DBPIA-NURIMEDIA

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1 J Korean Soc Food Sci Nutr 한국식품영양과학회지 37(11), 1427~1434(2008) DOI: /jkfn 초등학생의영양교육에따른영양지식, 식생활태도및식습관의비교 이옥희 1 장순옥 2 박민정 1 1 용인대학교식품영양학과 2 수원대학교식품영양학과 Comparison of Nutrition Knowledge, Dietary Attitude and Dietary Habit in Elementary School Children With and Without Nutrition Education Okhee Lee 1, Soon Ok Chang 2, and Min Jung Park 1 1 Dept. of Food Science and Nutrition, Yongin University, Gyeonggido , Korea 2 Dept. of Food and Nutrition, Suwon University, Gyeonggido , Korea Abstract This study was aimed to compare nutrition knowledge, dietary attitude and habit of elementary school children with and without education. Eighty-four subjects with unbalanced eating behavior were selected and assigned to either control or education group. The subjects in education group participated in a nutrition education program once a week for 8 weeks. The contents of nutrition education were on food tower, balanced nutrition, nutrient function, food group, importance of breakfast, and nutrition label, etc and the program was performed by a school dietitian. The effects of education was assessed by self-administered questionnaire prior to and after nutritional education. Nutrition knowledge except on snack, dietary self-efficacy except on low fat/ low calorie, attitude except on functional food and favorite, and general dietary habits of children in education group were significantly improved while those in control group showed no changes. Also, factors for unbalanced eating was improved by nutrition education indicating the need for correction on unbalanced eating was diminished. However, children's adherence to snack, instant and fast food remained to be corrected. The dietary habit of balanced eating was improved by education reducing the percentage of unbalanced eating on grain and meat fish milk groups. The nutrition education appears to be effective to provide nutrition knowledge thereby to improve dietary attitude, dietary self-efficacy, and partly to reduce children's unbalanced eating factor. Key words: elementary school children, unbalanced eating, nutrition education, dietary habits 서론어린이는미래의국가적성장동력이기때문에사회적으로어린이의건강관리에대한관심이급증하고있다. 아동기에일어나는왕성한신체적및정신적성장은영양과식품섭취에의해크게영향을받으므로, 최근어린이먹거리의안전관리가사회적인중요한이슈가되어국가적으로대책마련에고심하고있다. 아동기는성장을위한영양요구량이높을뿐아니라식습관도이시기에형성되지만, 건강과영양에대한지식과인식이부족한아동들은식품선택에서영양성보다기호성에치우쳐편식할우려가크다 (1). 현재우리나라의초등학교아동의편식율은 65 77% 로매우높아, 이로인한영양불균형이우려되고있다 (2). 여러연구에서아동들의가공식품이나패스트푸드, 사탕이나과자같은단음식이나탄산음료의섭취증가가보고되고있다 (3-5). 국민 건강영양조사 2005년도결과에의하면어린이들의채소류, 우유류섭취는부족한반면, 탄산음료, 햄, 소시지, 과자류등의기호식품의섭취는증가하였고, 그에따라아동들의철과칼슘섭취는부족한반면에열량과포화지방섭취가높고, 특히나트륨은한국인영양섭취기준의충분섭취량에비해 4배이상많은양을섭취하고있다 (6). 심각한편식은영양소결핍으로인한발육및건강장애를초래하게되는데, 철결핍성빈혈, 만성변비, 비만, 만성비특이성설사, 소화기질환, 호흡기질환, 피부질환, 비만, 음식알레르기등의질환의원인이며, 비타민을비롯한각종미량원소의결핍등이심한편식을하는아동에서보고되고있다 (7,8). 한편편식은성격이나정서적성향에도영향을주는데, 편식아의경우신경질적이며냉정한성격을가지거나침착성이낮은경우가많으며 (9), 정서적으로안정성과사회성부족도보고되고있다 (10,11). 그러므로아동의성격형성, Corresponding author. okheel@hotmail.com Phone: , Fax:

