A research-based nutrition education package on healthy ageing and reducing risk of metabolic syndrome was developed and well accepted among subjects in this study. To address the increasing prevalence of obesity and chronic diseases among Malaysian populations
], the package consisted of a flipchart, placemats and a booklet. The flipchart has been developed as a teaching tool for health professionals involved in the care of older adults, particularly those living in rural areas, with the aim of reducing the risk of chronic diseases. The design of the flipchart, equipped with nutrition educator notes, was useful for staff at health clinics where there were no nutritionists or dietitians. The flipchart was also equipped with illustrations that facilitated the understanding of specific concepts such as obesity, diabetes mellitus and hyperlipidaemia. In rural areas of Malaysia where the illiteracy rate is high, counselling sessions with health professionals are the most appropriate strategy for imparting nutrition education to older adults with health and nutritional problems
]. Individuals with low literacy often have unsatisfactory health status compared with those with higher educational level. Use of photos and illustrations can increase the understanding of health messages. In this study, most subjects understood the nutrition guidelines or messages primarily because of the illustrations provided. Print materials including a booklet and placemats developed in this study can be valuable tools for patient education, but they are only supplements and can never be a substitute for verbal communication. When used effectively, print materials can enable patients to manage their health better and help healthcare professionals maximize limited teaching time. According to the Nova Scotia Cancer Patient Education Committee
], print materials can convey basic repetitive information, freeing the health professional to concentrate on individualized follow-up instruction. They can also facilitate consistency in teaching.
Results of the study revealed that older adult subjects had difficulty understanding the food pyramid concept compared with the food plate, as reported in the needs assessment phase
]. In contrast, health professionals preferred the food pyramid rather than the food plate, probably because they had been trained with the pyramid. Most of the older adult subjects were exposed to food pyramids during their visits to the health clinics. The food plate concept is being used to translate nutrient recommendations to food choices in the National Food Guide in other countries
]. Consumers prefer the food plate with respect to its visual and contextual impact compared with the food pyramid, which is deemed to be less effective in conveying messages on portion size and a balanced diet
The food plate concept introduced in this study provided detailed recommendations on portion size and number of servings from the major food groups, namely cereals and grains; meat and dairy products; and fruits and vegetables, with the intake of simple sugars, fats and oils minimised. In addition, a recommendation of six to eight glasses of water a day was included because of the importance of water and higher risk of dehydration among older adults
]. This is in agreement with fluid recommendations in Malaysian Dietary Guidelines
]. However, until recently this recommendation was not incorporated into the Malaysian food pyramid
The Dietary Guidelines for Older People in this study were delivered as food-based recommendations as opposed to the Nutrition Guide for Elderly People developed by the Ministry of Health of Malaysia, which uses a nutrient-based approach
]. Food-based guidelines are more effective in conveying nutrition and health messages to the population as well as promoting traditional and healthy food
The Malaysian Dietary Guidelines
] were developed for the Malaysian population aged 2-60 years old. This study successfully developed dietary guidelines specific to Malaysian older adults aged 60 years and over termed ‘10 Healthy Eating Guidelines for Elderly People’. The aim of these guidelines is to provide recommendations enabling older adults to engage in a healthy lifestyle leading to a good quality of life.
The acceptance analysis of the nutrition education package showed that the majority of older adults did not understand terms such as 'diabetes mellitus', 'hypertension' or 'fibre'. In addition, they suggested the use of simple and short sentences. Researchers modified the package according to the suggestions and tested for face and content validity. However, some medical and scientific terms were retained with the intention of educating the population, with explicit explanations provided in simple language. The suggestion by health staff to incorporate more photos and illustrations in the flipchart and booklet are in agreement with the finding by Goldberg and Owen
] that photos and illustrations should facilitate understanding of health messages without the need for text. Use of colour in developing an education package is essential in attracting interest of the target group
]. Furthermore, the font size used in this study was considered acceptable by subjects. Small font sizes are unsuitable for older adults because of the high prevalence of eyesight problems due to ageing
The intervention package can be used by health professionals and non-governmental organisations (NGOs) as a guideline and tool in the care of older adults. It is being translated into other languages such as English and Mandarin to increase its outreach among other ethnic groups in Malaysia.