking too much of these five popular foods and drinks, as well as, the basic information

on the three mentioned diseases.

The intervention will be broken up into multiple sections to keep participants engaged

and interested while at the same time, remaining an effective way to help educate people on

nutrition. The first hour of the intervention will be a nutritional information session to provide

basic information on nutrition and healthy eating behaviors. This information session will be the

time where students address the health consequences of eating foods and drinking drinks from

the top five dietary trends found in Lao Nadi to excess, as well as discuss the issues surrounding

diabetes, hypertension, and heart disease as dietary diseases. Students will present information

on healthy portion size, alternative options for unhealthy snacks, the importance of not skipping

meals, drinking plenty of water throughout the day, keeping alcohol consumption to a minimum,

etc. The information session will also include an overview of the Thai nutrition flag.

Once the information session is completed, students will assist participants in planning

out a week-long healthy menu to demonstrate the feasibility of a healthy diet and to encourage

participants of behavior change. Also, intervention leaders will provide healthy samples of foods

and drinks to participants during the intervention in an effort to encourage them to choose those

options over unhealthier options the next time they are at the market purchasing food.

Finally, to make this intervention sustainable after the students have left the community,

the students plan to leave a list of 100 nutritional fun facts, for the headman to read out to the

community over his loud speaker at regular intervals. As a result, the information will be

distributed to the community as a whole and it can be a way to help people make health

conscious decisions for a better life.

Goals of the Intervention


Nutrition is a vast topic with many avenues, so it is important that researchers keep in

mind certain goals that can help them stay on track during this intervention. Producing goals

allows the researchers to see what is feasible in Lao Nadi and then successfully implement that

plan. Similarly, the first goal was to refer to the previous research findings when planning this

intervention. The researchers looked at collected data, saw trends, and created a plan that targets

the dietary trends that we uncovered. Next, the second goal is to keep in mind the community’s

own traditional cooking style. This means that the researchers may not be able to address

alternative cooking methods to deep frying and stir frying because these methods are so

ingrained into individual’s lives. The goal is to know that some things cannot be changed and the

researchers must plan around this. In addition, the third goal is to educate the community about

portion sizes. This alternative intervention plan keeps in mind that the consumed foods cannot be

limited. Instead villagers will be taught about how much of those foods they should eat daily.

Next, the fourth goal goes hand in hand with the third goal. It is to offer the Lao Nadi’s

community alternative ingredients. This will be done by educating villagers about ingredients

that are similar to ones that they use, but are healthier. For example, the researchers have set out

to introduce samples of healthier instant coffee. Members of the Lao Nadi community drink “3-

in-1” coffee, which has a drastically higher sugar content than other instant coffees. With this

goal the researchers would also like to show them healthier oils to use when frying dishes. This

goal ensures that the researchers are respecting their dietary habits, but showing them small ways

to make these habits healthier. Additionally, a fifth goal is to inform the community members

about dietary diseases and the importance of maintaining a healthy diet. This goal will educate

the community about diseases such as diabetes, hypertension, and heart disease and enables the

researchers to connect an unhealthy diet with such diseases. Lastly, the sixth and final goal is to


successfully work together amongst the research group and with the Lao Nadi community to

listen to their preferences and consequently respond to their needs. This goal is collective of the

whole intervention. The researchers would like to make an impact on the majority of

participant’s dietary habits. Since cooking and nutrition are often passed down to future

generations it would be the hope of the researchers that some households keep in mind the

nutritional information offered.

Timeline

The timeline for this intervention will be divided into two sections: one timeline for the

preparation of the intervention and another for the actual intervention. After approval of this

proposal, finalization and revision of the step-by-step intervention plan will be finished by

Sunday, December 1st. Materials to be translated and printed will be submitted by Friday,

November 29th. The group will practice the intervention amongst themselves on Sunday to

prepare for a formalized run-through on Monday, December 2nd. The materials needed for the

intervention will be collected over the weekend so that it can be determined if anything last-

minute items are needed during the run-through on Monday. The intervention will occur on the

afternoon of Tuesday, December 3rd, with a debriefing session as a group to occur afterwards. A

formal debrief session with the Ajaans will occur the next day, December 4th.

