Material and Methods
Design and setting
To investigate the effects of targeted nutritional education, a
mixed-methods pre–post intervention study was conducted in three
Government schools of Karnataka, one each in Bagalkot, Belagavi and
Raichur districts. All students in grades six and seven in the three
schools were invited to participate in the study. Written informed
consent was obtained from the students’ parents and assent from the
students. Pre and post - intervention tests were used to measure changes
in adolescents’ awareness due to the intervention, and qualitative
interviews were used to capture reactions and facilitators or barriers
to the implementation of the intervention.
Nutrition education intervention
A multimodal learning approach was used as a basis to develop the
intervention. The education intervention was delivered through teachers
and divided into seven sessions containing lectures, role play and
practical demonstrations. Teachers were chosen as educators to ensure
sustainability of the intervention and students of grades six and seven
were chosen, considering the higher attrition among older students. The
content and modes of delivery were co-developed through multiple
deliberations and discussions with community leaders, local school
teachers and nutrition experts. The resource materials were adapted from
the resources available for the Anemia Mukt Bharat programme and the
National Institute of Nutrition. The final intervention materials
included illustrative, pictorial, and colourful books, cards, wall
charts, handbooks for teachers and food samples (legumes, grains, dry
fruits, vegetables etc.). Emphasis was put on ensuring that materials
developed were appealing to children and easy to understand. All
materials were translated into the local language (Kannada) with photos
of local foods added, and messages modified as appropriate for the
Kannada language. The sessions covered: (i) Balanced diet; (ii) Anaemia
and its importance; (iii) Anaemia in pregnancy; (iv) Diet and anaemia –
iron-rich foods; (v) IFA supplementation; (vi) Myths and facts about
IFA, do’s / don’ts of IFA consumption; (vii) Good habits to be adopted;
(viii) Summary and mantras for adolescent health. The intervention was
delivered in Kannada in sessions of approximately half an hour once
every week for seven weeks.
A total of 11 teachers (one male and 10 female) from the three schools
were initially provided a one-day in-person training on the materials
and approach before the start of the intervention. Regular online weekly
refresher training was conducted during the intervention to reinforce
the material and resolve any challenges.