2 1428 이옥희 장순옥 박민정 성장발달과건강을위해학령기에영양교육을통한편식교정과올바른식습관확립은매우중요하다. 더욱아동기에형성된식습관은일생동안지속될수있으며, 특히아동기는학교생활을통한자극이나또래집단에민감하여, 급식이제공되고있는학교에서의영양사에의한영양교육은편식습관을교정하는데효과적으로알려져있다 (12,13). 바람직한식행동을위해서는영양지식과식생활태도의교정뿐아니라, 최근에는 dietary self-efficacy( 식이자기효능감 ) 이라는사회인지적요소가강조되고있다 (14-18). Bandura(19) 에따르면식행동과같은건강관련행위의교정은단순한영양지식의제공이나기술의습득만으로는유도하기는어렵고, 교정이가능하다는기대나신념에의해일어나기때문에, 식이자기효능감은편식행위에중요한영향을미칠것이다. 편식교정을위해서는영양지식을행동으로유도하기위한태도와자각단계의발전이필요하며이를나타내는식이자기효능감측정이필요하지만, 편식어린이를대상으로하는영양교육에서이를고려한국내연구는드문편이다. 나아가대부분의영양교육연구는대조군이없이오직교육군만을대상으로영양교육실시전후의효과를비교한경우가많다 (1,12,13,20,21). 그러나시간경과에따라영양습관은변화하며, 특히과거보다영상매체에노출된경우가많아매스컴등에서건강한식생활에대한각종홍보등사회적및환경적요인에의해식습관이영향받을수있다. 따라서아동대상영양교육연구에서영양교육만의독립적효과를평가하기위해서는대조군을포함하는것이필요하다. 본연구에서는초등학교저학년학생중학교급식을먹을때편식하는아동들을선정하여영양교육을실시하지않는대조군과영양교육을받는교육군으로나누어, 학년별로나누어영양사가직접교육을실시하였을때아동의영양지식, 편식교정인자, 식생활태도, 편식교정에대한식이자기효능감, 일반식습관에미치는영향을비교하고자한다. 연구대상및방법연구대상및기간연구대상은경기도용인지역에소재하고있는 O 초등학교급식아동 1학년에서 4학년아동중급식시간에편식이심하다고판단되는아동들중편식교육을받은적이없는아동들이었다. 담임교사의추천을받아각학년에서 20명내외로총 84명을대조군과교육군으로두군에남녀의구분없이각학년별균등하게 42명씩배정하였다. 영양교육은 2007년 9월부터 11월까지였으며, 주 1회약 30분정도 8주간동안학교급식영양사에의해학년별지도로교육군에실시되었다. 연구방법영양교육프로그램의실시 : 영양교육은초등학교 1학년에서 4학년까지의저학년아동을학년별로 9~12명을한집 단으로하여주 1회약 30분이상총 8회에걸쳐학년별로이루어졌으며, 교육프로그램은학교급식개선연구보고서 (22) 와서울시의튼튼히교실매뉴얼 (23) 을참고하여본연구에맞도록수정 보완하여사용하였다. 첫째주, 아동들의교육전영양지식, 식생활태도, 편식습관, 편식유형, 아침결식여부, 일반적식습관을진단을위한설문조사와친교시간둘째주, 편식의정의와원인, 편식에따른건강상문제점과해결방안. 좋아하는음식과싫어하는음식말하기셋째주, 올바른아침식사습관넷째주, 성장과건강에필요한영양소. 식품과영양소, 영양소의역할게임다섯째주, 식품의균형섭취와식품구성탑여섯째주, 영양표시와식품선택일곱째주, 올바른간식선택법여덟째주, 학습내용정리와빙고게임, 설문조사평가도구 : 교육전후에대상자들의영양지식, 식생활태도, 편식습관, 일반적식생활습관, 식품선택에대한식이자기효능감에대한평가는선행연구들을참고하여 (1,17,18, 24-26) 자기기록설문지법으로조사하였다. 설문문항중아동이이해하기어려운용어는영양사가예를들어구체적으로설명하여이해하게한후답을선택하도록하였다. 영양지식평가문항은식품구성탑, 균형잡힌식사, 우리몸과영양소, 비만, 아침식사, 편식, 적절한간식섭취방법의 7 가지영역에대한 12문항으로, 점수는정답에 1점, 틀리거나모르는경우 0점을주어산정하였다. 식생활태도와올바른식생활습관의평가는각각 10문항으로구성하여항목마다 그렇다 는 3점, 보통이다 는 2점, 아니다 는 1점으로분류하였으며부정적인답변은반대로분석하였다. 편식관련식이자기효능감평가는 Choi(24) 가 CDSS (Child Dietary Self-Efficacy Scale)(18) 와 Eating Self- Efficacy Scale(17) 을수정보완하여사용한문항중편식과관련되는 5가지문항을선정하여각각 3점척도를사용하여점수를산정하였다. 식이자기효능감에대한신뢰도로써내적일관성을나타내는 Cronbach α 값은 0.69를나타내었다. 편식교정인자는편식과관련된태도나행동에대해 7문항으로 3점척도로평가하였다. 그외편식하는유형과편식이유도조사하였다. 통계처리 : 수집된자료는 SAS ver. 9.0 통계프로그램을이용하여분석하였다. 영양지식, 식생활태도, 일반적식습관과편식개선에대한식이자기효능감, 편식교정인자는교육군과대조군의교육전 후에따른변화의유의적차이를 paired t-test로평가하였다. 편식하는식품군이나편식이유는 x²-test 를사용하여교육전후분포의유의성을 α=0.05에서검증하였다. 편식교정인자, 일반식습관과영양지식, 식생활태도, 식이자기효능감과의관계는 Pearson's correlation coefficient로상관성을검증하였다.

