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HST3501 HEALTH RESEARCH PROJECT

NAME OF STUDENT

SCHWARTZKOPFF TRISTAN

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10330671

NAME OF LECTURER DR DIANNE HAWK DUE DATE

9/11/2014

Topic of assignment SOCIAL HEALTH RESEARCH STUDY: PILOT STUDY AND REPORT WRITING

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1

HST3501: A quantitative look at the Western Australian public’s knowledge of

Australian Dietary Guidelines and how this affects weekly red meat consumption

Tristan Schwartzkopff

10330671

Edith Cowan University

HST3501: Health research project

Dr Dianne Hawk

2/11/2014

2

Table of contents

Introduction 4

Literature review 4

Australian Dietary Guidelines 5

Recommendations for red meat intake 6

Red meat consumption 6

Health outcomes related to consumption of red meat 7

Conclusion 8

Research questions and Sub-questions 9

Research aim 9

Main research question 9

Research sub-questions 9

Definition of key concepts 10

Research design 10

Research methodology 11

Ethics 13

Pilot study 14

Processes and procedures 14

Reflection 15

Study results 16

Descriptive statistics 16

Red meat intake 18

Understanding of the ADG 20

Health outcomes related to red meat intake 22

Discussion 23

Objective 23

Weekly red meat intake 24

Understanding of the ADG 24

Knowledge of health outcomes related to red meat intake 25

Strengths and limitations 26

Reflection 27

References 28

Appendix 1: Data collection instrument 31

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Introduction

The purpose of this study is to gain an understanding of what level of

knowledge Western Australian adults have of the current guidelines for red meat

intake, and whether this understanding influences their weekly red meat intake. This

paper will begin with a review of current literature relating to the Australian Dietary

guidelines and red meat consumption before stating the research question and sub-

questions. The paper will then define and describe the measurement of key

concepts, outline the research design and methodology, before discussing the

ethical considerations that were made before, during and after the implementation of

the study. Finally the methods used to administer the pilot study will be discussed

along with the pilot study results and a discussion and reflection section.

Literature review

With the recent increase in the promotion of a variety of diets throughout

social media, a certain level of confusion and misunderstanding regarding diets and

nutrition can be expected in the general public (Williams, Anderson, Rawson, 2013).

While a change in eating habits may be beneficial to many individuals, particularly

due to the high prevalence of overweight and obesity (Australian Bureau of Statistics

(ABS), 2010), it is important to plan and implement diets correctly so as to not

damage health further (Williams et al. 2013). Of particular concern is the

consumption of red meat, with some diets removing red meat completely, while

others promote an increase in protein and red meat consumption. To assist in

providing sound nutritional information to the general public, the Australian

government has published a list of diet recommendations aimed at providing eating

guidelines for all foods including red meat. These recommendations are titled The

Australian Dietary Guidelines.

This literature review will systematically examine current Australian Dietary

Guidelines and review current literature related to the public’s understanding of

nutrition related guidelines. It will then examine what the current level of red meat

consumption is, followed by what health issues can arise from both the under-

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consumption and over-consumption of red meat. Current literature will be reviewed

under the themes of the Australian Dietary Guidelines, recommendations for red

meat intake, red meat consumption and the health outcomes related to red meat

consumption.

Australian Dietary Guidelines

The Australian Dietary guidelines (ADG) are recommendations published by

the Australian government and are developed using the best available scientific

evidence (NHMRC, 2013). They are intended to promote health and wellbeing,

reduce the risk of chronic disease and can be applied to all healthy Australians. As

they have been developed to promote health to all healthy Australians, any benefits

to the population can only be achieved if the population knows and understands the

guidelines (NHMRC, 2013). However research into nutrition related government

guidelines suggests that public understanding of nutrition guidelines is limited (Brown

et al. 2011; Keenan, Abusabha, Robinson, 2002).

Studies looking into nutritional guideline knowledge have been performed in

both America and England, however minimal quality research has been undertaken

in Australia. Separate surveys in America looking at knowledge of dietary guidelines

reported 58% (Brown et al. 2011), and 45% (Keenan et al. 2002) of participants

knew of the guidelines. While similar studies in England showed knowledge of food

group pyramid recommendations was as high as 75% (Brown et al. 2011). It is

important to note however, that the food group pyramid is a visual aid which depicts

current dietary guidelines (Brown et al. 2011). Therefore its visual appeal may

explain the increased recognition among the study group. Similarly the public’s

knowledge of the food group pyramid may also be considered as understanding of

the dietary guidelines.

However these figures represent individuals who knew the guidelines exist.

Further surveys showed that as little as 27% of Americans used guidelines when

selecting food and as few as 13% could correctly describe specific guidelines (Brown

et al. 2011). Similar studies involving open ended questions requiring respondents to

repeat guidelines found many responses were not part of the guidelines; for example

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when asked to describe a dietary guideline, 52 of 400 respondents reported a diet

low in meat as a recommendation when no such guideline exists (Keenan et al.

2002).

Further issues highlighted in these American based studies included a lack of

knowledge regarding serving sizes. When asked what difficulties they had with

recommendations, a common response from participants was a lack of

understanding of what a portion size was and how large a cup size is (Brown et al.

2011; Keenan et al. 2002).

