Improved Knowledge, Attitudes, and Practices of Balanced Nutrition after Educational Intervention Based on the Self-determination Theory: An Intervention Study in Senior School Teachers in Makassar City


  • Nurhaedar Jafar Department of Nutrition, School of Public Health, Hasanuddin University, Makassar, South Sulawesi, Indonesia
  • Nurzakiah Hasan Department of Nursing, Health College Baramuli, Pinrang, South Sulawesi, Indonesia
  • Veni Hadju Department of Nutrition, School of Public Health, Hasanuddin University, Makassar, South Sulawesi, Indonesia
  • Ridwan M. Thaha School of Public Health, Hasanuddin University
  • Andi I. Arundhana Department of Nutrition, School of Public Health, Hasanuddin University, Makassar, South Sulawesi, Indonesia



health knowledge, attitudes, practices, school-based intervention, nutrition education, self-determination theory


BACKGROUND: Studies linking the association of nutrition knowledge, attitudes, and practices (KAP) with healthy behavior have been well established. However, the method to effectively deliver nutrition education to a particular population, especially middle-income population, was less studied.

AIM: This study aimed to examine the effects of school-based nutrition using the self-determination theory (SDT) on nutrition KAP of the senior secondary schoolteacher with metabolic syndrome risk.

METHODS: This study was a non-randomized pre-post intervention study conducted in eight senior secondary schools in Makassar City. The intervention group received a balanced nutrition package either delivered through modules, balance sheet (calendar), or physical activity poster for 4 months. The control group received a pamphlet that has been developed by the Ministry of Health of the Republic of Indonesia.

RESULTS: A total of 123 respondents (63 respondents) intervention and (60 respondent) control group completed post-test and were included in the analysis. There were increase knowledge, attitude, and practice in both groups, but increasing in the intervention group was a significant relationship compared to the control group (knowledge p < 0.001 and practice = 0.007).s

CONCLUSIONS: Delivering nutrition education using SDT concept can potentially improve the knowledge and practices of the teachers about balanced nutrition. The government may adopt the SDT approach when designing the nutrition education program with specific targets.


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Allen L, Williams J, Townsend N, Mikkelsen B, Roberts N, Foster C, et al. Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: A systematic review. Lancet Glob Health. 2017;5(3):e277-89. s2214-109x(17)30058-x PMid:28193397

World Health Organization. Noncommunicable Diseases Progress Monitor. Geneva: World Health Organization; 2017.

Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137-49. diabres.2013.11.002 PMid:24630390

Xu Y, Wang L, He J, Bi Y, Li M, Wang T, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310(9):948-58. PMid:24002281

Kaur J. A comprehensive review on metabolic syndrome. Cardiol Res Pract. 2014;2014:943162. PMid:24711954

Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2005;365(9468):1415-28. s0140-6736(05)66378-7 PMid:15836891

Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: A joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation. 2009;120(16):1640-5. circulationaha.109.192644 PMid:19805654

World Health Organization. Diagnosis and Classification of Diabetes Mellitus and its Complications Part 1: Diagnosis and Classification of Diabetes Mellitus. Vol. 15. Geneva: World Health Organization; 1999.

Garralda-Del-Villar M, Carlos-Chillerón S, Diaz-Gutierrez J, Ruiz-Canela M, Gea A, Martínez-González MA, et al. Healthy lifestyle and incidence of metabolic syndrome in the SUN cohort. Nutrients. 2019;11(1):1-15. PMid:30598006

Herningtyas EH, Ng TS. Prevalence and distribution of metabolic syndrome and its components among provinces and ethnic groups in Indonesia. BMC Public Health. 2019;19(1):1- 12. PMid:30943932

Hardinsyah Analisis konsumsi lemak, gula, dan garam penduduk Indonesia. Gizi Indones. 2011;34:92-100. https://doi. org/10.36457/gizindo.v34i2.105

Soewondo P, Purnamasari D, Oemardi M, Waspadji S, Soegondo S. Prevalence of metabolic syndrome using NCEP/ ATP III criteria in Jakarta, Indonesia: The Jakarta primary non-communicable disease risk factors surveillance 2006. Acta Med Med Indones. 2010;42(4):199-203. PMid:21063040

Amarasekara P, De Silva A, Swarnamali H, Senarath UP, Katulanda P. Knowledge, attitudes, and practices on lifestyle and cardiovascular risk factors among metabolic syndrome patients in an urban tertiary care institute in Sri Lanka. Asia Pac J Public Health. 2016;28(1):32S-40S. https://doi. org/10.1177/1010539515612123 PMid:26512029

Spronk I, Kullen C, Burdon C, O’Connor H. Relationship between nutrition knowledge and dietary intake. Br J Nutr. 2014;111(10):1713- 26. PMid:24621991

Popkin BM. Global nutrition dynamics: The world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr. 2006;84(2):289-98. ajcn/84.2.289 PMid:16895874

Hasan NM, Hadju V, Jafar N, Thaha RM. Prevalence of metabolic syndrome (MetS) and determinants among obese teachers in makassar, Indonesia. Int Med J Malaysia. 2019;18(2):29-37.

