Healthy and cheap dinner for exchange students in Holland, Haarlem

‘’At the end of the project the exchange students of the Inholland university of applied

sciences in Haarlem know what the ‘’schijf van vijf’’ is and they can apply it to their meals.

After knowing what healthy food is we will help them to prepare and find healthy, safe and

cheap Dutch meals regarding to dinner.’’

Names N.M. Ronda 498685

F. Godinho 531733

S. Doolaard 490831

T. Nguyen 460965

Study Sport, exercise and

health ’12-13

Class HSB3 Nutrition

Teacher M. van Zuidam

Date 12-06-2013

Healthy and cheap dinner for exchange students in Holland, Haarlem

‘’At the end of the project the exchange students of the Inholland university of applied

sciences in Haarlem know what the ‘’schijf van vijf’’ is and they can apply it to their meals.

After knowing what healthy food is we will help them to prepare and find healthy, safe and

cheap Dutch meals regarding to dinner.’’

Names N.M. Ronda 498685

F. Godinho 531733

S. Doolaard 490831

T. Nguyen 460965

University Inholland University

of Applied Sciences

Study Sport, exercise and

health ’12-13

Course Group Project

Class HSB3 Nutrition

Teacher M. van Zuidam

Date 12-06-2013

Foreword We are third year students from the Inholland University of Applied Sciences who are following the

study Sports, Exercise and Health.

During the last semester we did an international minor in nutrition, for this minor we had to do a

group project. Because the minor is internationally focused we did an investigation for the

International Office of Inholland Haarlem about the eating behavior of exchange students in

Haarlem.

During the project we had a lot of help from our tutor M. van Zuidam. She was very helpful and had a

lot of interesting ideas.

Of course we want to thank the international office of Inholland Haarlem for giving us the instruction

to change the behavior of the exchange students regarding to their dinner, and for the time they

have made for us during the project.

We also want to say thanks to ESN Network, and then especially to Nino. He was very enthusiast

about the project and wanted to participate during the classes. He also talked to the exchange

students to make them aware and warm for the project.

A special thanks to the exchange students who want to be part of our project. Without you we could

not do the project, thanks for your honesty and enthusiasm. It was nice working with you guys!

S. Doolaard ; T. Nguyen ; F. Godinho ; N.M. Ronda

Haarlem, 2013

Summary This report describes the investigation done for the International Office of Inholland Haarlem. The

main question is;

‘’At the end of the project the exchange students of the Inholland university of applied sciences in

Haarlem know what the ‘’schijf van vijf’’ is and they can apply it to their meals. After knowing what

healthy food is we will help them to prepare and find healthy, safe and cheap Dutch meals regarding

to dinner.’’

This investigation is started with a desk and field research to find out more about the problem. After

interviews with the International Office, Erasmus Student Network, the exchange students and

literature research on the internet and in books the problem became clear.

Literature research showed that students who do not live at their parents anymore, eat a lot of sugar

and fast-food. At the same time those students do not eat enough fruit and vegetables anymore.

The same is for international students who study in a different country. It is hard for them to eat

healthy and cheap food because they mostly want to retain traditional, sometimes healthier, eating

habits. They experience barriers of high cost, limited availability and sometimes they miss products.

According to intake interviews with the exchange students and conversations with the international

office and the Erasmus Student Network (ESN), there became much clear on the specific group of

exchange students in Haarlem.

The students do not have the right knowledge to prepare a cheap and healthy dinner. The results of

the intakes with the exchange students says that they do not know how to use the eat well plate and

where to find cheap ingredients to prepare a healthy dinner. The students are not eating really

healthy at the moment, but they do want to learn more about it. Because of the fact that the

students do not have enough knowledge it is hard for them to change their attitude.

With these findings there is made an intervention for the exchange students on changing the main

determinants knowledge and attitude.

The intervention contains four classes with active methods, PowerPoint presentations and games to

achieve the main goal. All the exchange students from Inholland Haarlem can participate in the

intervention classes.

Index Foreword ................................................................................................................................................. 3

Summary ................................................................................................................................................. 4

1. Introduction ..................................................................................................................................... 7

2. Method ............................................................................................................................................ 9

2.1 Desk research ................................................................................................................................ 9

2.2 Field research ................................................................................................................................ 9

3. Problem analysis ............................................................................................................................ 11

3.1 Nature, severity and scale of the problem ............................................................................ 11

3.2 Distribution of unhealthy eating among exchange students ................................................ 12

3.3 Problem perception by stakeholders .................................................................................... 12

3.4 Desk research ........................................................................................................................ 13

3.4.1 Healthy food .................................................................................................................. 13

3.4.2 Cheap food .................................................................................................................... 17

4. Determinants of the problem ....................................................................................................... 19

5. Field research ................................................................................................................................ 20

5.1 Target group .......................................................................................................................... 20

5.2 The interviews ....................................................................................................................... 21

5.2.1 The results of the interviews ........................................................................................... 21

5.3 Behavior analysis ................................................................................................................... 23

5.4 Conclusion ............................................................................................................................. 24

5.5 Communication ..................................................................................................................... 24

6. Program goals ................................................................................................................................ 25

6.1 Specific behavior goals .......................................................................................................... 27

6.2 Important modifiable determinants ..................................................................................... 28

6.3 Matrix .................................................................................................................................... 28

7. Program design .............................................................................................................................. 29

7.1 Strategies and methods ......................................................................................................... 29

7.2 Duration, intensity and timing .............................................................................................. 31

7.3 Fitting to the target group ..................................................................................................... 32

7.4 Effective techniques .............................................................................................................. 32

7.5 Feasibility in existing practice ............................................................................................... 33

8. Implementation ............................................................................................................................. 34

8.1 Supplier .................................................................................................................................. 35

8.2 Monitoring and generating feedback .................................................................................... 35

8.3 Incorporation in an existing structure ................................................................................... 35

9. Evaluation ...................................................................................................................................... 36

9.1 Clarity and agreement on the principles of the evaluation .................................................. 36

9.2 Process evaluation ................................................................................................................. 37

9.2.1 The researchers .................................................................................................................... 37

9.2.2 The international office ........................................................................................................ 37

9.2.3 The exchange students ......................................................................................................... 38

9.3 Effect evaluation .................................................................................................................... 39

9.4 Feedback to stakeholders ...................................................................................................... 40

10. Discussion .................................................................................................................................. 41

11. Conclusion ................................................................................................................................. 42

12. Advice ........................................................................................................................................ 43

Bibliografie ............................................................................................................................................ 44

Annex .........................................................................................................................................................

A. Results intakes ........................................................................................................................... 47

B. Intake ......................................................................................................................................... 51

C. Process evaluation researchers ................................................................................................. 54

D. Process evaluation international office ..................................................................................... 56

E. Intervention 1 ............................................................................................................................ 58

F. Intervention 2 ............................................................................................................................ 61

G. Intervention 3 ............................................................................................................................ 64

H. Intervention 4 ............................................................................................................................ 71

1. Introduction Nutrition in adolescents is a very important item now a day. Many students do not pay much

attention anymore to their food intake and physical activity, especially when they are going to live on

their own. (El Ansari, Stock, & Mikolajczyk, 2012)

The students have other interests, such as going to parties and doing things with their friends. You

can imagine that the problems for adolescents who are living in a for them new country away from

their parents are much worse.

Exchange students are students who live away from their parents in a new country for approximately

one semester. They become independent in many different ways and face a lot of problems in their

new environment, mostly cultural and social related problems. They have to make new friends, find a

place to work and take care of them self’s in way of; cooking, cleaning, shopping, making money and

washing. (ESN)

After doing interviews with the International Office, Erasmus Student Network and the exchange

students it became clear that there is demand for making an intervention about changing the

knowledge and attitude of the exchange students. To help the exchange students with preparing a

healthy and cheap dinner the next main goal is created;

‘’At the end of the project the exchange students of the Inholland university of applied sciences in

Haarlem know what the ‘’schijf van vijf’’ is and they can apply it to their meals. After knowing what

healthy food is we will help them to prepare and find healthy, safe and cheap Dutch meals regarding

to dinner.’’

Besides the main goal there is also a cookbook made. This cookbook contains information about the

eat well plate, buying places and recipes from different countries. With this cookbook the students

have some help with preparing their healthy and cheap dinner. For the International Office the

cookbook is very important, because they will give it to all the new exchange students in Haarlem.

Besides that they want to put the recipes on their internet page.

To achieve the main goal there is done a desk and field research. The desk research consists a

literature study and the field research interviews.

Structure of report

In chapter two you can find the method, which is followed by the problem analysis in chapter three

where the results of the desk and field research are listed. In chapter four you can find other

strategies and methods for implementations and in chapter five you can see the program goals for

the intervention.

Chapter six is for the program itself and in chapter seven you can find all the information of the

implementation, like the lessons and the PowerPoint’s.

Chapter eight consists of the evaluation, which is followed by the annex and sources that are used.

2. Method This paragraph contains the methods on how the researches answered the main goal of this project,

which is;

‘’At the end of the project the exchange students of the Inholland university of applied sciences in

Haarlem know what the ‘’schijf van vijf’’ is and they can apply it to their meals. After knowing what

healthy food is we will help them to prepare and find healthy, safe and cheap Dutch meals regarding

to dinner.’’

To collect information there are two different ways used;

Desk research

This is also called a literature study. To find relevant literature there is been searched on the

internet, in books and in reports in order to get a clear view on the problem.

Field research

Through administering questionnaires with the exchange students and conducting interviews

with the International Office and Erasmus Student Network there is gathered specific

information about the problem.

2.1 Desk research To achieve the main goal the researches started with a desk research. The desk research should

answer the following subjects:

What is the nature, severity and scale of the problem?

How is the distribution of unhealthy eating among exchange students?

What is healthy food?

What is the ‘’schijf van vijf’’?

How to prepare a healthy dinner according to the ‘’schijf van vijf’’?

Where can you buy cheap and healthy food in Haarlem?

What are determinants of unhealthy eating among exchange students?

The information is mostly found in scientific articles, internet pages such as ESN and Nuffic, and

books such as Nutrition: a lifespan approach.

2.2 Field research Having insight on the problem a desk research alone would not be enough. A field research is

necessary to find out what kind of information is needed to be provided during the interventions

with the exchange students. There are interviews done with six exchange students from different

countries. With these interviews the following information is collected:

Have the exchange students any knowledge about the ‘’schijf van vijf’’?

What do the exchange students consider as a healthy diet?

Do the students know where they can buy cheap and healthy ingredients for their dinner?

What kind of problems do the exchange students experience regarding to their current

dinner?

What are the exchange students buying and cooking regarding to their dinner? Is this a

problem for them?

Do the exchange students eat together with friend?

o Do they influence the eating pattern of the exchange students?

The information is divided in four determinants; knowledge, attitude, social influence and self-

efficacy. According to the results of the intake and the interviews there will be determinants who are

important for changing the behavior of the exchange students.

Also inside information from the international office and ESN is used, because they have a clear view

on the exchange students in Haarlem. The information is collected by having conversations with

both.

3. Problem analysis This paragraph shows the nature, severity and scale of the problems with the nutritional habits about

the international exchange students in Haarlem. It also provides information about the distribution

of the problem and the perception of stakeholders like ESN and the international office.

At least the desk research about healthy food, cheap food and cheap and healthy buying places in

Haarlem is included.