Recommendations for red meat intake

The Australian Dietary Guidelines recommend consuming one serve of lean

meat, fish, poultry nuts or legumes daily to provide protein and essential vitamins

and minerals (AIHW, 2012; NHMRC, 2013), the guidelines also define a serving size

as being between 65 to 100 g (NHMRC, 2013). Due to the high nutrient content of

red meat, the National Health and Medical Research Council recommends that 3 to

4 serves of red meat should be consumed each week (2013). These findings are

supported by several sources including the Cancer Council of Australia (2009), and

in a study undertaken by Wyness et al. (2011), which states that red meat

consumption within recommendations is beneficial to health.

With a common consensus that red meat intake among developed countries

is too high (Wang & Beydoun, 2009; Williams & Droulez, 2010; World Cancer

Research Fund, 2014; Wyness et al. 2011), research also suggests that simply

reducing intake to within recommendations will increase the overall health of the

population (White, 1998; World Cancer Research Fund, 2014; Wyness et al. 2011).

Red meat consumption

Red meat is a common staple in modern western diets and includes beef,

veal, pork and lamb (Williamson, Foster, Stanner, Buttriss, 2005). While the

influence of vegetarianism and veganism has lowered overall meat intake in the

past, a thorough longitudinal study completed in 2004 has shown a decline in the

number of vegetarians and an increase in meat consumption from 1993 to 2004

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(Beardsworth, Bryman, 2004), this corresponds with a 1995 Australian study

reporting daily intakes of 45 g and 56 g for metro and rural areas respectively (AIHW,

2012).

More recent studies investigating red meat consumption of the Australian

population have reported consumption levels at the higher end or above the current

recommendations of 195 g to 455 g per week (NHMRC, 2013). Multiple Australian

dietary intake surveys report male adult consumption at 53g per day or 371g per

week (Wang & Beydoun, 2009; Williams & Droulez, 2010), with Williams and Droulez

also stating that older individuals (41 to 68 years old) consumed more at 63g per day

or 441g per week. However, a study by Wong, Selvanathan and Selvanathan (2013)

recorded far higher intakes, reporting an annual intake of 67kg per person, or 1288g

per week. This figure may be influenced by several factors, the most notably being

the data collection method. While other researchers estimated intake using dietary

analysis surveys (Wang & Beydoun, 2009; Williams & Droulez, 2010), Wong et al.

(2013) estimated consumption by analysing annual red meat sales, therefore it is

unknown how much of this was consumed by humans.

Several other studies failed to provide data for daily red meat intake, yet still

reported consumption levels above recommendations. These studies advised that

intakes of red meat should be reduced (Henson, Blandon, Cranfield, Herath, 2010;

White, 1998). Also reporting intakes at or above recommendations was a study of

10561 women aged 50 to 55 years old, which reports that 92% of participants

consumed the minimum recommended number of red meat serves, however; as

total intake was not determined, the number of participants who over-consumed is

unknown (Ball, Mishra, Thane, Hodge, 2004).

Health outcomes related to consumption of red meat

The health effects of red meat in the diet are well researched and widely

published, with both high intakes and low intakes having their own risks. The

consumption of red meat above recommended levels has been linked with several

health outcomes, particularly Bowel and colon cancer (Burki, 2012; Cancer Council

of Australia, 2009; Cancer Council of Australia, 2014; World Cancer Research Fund,

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2014). While the link between red meat and cancer is well published, many sources

report that the lack of intervention studies into this association means a direct link

between red meat and cancer is not possible (Cancer Council of Australia, 2009;

Williamson et al. 2005).

Dietary red meat has also been linked to increased adipose tissue due to its

high levels of dietary fat when compared to other meats (Wang & Beydoun, 2009;

Wyness et al. 2011), while Williams and Droulez (2010) agreed that red meat

contributed to adipose tissue, it disagreed with its contribution to dietary fat stating

that only 17% of dietary fat was provided by red meat. Williams and Droulez state

further that over-consumption of red meat is a greater predictor of obesity rather than

red meat alone (2010).

The positive aspects of dietary red meat are also well documented with most

sources agreeing that from a biomedical perspective, red meat is a vital source of

several nutrients, including; protein, iron, zinc, vitamin B12, fatty acids and vitamin D

(Cancer council of Australia, 2009; NHMRC, 2013 Williamson et al. 2005). These

sources agree that individuals consuming red meat below current ADG

recommendations may be at risk of developing nutrient deficiencies in one or more

of these essential nutrients.

Conclusion

Current guidelines for red meat intake recommend the consumption of three

to four, 65-100g serves of red meat each week. This recommendation has been

developed provide adequate amounts of essential nutrients, while minimising the risk

of obesity and certain cancers related to red meat intake.

However, public confusion remains as to what the guidelines are and how to

use them. American and British studies have shown a general lack of understanding

of guidelines and the current lack of similar Australian studies highlights the need for

further research into the Australian public’s level of knowledge. Without correct

understanding of red meat guidelines it is possible that the current overconsumption

of red meat by members of the Australian population, particularly older Australians,

8

may be caused by a lack of nutrition related education. This lack of public knowledge

and understanding may be increasing the health risks related to the

overconsumption of red meat, such as obesity and certain cancers.