3 초등학생의영양교육에따른영양지식, 식생활태도및식습관의비교 1429 결과및고찰 영양교육에따른영양지식과식생활태도의변화 영양교육에서다루어진식품구성탑, 균형잡힌식사, 영양소의기능, 비만, 아침식사, 편식, 적절한간식섭취의 7가지영역에대한 12가지문항의교육전후평가결과는 Table 1에제시하였다. 교육을받지않은대조군은시간의경과에따라영양지식점수는차이를보이지않는반면에, 교육군은 7가지영역중적절한간식섭취방법을제외한 6가지영역에서영양지식이유의적으로향상되었다. 영양지식점수는교육군이교육전 4.1점에서교육후에 9.5점으로현저하게증가하였다 (p<0.001). 본연구에서교육에의한영양지식의향상은시간경과나사회적환경, 매스컴의홍보등에상관없이영양전문가에의한직접적영양교육이아동의영양지식향상에독립적으로효과를보인것을의미한다. 본연구와마찬가지로대부분초등학교학생을대상으로한영양교육프로그램은영양지식획득에는효과가있었는데 (1,27-31), 이러한영양지식의향상은올바른식생활에대한이해를의미하는것으로바람직한식행동변화를유도할수있는기초가된다. 영양교육에따른식생활태도의변화는 Table 2에제시된 Table 1. Changes in nutrition knowledge by nutrition education Nutrition knowledge Food tower Balanced meals Nutrient functions Obesity Unbalanced diet Breakfast Snacks Total score Education group Control group 0.3±0.5 1) 0.3± ± ± ± ± ± ± ±0.7 *** 0.9±0.4 *** 2.4±0.8 *** 1.8±0.5 *** 1.7±0.6 ** 0.7±0.5 *** 0.6±0.5 ns 9.5±2.3 *** 0.4± ± ± ± ± ± ± ±2.4 2) ns: non-significant by paired t-test. *** p<0.001 by paired t-test. 0.5±0.7 ns2) 0.2±0.4 ns 0.9±0.9 ns 1.1±0.8 ns 1.3±0.7 ns 0.5±0.5 ns 0.4±0.5 ns 5.0±2.5 ns 바와같다. 평가문항 10문항중영양교육에의해유의적향상이나타난항목은교육군의경우 예전에먹어보지않은음식이라도먹으려고노력한다, 다른재미있는일이있다면한두끼쯤은굶어도상관이없다고생각한다, 식사를거르더라도다음에많이보충하면된다고생각한다, 몸에좋다는음식은일부러먹으려고노력한다, 영양이많은음식도먹고싶지않으면먹지않으려고한다, 음식으로질병을예방하거나치료할수있다고생각한다, 음식을먹을때영양적인면을먼저생각한다 이었다. 즉 8주동안의영양교육에의해낯선음식에대한태도, 규칙적인 3끼식사, 식사의영양성, 건강을위한음식의중요성에대한태도등은개선되었다고할수있었다. 단편식에따른영양부족을영양제와같은건강보조식품섭취를통해기대하는태도나맛없는음식이나좋아하는식사에대한태도등은개선되지않았다. 본연구에서식생활태도총점은교육집단의경우교육전후에 18.9에서 22.4점으로향상되었지만, 영양지식만큼그상승폭이크지는않았다. 일반적으로식생활태도가긍정적인아동일수록식습관이바람직하다고알려져있다. 영양개선과식습관개선을위한영양교육은먼저교육대상자의지식습득에의한이해도향상이선행되어야하는데, 본연구에서는영양지식뿐아니라식생활태도도영양교육에의해개선되었으며, 이는비만아동을위한영양교육을실시하여영양지식과식생활태도가개선된결과와일치한다고하겠다 (32). 본연구의대상자들은다른연구의아동들보다저학년이므로인지능력이낮은점을고려하여영양사가학년별로나누어서 10명내외의소규모단위로편식을포함한식생활문제를다루어서아동의이해를돕고식생활에대한태도를개선하도록하였다고보여진다. 영양교육에따른식이자기효능감, 편식교정인자와편식유형편식개선과관련된식이자기효능감으로는 반찬을골고루섭취할수있다, 튀기거나부친음식대신굽거나찐 Table 2. Change in dietary attitude by nutrition education Variables Try to eat unfamiliar food Try to eat food for health Give priority to the nutrition of foods than taste Try to eat nutritious foods even if I don't like them Think to take meals later when skipped meals Think that food is helpful to prevent or treatment of disease Try to take functional foods for health if nutrition is poor by unbalanced diet Try to eat even distasteful foods if my family or friends eat Don't mind skipping meals when I indulged in something No need to change meals that satisfies me Education group Control group 1.9±0.8 1) 1.9± ± ± ± ± ± ±0.5 *** 2.3±0.6 * 2.3±0.7 * 2.2±0.8 ** 2.4±0.8 ** 2.5±0.6 * 2.3±0.7 ns 2.0±0.8 ns 2.5±0.7 *** 1.9±0.7 ns 2.4± ± ± ± ± ± ± ± ±0.8 ns2) 2.2±0.7 ns 2.3±0.7 ns 2.0±0.7 ns 2.4±0.7 ns 2.4±0.8 ns 2.2±0.8 ns 1.9±0.8 ns 1.5±0.7 ns 1.9±0.8 ns Total 18.9± ±2.7 *** 21.1± ±2.7 ns 2) ns: non-significant by paired t-test. * p<0.05, *** p<0.001 by paired t-test.

