- Title
- Development of a culinary nutrition education program for adults with mild-to-moderate intellectual disability
- Creator
- Asher, Roberta Callista
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2024
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- People with intellectual disability experience higher diet-related disease risk and on average have a 20-year shorter life expectancy than people without disability. This risk is in part amenable to diet and lifestyle change. Culinary nutrition programs teach healthy food provision and cooking skills and are an emerging area of diet-related health promotion to optimise dietary patterns, wellbeing, and reduce the burden of diet-related chronic disease. Different populations experience unique modifiable and non-modifiable personal, social, cultural and environmental influences on cooking behaviour. To create culinary nutrition programs that are effective in modifying healthy cooking behaviour, and ultimately health outcomes, there is a need to understand and address influences on healthy cooking most relevant to the target population and align curricular with healthy eating recommendations outlined in food-based dietary guidelines (FBDGs). However, there were no models to guide cooking program developers to develop, implement and evaluate healthy domestic cooking education programs. Influences on healthy cooking behaviour are particularly relevant in people with intellectual disability, who are a highly heterogenous population with a wide range of abilities, and who experience unique challenges that can be both intrinsic to the disability and created by broader society. People with intellectual disability experience multiple barriers accessing mainstream nutrition-based health promotion. To support program relevance and uphold the rights of people with intellectual disability health promotion created in partnership with people with intellectual disability is recommended. However, few culinary nutrition programs for people with intellectual disability exist, and there are none that have been created and delivered with and for people with intellectual disability in the Australian context using inclusive research or co-design principles. Therefore, my thesis aimed to address the overarching question “Can a culinary nutrition education program for adults with intellectual disability be feasible, acceptable and lead to changes in diet related health and wellbeing?” My thesis begins with the creation of the Cook-EdTM model, an eight-stage model that guides cooking program developers through the stages of healthy domestic cooking program development, implementation and evaluation, and to recognise factors that influence cooking behaviour, dietary and health outcomes. The PRECEDE-PROCEED model provided the underlying framework for the Cook-EdTM model. Existing literature informed the initial draft of the model which was created in an iterative collaborative process with an international team of experts in domestic cooking and nutrition research and education. As the Cook-EdTM model was being created the need for a tool to prioritise and align cooking education curricular with recommendations outlined in FBDGs was identified. This led to the creation of the Cook-EdTM matrix which was again created by an international team of experts in domestic cooking and nutrition research and education using a modified e-Delphi process. Common food groups included in international food-based dietary guidelines formed the basis of the matrix which contains 117 skill focus points for kitchen safety, food safety, general cooking and food skills, and food group specific cooking and food skills. The Cook-EdTM model and Cook-EdTM matrix were then used to guide development of a culinary nutrition intervention for adults with mild-to-moderate intellectual disability. The need for the culinary nutrition program was identified by a disability service provider. Collaboration with the disability service provider, an academic research team, and two co-researchers with intellectual disability, following inclusive and co-design research principles, led to the creation of the Food and Lifestyle Information Program (FLIP) and pilot study to evaluate the feasibility and acceptability of FLIP. A pre-program consultation survey of 16 disability support workers informed the first draft FLIP program, which was refined in a pre-pilot with co-researchers with intellectual disability. Recognising that people with intellectual disability have diverse abilities, and the potential to experience unique barriers to participation in FLIP, drawing on the field of occupational therapy, a cooking task analysis tool (FLIP-CTAT) was developed to objectively assess cooking performance. The International Classification of Functioning (ICF) and existing cooking task analysis tools informed the FLIP-CTAT and administration protocol. FLIP-CTAT assessed performance in a cooking task at the commencement and conclusion of FLIP, enabling FLIP facilitators to tailor FLIP components to the unique abilities and learning needs of FLIP participants, and potentially assess performance at completion of FLIP. The final stage of the thesis describes the FLIP pre-post pilot study which evaluated the feasibility and acceptability of FLIP in eight participants who attended in two groups. Co-researchers with intellectual disability attended FLIP sessions enabling iterative refinement of the FLIP curriculum. Results indicated that FLIP was feasible, well-received, and had high engagement rates. Areas to improve the FLIP intervention for future trials were identified. The studies outlined in this thesis represent a comprehensive approach to the development of an inclusive culinary nutrition program for people intellectual disability. The research addresses a gap in the literature regarding culinary nutrition interventions that have been created with and for people with intellectual disability. Findings can inform further work to establish the effectiveness of the FLIP culinary nutrition program and can be used to guide inclusive and tailored cooking and nutrition education that meet the diverse needs of the people they serve. This has implications for diet-related health of people with and without intellectual disability, community cooking and nutrition educators, allied health professionals and National Disability Insurance Scheme service providers.
- Subject
- culinary nutrition; diet; health promotion; intellectual disability
- Identifier
- http://hdl.handle.net/1959.13/1512416
- Identifier
- uon:56614
- Rights
- Copyright 2024 Roberta Callista Asher
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 13 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 550 KB | Adobe Acrobat PDF | View Details Download |