Effectiveness of Peer-Led Nutrition Education Intervention for Healthy Eating Intention among School adolescents in Rajbiraj Municipality, Nepal

Aim of the Study The aim of this study is to evaluate the effectiveness of a peer-led nutrition education intervention, guided by the Theory of Planned Behavior (TPB), in improving knowledge, attitudes, peer norms, perceived behavioral control, and behavioral intention toward healthy eating among adolescents in Grades 11 and 12 in Rajbiraj Municipality, Nepal. Materials and Resources Peer Facilitation Nutrition Education Booklet The Peer Facilitation Nutrition Education Booklet will be developed by the researcher based on TPB constructs. The development process will include: • Review of existing literature on adolescent nutrition and TPB-based interventions • Draft preparation aligned with study objectives and local context • Review by the study supervisor and Nutrition and Dietetics expert • Pre-testing with a small group of adolescents for clarity and usability • Final revision based on feedback The booklet will include: • Structured session guidelines for peer educators • Interactive activities (brainstorming, group discussion, role-play, scenario-based learning) • Motivational Interviewing (MI) guidance • Visual aids (balanced diet, food groups, comparison charts) • Printed handouts and weekly action planning worksheets The booklet will be finalized at least 4 weeks prior to intervention implementation. Procedures and Timeline Peer Leader Selection Ten peer leaders from Grades 11 and 12 will be selected using a participatory nomination process. This includes: • Peer nomination (students identify trusted and influential classmates) • Teacher recommendations based on communication skills, leadership, and interest in health promotion • Consideration of students with higher baseline healthy eating attitude scores Following initial selection, eligible students will undergo Motivational Interviewing (MI) sessions conducted by the researcher to assess: • Motivation and readiness • Self-efficacy • Interest in facilitating peer sessions • Potential challenges and support needs Peer Leader Training The training will be conducted by the Principal Investigator (researcher), with guidance from a public health/nutrition expert and academic supervisor if required. Training Content • Basic nutrition concepts (balanced diet, food groups) • TPB constructs (attitudes, peer norms, perceived behavioral control, intention) • Peer facilitation and communication skills • Motivational Interviewing techniques • Session delivery using the facilitation booklet Mode of Training • Interactive mini-lectures • Group discussions • Role-plays and demonstrations • Practice sessions using the booklet • Visual aids Duration • 1 day training, approximately 4 hours Monitoring During Training • Attendance tracking • Participation observation • Practice session feedback Intervention Delivery (Week 1–4) Peer leaders will conduct four peer-led group sessions, each lasting 60 minutes, among their classmates. • Sessions will follow the structured facilitation booklet • Activities will include brainstorming, group discussions, role-play, and action planning • Sessions will be delivered in Nepali language • Conducted in school settings during flexible time slots (e.g., free periods or agreed schedules) Post-Test (Week 4) After completion of the intervention: • The same TPB-based structured questionnaire will be administered • Outcomes measured: o Knowledge o Attitudes o Peer norms o Perceived behavioral control o Behavioral intention o Self-reported healthy eating behavior Monitoring and Fidelity Assurance To ensure consistency and quality of implementation: • Peer-led sessions will be supervised by the researcher • Monitoring tools will include: o Session observation checklists o Peer educator session logs o Attendance records o Participant feedback Flexible Implementation Strategies Flexible Scheduling • Sessions will be scheduled in coordination with school administration • Conducted during free or mutually agreed periods Interactive Activities • Brainstorming exercises • Group discussions • Scenario-based problem-solving • Role-plays (peer pressure situations) • Weekly action planning Reminders • Verbal reminders by peer leaders • Teacher reinforcement (if available) • Follow-up prompts during sessions Study Design and Group Allocation (Non-Randomized) As this study is non-randomized, group allocation will be determined using a purposive approach: • Two schools with similar characteristics (e.g., type, size, and student population) will be selected • One school will be assigned to the intervention group • Another comparable school will serve as the comparison group • Allocation will be based on feasibility, administrative approval, and logistical considerations, rather than randomization Comparator (Comparison Group) Population Adolescents in Grades 11 and 12 from selected schools not receiving the intervention. Assessments • Pre-test: Conducted at baseline (same timing as intervention group) • Post-test: Conducted after 4 weeks Intervention Exposure • No peer-led nutrition education sessions during the study period Expected Outcomes Primary Outcome • Change in healthy eating behavioral intention scores Secondary Outcomes • Improvement in: o Knowledge o Attitudes o Peer norms o Perceived behavioral control o Self-reported healthy eating behaviors The pre-testing of the Peer Facilitation Nutrition Education Booklet will be conducted among approximately 8–10 adolescents from Grades 11 and 12 in a school setting similar to the study site. Participants will be provided with the booklet and exposed to selected activities for approximately 45–60 minutes. They will then be asked to provide feedback on clarity, comprehension, cultural relevance, and usability through brief discussion and structured feedback questions. Data collected during pre-testing will be used only for refinement of the intervention materials and will not be included in the final analysis of the study outcomes.