Research questions and sub-questions

Research Aim:

The aim of this study is to determine what level of understanding Western

Australian adults in 2014 have of current Australian dietary recommendations

for red meat intake. The study will also examine any links between knowledge

of dietary recommendations and red meat intake, and how gender affects

both knowledge and consumption levels.

Main research question:

What level of understanding do Western Australian adults aged 18 and over,

have of current red meat intake guidelines and does their understanding

correspond to their average weekly intake of red meat? Does this differ by

gender?

Research sub questions:

What level of knowledge do Western Australian adults aged 18 and over have

of the current Australian guidelines for red meat consumption in 2014? Does

this differ by gender?

How many grams of red meat are consumed each week by Western

Australian adults aged 18 and over in 2014? Does this differ by gender?

What do Western Australian adults aged 18 and over in 2014 know about the

health outcomes of red meat consumption? Does this differ by gender?

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Definition of key concepts

• Australian dietary guidelines (ADG): These are the guidelines published by

the NHMRC (2013).

• Red meat: includes beef, veal pork and lamb (Wyness et al. 2011).

• Recommended levels of red meat consumption as per ADG: 3-4 serves per

week, each serve is 65-100g in size. This is the level recommended by the

NHMRC (2013).

• Weekly red meat consumption of Western Australian adults: The number of

grams of red meat the respondent consumes on average each week, to be

determined by food frequency questionnaire (Wang & Beydoun, 2009).

• Health outcomes related to red meat consumption: The benefits of red meat

consumption as described in the Australian Dietary Guidelines (NHMRC,

2013), and negative health outcomes such as increased risk of obesity and

certain cancers (Lea & Worsley, 2001).

Research design

For the purpose of this study we have utilised a quantitative approach. The

aim of the study was to investigate how understanding of guidelines influences red

meat consumption, this required the collection of measurable data on the level of

understanding and red meat intake, favouring a quantitative approach (Bryman,

2012). This approach is also a form of objective ontology as we investigated the

single truth that understanding the guidelines determines intake (Bryman, 2012). In

order to investigate this issue we needed to assume the role of a positivist

researcher by participating in objective observation in attempting to explain and

measure outcomes (Bryman, 2012).

We have used a cross-sectional study rather than a longitudinal study.

Longitudinal studies are typically expensive and time consuming due to the need for

follow up interviews (Bryman, 2012). In contrast the cross-sectional design allowed

for virtually simultaneous data collection (Bryman, 2012). As we investigated whether

individuals understand and follow current dietary guidelines, rather than evaluated a

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new campaign, simultaneous data collection was sufficient. Similarly; cross-sectional

designs are also useful for collecting quantitative data and participants could be

selected as to give a true representation of the population (Bryman, 2012).

The study is explanatory rather than descriptive as it was aimed at

understanding the effect that the public’s knowledge of current red meat intake

guidelines has on dietary intake. For the purpose of the study the public’s level of

knowledge was considered the independent variable, while weekly red meat intake

was the dependent variable. While the study was predominantly explanatory,

descriptive statistics were also collected to accurately describe the study group

providing external validity (Bryman, 2012).

Research methodology

The data collection method was a self-administered questionnaire. This

method is well suited to the cross sectional research style and quantitative approach

of the study due to the convenience to the respondent, cheap cost and speed in

which surveys could be administered (Bryman, 2012). Both understanding of dietary

guidelines and weekly red meat intake was determined by quantitative, close ended

questions. Pilot surveys were administered in person, however, future surveys will be

administered via post due to the cheap cost and minimal time taken to administer the

surveys (Bryman, 2012).

Study participants needed to represent the theoretical population of Western

Australian adult population. The key factors were an approximate even number of

males and females (ABS, 2012), and also a variety of age groups over the age of 18.

Other important factors included a range of socio-economic groups and a range of

ethnicities to represent Western Australia’s diverse population, minimising sampling

error (Bryman, 2012).

The unit of analysis for the study was individuals. For the purpose of the pilot

study our accessible population was close friends and classmates. However for

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future studies our accessible population will be the Perth metropolitan population,

this is due to the easy accessibility of the Perth metropolitan area and as it provides

a representative sample of our population, including a variety of socio-economic

groups, ethnicities, gender and a variety of ages. The sampling frame for future

studies will be the electoral role, providing names and postal addresses of all

enrolled voters in the Perth metropolitan area. To select participants we implement

multiple sampling techniques. First, stratified random sampling, separating males

and females to ensure an equal number of each is selected. Next we will use

systematic sampling, first using a random number sheet to select the initial

participant, then selecting every nth individual throughout the list (Bryman, 2012). As

there is no order to the electoral role except for alphabetical, there is minimal

sampling bias and the list will provide an accurate representative sample (Bryman,

2012).

For the purpose of the pilot study the sample size was 16. However for the full

study there are several factors to be considered. First a power calculation is

implemented to determine a minimum number of respondents required to provide a

statistically significant result (Bryman, 2012). An estimate of non-responses and

invalid surveys due to respondent error will be factored in and a minimum sample

size will be determined. Sample size is important as sampling error is decreased as

sample size increases (Bryman, 2012). This concept is important as minimal

sampling error produces a study more generalizable to our population (Webb and

Bain, 2011).

Participants will be selected from the sampling frame which provides names

and contact information, respondents will then be contacted via post. Follow up

letters and surveys will be sent one month after the initial letters to non-respondents

to maximise participation and minimise non response error (Bryman, 2012).