3.1 Nature, severity and scale of the problem Unhealthy lifestyle behaviors have been identified as a problem among students, they did not meet

the recommended guidelines for the five lifestyle risk factors; (Dodd, Al-Nakeeb, Nevill, & Forshaw,

2010)

Physiological stress

Physical activity

Fruit and vegetable intake

Binge drinking

Smoking

The problems for international students, and especially exchange students, are even bigger. They

become independent in many different ways from the moment they move out and they face a lot of

new problems in their new environment. The most problems are cultural and social related, they

have to make new friends, find a place to work and take care of them self’s in way of; cooking,

cleaning, shopping, making money and washing. (ESN)

It is hard for international students because mostly they want to retain traditional eating habits. They

experience barriers of high cost, limited availability and sometimes they miss products. (Papadaki &

Scott, 2002)

Researchers El Ansari, Stock and T. Mikolajczyk concluded that adolescents, and especially

adolescents who are living on their own, do not pay enough attention to their food choices and

practices anymore. The students do not eat healthy at all, but females make more healthy chooses

than men. In Greece, students living away from the family home made some positive changes. They

are eating less whole-fat, dairy products, white bread an margarine. On the other side decreased

their consumption of fresh fruit, cooked and raw vegetables, oily fish and increased their sugar and

fast food intake. For Polish female students living away from home, they significantly had less

percentage of energy provided by total fat and higher percentage of energy from carbohydrate than

students who live at their parents. (El Ansari, Stock, & Mikolajczyk, 2012)

Unhealthy eating habits can cause several diseases like; Obesity, chronic disease, diabetes and

cardiovascular disease. Improvement of dietary intake can prevent those diseases and keep the

prevalence of chronic diseases later in life low. Healthy eating habits also keep the energy and

resistance to illness high. (Besems, et al., 2012)

The international students also find themselves pressed for time or stressed, so they eat on the run.

Stress not only increased food consumption in certain individuals but also shifted their food choices

from lower fat to higher fat foods. (Mayne, 2011).

According to the data of the international office in Haarlem currently 69 exchange students study at

the Inholland University of applied sciences. Most of the students are between the age of 20 and 24,

so adolescents and young adults. They follow different kind of studies and generally stay one

semester of two periods in the Netherlands. The following studies, with the number of exchange

students behind, are distinguished;

Sport, exercise and health 5 students

Tourism and Recreation 16 students

International Business and Management 21 students

Media and Entertainment Management 12 students

PABO 1 student

Social Work 1 students

Medical Imaging and Radiation Therapy 13 students

From this 69 of exchange students at the Inholland University of Applied Sciences in Haarlem 49 of

the students are women and 24 students are men.

3.2 Distribution of unhealthy eating among exchange students There is not anything known about the distribution of problem for exchange students at the

Inholland University of Applied Sciences in Haarlem.

3.3 Problem perception by stakeholders The international office and ESN accompany international exchange students for the time being and

they are organizing international events and parties to integrate the students into the Dutch culture.

Activities such as; Trips to various places, film nights, language projects, international food festivals

and of course parties.

The problem of the international office and ESN is that the international exchange students faces a

lot of problems and they feel abandoned in their new environment. The students do not know much

about the country at all, their eating habits are mostly different and they have no idea where to buy

healthy and cheap food. Last but not least, they also do not pay a lot of attention to eating healthy

and cheap because going to parties and doing thinks with friends are more important for them. They

are not aware of the fact that eating healthy and cheap do not have to take a long time at all, and

above all, it is very important to eat healthy because of your health and the energy intake.

3.4 Desk research This paragraph contains information about the most important subjects related to international

exchange students and nutrition, the sub-questions are;

What is healthy food?

What is the ’’schijf van vijf’’?

How to prepare a healthy dinner according to the ‘schijf van vijf’’?

Where can you buy cheap and healthy food in Haarlem?

These sub-question are necessary to be answered according to the main goal of this whole project.

3.4.1 Healthy food

Eating healthy is an important part of a healthy lifestyle and is something that should be taught at, at

a young age. This sub paragraph gives more information about nutritional requirements for

adolescents and recommendations from the "schijf van vijf".

Adolescence is a time of rapid growth and the primary dietary need is for energy, so the foods in the

diet should be rich in energy and nutrients. In this age the teenagers begin to develop real

independence from their parents, including making decisions about the food they eat. (Langley-

Evans, 2009)

Requirements

The nutrient requirements for adolescents compared to childhood are increased, mostly due to

growth. Because of the fact that the guidelines are undefined, the requirements can best be related

to height, weight or energy intake rather than age.

The major source of energy within the diet are carbohydrate and fats. The requirements say that the

intake of carbohydrates should provide up to 55% and not more than 35% should consist of fat. The

rest of the energy should be taken from protein (12-14%). (Langley-Evans, 2009)

Schijf van vijf

The ‘’schijf van vijf’’ is an instrument

for health, and specific healthy food.

The "schijf van vijf" is designed as a

visual guide to show everybody how

much of each group should be eaten

in order to have a balanced diet.

(Figure 1)

As a general rule an average meal for

adolescent should be made up of

one-third carbohydrate and one-third

fruit and vegetables, with the

remaining one-third split between

dairy, protein and a little bit of fat.

(Oliver, 2013)

Figure 1: Schijf van vijf

There are guidelines for how many kilocalories every gender needs on a day. (Voedingscentrum,

2013)

Boys 14-18 Active 3300

Boys 14-18 Not active 2900

Girls 14-18 Active 2500

Girls 14-18 Not active 2200

Men 19-30 Active 3100

Men 19-30 Not active 2700

Women 19-30 Active 2400

Women 19-30 Not active 2100

The ‘’schijf van vijf’’ works with 5 general rules, those are; (Voedingscentrum, 2013)

Eat varied

Eating varied is important to get all of the foods like minerals or vitamins. The "eat well

plate" is a clever tool to eat varied because you can choose your meals out of the 5 parts.

Do not eat too much and exercise enough

Do not eat more than you burn, that’s why exercise and nutrition so closely related to each

other.

Eat less saturated fat

Fat is essential in the body, but there are good and bad fats. The good ones are unsaturated

fats, the bad ones are saturated fats. Saturated fats can cause cardiovascular disease

because of the high amount of cholesterol.

Eat lots of fruit, vegetables and bread

Fruit, vegetables and bread are very healthy and full of fibers, which are good for the

intestinal and digestive. They take care of your weight. Eat 30-40 gram fiber per day.

Eat 2 ounces of vegetables, 2 parts of fruit and enough whole-wheat bread.

Eat safe

It is important to eat safe because a lot of people annual run a food infection because of

poor hygiene. Wash your hands, separate your waste, store food in the refrigerator, buy

products that are not on the date and heat the products enough.

The products are divided in 5 parts; Bread, rice, potatoes, pasta / meat, fish, eggs, beans / fruit and

vegetables / dairy foods / food and drinks high in fat and/or sugar.

Carbohydrates

Bread, pasta, grains, cereals, rice, couscous, potatoes

(Figure 2)

Carbohydrates are starchy foods and should make up one-

third of your plate as they help to fill you up. Wholegrain

varieties are recommended where possible because once

broken down, they are released intro bloodstream more

slowly, giving you energy for longer (Oliver, 2013)

Figure 2: Carbohydrates

Fruit and vegetables

Fruit and vegetables should make up a third of your daily

food intake (Figure 3)

Try to eat a variety and mix up the colors. Darkly colored

fruit and vegetables contain more antioxidants, which are

great for your health. Products that is in season where you

are will taste a million times better than stuff that has been

flown in from another part of the world, so vary your

choices accordingly throughout the year. (Oliver, 2013)

Dairy foods

Butter, yoghurt, cream, cheese, milk (Figure 4)

The calcium from dairy foods is really important for strong

bones and healthy teeth. These foods are generally quite high

in fat so they should only be enjoyed in small quantities.

(Oliver, 2013)

Protein (non dairy)

Meat, fish, eggs, beans, lentils, pulses nuts or other

vegetable (Figure 5)

Protein is a vital part of your diet because it is essential for

growth and repair of body tissue. You only need a small

amount to get all the benefits, and you should try to eat

high-quality protein. No meat or fish that has been deep-

fried of battered in breadcrumbs. (Oliver, 2013)

Food and drinks high in fat and/or sugar

Cakes, crisps, chocolate, sweets, fizzy drinks (Figure 6)

It won’t be a shock to hear that the things in this food group

should only be enjoyed occasionally. A lot of food and drinks

high in fat and/or sugar will lead to weight gain and a

increased risk of diabetes, cancer and heart disease.

The foods in this group also create an instant sugar high of

energy rush. If the body becomes accustomed to this feeling

it can become dependent on it. (Oliver, 2013)

Figure 3: Fruit and vegetables

Figure 4: Dairy foods

Figure 5: Protein

Figure 6: Sugar and fat drinks

Recommended are six eating moments per day. (Voedingscentrum, 2013)

Breakfast Snack or fruit Lunch Snack or fruit Diner Snack

Besides the macronutrients, the micronutrients are also very important for adolescents. The demand

for micronutrients increase in proportion to energy requirements. (Langley-Evans, 2009)The most

important micronutrients for this age are;

Calcium (because of peak in bone mineralization)

Zinc (because of protein synthesis)

Iron (increase blood volume, lean body mass and myoglobine)

Calcium

A calcium deficiency can causes some serious implications for the future bone health of adolescent.

The most common disease is osteoporosis where bones become brittle and break very easily. Bones

continue to grow and strengthen until the age of 30, and the teenage years are very important to this

development. The body needs Vitamin D, calcium and phosphorous for this process, with calcium

requirements for the teenage years ranging from 800mg to 1,000mg per day.

Calcium rich food should be consumed every day the most common source of calcium is milk and

dairy products. Adolescent should eat three portions of dairy food each day. (BBC, 2013)

Zinc

Zinc is an essential trace element. Zinc intake is closely related to protein intake; as a result, it is an

important component of nutritionally related morbidity worldwide. Symptoms attributable to severe

zinc depletion include growth failure, primary hypogonadism, skin disease, impaired taste and smell,

and impaired immunity and resistance to infection. (Abrams, 2013)

Iron

One of the most common nutritional deficiencies is a low iron store. 13% of the teenage boys and

27% of the girls were found to have low iron stores. Rapid growth, a fast lifestyle and poor dietary

choices can result in iron-deficiency anemia. For girls it is more important than for boys because their

iron stores are depleted each month following menstruation.

The dietary source of iron is;

Red meat

Fortified breakfast cereals

Dried fruit

Bread and green leafy vegetables

Red meat is the main dietary source because the absorption of it goes very quick. (BBC, 2013)

3.4.2 Cheap food

Cheap food is a main issue for adolescents who are not living at home anymore, and especially for

exchange students in other countries. In this sub paragraph the next question is central; how do you

eat a nutritious diet while keeping the costs low?

Cheap is defined as affordable for students with a limited income, not specific an amount.

This sub question consists of some practical tips in order to have a more cheap diet. All the

information is based on the "eat well plated", so cheap and healthy food in one. After knowing what

cheap food is, it is important to know where to buy it. So after the practical tips there is some

information about the different buying places of cheap and healthy food in Haarlem.

There recommendations to have a healthy and cheap diet are; (Gezonde voeding, 2012)

Stop drinking Soda. They are very expensive and not healthy at all. Choose water or tea,

alternate with lemonade.

Use tap water instead of bottled water. The water in Holland is very clean, so bottles are not

essential. They are also more expensive than tap water.

Choose seasonable vegetables. They are less expensive en much tastier than not seasonable

vegetables.

Always make a plan for the week. You can buy the basics like pasta, rice and potatoes once a

month at one of the cheapest stores. Choose the weekly shopping items in the cheapest

shop near at home. Choose the house brand, most of the time they are just as well as the A

brands.

Eat well before going to the supermarket, and then you are less inclined to buy promotional

items. You also do not feel the need to buy delicious, unhealthy snacks.

Learn how to cook more efficient and healthy. It is good to make double portions sometimes,

because you can freeze it in. It is a fact that in the supermarkets it is hard to find food for

only 1 person, so you have to buy food for more than 1. Eating all of that food on your own is

not healthy, so freezing of food is a good solution for that.

Where to buy?

For people from other countries it might be a shock when it comes to food shopping. The

supermarkets are smaller, and the variety is not very big. To buy cheap and healthy food, you need to

visit several locations like supermarkets, open-air markets and grocers or farm shops.