4 1430 이옥희 장순옥 박민정 Table 3. Change in dietary self-efficacy on balanced eating by nutrition education Item Confident to choose balanced meals with various side dishes Confident to choose baked or steamed foods instead of fried foods Confident to choose fruits instead of candy or sweets Confident to choose fruit juice instead of soft drinks Confident to choose vegetables instead of fat-rich foods Education group Control group 1.9±0.9 1) 2.2± ± ± ±0.7 *** 2.4±0.7 ns2) 2.9±0.3 *** 2.5±0.8 *** 2.4±0.6 *** 1.9± ± ± ±0.8 * ns 2.4±0.8 ns 1.8±0.9 ns 2.1±0.8 ns Total score 9.9± ±2.0 *** 10.0± ±2.8 ns 2) ns: non-significant by paired t-test. *** p<0.001 by paired t-test. 음식을선택할수있다, 간식으로사탕이나과자대신과일을선택할수있다, 음료로콜라등청량음료대신과일주스를선택할수있다, 반찬으로기름진음식대신채소나나물류를선택할수있다 등 5가지항목에대해조사하여 Table 3에제시하였다. 교육집단의식이자기효능감은영양교육에의해 튀기거나부치는대신굽거나찌는저지방 저열량조리법의음식을선택할수있다 는항목을제외한 4가지항목에서유의적으로개선되어전체편식개선을위한식이자기효능감은교육전 9.9점에서 12.6점으로 2.7점이나증가하였다. 이러한영양교육에의한편식습관개선에대한자신감증대는중학생이나성인을대상으로한다른영양교육결과들과유사하며 (15,24), 초등학교 4학년만을대상으로한영양교육보다 (30) 식이자기효능감증대효과가크다. 식이자기효능감은어떠한식행동을성공적으로수행할수있는구체적인자신감이며, 궁극적으로식행동변화를유도하는인지활동에대한가장강력한예측인자이다 (33,34). 본연구에서교육군에서편식개선과관련된항목들의식이자기효능감이증대한것은앞으로편식해소를위한식행동변화가일어날것으로짐작하게한다. 여러선행연구에서우리어린이의편식유형은채소나김치와같은식물성식품의섭취는기피하는반면에패스트푸드나탄산음료를선호하는양상을보이는데, 이는아동에서비만을유발하는주요한식생활요인이기도하다. 그러나본영양교육에의해비만을유발할수있는편식요인중저지방 저열량조리법의음식을선택할수있다는식이자기효능감은개선되지않았다. 따라서앞으로저지방조리실습이나저열량음식을선택하는경험을통한자신감을증대하는영양교육이보완되어야할것이다. 편식교정인자는본인의편식에대한생각, 식습관수정의필요, 편식여부, 싫어하는음식이나낯선음식에대한태도, 간식선택시의행동등 7가지항목으로이들항목의점수가높으면편식교정이필요함을나타낸다. 편식교정인자 7개항목의총점은영양교육에의해 13.5점에서 10.5점으로유의하게감소하여편식습관이개선되고있음을보여준다 (Table 4). 세부항목으로는편식비율, 편식개선의필요성, 싫어하거나낯선음식에대한대응방법의점수는교육에의해유의적으로개선되었지만, 인스턴트및패스트푸드섭취, 간식과다섭취에의한결식, 튀김등기름이많은음식섭취등의세가지항목은영양교육에의해서개선되지않았다. 이는이미언급한것처럼편식에관한식이자기효능감중저지방 저열량조리법음식을선택하는자신감이교육에의해증대되지않았던점이나식생활태도중본인이만족하는식사에대해서는교정의지가낮았던태도와도관련이있다고하겠다. 이와같이저학년아동에서비만을유도할수있는고지방식품섭취에대한태도가개선되지못함은성장과함께비만발생의중대한위험을시사한다. 특정식품군에대한편식과편식의이유는백분율로써나타내었는데 (Table 5) 특정식품군에대한편식하는비율은교육전 92.9% 에서교육후 45.2% 로유의적으로감소되었으며, 특히육류 생선 우유를편식하는비율은 31% 에서 7.1% 로, 콩류 곡류 감자류는 31% 에서 9.5% 로감소하였다. 편식하는이유는교육전에는본인이좋아하는음식이거나싫어하는음식이라는이유의비율이높았으나교육후에는이러한이유에의한편식비율은유의하게감소하였다. 아동들은채소류 (8,35,36), 두류, 곡류, 어패류등을대표적으로 Table 4. Change in factors for unbalanced eating by nutrition education Item Agree on my meal being unbalanced My unbalanced eating should be corrected Need to cope with unfavorable foods Need to reduce frequent intake of fast instant or fast foods Need to cope with unfamiliar foods Happen to skip meals by overeating snacks Intake of foods cooked with oil Education group Control group 2.5±0.8 1) 2.5± ± ± ± ± ±0.7 *** 1.7±0.9 *** 1.3±0.6 *** 1.6±0.6 ns 1.5±0.6 ** 1.2±0.4 ns 1.6±0.5 ns 2.2± ± ± ± ± ± ± ±0.9 ns2) 2.2±0.8 ns 1.3±0.5 ns 1.8±0.6 ns 1.9±0.6 ns 1.2±0.4 ns 1.7±0.6 ns Total score 13.5± ±2.0 *** 12.6± ±2.6 ns 2) ns: non-significant by paired t-test. *** p<0.001 by paired t-test.