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Ethics

There are several ethical considerations required before undertaking any

research project. Ethical conduct is important in research to minimise potential harm

to participants, researchers and ensure research will benefit society (Hawk, 2014).

Before undertaking this research study, efforts were made to follow the 4 ECU

ethical principles.

ECU’s 4 major ethical principles include merit, beneficence, respect and

justice (ECU, 2010). Merit states that the researcher must demonstrate a genuine

intention to seek and share knowledge, also that the potential research outcomes

and benefits must outweigh any potential harm to both the researchers and

participants (ECU, 2010). Similarly beneficence and non-maleficence ensure the

research must benefit the public, while minimising harm and/or exploitation of

participants (ECU, 2010).

Respect includes both informing participants of the nature, purpose and

potential consequences of the research (ECU, 2010), while respecting autonomy

and ensuring the participants thoroughly understand the risks and benefits before

agreeing to participate (ECU, 2010). Finally, justice requires the researcher to

ensure an equitable distribution of the benefits, risks and costs of the research

throughout the research process (ECU, 2010).

As researchers the 3 ethical practices we engaged in while conducting

research included completion of the ethics approval process, informing participants

and ensuring confidentiality.

The ethics approval process is a formal process overseen by the ECU ethics

committee (ECU, 2010). Approval is only provided if the benefits of the proposed

research outweigh any risks and also ensures that the researcher will do no harm

when undertaking the research, as judged by the ECU ethics committee (ECU,

2010).

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As researchers we were required to inform participants of the aim, methods

and potential consequences of research before obtaining documentable consent,

indicating they freely and willingly agreed to participate (NHMRC, 2007). It was also

important to inform participants that they could withdraw from the study at any time

(NHMRC, 2007). This was achieved by providing participants with an information

letter upon recruitment and providing participants an opportunity to ask any

questions before completing the survey (Hawk, 2014). Participants were also asked

to sign a consent form before starting the questionnaire (Hawk, 2014).

Finally it was vital to ensure confidentiality. For the purpose of this study

consent forms and completed questionnaires were kept in separate locked drawers,

with all documents to be destroyed upon completion of HST3501 in December 2014

(Hawk, 2014). Similarly, no data raw data was shared with groups or individuals not

involved in the research process (NHMRC, 2007).

Pilot study

Processes & Procedures

The pilot study was completed by 16 individuals, 7 male and 9 female. All

participants were HST3501 classmates. Classmates were approached during an on-

campus lecture held for the purpose of completing surveys. Participants were

approached, introduced, and informed of the study and the ethical considerations

before filling out a consent form to ensure informed consent was gained. Participants

were also supplied with an information sheet outlining the study, providing contact

details should they have any questions, and informing them that participation was

optional and they may remove themselves from the study at any time. Upon

completion of the survey the consent form and completed questionnaire were

separated and stored separately to ensure confidentiality was maintained.

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Reflection

Several insights were gained from the piloting process including improved

instructions, possible changes to the design of the questionnaire, and questions that

should be included in future studies.

The initial insight from the pilot study was due to individuals failing to complete

the questionnaire correctly. Instructions informed participants to circle the number

corresponding to the correct response, however several individuals instead chose

place a tick next to the answer. While this did not affect the overall process, it may

indicate that participants skipped the instructions completely, possibly ignoring other

important information or instructions for the questionnaire.

The use of a tick rather than circling may also show a preference in the way

the questionnaire is designed. For future questionnaires it may be beneficial to utilise

a tick box rather than asking respondents to circle the number. This may remove any

confusion related to filling out the questionnaire.

Improvements can also be made regarding the questions included. Questions

were used to estimate weekly red meat intake and included asking for the

participants estimated average red meat size in grams. While this question worked

well, in future a question asking the participants to estimate the weight in grams of a

steak shown in a photograph of certain dimensions may be useful to gauge if the

participant can reliably estimate their own red meat serving sizes and improve the

overall rigour of the data collection instrument (Bryman, 2012).

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Study results

Descriptive statistics

Table 1: Number of participants

n %Males 7 44Females 9 56Total 16 100Of the 16 respondents, 7 were male and 9 were female.

Table 2: Current age of respondents

Age Malesn %

Femalesn %

Totaln %

18-34 7 100 8 89 15 9435-54 0 0 1 11 1 655-74 0 0 0 0 0 075+ 0 0 0 0 0 0Total 7 100 9 100 16 100100% of male respondents (n=7) were between the ages of 18 and 34. Of the female

respondents, 89% (n=8) were aged 18 to 34, while 11% (n=1) were aged 35 to 54.

Table 3: Current marital status

Malesn %

Femalesn %

Totaln %

Never married 7 100 5 56 12 75

Married/de facto

0 0 4 44 4 25

Divorced 0 0 0 0 0 0

Widowed 0 0 0 0 0 0

Other 0 0 0 0 0 0

Total 7 100 9 100 16 100

100% of males (n=7) have never been married, 56% (n=5) of females have also

never been married, while 44% (n=4) of females are currently married or in a de

facto relationship.

