title: Predicting achievement of a low-fat diet: a nutrition intervention for adults with low literacy skills.
abstract: BACKGROUND
  This paper identifies factors that predict achievement of a low-fat diet among 242 California adults with low literacy skills, following their participation in the Stanford Nutrition Action Program (SNAP), a randomized classroom-based nutrition intervention trial (1993-1994).
  
  
  METHODS
  The intervention classes received a newly developed curriculum that focuses on reducing dietary fat intake (SNAP); the control classes received an existing general nutrition (GN) curriculum. Data were collected at baseline and 3 months postintervention. This hypothesis-generating analysis uses a signal detection method to identify mutually exclusive groups that met the goal of a low fat diet, defined as < 30% of calories from total fat, at 3 months postintervention.
  
  
  RESULTS
  Three mutually exclusive groups were identified. Twenty-three percent of Group 1, participants with high baseline dietary fat (> 60 g) who received either the GN or the SNAP curriculum, met the postintervention goal of < 30% of calories from total fat. Thirty-four percent of Group 2, participants with moderate baseline dietary fat (< or = 60 g) who received the GN curriculum, were successful. Sixty percent of Group 3, participants with moderate baseline dietary fat who received the SNAP curriculum, were successful. Members of Group 3 also significantly increased their intake of vegetables, grains, and fiber.
  
  
  CONCLUSIONS
  Within this population of adults with low literacy skills, a large proportion of those with moderate baseline dietary fat who participated in the SNAP classes met the postintervention criteria for a low-fat diet. A much smaller proportion of those with high baseline dietary fat were successful, suggesting that this group may benefit from different, more intensive, or longer-term interventions.
authors.affiliation: Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, California 94304, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Winkleby
authors.forename: B
authors.initials: B
authors.lastname: Howard-Pitney
authors.forename: C A
authors.initials: CA
authors.lastname: Albright
authors.forename: B
authors.initials: B
authors.lastname: Bruce
authors.forename: H C
authors.initials: HC
authors.lastname: Kraemer
authors.forename: S P
authors.initials: SP
authors.lastname: Fortmann
mesh_terms: D000328:Adult; D000465:Algorithms; D003479:Curriculum; D018752:Diet, Fat-Restricted; D004522:Educational Status; D005247:Feeding Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D052756:Nutritional Sciences / Q000193:education*; D010353:Patient Education as Topic / Q000379:methods*; D011203:Poverty; D011237:Predictive Value of Tests; D015397:Program Evaluation; D011446:Prospective Studies; D011795:Surveys and Questionnaires