5 초등학생의영양교육에따른영양지식, 식생활태도및식습관의비교 1431 Table 5. Change in unbalanced eating food group and reason by nutrition education N (%) Specially preferred foods Reasons for unbalanced eating Item No Fruits & veg. Beans, grains, potatoes Meats, fish, milk Others No No experience Distasteful Disorder Favorite food Education group Control group Before After χ²-value Before After χ²-value 13 (31.0) 13 (30.9) 13 (31.0) 3(7.1) 4(9.5) 16 (38.1) 6(14.3) 16 (38.1) 1) ns: non-significant by χ² -test. *** p<0.001 by χ² -test 26 (61.9) 9(21.4) 4(9.5) 3(7.1) 26 (61.9) 5(11.9) 8(19.0) 2(4.8) 1(2.4) 24.1 *** 44.0 *** 4(9.5) 21 (50.0) 9(21.4) 8(19.0) 4(9.5) 11 (26.2) 14 (33.3) 3(7.1) 10 (23.8) 10 (23.8) 16 (38.1) 8 (19.0) 8 (19.0) 10 (23.8) 11 (26.2) 13 (30.9) 2 (4.8) 6 (14.3) 1.3 ns1) 3.8 ns 기피하며 (2,20,37), 패스트푸드나인스턴트음식, 쇠고기, 닭고기, 햄등단백질과지방이많은동물성식품을편식하는경향이증가하고있다 (5,36). 본연구에서는영양교육에의해동물성식품에대한높은편식이개선되어전체편식아동의비율도감소하게되어, 편식을포함한아동의일반적식습관개선을위한영양교육도동물성식품에대한편식율을감소시키는데효과가있음을보였다. 본연구에서교육에의해대체적인편식교정인자점수의감소나아동들이특정식품에대한편식습관이유의하게감소한결과는 Park(12) 과 Han(1) 의결과와는일부유사하다. 어떠한식품군을특히선호하거나기피하는아동들의경우자아개념이낮은데, 동물성식품을선호하면서특히채소식품을기피하는아동들의경우자아개념이낮을뿐아니라공격성과위축성이높다고보고되어 (36), 본연구의동물성식품에대한편식율감소는아동의신체적건강뿐아니라정신적건강을위해매우중요하다. 영양교육에따른일반식습관영양교육에따른일반식습관은 Table 6에제시된바와같다. 일반식습관항목은편식해소를위한식사시반찬골고루먹기, 간식횟수, 간식으로인스턴트또는패스트푸드대신과일및유제품섭취, 섭취반찬의가짓수늘이기, 아침 식사, 일정한시간에규칙적식사, 우유섭취, 식사예절, 외식등식생활전반에대한습관들을다루었다. 대조군의경우일반적식습관은아침먹기와식사시 TV보거나다른행동하는것은시간경과에따라개선되었지만 (p<0.01), 교육군은앞서제시한모든항목중간식횟수, 김치를포함한 3가지이상반찬먹기, 가족과함께식사, 외식빈도등의 4 항목을제외하고는영양교육에의해유의적으로개선되었다. 식습관점수총점은교육전 19.7±3.1점에서교육후 23.0±3.6점으로유의한개선을보였다 (p<0.001). 영양교육은일련의 KAP과정이라고한다 (38). 그러나영양교육이효과적이기위해서는적절한식행동을할수있다는자신감과신념을나타내는식이자기효능감증진이일어나야하며 (39), 어떤식품류에대한편식이단순하게영양지식의제공만으로는식행동과식습관개선이미흡함은유아를대상으로한연구에서도보고되었다 (37). 본연구에서는영양교육이영양사에의해급식현장에서실시되어아동의식생활태도와식이자기효능감증대에효과적이었을뿐아니라일반식습관도상당히개선되었다. 그러나아동의주요편식유형의하나로알려진김치를포함한 3가지이상의반찬먹기가개선되지않았다. 이는본연구의대상자가편식아동이지만영양교육내용이일반식습관개선중심으로구성되어채소반찬선택과같은체험과편식유형을고려한영양교육이상대적으로 Table 6. Change in general dietary habits by nutrition education Item Education group Control group Eat breakfast daily Eat 3 meals regularly Take snacks more than once a day Eat fruit or milk instead of instant or fast food. Take over 200 ml of milk daily Eat more than 3 side dishes including kimchi. TV-watching or other actions while eating Take meals together with family Take various side dishes Eat out more than once a week 1.8±0.7 1) 1.6± ± ± ± ± ± ± ± ±0.7 *** 2.5±0.7 *** 1.9±0.8 ns 2.4±0.7 * 2.3±0.7 * 2.5±0.7 ns 2.6±0.6 *** 2.2±0.8 ns 2.3±0.7 ** ns 1.9± ± ± ± ± ± ± ± ±0.8 *** 2.6±0.6 ns2) 2.1±0.7 ns 2.1±0.8 ns ns 2.5±0.7 ns 2.1±0.8 * 2.3±0.7 ns 2.2±0.7 * 2.2±0.8 ns Total score 19.7± ±3.6 *** 22.0± ±3.1 ns ns: non-significant by paired t-test. p<0.05, p<0.01, p<0.001 by paired t-test.