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Table 4: Number of males and females representing each education level

Malesn %

Femalesn %

Totaln %

Did not finish year 12

0 0 0 0 0 0

Year 12 5 71 5 56 10 62

Vocational training/TAFE

0 0 2 22 2 13

University undergraduate

2 29 2 22 4 25

University postgraduate

0 0 0 0 0 0

Total 7 100 9 100 16 100

71% (n=5) of male respondents reported finishing year 12 as the highest education

level currently achieved, with 29% (n=2) of males completing university

undergraduate degrees. 56% (n=5) of females state finishing year 12 as their current

highest level of education completed, with 22% (n=2) having completed university

undergraduate courses.

Table 5: Number of males and females representing each level of employment

Malesn %

Femalesn %

Totaln %

Part time 4 57 3 33 7 44Full time 0 0 1 12 1 6Retired 0 0 0 0 0 0Unemployed 1 14 2 22 3 19Other 2 29 3 33 5 31Total 7 100 9 100 16 10057% (n=4) of males and 33% (n=3) of females are currently working part time. 14%

(n=1) of males and 22% (n=2) of females are unemployed. Only 12% (n=1) of

females are currently working full time, while there are no males currently employed

in full time work. 29% (n=2) of males and 33% (n=3) of females selected other, with

all 5 respondents stated working on a casual basis.

17

Table 6: Number of males and females representing each ethnicity

Malesn %

Femalesn %

Totaln %

Australian 4 58 6 67 10 61

Aboriginal/TSI 0 0 0 0 0 0

Asian/Pacific Islander

1 14 1 11 2 13

UK & Ireland 1 14 1 11 2 13

African 1 14 1 11 2 13

European 0 0 0 0 0 0

American 0 0 0 0 0 0

Other 0 0 0 0 0 0

Total 7 100 9 100 16 100

58% (n=4) of males and 67% (n=6) of females are of Australian ethnicity. For males

other ethnicities include; Asian/Pacific Islander (n=1), UK & Ireland (n=1) and African

(n=1). Similarly for females other ethnicities include; Asian/Pacific Islander (n=1), UK

& Ireland (n=1) and African (n=1).

Red meat intake

Table 7: Weekly red meat consumption level

Malesn %

Femalesn %

Totaln %

Under consume

1 14 3 33 4 25

Healthy consumption

1 14 5 56 6 38

Over consume

5 72 1 11 6 38

Total 7 100 9 100 16 100

Respondents were asked to state how many times they consumed red meat each

week and their average red meat serving size. Weekly red meat intake was

determined by multiplying weekly serves by average serving size. Weekly red meat

intake was then categorised as over-consumption, under-consumption and healthy

consumption levels. Under-consumption is considered as below 195 g per week as

18

per the ADG recommendations (NHMRC, 2013), over-consumption is considered as

above 455 g per week as per the ADG (NHMRC, 2013), healthy consumption is

considered between 195 g and 455 g per week. 72% (n=5) of males reported

consuming red meat above recommended levels compared to 11% (n=1) of females.

Only 14% (n=1) of males were within recommended consumption levels while 56%

(n=5) of females consumed red meat within recommendations. 14% (n=1) of males

under-consumed while 33% (n=3) of females under-consumed.

Table 8: Self-reported under consumption, healthy consumption and over

consumption of red meat

Malesn %

Femalesn %

Totaln %

Under-consumed 1 14 3 33 4 25

Healthy consumption

5 72 6 67 11 69

Over-consumed 1 14 0 0 1 6

Total 7 100 9 100 16 100

Respondents were asked to rate their own red meat intake as over-consuming,

under-consuming or healthy. 72% (n=5) of males and 67% (n=6) of females reported

that they believed their weekly red meat consumption was within recommendations.

14% (n=1) of males and 33% (n=3) of females believed they under-consumed red

meat, while only 14% (n=1) of males believed they over-consumed red meat.

19

Table 9: Reasons for consuming red meat

Malesn %

Femalesn %

Totaln %

Health 2 29 5 56 7 37

Enjoyment/taste 5 71 4 44 9 47

To feel full 0 0 1 11 1 5

Don’t eat red meat

0 0 2 22 2 11

Other 0 0 0 0 0 0

Total 7 100 12 100 19 100

Respondents were asked why they chose to consume red meat. Of the respondents

29% (n=2) of males and 56% (n=5) consumed red meat for health, 71% (n=5) of

males and 44% (n=4) of females consumed red meat due to enjoyment/taste, with a

further 11% (n=1) of females consuming red meat to feel full. 22% (n=2) of females

reported not eating red meat.

Understanding of the Australian Dietary Guidelines

Table 10: Number of respondents who have heard of the Australian Dietary

Guidelines

Malesn %

Femalesn %

Totaln %

Yes 7 100 8 89 15 94No 0 0 1 11 1 6Total 7 100 9 100 16 100Respondents were asked if they have heard of the Australian Dietary Guidelines. Of

the respondents; 100% (n=7) of male respondents and 89% (n=8) of females had

heard of the Australian dietary guidelines. Only 11% (n=1) of females had not heard

of the Australian Dietary Guidelines.

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Table 11: Respondents who believe they understand the Australian Dietary

Guidelines

Malesn %

Femalesn %

Totaln %

Yes 4 57 6 67 10 62No 1 14 1 11 2 13Unsure 2 29 2 22 4 25Total 7 100 9 100 16 100Respondents were asked whether they understood the guidelines, 57% (n=4) of

males reported understanding the Australian Dietary Guidelines along with 67%

(n=6) of females. 14% (n=1) of males and 11% (n=1) of females report not

understanding the guidelines. 29% (n=2) of males and 22% (n=2) of females are

unsure.

