Page 282 - Nutrition Counseling and Education Skills: A Guide for Professionals

objectives describe values, interests, and attitudes that are thought to predispose dietary changes. While the
cognitive and psychomotor domains are concerned with what individuals can do, the affective domain deals
with what they are willing to do. These changes are covert or internal and develop more slowly over a period
of time. Evaluation of their achievement is more difficult and needs to take different forms.

Attitudes are inferred based on the evidence of what people say or do. To assess whether the individual has
been influenced by education, the professional may conduct a discussion and listen to what the individual says
or observe what he or she does, since both saying and doing are overt behaviors. In measuring attitudes and
values, the person needs the opportunity to express agreement rather than deciding on right or wrong answers.
A self-reported attitude survey may be used, for example. Statements can be given to which the person
responds on a 5-point scale, from “strongly agree” to “strongly disagree.” To evaluate change in the learner’s
behavior, the practitioner attempts to secure data that permit an inference to be made regarding the person’s
future disposition in similar situations. In the affective domain, this is a more difficult task.

It is conceivable that the individual may display a desirable overt behavior only in the presence of the
practitioner. The attitude toward following a diabetic diet or an employee work procedure may differ
depending on the dietetics professional’s presence or absence. Since time is required for change in attitudes
and values, evaluation may have to be repeated at designated intervals. To determine realistically how the
person is disposed to act, the measurement approach needs to evaluate volitional rather than coerced
responses.

Other Outcomes

An outcome is a result and can be defined as what does or does not happen after an intervention. The
criterion of nutrition education program effectiveness has generally been improvement in knowledge, in
awareness, and in dietary behaviors or physiologic parameters, or both. This criterion can be measured in
many ways depending on the application and outcome data available. For professional education programs,
the use of hard copy and electronic portfolios representing evidence of skills and competency is one way to
assess outcome measures.28–30

SELF-ASSESSMENT 1

You have just discussed sodium restriction with a man diagnoses with hypertension. How
can you assess what he has learned?

Outcomes should have clear interpretations related to the dietitian’s intervention in improving nutrition
and health status. They may be of several types: (1) physiologic or biologic measures, (2) behavioral change
based on self-report, (3) diet-related psychosocial measures, and (4) environmental or other measures of
dietary behavior. Biologic indicators are changes in clinical or biochemical indices, such as serum lipid levels in
cardiovascular disease, hemoglobin or serum albumen level in pregnancy, and glycosylated hemoglobin level in
diabetes. Eating behavior changes such as decreasing fat intake or increasing fiber intake are based on self-
reports, which can be subject to bias. Psychosocial outcomes include increased nutrition knowledge, attitude
change, or self-efficacy for behavior but do not prove the change in food choices. Other changes are in body

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