6 1432 이옥희 장순옥 박민정 Table 7. Correlation coefficients among dietary habits and self efficacy before and after education Nutrition knowledge Dietary attitude General dietary habits Dietary self-efficacy Unbalanced eating factor Nutrition knowledge Dietary attitude General dietary habits Dietary self-efficacy ) * (0.324 ** ) 2) (0.306 ** ) (0.409 *** ) ( ** ) 1) Pearson correlation coefficient before education. 2) Pearson correlation coefficient after education. Significant at * p<0.05, *** p< ** (0.651 *** ) (0.363 *** ) *** ( *** ) *** (0.298 *** ) ( *** ) ( ** ) 부족하였기때문으로보인다. 따라서앞으로영양교육의내용으로는편식유형을고려한식품선택이나맛이나기호보다는영양을중시하고, 고지방식품에의한열량섭취와건강과의관계를강조하고, 전달방법으로는다양한매체를이용하여흥미를높이고, 채소식품을선택하는실습등이보완되면식이자기효능감과그에따른식습관개선에더욱효과적일것이다. 나아가영양교육의효과평가도식품선택이나영양섭취와같은직접적인효과평가로확대하는것이필요하다. 영양지식, 식생활태도와식이자기효능감, 편식교정인자, 일반식습관의관계영양교육전후의영양지식, 식생활태도와편식교정인자점수, 편식관련식이자기효능감, 식습관간의상호관계를상관계수로써 Table 7에제시하였다. 교육전의경우편식교정인자점수는높을수록식생활태도나일반식습관점수가낮은역의상관성 (r=-0.410, r=-0.480) 을보였으며, 영양교육이후에는그뿐아니라영양지식과식이자기효능감도낮은역의상관성을보였다 (r=-0.323, r=-0.389, r=-0.480, r=-0.310). 일반식습관점수는교육전에는영양지식및식생활태도가좋을수록높은정의상관성을보였으나 (r=0.274, r=0.287), 식이자기효능감점수와는상관성을보이지않았다. 그러나영양교육이후에는일반식습관점수는영양지식, 식생활태도뿐아니라, 식이자기효능감의향상에따라높아지는정의상관관계를보여세가지요인의향상에의해식습관이개선됨을보였다 (r=0.306, r=0.651, r=0.298). 한편식이자기효능감은오직영양교육후에만영양지식뿐아니라식생활태도의향상과밀접한관련성을보였다 (r=0.459, r=0.383). 본연구결과는영양교육후에편식을하지않고골고루먹을식이자기효능감은영양지식향상과식생활태도의향상에의해, 편식교정인자감소나일반식습관에긍정적인영향을미치는데, 영양교육에따른이러한양상은초등학생이나성인을대상으로한다른연구에서도보고된바있다 (40,41). 우리나라청소년을대상으로식이자기효능감에대한경로분석을하였을때영양지식은식이자기효능감에직 간접적으로영향을미치지만, 식생활태도는직접적영향을미친다고보고되고있다 (42). 여러선행연구에서식이자기효능감이식행동과관련성을보이고있으며 (24,30,35,42,43), 식이자기효능감은비만조절행위나저염 저지방식이행위 등식행동조절의가장중요한요소로제시되고있다 (16, 42,44). 본연구에서영양교육에의한편식교정인자나일반식습관의개선은영양지식의증대, 식생활태도의개선및식이자기효능감의증대와연관되어있으며, 편식을하지않을식이자기효능감은영양지식의수용뿐아니라식생활태도의향상과상관관계를보이는것은이를확인하는것이라할수있다. 이와같이학년에따라분리하여 10명내외의소규모단위로기존의프로그램으로이루어진영양교육은저학년아동의편식에대한태도와식이자기효능감을개선시켜, 편식습관과일반식습관을개선시킬수있음을보였다. 요약본연구에서는초등학교 1학년에서 4학년까지의급식아동중편식이있는아동들을선정하여각학년마다비슷한인원수로교육군과교육을받지않는대조군으로배정하였다. 교육군은영양사가직접주 1회 8주간영양교육을학년마다분리하여실시하였으며, 교육군과대조군모두교육전후에영양지식, 식생활태도, 편식과관련된식이자기효능감, 편식교정인자, 일반식습관등을조사하여영양교육에따른변화를비교하고자하였다. 영양지식과식생활태도는교육집단은교육전 4.1±2.0점과 18.9±3.7점에서교육후 9.5±2.3점과 22.4±2.7점으로각각유의하게증가하였다 (p<0.01, p<0.001). 그러나식생활태도는교육집단의경우교육후 10항목중 7항목에서유의적인변화를보여긍정적인변화를보인반면, 대조군은모든항목에서유의적인변화를보이지않았다. 편식과관련된식이자기효능감은영양교육에의해저지방 저열량조리법의음식을선택할항목을제외하고개선되어 9.9±2.8에서 12.6±2.0으로유의적향상을보였다 (p<0.001). 편식교정인자는영양교육에의해편식여부, 식습관수정필요, 편식하는식품군, 새로운음식이나싫어하는음식에대한태도등이유의적으로변화하였다. 그러나기름을많이사용한식품의섭취, 간식섭취에의한결식, 인스턴트와패스트푸드섭취항목은영양교육에의해개선되지않았다. 교육에의해편식유형중육류 생선 우유군및콩류 곡류 감자군에대한편식이현저하게감소하였다. 일반식습관총점은영양교육에의해유의적으로향상되었으며 (p<0.001), 조사된세부항목중올바른간식섭취횟

7 초등학생의영양교육에따른영양지식, 식생활태도및식습관의비교 1433 수, 김치를포함한세가지이상반찬섭취, 외식습관, 가족과함께먹기를제외한다른일반식습관은유의적으로개선되었다. 영양교육후편식교정인자는영양지식이나식생활태도, 식이자기효능감과역의상관성을보여 (r=-0.323, r=-0.389, r=-0.310), 교육에의해향상된영양지식, 식생활태도, 식이자기효능감은편식교정필요를낮출수있음을보였다. 한편일반식습관은영양지식, 식이자기효능감, 식생활태도와정의상관성을보여 (r=0.306, r=0.298, r=0.383), 영양지식의개선은식이자기효능감을높이고식생활태도를개선하여일반식습관에영향을주었을것으로사료된다. 이와같이본연구에서는급식이제공되고있는학교현장에서영양전문가인영양사가기존의선행연구에서개발된영양교육프로그램을이용하여초등학생의인지수준을고려한학년별로소규모로실시한영양교육은아동의영양지식, 식생활태도, 편식과관련된식이자기효능감증진에는대체적으로효과적이었으며, 편식교정인자, 일반식습관의개선에는부분적효과가있음을보였다. 본연구에서시간적제약과영양교육프로그램의전달방법의미흡으로인해이러한일부식습관의개선효과가제한적이었으므로, 앞으로저학년아동의편식유형과인지수준을좀더고려하여자신감을더욱높이는실천적프로그램이개발되어학교현장에서활용되어야할것이다. 