Supermarkets are mostly the number one choice because you can buy there fruit and vegetables,

dairy products and a lot more. The fact is that the variety depends on the supermarket chain and the

size of the branch. (Expatica, 2008)

Albert Heijn is the supermarket with the most stores in Holland, more than 800. The fact is that this is

also the most expensive one. (Albert Heijn, 2013)

There are a lot of supermarkets in Haarlem where the Dutch people buy there foods and drinks. The

following supermarkets are distinguished in Haarlem. (Supermarkt in de buurt, 2013)

- Albert Heijn - Lidl

- Vomar - Jumbo

- Dekamarkt - C1000

- CoopCompact - Aldi

- Plus - Sligro

As said before Albert Heijn is the biggest and most expensive one of all.

Lidl and Aldi are relatively cheap supermarkets because they do not sell A products, they have a limited

assortment, many products are still in boxes and they have less staff in the supermarket. The Albert

Heijn have a wide range of A and B products, they attach a great value to appearance and they have a

lot of staff in the supermarket to make the store clean, to complement deficiencies and to help the

customers find the right ingredients. (InfoNu, 2012)

Because the supermarkets are not very big, the health food shopping can be carried out more

comfortably at a healthy food store. In stores like that you will be able to find everything you need for

healthy eating and living. They also have a big variety on bread. The largest health food association in

the Netherlands is called De Natuurwinkel. The size of the stores and offering varies from one shop to

the next because the most are independent. Because all the products at the healthy food stores are

organic, this will also be a bit more expensive that healthy food in the supermarket.

There are also open-air markets who sell fresh vegetables, fruits, nuts, fish, seafood, cheese, bread and

herbs/spices. These products are quite cheap, the cheapest place to buy food. The disadvantage is that

there is not always market, only on certain days and times. (Expatica, 2008)

In Haarlem there are three big markets (Hollandse markten, 2013)

Grote markt Monday 11:30 till 18:00 hour and Saturday 08:30 till 17:00 hour

W.C Schalkwijk Tuesday 08:30 till 17:00 hour

Floresstraat Thursday 08:30 till 16:00 hour

In Holland there are also al lot of grocers or farm shops (mostly Asian, Turkish, Moroccan or Middle

Eastern). Here they also sell a lot of fresh vegetables, fruit, rice etc.

So overall, there is cheap healthy food available only it cost some time to find out the right stores and

places. (Expatica, 2008)

And there is a place called "De Bazaar". For over 30 years, De Bazaar, located in Beverwijk, has been the

place for divergent cultures to come together and is made up of different markets; the 'Black' Market,

Eastern Market, Grand Bazaar, Computer Market, Hall 30 and the Outdoor Markets. Since 1982,

the Eastern Market has been the gathering point for different cultures. If it has to do with food, you can

find it here; the most varied vegetables, all kinds of spices, Eastern butchers, bakers and

delectable olives and nuts (debazaar, 2013).

The Eastern Market is the place for all the exotic ingredients.

4. Determinants of the problem The theoretical model ASE is based on the theory of planned behavior and is focusing on the

explanation of behavior. This model proposes that behavior is explained with the intention to show

that behavior en that the intention is explained by three main determinants;

Attitude (A) – How positive is someone regarding to the behavior (pros and cons)

Social influence (S) – How positive is the environment regarding to the behavior? (Observed

behavior, perceives opinions, standard, experienced support)

Self efficiency (E) – Can someone show the behavior? (opportunities, skills)

(Vries, 1988)

This model, in combination with PREFFI, is used to explain the behavior of the international exchange

students.

A lot of different factors are involved in the development of an unhealthy eating pattern among the

exchange students.

Unhealthy dietary habits like consuming insufficient fruits, unhealthy breakfast or skipping breakfast,

and consuming to many high-fat snacks, are common among the youth in the Western world.

(Besems, et al., 2012)

The social influence on this age, adolescence, is very huge. They rebellion against authority, but the

arguments decrease with increasing age. (Langley-Evans, 2009)

Some changes in living arrangements that some students encounter influence their lifestyle factors,

like food choices. But the diet of university students consist of some undesirable thinks, especially for

those living away from the family home (El Ansari, Stock, & Mikolajczyk, 2012).

The health behaviors of university students which has formed during young childhood may have

sustaining impacts on their health throughout later life. So if those health behaviors are good, there

is a bigger change that the health behaviors later in life will be better. (Mikolajczyk, Ansari, &

Maxwell, 2009)

Many students who are away from home for the first time have the freedom to eat what they want.

They abandon the healthy eating habits they’ve grown up with. (Mayne, 2011). The fact is that the

students also find themselves pressed for time or stressed, so they eat on the run. Stress not only

increased food consumption in certain individuals but also shifted their food choices from lower fat

to higher fat foods. (Mayne, 2011).

5. Field research This paragraph contains information about the nutritional problems of the exchange students at the

INHolland University of applied sciences. This paragraph contains the description of the target

group, results of the interviews and ASE model and a conclusion which is also related to the desk

research. By means of this conclusion it is possible to give an answer on the main question. With this

answer there will be made an intervention. During the intervention classes the exchange students

will learn how to prepare a healthy and cheap dinner.

5.1 Target group At INHolland Haarlem there are 67 exchange students. Those students are following different kind of

studies at INHolland University of applied sciences for about six months. These students are following

one semester of two periods.

To develop an intervention there are interviews done with six exchange students. These students are

from different countries and are doing different kind of studies. With the outcome of the interviews

there is made an intervention. All the 67 exchange students are welcome to participate in the

intervention classes. During the last class of the intervention the students have to answer a few

questions to look if their behavior towards their food intake has changed. The results of these

questions will find out if the exchange students have learned anything from it and already

implemented something in their nutrition behavior.

The students with whom the interviews are done should comply with a number of conditions. These

conditions are; Gender, Age, Study, Country and time in Holland so far. With these conditions it is

possible to make a specific target group who will represent for the other exchange students.

Conditions;

Gender: Because this group is representing for all the exchange students it is important to have man

and women. If the this group only contained women it would not be reliable.

Age: Because this group is representing for all the exchange students it is important to have students

who are in the age between 19 and 25 years. This is because all the students are in this age.

Study: Because this group is representing for all the exchange students it is important to have a few

different studies. This is because all the other students are also doing different kind of studies.

Country: Because this group is representing for all the exchange students it is important to have no

Dutch students. All the exchange students are from different countries but new in the Netherlands.

Time in Holland: Because this group is representing for all the exchange students it is important to

have students who are in the Netherlands for a short period of time. This is because the intervention

and implementation are focused on new students in Haarlem who don’t know where to buy and how

to prepare their food.

Table 1: Target group

Name Gender Age Study Country Time in Holland so far

Pauline Bladin Female 20 Business France 3,5 months

Anne Mareike Moller

Female 24 Tourism & recreation

Germany 1,5 year

Marco Mascape

Male 21 Business and Management Studies

Italy 3,5 months

Shivam Patel Male 20 Business and Management Studies

USA - Florida

3,5 months

Henna Hietalahti

Female 20 Tourism recreational management

Finland 1,5 year

Yunhye Kim Female 21 Minor Design Management

Korea 3,5 months

5.2 The interviews Before the interviews with the exchange students where done there is thought about which

information is relevant in order to answer the main question. For this reason the students were

asked to answer the following points:

Have the exchange students any knowledge about the ‘’schijf van vijf’’?

What do the exchange students consider as a healthy diet?

Do the students know where they can buy cheap and healthy ingredients for their dinner?

What kind of problems do the exchange students experience regarding to their current

dinner?

What are the exchange students buying and cooking regarding to their dinner? Is this a

problem for them?

Do the exchange students eat together with friend?

o Do they influence the eating pattern of the exchange students?

With these questions there is made an interview for the exchange students (Annex B. Interview).

The information is divided in four determinants; knowledge, attitude, social influence and self-

efficacy. According to the results of the intake and the interviews there will be determinants who are

important for changing the behavior of the exchange students.

5.2.1 The results of the interviews

All the students find that fruits and vegetables are healthy food. Beside that a few students find

pasta, rice, potatoes, meat and fish also important for a healthy food pattern. Five out of six students

find it important to eat healthy. Only Yunhye doesn’t find it important because she’s still young. All

the students are enjoying eating healthy and here in Haarlem they always eat together with friends.

This is very important for them. Especially here in Haarlem friends are important because they do not

know a lot of people. All the students say that their environment has some influence on their

nutrition intake. This is because their friends have a big influence on their food intake. When you as a

student try to eat healthy, but all your friends are eating unhealthy things like pizza etc. it is hard to

maintain your healthy nutrition pattern.

The students are not familiar typical Dutch meals for dinner. They know a few names of typical dishes

but they do not know how to prepare it.

Three out of six students do not know where to buy cheap healthy food or how to prepare a healthy

dinner. The other three students can find cheap and healthy food at the market and at the Lidl.

Mostly the students buy their food at the Vomar or at Albert Heijn. This is because these

supermarkets are close to their house. Sometimes they go to the open-air market, the Lidl or the

Dekamarkt.

They are not really sure how to cook foods for dinner with regard to health. Most of the students

think that a meal with meat/fish and rice/pasta with a salad is the best way.

Fifty percent of the students say that they are not eating varied at the moment. This is because they

can’t always find the right ingredients here and because there are always eating together with

friends.

From the exchange students has 50% heard about the ‘schijf van vijf’ but they do not know how to

use it. The other 50% doesn’t know about the ‘schijf van vijf’. All the six exchange students say that

they want to learn more about the ‘schijf van vijf’ so they can use it with preparing their meals.

From the six students will 67% eat healthier when they know where to buy cheap and healthy food.

The other 33% will only buy the cheap and healthy food when the shops are not too far away.

Looking to the ASE model the exchange students gave the following answers. Based on these

answers an intervention is made.

Knowledge

The students have some ideas of eating healthy. But they do not know enough to use it to their daily

nutrition. They also know some of the health risks when you are not eating healthy, but they say

that they want to learn more about it.

Most of exchange students say that they do not know about the ‘schijf van vijf’ and how to use this in

their food intake.

Attitude

Almost all the students say that it is important for them to eat healthy and also want to do this if they

know how and where to find the ingredients. They say it is important for them, but they still do not

eat healthy all the time and they say thinks like; I do not know where to buy it, I like fast food very

much etc.

Social influence

The friends and family of the students have a big influence on the students food intake pattern.

Some of them live together with friends, so they cook together. They also found it important because

it is not fun to eat alone.

Self-efficacy

The students want to learn more about the ‘schijf van vijf’ and eat more healthy. Only when the

shops are far from their house it will be hard for some students to maintain.

5.3 Behavior analysis

Table 2: Important determinants to change the student’s behavior

Important Less important

Changeable Knowledge

(If they have the knowledge and

know how to change they can

change their attitude)

Attitude

(With the knowledge they have it’s

possible to change your attitude)

Difficult to

change

Social influence

(This can be changed if all the

exchange students will learn about

the ‘schijf van vijf’)

Self-efficacy

(This will change during working on the

other determinants)

To achieve a behavioral change of the exchange students, the focus should be on the determinants;

knowledge and attitude. This is because these determinants can be changed with the intervention

classes. These classes consist of practical and theoretical lessons about the ‘schijf van vijf’ and how to

use this to your daily food intake. Besides that they will learn where they can find the right

ingredients and how to prepare them. They will also get information about the possible health risks.

When the students now about the risks of eating unhealthy they can change it and increase their

quality of life. With these intervention classes the knowledge of the students will be expanded. When

the students have the right knowledge the will be able to change their attitude.

The main focus is on the knowledge and attitude of the students. To change the behavior of the

students the social influence and self-efficacy are also very important. To change the social influence

of the students the classes are offered for all the exchange students. This is because a lot of the

students are living and eating together. When all the students learn about the ‘schijf van vijf’ they

can make dinner together, help each other and change their attitude and eventually their behavior.

If they will do it together they can motivate each other.

