17.2 Designing a Nutrition Education Program and Measuring Customer Satisfaction
Key Takeaways
Program design starts with an audience analysis, often a knowledge, attitude, and practice (KAP) survey or focus group discussions, to find the behaviors and barriers to address.
Materials are pretested with the intended audience for comprehension, attractiveness, acceptability, self-involvement, and persuasion before mass production.
A lesson plan states the objectives, content, methods, materials, time allotment, and evaluation for each session.
Customer satisfaction can be measured with Likert-scale questionnaires, facial hedonic scales for young children, comment cards, interviews, and plate waste observation.
A satisfaction rate is the number of respondents rating a service as satisfied or very satisfied divided by all respondents, multiplied by 100.
The table of specifications asks examinees to design a nutrition education program and to select and design tools that measure customer satisfaction. Planning theory, SMART objectives, and evaluation types are covered in the program planning and evaluation section; this section applies them to education programs.
Steps in Designing a Nutrition Education Program
| Step | Activities | Example: anemia education for adolescent girls |
|---|---|---|
| 1. Assess needs and analyze the audience | Review data; conduct a KAP survey, FGDs, or interviews | Survey shows low intake of iron-rich foods and myths about iron tablets |
| 2. Select priority behaviors | Choose a few specific, doable behaviors | Eat an iron-rich food daily; take weekly iron-folic acid as advised |
| 3. Identify determinants | Use theory (Health Belief Model, Social Cognitive Theory) to find barriers and motivators | Girls fear weight gain from tablets; peers influence snacks |
| 4. Write objectives | SMART objectives at behavior and learning levels | By March, 70% of girls in Grades 7-10 will report eating an iron-rich food daily |
| 5. Develop key messages | Short, positive, action-oriented messages | "Malunggay at isda, panlaban sa anemia" (malunggay and fish against anemia) |
| 6. Choose methods and channels | Match to audience and resources | Classroom sessions, peer educators, social media posts |
| 7. Develop and pretest materials | Draft, test with the audience, revise | Posters and short videos tested with 20 girls |
| 8. Plan implementation | Schedule, staff, budget, venue, partners | Work with school nurses and teachers |
| 9. Monitor and evaluate | Process, outcome, and impact indicators | Attendance, knowledge scores, reported intake, hemoglobin |
The Lesson Plan
Each session should have a written plan with:
- Topic and target audience
- Objectives stated with action verbs (list, explain, prepare, choose)
- Content outline with key messages
- Methods (discussion, demonstration, games)
- Materials and teaching aids
- Time allotment for each activity
- Evaluation (questions, return demonstration, short quiz)
Action verbs by domain: cognitive (identify, list, explain, compare); affective (express, choose, value, support); psychomotor (prepare, measure, demonstrate, cook).
Pretesting Materials
Pretesting checks draft materials with members of the intended audience before final production. Common components:
| Component | Question asked |
|---|---|
| Comprehension | Do people understand the message as intended? |
| Attractiveness | Does the material catch attention? |
| Acceptability | Is anything offensive, embarrassing, or culturally inappropriate? |
| Self-involvement | Do people feel the message is meant for them? |
| Persuasion | Does it convince them to try the behavior? |
Methods include individual interviews and focus groups. Revise and retest if comprehension is low.
Common problems found during pretesting:
- Technical words such as "micronutrient" or "anemia" that the audience does not use; replace them with everyday terms in the local language.
- Pictures that do not look like local people, homes, or foods, which reduce self-involvement.
- Too many messages on one poster, so the main action gets lost.
- Colors or symbols with unintended meanings in the community.
- Small print that older adults cannot read.
Measuring Learning and Behavior Change
- Knowledge: pretest and posttest questionnaires.
- Attitudes: Likert-type statements (strongly agree to strongly disagree).
- Skills: return demonstrations scored with a checklist.
- Practices: 24-hour recalls, food frequency checklists, observation, or records (such as iron-folic acid intake cards).
- Nutritional outcomes: weight, height, hemoglobin, depending on the program.
Example of a knowledge gain calculation. The mean pretest score is 12 out of 20 and the mean posttest score is 17 out of 20. The gain is 5 points, which is 5 ÷ 12 × 100 ≈ 42% above the baseline score.
Tools to Measure Customer Satisfaction
Satisfaction data guide improvements in education sessions, counseling, school feeding, hospital meals, and cafeterias.
| Tool | Best use | Design tips |
|---|---|---|
| Questionnaire with a Likert scale | Adults rating services on 4- or 5-point scales | Short; clear single-idea items; anonymous; include open comments |
| Facial hedonic scale | Young children or low-literacy respondents rating food | Use 3-5 faces from unhappy to happy; explain with an example |
| Comment cards and suggestion boxes | Continuous feedback in cafeterias or clinics | Easy to fill; respond visibly to suggestions |
| Interviews | Patients in hospital wards; in-depth feedback | Use trained, neutral interviewers |
| Focus group discussions | Exploring reasons behind ratings | Homogeneous groups of 6-10 |
| Plate waste observation | Food acceptance in schools and hospitals | Weigh or visually estimate leftovers |
| Complaint logs and mystery shoppers | Monitoring service quality | Track trends and corrective actions |
Steps in designing a satisfaction tool:
- Define what to measure: food quality, temperature, portion size, staff courtesy, timeliness, cleanliness.
- Choose the format suited to the respondents.
- Write clear items and a balanced response scale.
- Pretest with a small group and revise.
- Decide sampling, timing, and how results will be reported and acted on.
Satisfaction rate. Out of 250 patients surveyed, 190 rate the meals as "satisfied" or "very satisfied". The satisfaction rate is 190 ÷ 250 × 100 = 76%. Comparing results over time, and by item, shows where to act; for example, low ratings on food temperature point to problems in tray assembly or delivery.
Before printing 5,000 posters, an ND shows draft posters to 15 mothers and asks what each one means to them. Which pretesting component is the ND mainly checking?
Persuasion
Comprehension
Attractiveness
Acceptability
A school feeding coordinator wants Kindergarten pupils to rate the taste of a new vegetable dish. Which tool is most appropriate?
A written 10-item Likert questionnaire
A key informant interview with the school principal only
A food frequency questionnaire
A facial hedonic scale with smiling and frowning faces
Out of 320 cafeteria customers surveyed, 224 rate the service as satisfied or very satisfied. What is the satisfaction rate?
60%
64%
70%
76%
Sections you finish are checked off in the contents.