문 헌 1. Han HY Effects of nutrition education program on nutrition knowledge, attitude, food habits, food preference and plate wastes of elementary school children attending national school lunch program. MS Thesis. Kangnung National University. 2. Ku PJ, Lee KA A survey on dietary habit and nutritional knowledge for elementary school children s nutritional education. Kor J Dlet Culture 15: Kim KA, Shim YH Cognitive performance and hyperactivity in terms of eating behavior and physical growth among preschoolers. Kor J Diet Culture 10: Park HS, Ahn SH Eating habits and social behavior in Korean preschool children. Kor J Nutr 36: Choi SK, Choi HJ, Chang NS, Cho SH, Choi YS, Park HK, Joung HJ Snacking behaviors of middle and high school students in Seoul. Kor J Comm Nutr 13: Ministry for Health and Welfare Korean National Health and Nutrition Survey. 7. Moon JS Common clinical features with childhood feeding problems. Inje Medical J 23: Chang SO, Lee KS The effects of nutrition education on children who avoid to eat vegetables. J Kor Dietetic Assoc 1: Min KO The study on the unbalanced diets of protein-rich food in elementary school children. MS Thesis. Kyungnam University. 10. Kim GN A study on relationship between food habits and personality. Korean J Nutr 15: Her ES, Lee KH, Bae EY, Lyu ES Interrelations among beverage intake, food behavior, personality in adolescents. Kor J Comm Nutr 13: Park SJ The effect of nutrition education program for elementary school children. J Kor Dietetic Assoc 6: Lee YM, Lee MJ, Kim SY Effects of nutrition education through discretional activities in elementary school- Focused on improving nutrition knowledge and dietary habits in 4th-, 5th- and 6th-grade students-. J Kor Dietetic Assoc 11: Kim MH, Chung YK A study on the relations of health promoting life style and self-efficacy about boy s obesity. Chung-Ang J Nurs 4: Yim KS, Han MH, Kang YH, Park HR, Kim CH Analysis of dietary characteristics of participants attending the nutrition education program for hypertensive patients at a public health center. J Kor Dietetic Assoc 6: Kim SR Relationships among nutritional knowledge, eating behavior and dietary self-efficacy of elementary school students in Chonbuk province. MS Thesis. Chonbuk National University, Chungju. 17. Mathew MC, David BA, Raymond SN Self-efficacy in weight management. J Consult Clinic Psycho 59: Guy S, Parcel EE, Cheryl LP, Henry AF Measurement of self-efficacy for diet-related behaviors among elementary school children. J School Health 65: Bandura A Social foundation of thought and action. Prentice-Hall, Englewood Cliffs, NJ. 20. Lim SJ, Kyoung EJ A nutrition program for children of obese or unbalanced dietary habits. Kor J Nutr 23: Lee AR, Moon HK, Kin EK A study on dietary habits, dietary behaviors and body image recognition of nutrition knowledge after nutrition education obese children in Seoul. J Kor Dietetic Assoc 6: Keungi-do Yongin Department of Education Research Report for the Improvement of School Meal Program. 23. Seoul Administration for Education Class for children's health Choi SJ Dietary self-efficacy and physical activity self-efficacy in elementary school children. MS Thesis. Seoul National University. 