5.4 Conclusion The points knowledge and attitude are points where the intervention can help the students. This is

because these determinants can be changed with the intervention classes. With the intervention

classes they will learn more about the ‘schijf van vijf’ and how to use this to their dinner meals. With

the knowledge and possible health risks they can change their attitude. The students learn more

about the possible health risk for now and on the long-term of life. With this information they will

see it from another perspective and be aware that it is of big importance to change their attitude

right now and not later in life. The points social influence and self-efficacy are hard to change, but it

is possible. Because the intervention classes are available for all the exchange students in Haarlem

they will hopefully also change their attitude. As a result of this the students have a positive influence

on each other. With the knowledge, attitude and social influence changed it is possible to change the

self-efficacy. They will realize the benefits and that it is possible for them to change. This will give

them confidence to start and maintain a more healthy and better nutritional pattern.

All the students want to learn more about the ‘schijf van vijf’ and how to use it in their meals. The

intervention is focused on learning the students more about the ‘schijf van vijf’ and how they can use

this in their meals. With this intervention their knowledge and attitude will be changed. Eventually

the social influence and self-efficacy will also be changed.

Besides that some students have problems with finding cheap and healthy ingredients. For these

students it is good to make a list with shops and places that offers cheap and healthy food. This is a

good overview of the available shops and ingredients. Hereby the students can first think about the

meal they want to prepare and then which ingredients they need. This list is a fast way to get to

know the shops and their products. Almost all the students do not know much about typical Dutch

meals. By giving the students information about this it is easy for them to find ingredients for meals

and they learn more about the Dutch culture.

5.5 Communication It is important to have a good communication with the students. With the six students with whom

the intakes are done, there is communication by email. Through this way appointments can be made

for the intervention classes. These classes will be at the school so everybody can find it.

Besides that there also will be massages on the Facebook page of the exchange students. This is a

quick and easy manner to reach all the students. On the Facebook page there will be announcements

for the students to participate in the intervention classes. Because Francisco is also an exchange

student he can put the massages on the Facebook page. Besides that the Sebastiaan Poppen from

the international office and Nino Loupatty from ESN, they also put the messages on their Facebook

page, so all the students will see the announcements on time.

6. Program goals This paragraph contains the program goals of the project. It will describe the goal of what the

researchers hope to achieve at the end of the project, the goal of the client and the goals for the four

interventions.

The main goal: During the last two semesters (20 weeks) the exchange students of the INHolland

University of applied sciences will learn about and knows what the “Schijf van vijf” is and they can

apply it into their meals, focusing on the dinner, starting February 11th and ending on June 7.

The sub goals for the intervention are: giving the exchange students information, so they;

- Know the locations of the markets in Haarlem.

- Know where they can find cheaper ingredients and products.

- Know about the ‘’Schijf van vijf’’

- Know what a healthy diets contains.

- Know how to read labels and recipes.

Another sub goal of this intervention is is;

- change the attitude of the exchange students towards a healthy diet.

For the project the researchers have a group of six exchange students from the ESN in Haarlem, they

will work more specifically with this group but not only this group. For the interventions they hope to

work with all exchange students in the events of ESN

The aim of the researches

At the end of this project the researchers that started this project have worked with the six exchange

students. At the end the exchange students learned from the interventions and will take what they

have learned into practice in their daily nutrition.

The goal from the client

The client asked for something tangible during one of the first meetings. They showed the

researchers the idea of a small book with different ingredients from countries all over the world. So

the plan is to make an information/cookbook for the next group of exchange students.

The client has asked for an information/cookbook containing information about the next topics;

- Information about the “Schijf van vijf” and how the exchange students can use it in their daily nutrition.

- Information on locations where the exchange students can find cheaper ingredients. - Six Dutch dinner recipes with the “Schijf van vijf” in mind. - Six international, healthy and cheap, dishes from the countries of the participating exchange

students. So that the other exchange student that are coming to Haarlem can try other recipes.

This information/cookbook will be included in the information package that the exchange students

receive from the ESN and the international office.

The first two interventions

The main subject of the interventions will be the “Schijf van vijf”. During the interventions the focus

is too show the exchange students what the ‘’Schijf van vijf’’ is and how they can incorporate the

plate in their daily nutrition.

The first intervention will consider of information on the “Schijf van vijf” and focusing on each part of

the plate and general nutrition rules. So after the first intervention the exchange students know what

the ‘’Schijf van vijf’’ is with help from a PowerPoint and an active method. The exchange students are

able to say something about general nutrition rules.

The second intervention is repeating the first intervention, but the focus will be on the exchange

students. So let them recall what the “Schijf van vijf” is and talk about the different part of the plates.

It will be more like a workshop. During the second intervention the students will hear about the

"Food pyramid", this is also a nutrition tool, and they learn were the market and buying places are in

Haarlem. So after the second intervention the exchange students are able to explain the ‘’Schijf van

vijf’’ and they know how to they can eat healthy and cheap with the market places in mind. The

exchange students have help from a PowerPoint and an active method.

During the first two interventions the exchange students will learn about the “Schijf van vijf”. This

will be the basis for all the upcoming interventions because without the knowledge on the “schijf van

vijf” the rest of the interventions will not be very helpful at all.

The last interventions

The last two interventions will consider of reading labels, applying their gained knowledge on

nutrition and a final competition.

After the third intervention the exchange students are able to read and understand the labels of

ingredients and the recipes of dishes so they can buy healthy stuff in the supermarkets or other

buying places.

After the fourth intervention the students are able to use all the learned stuff in their daily life and

nutrition. The meeting will be more like a final competition where they can use all the gathered

information.

6.1 Specific behavior goals The specific behavior that the researchers want to change is the knowledge and attitude of the

students towards their daily nutrition. In the interviews the exchange students said that they would

like to eat healthier, it's just that they are a bit lazy and it is cheaper and easier to eat unhealthy.

This is why the behavior of the exchange students needs to change. If they go out and buy the

ingredients, they can make their own breakfast and lunch. And they can make this as healthy or

unhealthy as they want to. At the end this is cheaper, but they have to put effort into this.

In order to do this you have to look into the modifiable determinants.

To change the exchange students view on cheaper and easier unhealthy meals. The researchers are

going to give the exchange students information on locations to buy cheaper ingredients and

products. So the exchange students know where they can get cheaper healthy ingredients and

products.

All six students consider fruits and vegetables as healthy food, but healthy food is much more than

only fruits and vegetables. A few students also mentioned pasta, rice, potatoes, meat, fish and

proteins as healthy ingredients in a healthy diet, and that is what all of the students has to be aware

of; healthy food is more than fruits and vegetable.

That is a specific goal for the researchers, make all of the students that attending the interventions

aware of the ingredients that belongs in a healthy diet. So that they know what ingredients they can

use while preparing their meal. The researchers are going to use the “Schijf van vijf” as nutrition tool

to do this.

Another objective that needs attention is preparing the meals. This is also an objective that came out

of the interviews. The exchange students do not really know how to cook or prepare a dinner regards

to a healthy on. Most of them think a meal that has meat/fish and rice/pasta with a salad is enough.

In addition to that the exchange students do not have a varied diet at all. This has to do with the fact

that they cannot find the right ingredients and most of the time they are eating together with

friends. And if they know what ingredients they can use, they can incorporate this with the “Schijf

van vijf” and use this when they are eating with their friends.

At the moment most of the students are not eating really healthy. They also do not know how to use

the ‘eat well plate’ for their meals. They all say that they do want to learn more about it.

So the objectives above will help the exchange students with the location for the ingredients, which

ingredients, how to prepare them and how they can incorporate the “Schijf van vijf” in their daily

routine.

After the interventions the exchange students have the knowledge on the locations, what

ingredients, the “Schijf van vijf” and how to prepare a healthy dinner.

If they want to they have the knowledge to prepare a healthy dinner.

6.2 Important modifiable determinants An important determinant that needs changing is the knowledge of the students on healthy

nutrition. If the researchers can change this, then the attitude of the students toward a healthy diet

can change. The objectives that need work are listed above.

At this moment all six students thinks healthy food has (green) vegetable. Five of them also said fruit.

Three of them mentioned pasta, rice and potato. Three of them say it has fish in it. Two also talked

about meat. And one of them mentioned proteins in a healthy diet.

With this information the researchers think that knowledge and attitude are the most important

determinants to focus on. And because of the time limit it's also the only determinants the research

will focus on.

6.3 Matrix

Table 3: Matrix

May 17 May 24 May 31 June 7

Information about nutrition

X

X

X

Food pyramid

X

x

Eat well plate

X

X

X

X

Locations for cheaper food

X

X

X

What is good and what is not?

X

X

X

X

Quiz X X X

Making own recipe

X

X

X

Jigsaw method

X

X

X

Discussion method

X

Game based method

X

Evaluation x

All this information has to be passed on to the students in six weeks. Due to complications the

researchers only have four weeks left to give the students this information. The researchers will

provide interventions of one to one and a half hours. During the intervention the exchange students

will go through the subject that are mention earlier in this chapter. In the matrix above you can find

some other subject and some of the methods the researchers are going to use during the

interventions.

7. Program design This paragraph contains information about the development of the interventions, like strategies and

methods, timing, duration and intensity. The program that will be used during the interventions. It

describe what researches had been doing and what they a still planning to do with the students.

7.1 Strategies and methods This paragraph contains the strategies and methods of this project. It describes the approach of the

researches and the methods they will apply to reach their goals. And it also describes other

implementations or ideas from evidence based lifestyle interventions.

Evidence based lifestyle interventions

Dietary habits are a major aspect of people’s lifestyle that influences health, morbidity and mortality

for a range of conditions. Therefore patterns of food consumption and their relation to mental health

have received some attention in research (Mikolajczk, Ansari, & Maxwell, 2009). The researches have

looked into evidence based lifestyle interventions to see what is the best approach to change the

dietary habits of the exchange students in Haarlem.

Social norms interventions to reduce alcohol misuse in university and college students.

A review based on 22 controlled trials involving 7275 college and university students randomly

assigned to the social norms intervention or a control group. Interventions delivered using the web

or computer, or in individual face-to-face sessions, appeared to reduce alcohol misuse. The evidence

was less convincing for group face-to-face sessions. Mailed and group feedback on the whole wasn’t

different than with the control intervention. Two large studies showed contradictory results for a

social marketing campaign. Only a small number of good quality studies were available for many of

the outcomes and analyses, and most of the studies were from the USA. The intensity of the

intervention differed between trials as did the control intervention, which was no intervention,

educational leaflets or an alcohol educational session. Individual face-to-face feedback typically

involved social norms feedback as just one aspect of a broader motivational interviewing

intervention.

Web/computer feedback (WF) and individual face-to-face feedback (IFF) are probably effective in

reducing alcohol misuse. No direct comparisons of WF against IFF were found, but WF impacted

across a broader set of outcomes and is less costly so therefore might be preferred. Significant

effects were more apparent for short-term outcomes (up to three months). For mailed and group

feedback, and social norms marketing campaigns, the results are on the whole not significant and

therefore cannot be recommended (Moreira, Smith, & Foxcroft, 2007 ).

De effectiviteit van interventies ter stimulering van gezonde voeding. This article looks at nutrition interventions that can be applied by the company healthcare. Since an objective of the series of articles is to provide insight into the applicability of the BRAVO lifestyle interventions by the company doctor and / or from the company healthcare.

For this article the researchers used 37 studies. In almost all interventions they provided information: individual, groups or through mass media. Also giving feedback on the own nutritional consumption is regularly occurred, with the aim of increase of awareness about their own (unhealthy) eating. In one case the intervention also contained a practical component, such as giving cooking lessons. The nutritional components that have received particular attention was fruits and vegetables, fat and fibers. Although most studies only focus on promoting healthy food, is also directed to a number of

other lifestyle factors such as exercise, smoking or alcohol. The information was provided through; company nutrition intervention, company and home nutritional intervention, nutritional lessons, individual nutrition advice, computerized intervention, flyers, posters, personal letters, emails and feedback.