Table 12: Knowledge of Australian Dietary guidelines and red meat consumption

UC

M(n) M(%) F(n) F(%)

H

M(n) M(%) F(n) F(%)

OC

M(n) M(%) F(n) F(%) T(n) T(%)Good knowledge

0 0 0 0 1 100 3 60 0 0 0 0 4 25

Some knowledge

1 100 0 0 0 0 1 20 3 60 1 100 6 38

Lack of knowledge

0 0 3 100 0 0 1 20 2 40 0 0 6 38

Total 1 100 3 100 1 100 5 100 5 100 1 100 16 100

Respondents were asked a variety of questions designed to test their knowledge of

the guidelines. Questions included identifying current guidelines, stating

recommended serving sizes and weekly recommended intakes, and identifying

sources of red meat. Respondents were given a score out of 14, scores of 12 and

above were classified as having a good knowledge of the guidelines, a score of 9 to

11 was classified as having some knowledge of the guidelines, while a score of 8 or

below was classified as having a lack of knowledge. Scores were compared to the

respondents weekly red meat intake (over-consumption, under-consumption and

healthy consumption). Of the respondents who under-consumed red meat, 100%

(n=1) of males had some knowledge of dietary guidelines while 100% (n=3) of

females lacked knowledge of the guidelines. For respondents who had a healthy

level of red meat intake, 100% (n=1) of males and 60% (n=3) of females had a good

level of knowledge of the guidelines, 20% (n=1) of females had some knowledge and

20% (n=1) lacked knowledge. For respondents who over-consumed red meat 60%

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(n=3) of males and 100% (n=1) of females had some knowledge while 40% (n=2) of

males lacked knowledge.

Health outcomes related to red meat intake

Table 13: Over-consumption of red meat contributes to obesity

SAn %

An %

Nn %

Dn %

SDn %

Male 0 0 4 57 2 29 1 14 0 0Female

1 11 4 45 3 33 1 11 0 0

Total 1 6 8 50 4 25 2 13 0 0Respondents were asked whether they agree or disagree with the comment;

“Obesity can be linked to consuming red meat above recommended levels”. 57%

(n=4) of males agree that over-consumption of red meat contributes to obesity, while

14% (n=1) disagree with 29% (n=2) being neutral. For females 11% (n=1) strongly

agree with the statement while 45% (n=4) agree and 11% (n=1) disagree. 33% (n=3)

of females were neutral

Table 14: Over-consumption of red meat may increase the risk of developing bowel

cancer

SAn %

An %

Nn %

Dn %

SDn %

Male 1 14 1 14 4 57 1 14 0 0Female

2 22 5 57 1 11 1 11 0 0

Total 3 19 6 38 5 31 2 13 0 0Respondents were asked whether they agree or disagree with the comment; “Bowel

cancer can be linked to consuming red meat above recommended levels”. 14%

(n=1) of males and 22% (n=2) strongly agree that over-consumption of red meat

increases the risk of developing bowel cancer. Similarly, 14% (n=1) of males and

57% (n=5) agree with the statement. On the other side are 14% (n=1) of males and

11% (n=1) of females who disagree. 57% (n=4) of males and 11% (n=1) of females

are neutral.

22

Table 15: Over-consumption of red meat may increase the risk of developing colon

cancer

SAn %

An %

Nn %

Dn %

SDn %

Male 1 14 1 14 4 57 1 14 0 0Female

2 22 5 57 2 22 0 0 0 0

Total 3 19 6 38 6 38 1 6 0 0Respondents were asked whether they agree or disagree with the comment; “Colon

cancer can be linked to consuming red meat above recommended levels”. 14%

(n=1) of males and 22% (n=2) of females strongly agreed that over-consumption of

red meat may increase the risk of developing bowel cancer. 14% (n=1) of males and

57% (n=5) of females agree with the statement, while only 14% (n=1) of males

disagree. 57% (n=4) of males and 22% (n=2) of females were neutral.

Table 16: Red meat is necessary for muscle mass

SAn %

An %

Nn %

Dn %

SDn %

Male 1 14 4 57 1 14 0 0 1 14Female

3 33 6 67 0 0 0 0 0 0

Total 4 25 10 63 1 6 0 0 1 6Respondents were asked whether they agreed or disagreed with the comment; “red

meat in the diet is essential for muscle mass”. Both males and females perceived red

meat as being necessary for muscle mass with 14% (n=1) of males and 33% (n=3)

strongly agreeing, and 57% (n=4) of males and 67% (n=6) of females agreeing with

the statement. 14% (n=1) of males strongly disagreed while 14% (n=1) of males

were neutral.

Discussion

Objective

This study was designed to establish what level of understanding Western

Australian adults have of current Australian Dietary Guidelines (ADG), and whether

that level of understanding is related to the amount of red meat consumed each

week. This level of knowledge and weekly red meat intake was compared between

23

males and females. It was assumed individuals with a good understanding of the

ADG would have a weekly red meat intake within current recommendations.

