DOI: 10.5152/EurJTher.2017.49 European Journal of Therapeutics Comparing peer-led and adult-led education to promote a healthy diet among Turkish school children Meryem Öztürk Haney, Akgün Yeşiltepe Department of Public Health Nursing, Dokuz Eylül University, School of Nursing, İzmir, Turkey ABSTRACT Objective: The aim was to compare the effect of peer-led and adult-led educational models that deliver educational programs to promote healthy dietary habits among school children. Methods: Pre-test and post-test design was used for group comparisons. The participants were 51 fourth-grade students. The data were collected with a socio-demographic questionnaire, the Children’s Dietary Self-Efficacy Scale (CDSS), and the Diet Behavior Scale (DBS). Descriptive, chi-square test, paired sample t-test, Mann-Whitney U test, Wilcoxon test and a Multivariate Analysis of Variance (MANOVA) test were administered for data analysis. Results: No statistically significant difference was found between the groups with regard to pre-test diet scores (p>0.05). After ed- ucation, diet self-efficacy and diet behavior scores significantly improved in the adult-led group (p<0.05). No significant difference was observed between the groups with regard to post-test diet scores (p>0.05). Conclusion: Use of an integrated educational approach that contains both adult-led and peer-led education can be more effective in the improvement of student’s dietary scores. Keywords: Adult-led education, diet behavior, diet education, peer-led education, school children Corresponding Author: Meryem Öztürk Haney E-mail: meryempub@yahoo.com Received: 04.07.2017 • Accepted: 04.08.2017 Original Investigation INTRODUCTION Childhood obesity has become a rapidly growing epidemic (1, 2). In several studies conducted in Turkey, the overweight rate among school-aged children ranges from 12% to 22.1% (3-6). Overweight children are at an increased risk of being overweight, develop- ing diabetes, certain cancers, and cardiovascular diseases during adulthood (7). The Healthy Nutrition and Active Living Program launched by the Ministry of Health considers that school-aged children and young people are the most important target groups between 2013 and 2017, due to the increasing rates of obesity in Turkey in recent years. In this context, children’s knowledge, atti- tudes, and behaviors toward nutrition are expected to be affected by training program that aim to promote healthy dietary habits in schoolchildren (8). Therefore, for the improvement of public health, it is essential that schoolchildren are taught healthy dietary habits that encourage them to consume less fat and salt, but more fruit and vegetables (9). To prevent diseases, it is essential to focus on children. Life- long health habits and beliefs develop early in life. Prevention efforts targeting children strengthen health protection and dis- ease-preventive behaviors (1). Schools play a critical role in the development of children’s lifelong health behaviors since they provide an environment where most children in a community can be directly contacted, and where their effects on children’s social, psychological, physical, and intellectual development last for many years (2). Nurses play a key role in conducting healthy nutritional pro- grams in schools (10). Nurses can prevent childhood obesity by training children on healthy food choices (how to reduce calo- ries and fat, sugar, and salt consumption, and how to increase fruit and vegetable consumption) at home, in school, and at other places (11). In Turkey, about 6 million students attended elementary school in the 2012–2013 school year (12). A very large number of these students attend government schools, yet in many of these schools, there are no nurses. Despite the efforts to prevent obesity in Turkey, attempts to promote health education via students’ healthy dietary habits are insuf- ficient, due to the lack of nurses in schools. Therefore, effective approaches to ensure healthy dietary habits in schools should be put into action urgently. Peer-led training is defined as the education of young peo- ple by young people. After being trained by adults, peers can share health-related knowledge with each other by using so- cial factors (13). Peer-led training has been found to increase knowledge, attitudes, and beliefs, and to promote health be- haviors more than adult-led training (13, 14). Peer-led training has been used in the school environment for the following purposes: prevention of obesity (15), prevention of substance abuse (16), prevention of smoking (17), nutrition promotion (14, 18), and prevention of injuries (19). In schools lacking nurses, promoting students’ healthy dietary habits through peer-led training should be considered as a method that will 146