Diet and colorectal cancer risk. Impact of a nutrition education leaflet
Authors: Dyer K. , Fearon K. , Buckner K. , Richardson R.A. 
Published: November 2004

Background:  Poor diet is associated with the development of colorectal cancer with the greatest risk from diets low in vegetables, fruits and fibres and high in red and processed meats (Wilmink, 1997; Bingham, 2000). Improving people's diet remains a challenge, but evidence suggests that those attending cancer‐screening clinics may be more receptive to dietary advice than the general population (Baker and Wardle, 2002). This study aimed to establish the impact of a needs‐based nutrition education leaflet when used in a colorectal cancer‐screening clinic.

Method:  Fifty subjects (mean ± SD age, 62 ± 15.1 years; male : female, 22 : 28) attending a colorectal clinic were interviewed at baseline using a validated, semi‐structured questionnaire (Dyer et al., in press). The interview was used to establish subjects’ nutritional knowledge, attitudes and understanding. Using these interviews as a form of needs‐assessment, a nutrition education leaflet was designed by the authors. Thirty‐five of the original 50 subjects agreed to participate in evaluation of the leaflet and have their knowledge re‐tested. A second group (n = 52) of colorectal clinic patients was recruited and their nutrition knowledge was tested immediately after exposure to the leaflet and again 1 month later (mean age 52 ± 15.0 years; male : female, 23 : 29). All interviews were conducted by the researcher (KD). Results were analysed using paired and unpaired t‐tests and level of significance was set at P < 0.05.

Results:  After exposure to the leaflet, there was a significant increase in awareness of the messages ‘5 fruit and vegetables a day’ (46% vs 91%, P < 0.001) and ‘what constitutes a portion of fruit and vegetable’ (38% vs 71%, P < 0.05). This significant increase in nutrition knowledge was sustained over a 1‐month period. During this time, 12 (23%) out of 52 reported improvement in their fruit and vegetable intake.

Conclusion:  This small study suggests that a targeted education leaflet can lead to a significant increase in nutrition knowledge that may be sustainable. Although education alone cannot guarantee behavioural change, it appears to challenge people's attitude towards the adequacy of their fruit and vegetable intake. Targeting this leaflet at attendees of a colorectal clinic led to reported behavioural change in nearly a quarter of the group studied. Further, robust work is needed to confirm the sustainability and longevity of this positive change in diet.

References:  Baker, A.H. & Wardle, J. (2002) Increasing fruit andvegetable intake among adults attending colorectal cancer screening: the efficacy of a brief tailored intervention. Cancer Epidemiol. Biomarkers Prev. 11, 203–206.

Bingham, S.A. (2000) Diet and colorectal cancer prevention. Biochem. Soc. Trans.28, 12–16.

Dyer, K.J., Fearon, K.C.F., Buckner, K. & Richardson, R.A.Diet and colorectal cancer: baseline dietary knowledge of colorectal patients. Health Educ. J. in press.

Wilmink, A.B.M. (1997) Overview of the epidemiology ofcolorectal cancer. Diseases Colon. Rectum. 40, 483–493.