Piaget-Based Nutrition Education in Preschools

Primary outcomes

1. Change from baseline in food consumption frequency

   Time frame: Baseline and immediately after completion of the six-week intervention

   In the Food Consumption Frequency Questionnaire, there are foods that include 7 food groups (dairy group, meat group, vegetable group, fruit group, grain group, oil/margarine group, and sweet group) aimed at determining the child's food consumption status (Güneş et al., 2016). Food consumption frequency is recorded in nine different categories (>6/day, 4-5/day, 2-3/day, 1/day, 5-6/week, 2-4/week, 1/week, 1-3/month, 1-none/month). The Food Consumption Frequency Questionnaire specific to Turkish children was developed by Güneş and colleagues in 2016. The form includes not only food items but also commonly used ingredients in Turkish cuisine. During the development phase of the form, a food atlas containing the most frequently consumed foods, beverages, and some Turkish dishes was used. Results are reported by food item or food group; the questionnaire does not yield a single total score.

2. Change in Nutrition Behavior Scale (NBS) Score

   Time frame: Baseline and immediately after completion of the six-week intervention

   In determining eating behaviors, the Nutrition Behavior Scale developed by Edmundson et al. (1996) and adapted for Turkish children by Öztürk (2010) was used. The scale consists of fourteen different items, each containing two different food items-low-fat, high-fat, salty, and unsalted-depicted in pictures and presented as choices, to determine children's food consumption. Students are asked to indicate which of the two comparable food items in each question item they eat more. The scale items receive a value of -1 for unhealthy food and +1 for healthy food. The total score ranges from -14 to +14. A high total score on the scale indicates a healthy eating habit. The reliability of the scale has been reported as r=0.76 (Öztürk, 2010).

3. Change in Children's Eating Behavior Questionnaire (CEBQ) Subscale Scores

   Time frame: Baseline and immediately after completion of the six-week intervention

   Developed by Wardle et al. (2001), the Children's Eating Behaviour Questionnaire (CEBQ) is a 35-item parent-reported instrument that assesses children's eating behaviours on a five-point Likert scale ranging from 1 (never) to 5 (always). It comprises eight subscales: Food Responsiveness, Emotional Overeating, Enjoyment of Food, Desire to Drink, Satiety Responsiveness, Slowness in Eating, Emotional Undereating, and Food Fussiness. Each subscale is scored separately, with higher scores indicating a greater level of the behaviour represented by that subscale. The original instrument demonstrated an eight-factor structure, with Cronbach's alpha coefficients ranging from 0.74 to 0.91. The Turkish validity and reliability study was conducted by Yılmaz et al. (2011).