Weekly red meat intake

Weekly red meat consumption was categorised as under-consuming, over-

consuming and healthy consumption. Generally speaking males appear to over-

consume with 72% of respondents consuming above 455 g (table 8), while females

on average had a healthier level of consumption with 69% consuming between 195 g

and 455 g of red meat each week (table 8).

These results are in line with current reports by the NHMRC (2013) which

state that the Australian population typically consumes red meat at the higher end or

above recommendations. Other studies also agree that males typically consume

more red meat than women with Wang & Beydoun (2009) reporting male weekly

consumption at 371 g per week, with females typically consuming 196 g per week.

While these figures are below our weekly red meat intake figures, they agree with

our findings that males typically consume more red meat than females.

Understanding of ADG

Although 100% of males and 89% of females had heard of the ADG (table

10), only 57% of males and 67% of females believed they had a good understanding

of the ADG (table 11). Similar studies have shown that 75% of English respondents

(Brown et al. 2011) and between 45% Keenal et al. 2002) and 58% (Brown et al.

2011) of American respondents have heard of the guidelines. While our results show

a higher percentage of respondents have heard of the guidelines, the number of

respondents who had a good understanding of the guidelines was similar. Our study

reports that 14% of males and 33% of females had a good understanding of the

guidelines, in comparison, only 13% of Americans surveyed were reported as

understanding the guidelines (Brown et al. 2011).

Comparison of individual intakes of red meat and corresponding knowledge of

the ADG show that 100% of males and 60% of females who consumed a healthy

level of red meat each week, also had a good knowledge of the ADG (table 12). For

24

individuals who over-consumed red meat, 60% of males had some knowledge of

guidelines while 100% of females also had some knowledge of the guidelines. The

concerning result were with females who under-consumed red meat with 100%

lacking knowledge of the ADG (table 12). Interestingly, 100% of respondents who

had a good knowledge of the ADG had a healthy level of red meat consumption.

These results confirm a possible link between understanding of the guidelines and

red meat intake. While further investigation is needed to provide statistically

significant results, it appears that a good knowledge of the ADG may influence

individuals to consume a healthy level of red meat each week.

Knowledge of health outcomes related to red meat intake

There were several worrying results from the questions relating to knowledge

of the health outcomes related to red meat intake. Of particular concern was the

100% of females and 71% of males who either agreed or strongly agreed that red

meat is necessary for muscle mass (table 16). The key requirements for muscle

mass are adequate energy intake, dietary protein and the body’s ability to synthesise

muscle tissue (Williams et al. 2013). While red meat is a good source of dietary

protein (NHMRC, 2013), there are several other adequate sources of protein, these

include other meat sources such as poultry and fish, and non-meat sources such as

eggs, beans, legumes and grains (NHMRC, 2013). These non-red meat alternatives

can adequately provide the nutrients required to synthesise lean muscle tissue for all

individuals, no matter what their individual requirements are (Williams et al. 2013).

These responses to the requirements of red meat for muscle size and strength are in

line with similar studies by Lea & Worsley (2001) who reported a common response

by individuals who regularly consume red meat was the requirement for strength and

a perception of vegetarians as lacking masculinity.

Other concerns include 14% of males and 11% of females who disagree that

the over-consumption of red meat contributes to bowel cancer, while 14% of males

disagreed that over-consumption of red meat contributes to colon cancer.

Consumption of red meat below 455 g each week has been shown to be safe

(Cancer Council of Australia, 2009; Williamson et al. 2005), whereas consumption

above 455 g per week has been linked with both bowel and colon cancer (Burki,

25

2012; Cancer Council of Australia, 2009; Cancer Council of Australia, 2014; World

Cancer Research Fund, 2014). The lack of understanding of the health outcomes

related to red meat intake highlight the need for further public education of both the

positive and negative aspects of consuming red meat. Similarly, the tendency of

individuals with a good understanding of the ADG to consume red meat within

recommendations, shows the potential health related benefits of increased

promotion of the guidelines to the general public.

Strengths and limitations

The limitations of the study include the recruitment method. While the

recruitment method was convenient for piloting the study, the sample is not

representative of the population and cannot be generalised to the population

(Bryman, 2012). While the number of male and female respondents were

approximately equal, a greater spread of age groups, education level and ethnicities

should be utilised in future studies to provide a better representation of the Western

Australian population.

The sample size is also inadequate for providing a statistically significant

result (Bryman, 2012). Future studies should utilise power calculations to determine

a minimum sample size to provide statistically significant results (Bryman, 2012).

Other limitations include the use of a self-administered questionnaire. While

this form of questionnaire is useful for collecting data from large populations and for

cross-sectional studies (Bryman, 2012), the data may not be considered as reliable

due to possible misunderstanding of questions and without an interviewer to probe

for answers or clarify any confusion (Bryman, 2012).

The strengths of the study include the use of close ended questions for easy

analysis and the short duration of the questionnaire to reduce respondent burden

(Bryman, 2013). Other strengths include the use of a cross-sectional study design to

allow for cheap and easy collection of data from a large population (Bryman, 2012).

26

Reflection

There were several difficulties encountered while completing this research

project, including difficulties formulating research questions, developing the survey

and writing a thorough literature review. As this was the first research project I have

developed, most of the content was completely new to me. The thought process

involved in developing the research aim and research questions was completely

different to what I am used to and I found it far more difficult than other university

projects.