The short term outcome of this intervention was positive. One more than the other but it was positive. For most of the interventions the result for a healthier nutrition intake were positive even after a year. And some of the interventions still showed positive results after two years. But some intervention didn’t show any chance in the nutritional intake.

In addition to the literature the researchers also include organizations which are active with nutritional interventions like; het Voedingscentrum, het Nationaal Instituut voor Gezondheidsbevordering en Ziektepreventie (NIGZ, Programma Werk & Gezondheid), de Nederlandse Hartstichting (NHS), de Nederlandse Zuivel Organisatie (NZO), KLM Arboservices, de Nederlandse Spoorwegen en ArboNed.

These organizations has different generic and specific interventions running and performed. The generic interventions target the general population and the main goal is to inform people on healthy food. The specific interventions are mostly temporary and target a specific target group. A few examples for generic interventions are; 'Let op vet' (1991-1994), 'Goede Voeding, wat let je?' (1996-2001) en 'Maak je niet dik' (2002-2006). And in addition to that ‘het Voedingscentrum’ developed a CD-rom that gives you customized advise one your eating habits. A few examples for specific interventions are; simple interventions like poster, flyers or a brochure. Or more intensive interventions like personal nutrition advice or adjust the food supply in the cafeteria.

Based on the literature, it was concluded that in general nutrition interventions are effective on the consumption of fruit and vegetables, and the intake of fat (Proper, Bakker, Overbeek, Bergstra, Hopman-Rock, & Mechelen, 2005).

7.2 Duration, intensity and timing This paragraph contains the duration, intensity and timing of the interventions. It describes the

duration of an intervention, the intensity of the interventions and when the interventions will take

place.

Table 4: Planning intervention

Week Date What? Materials / methods

1 March 11 Interviews weeks

3 March 26 International Dinner Verbal presentation

Get them exited

15 May 17

1ste intervention, information on the

“Schijf van vijf”

General nutrition rules

PowerPoint presentation

Quiz

16 May 24

“Schijf van vijf”

Food piramid

What is good and what is not

Market locations

PowerPoint presentation

Quiz

17 May 31

What is good and what is not

Quiz, putting together the "Schijf van vijf"

PowerPoint presentation

Reading the labels

Reading a recipe

18 June 7

“Cheap and healthy Dutch dinner”

Recipes from six different countries

Final competition ”The Quiz’’

Discussion

PowerPoint presentation

Quiz

During the intervention the exchange students will go through the subjects that are mentioned in

chapter six.

The interventions will take place, mostly, on Friday afternoon. On Friday most student are able to

join the meeting because they have no class. The intensity of the interventions will be moderate. This

is due to the fact that the researches want the exchange students to participate in the class. So the

interventions will not consider of giving information to the exchange students alone. They have to

think about the information they get, by answering some questions on the subjects and doing active

methods. Mostly related to their own experiences.

7.3 Fitting to the target group This paragraph contains information on how the interventions will work on the target group.

Participation of the target group:

All the 67 exchange students were invited to participate in the project. Of these students the

researchers did an individual intake with six of them. During the intake the researchers tried to gain

knowledge on the nutrition problems of the exchange students and what the best way is to help

them eating healthier.

They were consulted about their spare time for the project and they were informed about the

project since the beginning. The group participated in the development of the project, with some

ideas for the events and meetings. Without their help it is impossible to structure the project.

The interventions will also fit the target group because the researches are going to work with

subjects that are familiar to the students and subjects that are not familiar to the students. By doing

this the researchers hope that the students can link the subjects together.

Fitting to the ‘Culture’:

This project consist of exchange students where the culture is different in each country. During the

project the researches will try to give more information about the Dutch culture and Dutch meals

because none of the exchange students really has an idea about typical Dutch food. There is also

time for the culture and eating habits of the countries from the participating exchange students.

The researchers are not going to use technical terminology during the interventions. So all the

students can understand and know what the researchers are talking about.

7.4 Effective techniques The researchers are going to work with the following techniques;

- Providing information

- Quiz

- Jigsaw method

- Discussion Method

- Game based method

- Give positive feedback

Providing information

The information will be presented to the exchange students with a PowerPoint presentation. And the

researchers will tell the exchange students more on the subjects. During the presentation the

student can ask questions, and the researchers will ask the students some questions as well like; do

one of you guys drink the required amount of water? And why don’t you or why not. And give the

students tips on how they can match the requirement of liquid per day.

The international students live together in a student hostel, so they eat together several times, the

social environment is very important and if they want to change they have to help each other with

eat well plate.

Quiz

At the end or during an intervention the students has to answer a few questions, the subjects will be

about the last and previous interventions. Just to refresh the memory or keep the students sharp.

This is also a short test for them, just to see what they have remembered of the interventions

(Chickering & Gamson, 1987).

Jigsaw method

This is a group discussion method employing many aspects of cooperative learning. For example;

if the intervention group is big enough, the group will be divided in two groups. A group gets a

statement that they have to defend. The second group gets statements and they have to try to set

the first group on the wrong foot. By doing this the students have to think about the statement that

they are defending (Chickering & Gamson, 1987).

Discussion method

This method is a little different from the Jigsaw method. With the discussion method the researchers

try to promote a successful discussion by correctly framing questions. And then try to discuss the

questions with the students (Chickering & Gamson, 1987).

Game based method

With this method the researchers will try to use competitive exercises and try to put the students

against each other in their answers (Chickering & Gamson, 1987).

By using the methods above the exchange students needs to apply the information that was given to

them during the interventions.

Give positive feedback

During the interventions the students will get a lot of positive feedback. By doing this the researchers

want to motivate the students to participate in the interventions. And as a reward the students can

apply the information that was given to them (Chickering & Gamson, 1987).

7.5 Feasibility in existing practice For the interventions the researchers only need a classroom with access to a computer and a

beamer. So that they can use the PowerPoint’s presentation.

And three of the four researchers are familiar with the method above. They had classes on using

different learning methods. So they know how the method works.

The methods are easy to apply during an intervention. The questions and statements have to be

made upfront. But that is just preparation for the interventions. And the methods can be used at the

beginning or the end of the interventions. But commonly the practice of the methods will be at the

end, when the students have the right information.

Because the interventions are going to take one or one and a half hour, there is enough time to

include a discussion or a game at the end. This way the students can apply the information and they

need to think about it, so they will be capable to access the information again.

8. Implementation This paragraph consist the implementation of the project. It describes how the interventions will be

set up by the researches. The content of the interventions will depend on the knowledge and

participation of the exchange students.

The interventions consist of four meetings with the students, the subject are set in chapter 7. The

first two meetings are especially focused on giving information, the last two meetings are more

active so the students are not only sitting in the school desks and they have to apply the knowledge

they gained. Using active methods will challenge the students more and they have the opportunity to

meet other students. The meetings are at school, so it is not hard for the students to find and it is at

a safe and known place.

The exact day and time depends on the schedule of the students and the teachers.

The first one or two interventions will mostly consist of giving information. (Annex C and D) A picture

is worth a thousand words. To teach the exchange students about nutrition, the intervention will not

consist of giving information alone.

There are two ways to show people how a balance diets looks like. There is the “food pyramid” and

the “Schijf van vijf”, in Holland they uses both examples to educate people and the researchers are

going to use the “Schijf van vijf” to show the exchange students how to have a healthy diet. It’s a

easy way to show the students what is needed on their “dinner plate” but it’s also a tool too show

what the amount of each nutrition is needed for a healthy diet.

For example; Fill half your plate with colorful vegetables, the more varied the better, and fruits.

(Remember French fries do not count as vegetables!) Save a quarter of your plate for whole grains. A

healthy source of protein, such as fish, poultry, beans, or nuts, can make up the rest (Willett &

Skerrett, 2011).

With the last interventions the researchers are going to use active methods to teach the exchange

students about nutrition. (Annex E and F)

“ Learning is not a spectator sport. Students do not learn much just by sitting in class listening to

teachers, memorizing prepackaged assignments, and pitting out answers. They must talk about what

they are learning, write about it, relate it to past experiences, apply it into their daily lives. They must

make what they learn part of themselves” (Chickering & Gamson, 1987)

The researchers probably going for one of the following methods;

Jigsaw: this is a group discussion method employing many aspects of cooperative learning. Discussion: promoting a successful discussion depends on correctly framing questions.

Game based learning: uses competitive exercises, either pitting the students against each

other or through computer simulations.

These interventions will contain repeating the information of the previous interventions. Just to

refresh the memories. Then there will a question round about the nutrition of the students. Too see

if they are already using the “ eat well plate” in their diet.

During the last interventions the exchange students will be putting together a meal regarding too the

“Schijf van vijf”. The students will be paired up and receive pictures of ingredients, with which they

have to put together a meal. At the end the students will be asked to bring a healthy recipe from

home to put in the cookbook. Also during the last intervention there will be a game involving all the

interventions to refresh everything for the last time in a classroom setting. From there it is up to the

students to do what they want with the knowledge they gained during the interventions.

8.1 Supplier

The researchers are able and suitable to provide the information and giving the interventions for the

exchange students.

The researchers have enough expertise about healthy and cheap nutrition because they learned

about it during their school period.

They learned how to work with a group, so they have authority and they know how important

support is so they will support the exchange students in all possible ways. For example by giving

them the phone numbers of the researchers, the e-mail addresses and they can talk with the

researchers at school.

The researchers have good position within the network, because one researcher is also an exchange

student. Because of that the researcher are able to understand the target group and respond on

their wishes and questions.

The researcher also used different contact persons so they have more access to the exchange

students. For example the Erasmus School Network and the international office in Haarlem.

8.2 Monitoring and generating feedback After every intervention there is a feedback moment with the target group. The progress of the

diffusion and the use of the interventions is assessed on different ways.

1. Using an active method every meeting to test the knowledge of the group

2. Asking the group questions to test their attitude, during the second and last meeting

3. Asking for the opinion of the target group about the interventions, during the second and

last meeting.

With this information the researcher are able to improve the implementation.

8.3 Incorporation in an existing structure Because this was the first time an intervention like this was been done at the Inholland University for

Applied Sciences in Haarlem, the intervention was not been incorporated in an existing structure.

First ESN and the international office want to see the effect of the intervention before they will try to

incorporate it in an existing structure.

9. Evaluation This chapter describes the evaluation of the intervention and the process. Target group and

stakeholder are involved because they are able to judge about it without prejudices.

9.1 Clarity and agreement on the principles of the evaluation For the evaluation of the intervention and the whole process different people and groups are

involved;

Sebastiaan International Office Haarlem

Target group Six exchange students from the Inholland University of Applied

Sciences

Researchers Four students from the study sport, exercise and health on the

Inholland University of Applied Sciences

All the stakeholders were able to express their opinion, and in the end they all agree with the

questions made.

The international office is mostly interested in the cookbook. Because the cookbook consist of

healthy and cheap dishes made by the exchange students, it is an evaluation tool. If the dishes are

not healthy and cheap at all, the interventions did not the right work.

The researchers are mostly interested in the behavior of the exchange students. Do they have more

knowledge know then they had before the intervention? And is their attitude against healthy and

cheap food changed?

Because the target group is not that big the form of evaluation will be vocal during a class. During

every meeting there was a little evaluation afterwards. It was mostly to test the knowledge of the

exchange students. In the last class there was a big, final quiz to test the knowledge and attitude of

the students about nutrition. Because the researchers are also interested in the attitude of the

students right now, some questions will be asked during the last meeting.

The advantage of this form is that the researchers are able to ask for clarification if that is necessary

and that it does not take much time from the students because they are already in class.

9.2 Process evaluation This chapter describes the process evaluation of the project. A distinction is made between the

process evaluation of the researchers, the target group and the international office.

9.2.1 The researchers

At the beginning of the project it was necessary to find a client to work for, and the problem has to

be nutritional related.

One of the researchers is an exchange student from Portugal and during one of the first classes he

asked the other researches where he could buy sweet potatoes, because he could not find one in the

supermarket where he goes to. This question was the set up for the project.