25. Chung MG Implementation and evaluation of nutrition education program for elementary school student. MS Thesis. Seoul Women's University, Seoul. 26. Chin JH, Lee KJ, Lee YO Effects of nutritional education on food behavior of unbalanced diet in children: an investigation of children at elementary schools in Incheon. J East Asian Soc Dietary Life 12: Kim EK, Kang MH, Kim EM, Hong WS The assessment of food service management practices in elementary school food services. J Kor Dietetic Assoc 3: Lee YJ, Kim GM, Chang KJ The analysis of effect on nutrition education of elementary school children in Inchon. J Kor Dietetic Assoc 6: Yoon HS, Yang HL Effect of nutrition education on nutrition knowledge of elementary school children. J Res Inst Human Ecol 4: Han MS Effects of dietary habits, nutrition knowledge, dietary self-efficacy and the change of hematological characteristics of primary 4th graders in Gyeung-gi province in Korea. MS Thesis. Chung-Ang University, Seoul. 31. Yon MY, Han YH, Hyun TS Dietary habits, food frequency and dietary attitudes by gender and nutrition knowledge level in upper-grade school children. Kor J

8 1434 이옥희 장순옥 박민정 Comm Nutr 13: Kim HA, Kim EK A study on effects of weight control program in obese children. Kor J Nutr 29: Kelly RB, Zyzanski SJ, Alemagno SA Prediction of motivation and behavior change following health promotion: Role of health beliefs, social support, and self-efficacy. Soc Sci Med 32: Weizel MK A test of the health promotion with blue collar workers. Nurs Res 38: Jung SM A study of the nutrition knowledge, the eating attitude, and the eating behavior of elementary school students in Busan. MS Thesis. Dong-A University, Busan. 36. Song JE Relationship between unbalanced eating and self concept, behavior in adolescents. MS Thesis. Korea University. 37. Yang IS, Kim KE, Bai YH, Lee SJ, Ahn HJ Development of nutrition education program that promotes eating behavior of preschool children-especially focused on being familiar with vegetable-. Kor J Food Culture 8: Mo SM The present status and a future scheme in nutrition education. Kor J Nutr 23: Lee JS, Yoon JW A study on perception about body image, dietary attitude, dietary self-efficacy and nutrient intake of school students in Busan. J Korean Soc Food Sci Nutr 32: Lee YM Eating trends in Korean children. In Ensuring healthy and safe food environment for children. Proceeding of Korean Society of Community Nutrition. p Rosander K, Sims LS Measuring effects of an affective-based nutrition education intervention. J Nutr Edu 13: Lee JS The effects of gender, obesity rate, nutrition knowledge, dietary attitude on the dietary self-efficacy of adolescents. Kor J Comm Nutr 8: Lee JY A study on the effect of the nutrition education program on the dietary self-efficacy and dietary practice for elementary school children. J Kor Comm Health Nursing Acad Soc 18: Parcel GS, Edmundson E, Perry CL, Feldman HA Measurement of self-efficacy for diet-related behaviors among elementary school children. J Sch Health 65: (2008 년 8 월 18 일접수 ; 2008 년 11 월 8 일채택 )

서론 34 2

서론 34 2 34 2 Journal of the Korean Society of Health Information and Health Statistics Volume 34, Number 2, 2009, pp. 165 176 165 진은희 A Study on Health related Action Rates of Dietary Guidelines and Pattern of