On the day of the intervention, the van will leave CIEE for Lao Nadi at 3:30 pm and will

arrive in the community at approximately 3:45-3:50 pm. Next, the group will set up for the

intervention in the community meeting space and prep the translator. The intervention will begin

at 4:30 with a welcoming of the participants followed by an information session that will last

approximately one hour. The information session will be divided into three sections lasting

approximately 15-20 minutes. The first will be about the top five foods consumed in the


community and associated risks and consequences, as well as portion control information. The

second component focuses on basic information about hypertension, diabetes, and heart disease.

Finally, the Thai Nutrition Flag will be explained to the participants as an introduction to a

balanced diet. Examples of fun facts about nutrition will also be told to the participants. The

information session will end with a few minutes for questions. A 10-minute break will be given

before the second component of the intervention, which is an interactive meal planning activity.

40 minutes will be allotted for this activity. The first 5-10 minutes will be spent explaining and

clarifying any questions about the activity, then the participants will be given 30 minutes to plan

a week’s worth of balanced meals. After this activity, the participants will be thanked for their

participation in the afternoon’s intervention and will end with an evaluation of the intervention in

the form of a 10-15 minute discussion of what was learned. As the participants leave, they will

be handed gift bags with samples of healthier instant coffee and cooking oils. The day will end

with thanking the headman and cleanup of the intervention space. Finally, the group will debrief

amongst themselves about the intervention before leaving the community.

Budget

A maximum budget of 9,997 Baht is provided for the purpose of this intervention. A

maximum budget of 4,950 Baht will be allocated for refreshments, snacks, and a gift.

Transportation is expected to be 700 Baht. Translation of materials and translation during the

intervention will cost 1,300 Baht. The remaining maximum of 3,047 Baht will be used for

materials to be used during implementation of the intervention. These items include posters,

handouts, templates for an activity, and samples for the adult participants.

Materials


Materials needed include bowls, plates, spoons, and rice for educational purposes to show

the actual size of correct portion sizes. Small versions of the Thai Nutritional Flag will be cut and

laminated to hand out to the participants so they can keep them at home. Templates for creating a

weekly menu will be printed for the participants to fill out during an activity. Gift bags with food

samples will be handed out at the end of the intervention session and will tentatively consist of a

healthier alternative to “3-in-1” instant coffee and a healthy oil that can be used for cooking.

Water and refreshments will also be provided for the participants and translator.

Budget

Transportation – 700 Baht

Translation of printed materials (poster and menu templates) – 800 Baht

Translation during intervention – 500 Baht

40 menu templates printed (in color) - 280 (B/W)

40 Nutrition flags printed and laminated - 1500 Baht

Printing of poster - 1000 Baht

Printing of schedule and plan for our group (1 Baht/page) - 25 Baht

40 pens - 6 baht each - 240 Baht

Utensils/plates/bowls for example portion sizes - 12 baht small/25 baht large.

Rice for portion size demonstration - 25 Baht/kilo

Gift for Lao Nadi headman - 800 to 2000 Baht

Ideas: whiteboard (1500 Baht), electric fan (800 Baht), charcoal grill (2000 Baht)

Food for 50 people (participants + translator + us) - 2 Fruit Platters - 600 to 1000Baht

Water for 50 people (participants + translator + us) – 350 Baht

40 samples of instant coffee – 25 Baht each - 1000 baht


40 small bottles oil - 600 Baht

Anticipated Outcomes

The goal of the intervention is to improve community members’ overall knowledge on

nutrition and the risks of unhealthy eating behaviors. Participants of the intervention will be

provided information on the nutrition flag, dietary diseases and ways to maintain a healthy diet.

It is the goal of the students to leave the community with a sufficient amount of information

needed to help people make health conscious decisions next time they are shopping for

ingredients or meals. By the end of the intervention, participants should have a plan for a week-

long menu of healthier food to prepare for themselves and their families that they hopefully will

follow. The headman will be left with a list of nutrition facts that he can read out frequently in a

while over his loudspeaker so that the intervention will not be forgotten and community

members will keep the importance of nutrition in mind. The overall outcome goal is to help

community members live healthier lives by making small but very valuable modifications to

their diets.

References

Taechangam, S., Pinitchun, U., Pachotikarn, C. (2008). Development of nutrition education tool:

healthy eating index in Thailand. Asia Pacific Journal of Clinical Nutrition, (17) 1, 365-367.

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