The researchers contacted the international office as a client, and after some interviews both

decided to work with exchange students at the Inholland University of Applied sciences. So the

research and intervention would focus on healthy and cheap food for exchange students in Haarlem.

The recruit of exchange students to participate in the project was very hard, both direct and indirect.

The exchange students did not react on Facebook message, e-mail contact and the presentation at

the international dinner. After much effort six exchange students would participate in the project,

with help from the international office and ESN.

Before participating an intake interview with the exchange students was necessary, this took longer

than expected because sometimes it was impossible to make an appointment with them because of

the timetables at school. All the students agreed to participate during the interventions.

So the whole part of finding students and collecting information about them took much longer than

expected, that is why the researchers deviated from the planning.

During the project the communication about the date, time and classroom with the students went

through mail and messages at the Facebook page of the international office, so that all the exchange

students in Haarlem could participate during the interventions. This way of communications turned

out ineffective because only two of the six participating students was present, the other exchange

students did not react on the mail and messages on Facebook.

The interventions went well, although the researchers would like to had more participants. Doing a

interventions with only two participants is difficult when you want to have discussions among the

participant (Annex C).

9.2.2 The international office

During the beginning of the project there was contact with the international office in Haarlem. The

first meetings were marked as informative and making appointments about the rest of the project.

The communication during the first weeks was very intensive and good.

The researchers and the international office decided to make a cookbook in order to let the new

exchange students benefit from the finding of the researchers. The international office can send it to

all the exchange students when they come in Holland, immediately they are having some handles.

The structure of the cookbook was is in agreement between both and the international office liked

the idea of six international recipes an six Dutch recipes, all regarding to a cheap and healthy dinner.

The interventions were nice and well prepared, but not necessary for the international office. They

have no interest in giving interventions because it took too much time and they have not enough

knowledge about it, they really wanted something tangible to give to the new students so they can

work with it and improve their eating pattern on a more indirect way.

During the second part of the project there was some less contact between the researchers and the

international office because the researchers did not have much new information. The

communication could be better during this part because now the international office was not aware

of possible claims.

During the meetings with the international office most of the time only three researcher were

present, the international researcher was not there and did not know much about the subject.

This was not properly to the client. But the researchers who were there, were very prepared. A

agenda was made before and the conversation between both was pleasant (Annex D).

9.2.3 The exchange students Because there were only two exchange students present at the intervention meetings, the process evaluation is done by them. Over all they are enthusiastic and they would recommend other exchange students to participate during interventions like this because the information is really useful and the way of teaching is attractive. Like said before the provided information was good and it met their expectations. They liked the active way of giving the information, like doing a quiz and reading labels/recipes. The exchange students never had the feeling that they had to answer to much questions and they really had to think about some of the answers. The use of pictures in the PowerPoint’s was good. They said the questions about the calories in certain food was funny and that they still think of that on. The two exchange students feel sad about the fact that they were the only ones at the intervention meetings, because of that the meetings did not take long. There was no place for a discussion, and the quiz went very fast because there were only two students. So most of the time after 30 minutes the intervention was done. The researchers were well prepared, but sometimes there was only one researcher to give the intervention. The interaction between them and the researcher(s) was good and it was not uncomfortable at all. Because the communication went through mail it was sometimes hard to communicate. The exchange students and researchers only see each other in real life at the inventions, that made is hard sometimes.

9.3 Effect evaluation This sub paragraph contains the effect evaluation of the results of the intervention.

The main questions is; does the interventions had an effect on the exchange students? The answer is simple, the interventions did not had effect on all the exchange students at the Inholland University of Applied Sciences. But it had an effect the two participating student during the interventions. Overall the researchers achieved some of their goals and some not. The researchers wanted:

To teach the exchange students about the “Schijf van vijf” so that they can apply it into their meals, focusing on their dinner.

Giving the exchange students information about the following things so they will use it in their daily life.

o Know the locations of the markets in Haarlem. o Know where they can find cheaper ingredients and products. o Know about the ‘’Schijf van vijf’’ o Know what a healthy diet contains. o Know how to read labels and recipes.

Change the attitude of the students towards healthy and cheap food

Because only two of the six participating exchange students attended the interventions meetings, it

is hard to say if the goals are achieved.

Both exchange students know how to use the ‘’Schijf van vijf’’ into their meals, and is able to make a

healthy and cheap dinner. The researchers lets made the students put together a meal during one of

the interventions and the two students showed that they know how to apply the “schijf van vijf”.

Also the meetings of the market locations in Haarlem was very helpful for them, it is near the student

flat they live so they were happy to learn about the location of the market. The two participants

already went to the market and bought some groceries there, they could not say if it was cheaper or

not. But they liked the fact that there was a market nearby.

When looked into the knowledge of the students, everything the researchers wanted to achieve

during class the two exchange students did. When the students needed to answers the questions on

the end of each interventions, they mostly had knew the right answers.

By putting together an imaginative dinner regarding to the “schijf van vijf” the researchers can only

say that they know how to use the “schijf van vijf”. The researchers cannot say if the students are

really going to apply it in their day to day life.

The students knows what a healthy diets contains. And when asked the students says they are more

aware of what they eat and they are trying to change a few things, like eating more fruits and

drinking more water. The students also say that the weather would help them with this. When the

sun will shine they will drink more water and eat more fruits. They also claimed that they will eat

more vegetables and more healthy. But this is something they only said to the researchers. The thing

is, this is not something the researchers can and going to measure. The students also said that they

are not reading the labels and probably never will do that because it takes too much time. They will

use the recipes because the dishes looks very good.

They still do not thing it is that important to eat healthy, because right now they are healthy. But

they will try to think about it every time they go to the supermarket. So it is hard to say if the attitude

of the exchange students toward a healthy and cheap dinner changed, but the fact is that they will

try to use the material from the interventions so probably they will see in the future the effect of it.

So the researchers did achieve a lot of their goals, but only with two of the six exchange students

that participate in the interventions. The other exchange students at the Inholland University of

Applied Sciences in Haarlem did not participate at all, so not a change in their behavior has been

measured.

9.4 Feedback to stakeholders The researchers had a few meeting with the international office. During these meeting they talked

about the progress of the interventions.

The international office can relate to the literature findings of the project. The office is aware that

the students have a problem with “healthy” eating. Then again the students are here and they also

want to party and they have a limited budget. So “healthy eating is a priority for them.

The information that is the cook/information book does not provide the international office the tools

to change the behavior of the exchange students in Haarlem. But this was not something they asked

for. The cook/information book contains everything the international asked for, for the next group of

exchange students in Haarlem.

But the international office will receive a copy of the rapport. The researchers will also provide all the

presentations of the interventions they did with the students. So if the international office want to,

they can give the upcoming exchange students the information through the presentations as well.

The course Nutrition was a newly develop course and this was the first year it was implemented. So

next year the same course will be given to the students of Sport, exercise and health. There is a big

chance that next year students of Sport, exercise and health who follows the course nutrition needs

a client like the international office. Then the international can provide the same intervention or let

the students evaluate the effectiveness of the cook/information book.

10. Discussion The study showed an intervention effect on the knowledge of healthy and cheap food regarding to dinner. However, no intervention effect was found on the attitude of the exchange students. This may have several causes;

Geographic In order to have an accessible and manageable working frame for this thesis, this research will be limited in a geographic way and namely to the Inholland University of Applied sciences in Haarlem. By doing this, it becomes easier to organize the fieldwork (e.g. interviews, intervention) and to focus more specifically on the exchange students in Haarlem. Possibly the intervention would have worked on the attitude if more exchange students joined the intervention. Researchers in the future could be extended to other universities in Holland with exchange students to get a better result.

Target grout In order to have an accessible and manageable working frame for this thesis, the researches only focus on exchange students at the Inholland University of Applied Sciences, and not all the international students at the same university. Possibly the intervention would have worked on the attitude if all the international students joined the intervention because the exchange students could learn something from them.

Interviews Where interviewing is generally a time intensive process, the number of interviews is limited accordingly to the available time to perform field-research. Within the available time period, and with the fact that the target group is not that big and do not have much time for things like this, 6 interviews have been conducted. Possibly this number of interviews is not sufficient to get a honest and reliable image of the problem and was the attitude a big issue for those six students.

Language barrier There is a language barrier between the researchers, the target group and the stakeholders. Because all the involved people are able to speak English, there will not be a huge problem. But the researcher have to pay special attention to this barrier, they have to make sure the target group and the stakeholders understand everything. Possibly the language barrier was too big for some exchange students so the information was misinterpreted

Limited time There was limited time for doing research and the intervention. Because the target group was hard to reach, it take a little longer to start with the interventions. Probably more time will give better results, because three interventions is not enough to change the attitude. When comparing the results with the results of other interventions in the past, the change in knowledge and eating behavior is the same. But to change the attitude more is needed, preferably a bigger target group and more time.

11. Conclusion After the intake interviews with the exchange students and the interviews with the international

office the problem became clear. The exchange students did not knew how to use the ‘’schijf van

vijf’’ in preparing their dinner. They struggle with finding cheap and healthy ingredients for their

dinner meal. For this reason an intervention was made which was focused on changing the exchange

student’s knowledge and attitude about healthy and cheap eating regarding to dinner.

Six students participate in the project as a target group, but the intervention meetings were

accessible for all the exchange students at the University of Applied Sciences in Haarlem. Only two of

the participating students joined the intervention meetings with the researchers, so the main goal for

this project is not achieved because the researchers did not succeed in reaching the whole group of

exchange students. Because of that the behaviour of only two exchange students changed. For the

two students who were joining the meetings it is possible to say that the knowledge about healthy

and cheap food regarding to dinner changed. Both exchange students are able to use the schijf van

vijf in their dinner. They can buy the ingredients for their dishes in healthy and cheaper stores than

they did before, because they did not knew about more healthy and cheaper supermarkets.

The students liked the meetings and they had a lot of fun. Some information they already knew and

some information was new and sometimes quit shocking. The active methods helped them a lot,

because only listening is not enough. They have learned a lot from the quiz and working on the

recipes. So the used method and techniques during the interventions for achieving the main goal is

shown successful .

The methods and strategies used to approaching and recruiting the exchange students was not

successful at all, only six exchange students participate in the project and only two of them joined

the intervention meetings.

It is hard to say if the attitude of the students changed because the time was not long enough. The

students still do not think they are in any danger because they do not have problems right now. But

both students agreed with the fact that they are more aware and will change some things like

drinking more water and eating more fruit. They have learned that some changes in lifestyle do not

have to be very radical, so that made is some easier for them.

12. Advice As said in the discussion there are a few aspects that did not worked out the way it should be. This part of the report will describe an advice for the international office at Inholland Haarlem to start over or continue with the research and intervention. For this research there are six exchange students interviewed, because nobody else wanted to do that. These six exchange students represented all the 67 exchange students at Inholland Haarlem, which is not quite reliable. Therefore it would be better to work with all the international students at the Inholland University of Applied Sciences in Haarlem. Because it is hard to let students participate in a project a bigger target group is necessary to make it a success. It is necessary to inform all the international students about the importance of eating healthy, and how they can eat healthy and cheap. Because the students do not have much time and their attitude regarding to healthy food is not that good, it is important to convince them to join the intervention. More advertisement and promoting is essential to make the project work, and working with a cook book is recommended. Because the exchange students have to know about the cook book the advice is to present the book made in this project at an international party. First and second year students from Sport, Exercise and Healthy can present it, and afterwards they can evaluate the effect of the cookbook among the exchange students. Overall the intervention meetings are experienced as very instructive, pleasurable and active. So using active methods, PowerPoint’s and being very enthusiastic and convincing will pay off.

To summarize the advice together; More advertisement and promoting is absolutely recommended.

A bigger target group is also necessary because student generally are not very willing to participate in

a research, especially if it is focused on healthy food.