Blackford K, Jancey J, Lee AH, James A, Howat P, Waddell T. Effects of a home-based intervention on diet and physical activity behaviours for rural adults with or at risk of metabolic syndrome: A randomised controlled trial. Int J Behav Nutr Phys Act. 2016;13:1-10. PMid:26830197

Silva MN, Vieira PN, Coutinho SR, Minderico CS, Matos MG, Sardinha LB, et al. Using self-determination theory to promote physical activity and weight control: A randomized controlled trial in women. J Behav Med. 2010;33(2):110-22. https://doi. org/10.1007/s10865-009-9239-y PMid:20012179

Markland D, Ryan RM, Tobin VJ, Rollnick S. Motivational interviewing and self-determination theory. J Soc Clin Psychol. 2005;24:811-31.

Patrick H, Williams GC. Self-determination theory: Its application to health behavior and complementarity with motivational interviewing. Int J Behav Nutr Phys Act. 2012;9:1-12. https://doi. org/10.1186/1479-5868-9-18

Ministry of Health. Peraturan Menteri Kesehatan Republik Indonesia Nomor 41 tentang Pedoman Gizi Seimbang. Indonesia: Ministry of Health; 2014.

Leblanc V, Bégin C, Hudon AM, Royer MM, Corneau L, Dodin S, et al. Effects of a nutritional intervention program based on the self-determination theory and promoting the mediterranean diet. Health Psychol Open. 2016;3(1):1-11. https://doi. org/10.1177/2055102915622094 PMid:28070382

Pollard C, Miller M, Woodman RJ, Meng R, Binns C. Changes in knowledge, beliefs, and behaviors related to fruit and vegetable consumption among Western Australian adults from 1995 to 2004. Am J Public Health. 2009;99(1):355-61. https://doi. org/10.2105/ajph.2007.131367 PMid:19059859

Wang H, Song Z, Ba Y, Zhu L, Wen Y. Nutritional and eating education improves knowledge and practice of patients with Type 2 diabetes concerning dietary intake and blood glucose control in an outlying city of China. Public Health Nutr. 2013;17(10):2351- 8. PMid:24124930

Hakli G, Asil E, Uçar A, Özdogan Y, Yilmaz MV, Özçelik AÖ, et al. Nutritional knowledge and behavior of adults: Their relations with sociodemographic factors. Pak J Nutr. 2016;15:532-9.

Mäntyselkä P, Kautiainen H, Miettola J. Beliefs and attitudes towards lifestyle change and risks in primary care a community-based study. BMC Public Health. 2019;19:1-9. https://doi. org/10.1186/s12889-019-7377-x

Ahadi Z, Heshmat R, Sanaei M, Shafiee G, Ghaderpanahi M, Homami MR, et al. Knowledge, attitude and practice of urban and rural households towards principles of nutrition in Iran: Results of NUTRIKAP survey. J Diabetes Metab Disord. 2014;13(1):100. PMid:25551099

Parmenter K, Waller J, Wardle J. Demographic variation in nutrition knowledge in England. Health Educ Res. 2000;15(2):163-74. PMid:10751375

Downs SM, Farmer A, Quintanilha M, Berry TR, Mager DR, Willows ND, et al. From paper to practice: Barriers to adopting nutrition guidelines in schools. J Nutr Educ Behav. 2012;44(2):114-22. PMid:22119449

Stran KA, Knol LL. Determinants of food label use differ by sex. J Acad Nutr Diet. 2013;113(5):673-9. PMid:23402696




How to Cite

Jafar N, Hasan N, Hadju V, Thaha RM, Arundhana AI. Improved Knowledge, Attitudes, and Practices of Balanced Nutrition after Educational Intervention Based on the Self-determination Theory: An Intervention Study in Senior School Teachers in Makassar City. Open Access Maced J Med Sci [Internet]. 2020 May 20 [cited 2023 Sep. 27];8(E):228-35. Available from:



Public Health Education and Training


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