Development of Flashcards of One Exchange Portion of the Foods Included in the Culturally Modified Food Exchange List as a Communication Tool in Nutrition Counseling


 Introduction: Diet and nutrition play a significant role in many chronic non-communicable diseases. Therefore dietary changes occupy a prominent position in prevention and treatment of such diseases. A number of literature has been described the effectiveness of nutrition counseling in changing the dietary habits. Moreover, nutrition counseling and education by using visual tools are believed to be more effective and more communicable. Therefore, the researchers have been developing various counseling and education tools to facilitate nutrition care process. Among them, the ''Food Exchange List'' was one of the best inventions by the nutrition researchers. It was originally developed the American Dietetic Association, the American Diabetes Association and the United States Public Health Service, in 1950.

Justification: After the American efforts to make and update the food exchange lists, many countries worked to design their own food exchange lists based on the traditional foods. However, to date, food exchange list of the local foods is non-existent in Myanmar, and Myanmar nutritionists and dietitians are adopting the American Dietetic Association's food exchange list. Therefore it is interested to develop a culturally-modified food exchange list which is believed to make more practical and realistic meal plans and facilitate higher compliance as it includes traditional foods. Besides, it is also needed visual aids to show while explaining the list and meal planning for the patient to be a more effective counseling and education.

Aim and objectives: The aim of this research is to develop flashcards of one exchange serving size of foods which are included in the culturally modified food exchange list, as a communication tool in nutrition counseling of nutritionists and dietitians in Myanmar. The specific objectives include developing culturally modified food exchange list, developing flashcards of one exchange portion of the foods included in the proposed list, and evaluating the user's opinion about the developed tool.

Methodology:  This was an action research which was mainly carried by qualitative approach. The 2008 ADA's food exchange list was the initial starting point of this research. To make culturally sensitive food exchange list, foods that were inconsistent with Myanmar culture were removed after market research. Then the interviews were conducted 25 diabetic and/or obese or overweight patients to know most common foods consumed by this target population. The foods resulting from the interviews and suggestions from the experts were added to the list. The foods removed from the original list were fast foods, combination foods and other 158 items. The 47 food items were added including Myanmar traditional snacks and therefore the final list had 315 food items under the 9 food groups. Then the required nutrient values of the added foods were calculated according to the food groups. The nutrient information for 100 grams of foods was obtained from Asian and Myanmar Food Composition Tables. After calculating one exchange serving for each food, this amount in grams was expressed by using household utensils. When the full list was obtained, flashcards for one exchange serving for certain popular foods were created by providing carbohydrate, protein, fat and energy contents in the back of the cards. Then the research was evaluated by assessing user's opinion. The individual depth interviews were done with 4 nutritionists and 6 patients. Then theme analysis was done their interviews.

Result: The developed Myanmar Food Exchange List includes total 315 food items under the 9 food groups, namely starch, fruits, milk and milk substitutes, nonstarchy vegetables, sweets, desserts and other carbohydrates, protein, fats, free foods, and alcohol. According to the results of interviews, the developed tool was said to be useful in both nutrition counseling and education and beneficial for both nutritionists and patients. It was applicable, portable, visual, interesting and culturally sensitive. It could also be used by other health care professionals.


Conclusion: The tool resulted from this research was effective in the communication between nutritionists and patients.