To make the students aware of the problem and give them some tools to work with it, the cook book

made in this project has to be presented during a meeting with all the exchange students, probably

at the international dinner. It is important to evaluate the impact of the cookbook afterwards,

because probably other universities can use it to.

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Annex

A. Results intakes Questions Pauline

Bladin

Anne

Mareike

Moller

Marco

Mascape

Shivam

Patel

Henna

Hietalahti

Yunhye Kim

1. What’s

your age?

20 24 21 20 20 21

2. Which

course our

you

following?

Business Tourism &

recreation

Business

and

Manageme

nt Studies

Business

and

Managemen

t Studies

Tourism

recreational

manageme

nt

Minor

Design

Manageme

nt

3. Which

country

are you

from?

France Germany Italy USA -

Florida

Finland Korea

4. For how

long are

you in

Holland?

6 months,

until 4th of

July

Now already

1.5 year

until the

end of the

year, and

then back

for a year in

Sept. 2014

Till the end

of June

Till the

beginning of

May

1,5 year -

two more

years until

the end of

her study

6 months

5. What is

healthy

food for

you?

Fruits,

vegetables,

salads

Vegetable,

fruit, meat

and fish,

potato/past

a, bread

Vegetables,

fruit, fish,

pasta, rice

Vegetables,

fruit, lot of

proteins,

some kind

of fats, like

omega 3.

green

vegetable,

pasta/rice

or potatoes

and meat

vegetables

and fruits

6. Is it

important

for you to

eat

healthy?

Yes, but she

thinks she

doesn’t eat

healthy

Yes,

because of

her chronic

gastris

Yes,

because I

take care of

my health

and I do not

want to be

fat.

If you want

to feel good

you have to

eat healthy.

Healthy

food is a

start to a

Yes, 8 No, only

when I’m

older

healthy

lifestyle.

7. Do you

enjoy

eating

healthy?

Yes Yes,

especially in

the summer

lighter

meals

Yes, “I’m

Italian”

Yes

Yes Yes

8. Do you

eat alone

or together

with

friends and

family?

With 3 other

French

students

French food

Sometimes

alone,

sometimes

with friends

When I’m

home I

usually eat

with my

family but

here I eat

with my

friends

With the

friends,

never alone

With my

boyfriend

or friends

Together

with friends

and family

9. Is it

important

for you to

together?

Yes Yes I prefer to

eat with

other

people, it’s

more social.

Yes,

together for

social

environmen

t, talk to

people.

Yes Yes

10. Do

they have

any

influence

on your

nutrition

intake?

Yes, a lot Yes, a little At home my

parents

cook for

me, my

friends do

not have

much

influence

Yes Yes Yes

11. Do you

know any

typical

Dutch

meals

regarding

to dinner?

Only meat

balls

(gehaktballe

n)

Only

hotchpot

(stamppot)

No Yes, lives

with Dutch

guys

Only,

boerenkool

Yes, a little

12. If yes,

do you

- No - Only with No No

know how

to prepare

these

meals on a

healthy

and cheap

way?

recipe

13. Do you

know

where to

buy cheap

and

healthy

food in

Haarlem?

Yes, Lidl. But

she doesn’t

like it

Maybe at

the market

Only knows

Albert Heijn

A lot of

supermarke

ts

No -

14. Where

do you buy

your food?

Albert Heijn

because its

nearby.

Sometimes

Deka markt

Vomar,

because it’s

nearby

Albert Heijn

because its

nearby.

Albert Heijn,

Dekamarkt

Lidl, Vomar,

Albert heijn

Albert

Heijn,

Dekamarkt,

open air

market

15. How do

you think

is the best

way to

cook the

foods for

dinner

with

regard to

health?

Meat/fish.

Sometimes

salad

- Vegetables

with meat,

some fruit,

a lot of

water, or

fish.

Meat, rice,

vegetables,

pasta

- -

16. Do you

know

about the

eat well

plate?

No Yes, a little I do not

know it

(because

I’m not

following a

diet)

I have some

ideas how

to eat

healthy

Yes No

17. Do you

eat varied?

Not much

(rice, pasta,

fish, meat,

salad)

No Yes. Pasta is

his

favourite

meal.

Yes Yes Not here in

Holland.

18. Do you

have any

problems

regarding

to finding

food for

dinner?

Yes

sometimes

buys

prepared

meal

Yes No No Yes, some

things

Yes

19. Do you

want to

learn more

about the

eat well

plate and

how to use

it in your

dinner

meals?

Yes Yes, so she

can learn to

eat more

varied

Yes,

because is

good to

improve my

health

Yes, it’s

always good

to learn

more.

Yes Yes

20. Would

you eat

healthier

when you

know

where to

buy

cheaper

and

healthier

ingredients

?

Maybe more

vegetables,

but not if it’s

too far away

If the

cheaper

shops are

further

away only

with good

weather

Yes Yes Yes Yes

B. Intake Start measurement

Who are we? - Names - Ages - Study - Reason for this project

Personal information

- What is your name? - What is your age? - What is your study? - From which country are you? - For how long are you staying in Holland?

What’s this meeting about - What are we expecting from each other - Available till the end ( mid-June ) - Intervention will start around week 8 (25 – 29 March) - Total collaboration - Want do you expect from us? - Find out what their knowledge is. - Questions about nutrition - The intervention plan - Making appointments - Next meeting Questions regarding to nutrition - What is healthy food for you? - Is it important for you to eat healthy? - Do you enjoy eating healthy? - Do you eat alone or together with friends and family? - Is it important for you to eat alone or together? - Do they have any influence on your nutrition intake? - Do you know any typical Dutch meals regarding to dinner? - If yes, do you know how to prepare these meals on a healthy and cheap way? - Do you know where to buy cheap and healthy food in Haarlem? - Where do you buy your food? - How do you think is the best way to cook the foods for dinner with regard to health? - Do you know about the eat well plate? - Do you eat varied? - Do you have any problems regarding to finding food for dinner? - Do you want to learn more about the eat well plate and how to use it in your dinner meals? - Would you eat healthier when you know where to buy cheaper and healthier ingredients? SUMMARIZE The intervention plan

- Giving information about the eat well plate and how to use it regarding to Dutch meals.

- Active methods about the eat well plate and how to use it regarding to Dutch meals - Event with ESN students - Making a cook book with healthy Dutch meals regarding to dinner.

Closure - When will the next appointment be? - Week 8 - Check her availability - What’s the next meeting about? - Information about the intervention - Do you have any questions? SUMMARIZE

Substantiation

Who are we? Professional attitude and then she knows with whom she works. It will also give her a good image of the project and why we are doing it. Personal information We have to know with who we are working with. What’s this meeting about It’s good to do some kind of an introduction so she feels comfortable and knows exactly what to expect today. She also know the time that she has to be available. Questions regarding to nutrition 1. What is healthy food for you? This questions will give us the information about her perception and knowledge about healthy food. We first want to know what she already knows and how she think about it. 2. Is it important for you to eat healthy? We ask this question so we know more about her attitude. 3. Do you eat alone or together with friends and family? We ask this question so we know if there will be any influence on her from her family or friends. 4. Do they have any influence on your nutrition intake? We ask this question so we know if there will be any influence on her from her family or friends. 5. Do you know any typical Dutch meals regarding to dinner? We ask this question so we will know if she have any knowledge about typical Dutch meals. 6. If yes. Do you know how to prepare these meals on a healthy and cheap way? We ask this question so we know which Dutch meals she know, maybe we can use it in our cook book. We also know her perception of Dutch meals. 7. Do you know where to buy cheap and healthy food in Haarlem? We ask this question so we know exactly how many knowledge they have about the shops where they can find healthy and cheap food. 8. Where do you buy your food?

We ask this question so we know exactly where the exchange students buy their food. We can use it in our intervention, because maybe they only go to expensive shops and they do not know about more cheaper supermarkets or markets 9. How do you think is the best way to cook the foods for dinner with regard to health? We ask this question so we know how they cook their meals for dinner. Maybe they have different ways of cooking because of their own country or something. 10. Do you know about the eat well plate? We ask this question because this is the most important thing of eating healthy. We will use the eat well plate in the intervention, so we have to know what their knowledge is right now. 11. Do you eat varied? With this question we can check if they really understand what the eat well plate means and if they do something with it. 12. Do you have any problems regarding to finding food for dinner? We ask this question to make sure they do not have any other problems regarding to the dinner. If they have any other problems, maybe we can do something about it in the intervention 13. Do you want to learn more about the eat well plate and how to use it in your dinner meals? We ask this question to make sure if they are willing to work with us and to learn more about the eat well plate and how to use it regarding to dinner.

C. Process evaluation researchers Did the intervention reach the target group?

Yes No

The intervention did not reach the whole

target group. Only six of the 67 exchange

students signed in for the intervention.

Did the intervention had a big range?

Yes No

From the six students that signed in, only two

ware able to meet for the interventions

Were the interventions preformed as

planned?

Yes No

Not really, This was due to the number of

participants, the researchers wanted to have

discussions in class, but with only two

participants this was difficult to do.

Did the target group understood and

appreciated the interventions?

Yes No

The two participants understood and

appreciated the interventions, this was

checked with them during the meetings.

If the target group appreciated the

interventions or not is difficult to say, this

wasn’t something the researchers looked into.

What can be said is: for now the exchange

students didn’t think a healthy nutrition is a

priority.

Did all participants completed the

interventions?

Yes No

Only two participants from the six did.

Did you deviated from the planning?

Yes No

Due to the lack of time the researchers could

only do four instead of six interventions.

And because of the attendance wasn’t big the

interventions were shorter than planned.

Can the program be better the next time?

Yes No

A program like these can always be better and

the design of it also depends on the target

group.

Can the program be reproduced efficiently

the next time? Investment from the client

(money/manpower)

Yes No

Maybe the next years students of exercise and

health will need to do a similar project. If they

are going to look into the same problem they

can reproduced this program.

Education focus, does it fits within the

education?

Yes No

The students are familiar with the setting of

the interventions. And in addition to that, they

learned about a healthy nutrition.

Does the program has room for diversity

Yes No

The information in this interventions can be

presented in different ways and can be

adapted for every target group.

The choices that has been made during the

project, were they the right ones?

Yes No

The researchers worked with a workbook from

the course and met all criteria from the

workbook.

with that being said, the researchers could

have a more pro-active attitude towards

contacting the exchange students and letting

them now this intervention was for them.

Were there rooms available for the

meetings?

Yes No

Rooms were available, but they need to be

booked in advanced.

Was all the materials that was needed for the

project available?

There for you only need to book the right room

and have to prepare for the meeting.

Did the project met the conditions of the

school?

Yes No

The researchers had a workbook of the course

as guideline so everything the researchers did

met the guidelines of the workbook

Was the attendance as expected?

Yes No

No not at all. The researchers hoped for at

least six students. And that other exchange

students would participated to. But only two

participated.

How was the implementation?

Good Poor Bad

Not all the information was new for the two

participating students. The interactions with

the students was good as well. They

responded very well and one student already

tried to drink more water.

What were the strong and weak points of this project?

Strong points:

The researchers prepared a PowerPoint presentation en visualized what they wanted to teach the

participants. By doing this it was easier for the participants to take the information in. The

researchers then asked the participants about the products they talked about, and if they met the

nutritional guidelines. By doing this the participants could see in which product they needed to add to

their food pattern and of what product they already have sufficient of.

Weak points:

The intervention did not reach the whole target group and not even all the students that signed in for

the interventions. Due to this the researchers can’t say if the interventions really worked or not.

D. Process evaluation international office Did the project met your expectations?

Yes no

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

Did the researchers communicated the

progress of the project?

Yes no

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

Do you think the researchers put enough

effort into the project?

Yes no

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

Could the researchers done more for the

project?

Yes no

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

If you think back, was there anything you

miss during the process?

Yes no

……………………………………………………………………….

……………………………………………………………………….

B. Do you think you will get what you

werDo you think you will get what you

Do you think you will get what you were

looking for?

Yes no

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

Were the researchers prepared during the

meetings?

Yes no

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

Did every researcher knows the subject?

Yes no

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

Did the researchers followed through on

what they say?

Yes no

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

………………………………………………………………………

………………………………………………………………………

How was the communication overall?

Good Poor Bad

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

What were the strong and weak points of this

project?

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

v v

E. Intervention 1

Eat well plate

Francisco Godinho

Suzanne Doolaard

Nikki Ronda

Tam Nguyen

Content

Introduction Meetings Results of the intake What is the eat well plate? Requirements General rules Quiz Questions?

+- 30 / 45 minutes

General information Tam Nquyen

Suzanne Doolaard

Francisco Godinho

Nikki Ronda

International nutrition class

Project focused on exchange students and their eating habbits

Meetings Meeting 2 Week 21 Meeting 3 Week 22

You will gain information and we will make a cookbook together.

PowerPoint Discussions Reading labels Quiz Cook class???

Results of the intake

Not familiar with the eat well plate

Like eating healthy

Don’t know much about Dutch meals

Little knowledge about healthy and

cheap buying places

Eat well plate

Eat well plate Visual guide for a balanced diet

5 important groups, but different recommendations

Average meal?

One-third carbohydrates

One-third fruit and vegetables

One-third dairy products, protein and a little bit of fat

Macronutrients Carbohydrates

Bread, pasta, grains, cereals, rice, potatoes

Fruit and vegetables

Dairy foods

Butter, yoghurt, cream, cheese, milk

Protein

Meat, fish, eggs, beans, lentils, pulses nuts

Fat

Cakes, crisps, chocolate, sweets, fizzy drinks

General rules Eat varied

Don’t eat too much and exercise enough

Eat less saturated fat

Eat lots of fruit, vegetables and bread

Eat safe

Recommended are 6 eating moments

Don’t forget to drink water!!!! 1,5 to 2 liters per day

Healthy food

Eat well plate

Calcium / Zinc and Iron in diet

Why?

Less change of disease

Obesity, cardiovascular disease, mental

problems

Feeling happier

Quiz

Two groups

10 questions

Question 1

What is the biggest part of the eat well

plate?

Anwser: Fruit and vegetables

Question 2

Is fat by definition not good for the human

being?

Anwser: No. Saturated and unsaturated

fats.

Question 3

One third of an average meal has to

consist of one-third carbohydrates and

protein together?

Anwser: No. One-third carbohydrates and

one-third protein

Question 4

Is this a healthy meal regarding to the eat

well plate?

Anwser: Yes. Protein,

vegetables,

carbohydrates,

a little fat and

dairy products

Question 5

Is this a healthy meal regarding to the eat

well plate?

Anwser: No. To much

protein, less vegetables

and carbohydrates

Question 6

One of the general rules is; Eat less

unsaturated fats?

Anwser: No, eat less saturated fats.

Question 7

Important for humans at your age is Iron

for the bones?

Anwser: No. Iron is not for the bones, but

for blood volume, body mass and

myoglobine

Question 8

Iron is more important for girls than for

boys?

Anwser: Yes, because of menstruation.

Question 9

What are the three most common

diseases because of bad food?

Anwser: Obesity, cardiovascular disease

and mental problems

Question 10

You have to drink at least 2,5 liter water

per day?

Anwser: No, between the 1,5 and 2 liters

per day.

Questions?

F. Intervention 2

What is good and what is not?Second meeting

Francisco Godinho

Suzanne Doolaard

Nikki Ronda

Tam Nguyen

Eat well plate / Food piramide

Good vs Bad

Freshly squeezed orange juice

vs

a glass of cola

Good vs Bad

Fruit is rich on vitamines

Apples, grapes and pears hardly contain vitamins

Citrus fruits contain vitamin C, but we have already sufficient

No fruit contains vitamin B12 and D whichsome Dutch gain too little in

Good vs Bad

It’s bad to eat before going to bed

Good vs Bad

Good vs Bad

+/- 190 kcal+/- 190 kcal

+/- 190 kcal +/- 190 kcal

Market locations

3 locations in Haarlem

Grote markt Monday 11:30 till 18:00 hour and Saturday 08:30 till 17:00 hour

W.C Schalkwijk Tuesday 08:30 till 17:00 hour

Floresstraat Thursday 08:30 till 16:00 hour

De Bazaar – Beverwijk

Every weekend 08:30 till 18:00

Market locations

Grote markt

Monday 11:30 till 18:00 hour

Saturday 08:30 till 17:00 hour

Market locations

W.C Schalkwijk

Tuesday 08:30 till 17:00 hour

Market locations

Floresstraat

Thursday 08:30 till 16:00 hour

Market locations

De Bazaar – Beverwijk

Every weekend 08:30 till 18:00

De Bazaar

Black Market

Eastern Market

Grand Bazaar

Hall 30

Car-Boot Market

Out door Market

Quiz

Prunes has a laxative function Myth/Fact

Milks contains vitamin D. Myth/Fact

Freshly squeezed orange juice is

healthier than a glass of cola Myth/Fact

Fruit is rich in vitamins. Myth/Fact

Healthy eating increases

your resistance. Myth/fact

You should not eat before bedtime,

because is not digested. Myth/fact

Losing weight is a matter

of the right diet. Myth/fact

G. Intervention 3

What is goodand what is not

Francisco Godinho

Suzanne Doolaard

Nikki Ronda

Tam Nguyen

Reading labels

What labels claim and what it means

What labels claim and what it

means

Calorie free – less than 5 calories

Sugar free – less than 0.5 grams

Fat free – less than 0.5 grams

What labels claim and what it

means

Low fat – 3 grams or less

Reduced or less fat – at least 25% less than

the normal product

Low in saturated fat – 1 gram or less, with

no more than 15% of the calorie intake

What labels claim and what it

means

Lean – less than 10 grams of fat, 4,5 grams of saturated fat

Extra lean – less than 5 grams of fat, 2 grams of saturated fat

Light (lite) – at least 1/3 fewer calories or no more than half the fat of the regular product, or no more than half the sodium of the regularporducts

What labels claim and what it

means

Cholesterol free – less than 2 milligrams of cholesterol and 2 grams of saturated fat

Low cholesterol – 20 or fewer miligrams of cholesterol and 2 grams or less of saturatedfat

Reduced cholesterol – at least 25% lesscholesterol than the regular product and 2 grams or less of saturated fat

What labels claim and what it

means

Sodium free – less than 5 miligrams of

sodium

Very low sodium – 35 miligrams or less

Low sodium – 140 miligrams or less

What labels claim and what it

means

Reduced or less sodium – at least 25% less

sodium than the regular products

High fiber – 5 grams or more

Good source of fiber – 2.5 to 4.9 grams

What labels claim and what it

means

General guidlines

Free – food has the least possible amount

Very low and low – has a litlle more

Reduced or less – the food has 25% or less

Reading Recipes

Read through the recipe at least twice to make sure that you understand the directions.

Look at the recipe yield and decide if the number of servings is what you need. If not, consider whether you should cut the

ingredient amounts in half or double them.

Check that you have all the necessary equipment and ingredients.

Reading Recipes Check whether you can (or need to) make

any part of the recipe ahead of time. Read through the ingredients to see whether

you like them all, as well as whether the recipe has too much fat, sugar, or salt for your dietary needs.

Check whether you need to use an ingredient, such as butter or oil, at different stages in the recipe so that you don’t make the mistake of using that ingredient all at once.

Reading Recipes

Make sure that you can perform all the

techniques.

Find out whether you need to preheat the

oven.

Make sure that you have enough time

before serving to prepare and cook the

recipe.

Eat well plate

Cutting and pasting

Start here. Note the size of a single serving and how many servings are in the package.

Check total calories per serving. Look at the serving size and how many servings you’re really consuming. If

you double the servings you eat, you double the calories and nutrients, including the Percent Daily Value (% DV).

Limit these nutrients. Remember, you need to limit your total fat to no more than 56–78 grams a day —

including no more than 16 grams of saturated fat, less than two grams of trans fat, and less than 300 mg

cholesterol (for a 2,000 calorie diet).

Get enough of these nutrients. Make sure you get 100 percent of the fiber, vitamins and other nutrients you

need every day.

Quick guide to % DV. The % DV section tells you the percent of each nutrient in a single serving, in terms of the

daily recommended amount. As a guide, if you want to consume less of a nutrient (such as saturated fat,

cholesterol or sodium), choose foods with a lower % DV — 5 percent or less is low. If you want to consume more

of a nutrient (such as fiber), seek foods with a higher % DV — 20 percent or more is high.

Here are more tips for getting as much health information as possible from the Nutrition Facts label:

Remember that the information shown in these panels is based on 2,000 calories a day. You may

need to consume less or more than 2,000 calories depending upon your age, gender, activity level,

and whether you’re trying to lose, gain or maintain your weight. Find out your personal daily limits on

My Fats Translator.

In general, as you think about the amount of calories in a food per serving, remember that for a

2,000-calorie diet:

40 calories per serving is considered low;

100 calories per serving is considered moderate; and

400 calories or more per serving is considered high.

There is no % DV shown for trans fat on the panel because the U.S. Food and Drug Administration

(FDA) does not have enough scientific information to set this value. We recommend eating less than

20 calories or (less than two grams of trans fat) a day – that’s less than 1 percent of your total daily

calories (for a 2,000-calorie-a-day diet).

When the Nutrition Facts panel says the food contains “0 g” of trans fat, it means the food contains

less than 0.5 grams of trans fat per serving.

When the Nutrition Facts label says a food contains “0 g” of trans fat, but includes “partially

hydrogenated oil” in the ingredient list, it means the food contains trans fat, but less than 0.5 grams

of trans fat per serving. So, if you eat more than one serving, you could quickly reach your daily limit

of trans fat.

In addition to the Nutrition Facts label, a lot of foods today also come with nutrient content claims provided by the

manufacturer. These claims are typically featured in ads for the foods or in the promotional copy on the food

packages themselves. They are strictly defined by the FDA. The chart below provides some of the most

commonly used nutrient content claims, along with a detailed description of what the claim means.

If a food claims

to be...

It means that one serving of the

product contains...

Calorie free Less than 5 calories

Sugar free Less than 0.5 grams of sugar

Fat

Fat free Less than 0.5 grams of fat

Low fat 3 grams of fat or less

Reduced fat

or less fat

At least 25 percent less fat than the regular

product

Low in

saturated fat

1 gram of saturated fat or less, with not more

than 15 percent of the calories coming from

saturated fat

Lean Less than 10 grams of fat, 4.5 grams of

saturated fat and 95 milligrams of cholesterol

Extra lean Less than 5 grams of fat, 2 grams of saturated

fat and 95 milligrams of cholesterol

Light (lite) At least one-third fewer calories or no more than

half the fat of the regular product, or no more

than half the sodium of the regular product

Cholesterol

Cholesterol

free

Less than 2 milligrams of cholesterol and 2

grams (or less) of saturated fat

Low

cholesterol

20 or fewer milligrams of cholesterol and 2

grams or less of saturated fat

Reduced

cholesterol

At least 25 percent less cholesterol than the

regular product and 2 grams or less of

saturated fat

Sodium

Sodium free or no

sodium

Less than 5 milligrams of sodium and no

sodium chloride in ingredients

Very low sodium 35 milligrams or less of sodium

Low sodium 140 milligrams or less of sodium

Reduced or less

sodium

At least 25 percent less sodium than the

regular product

Fiber

High fiber 5 grams or more of fiber

Good source of

fiber

2.5 to 4.9 grams of fiber

If you can’t remember the definitions of all of the terms, don’t worry. You can use these general guidelines

instead:

“Free” means a food has the least possible amount of the specified nutrient.

“Very Low” and “Low” means the food has a little more than foods labeled “Free.”

“Reduced” or “Less” mean the food has 25 percent less of a specific nutrient than the regular version

of the food.

http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HeartSmartShoppi

ng/Reading-Food-Nutrition-Labels_UCM_300132_Article.jsp

H. Intervention 4