Heading in to this study I understood the difficulties associated with research

projects, however, I found the entire process far more tedious than I believed it

would be. The constant iteration was very frustrating, but the improvements this

process made to the overall project was very satisfying. In general, the actual

process was more difficult than I expected, but very satisfying when completed. I feel

like this has been the most difficult unit I have studied at university and also the most

satisfying to complete.

In the future I would like to be involved in further research projects. My plan is

to complete my undergraduate health science degree, complete my masters of

nutrition and dietetics then move into the field of sports dietetics. In this field it is my

intention to be involved in clinical sports nutrition research working with athletes to

improve performance through diet and dietary supplements.

27

References

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Australian Bureau of Statistics (2012). 3235.0 - Population by Age and Sex, Regions

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ures~Western+Australia?OpenDocument

Australian Institute of Health and Welfare. (2012). Australia’s food & nutrition 2012.

Canberra: Australian Institute of Health and Welfare

Ball, K., Mishra, G. D., Thane, C. W., & Hodge, A. (2004). How well do Australian

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Beardsworth, A., & Bryman, A. (2004). Meat consumption and meat avoidance

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Bryman, A. (2012). social research methods (4th ed.). Oxford, England: Oxford

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Burki, T. K. (2012). End of the road for red meat? Lancet Oncology, 13(4), 147.

Cancer Council of Australia (2009, July). Meat and cancer prevention. Retrieved

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PS_Meat_and_cancer_prevention_October_2007_Updated_July_2009.pdf

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food-and-nutrition.html

Edith Cowan University [ECU]. (2010). Conduct of ethical human research.

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Hawk, D. (2014). HST2122 Lecture notes. Retrieved from Edith Cowan University,

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applications/policy-and-legislation

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NHMRC (2013). Dietary Guidelines for Australians. Retrieved from

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30

Appendix 1: Data collection instrument

Questionnaire

Thank you for participating in this research study. This questionnaire will help identify

the understanding of the Australian Dietary Guidelines and red meat consumption.

Instructions:

The following questionnaire contains a total of 22 questions spread across 4

sections entitled demographic questions, red meat weekly consumption,

understanding of Australian Dietary Guidelines and health outcomes related

to red meat consumption.

Please complete all 22 questions by placing a tick in the box corresponding to

your response.

Demographic questions

1. Which gender are you? (please circle corresponding number)

1. Male

2. Female

2. Which of the following age categories represents you? (please circle

corresponding number)

1. 18-342. 35-543. 55-744. 75+

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3. What is your marital status? (please circle corresponding number)

1. Never married2. Married/de facto3. Divorced4. Widowed5. Other (Please specify):

4. What is the highest level of education have you achieved? (please circle

corresponding number)

1. Did not finish year 122. Year 123. Vocational training/TAFE4. University undergraduate5. University postgraduate

5. Employment status? (please circle corresponding number)

1. Part time2. Full time3. Retired4. Unemployed5. Other (Please specify):

32

6. Which of the following ethnicities do you identify with? (please circle

corresponding number)

1. Australian2. Aboriginal/TSI3. Asian/Pacific Islander4. UK & Ireland5. African6. European7. American8. Other (Please specify):

7. Residential post code? (please specify below)

1. _____

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Red meat weekly consumption

8. On average how many times a week do you consume red meat? (please specify

below)

1. _____

9. What is your average red meat portion size in grams? (please circle

corresponding number)

1. 0-75 g2. 76-150 g3. 151-225 g4. 226-300 g5. 301+ g6. Unknown (Please answer question 9.A below

9.A. If unknown, please circle which diagram best represents your

average red meat portion size?

1. 2.

3. 4.

(Images from San Francisco examiner. November 16, 2012)

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10. What do you believe best describes your red meat intake? (please circle

corresponding number)

1. Under consume2. Healthy consumption level3. Over consume

11. Which of the following best describes the reasons for your red meat

consumption? (please circle corresponding number)

1. For health

2. Enjoyment/taste

3. To feel full

4. Don’t eat red meat

5. Other (Please specify):

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Understanding of Australian Dietary Guidelines

12. Have you heard of the Australian Dietary Guidelines? (please circle

corresponding number)

1. Yes2. No

13. Would you say you understand the Australian Dietary Guidelines? (please circle

corresponding number)

1. Yes

2. No

3. Unsure

14.Which of the following are examples of current Australian Dietary Guidelines?

(please circle corresponding number for all that apply)

1. Enjoy a wide variety of nutritious vegetables of different types and colours, and legumes/beans every day.

2. Limit your intake of carbohydrates such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley.

3. Limit your intake of lean meat and poultry, fish, eggs, and/or plant based alternatives.

4. Adults should aim to consume 2.5 serves each day of milk, yoghurt, cheese, and/or their alternatives, mostly reduced fat.

5. Limit intake of foods and drinks containing added sugars such as confectionary, sugar-sweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and sports drinks.

36

15.Which of the following is the current recommendations for daily serves of lean

meat, poultry, fish, eggs and/or plant based alternatives? (please circle

corresponding number)

1. 0-1 serves2. 2-3 serves3. 4-5 serves4. 6+ serves5. Unsure

16.Which of the following is considered as red meat according to the Australian

Dietary Guidelines? (please circle corresponding number for all that apply)

1. Beef2. Chicken3. Pork4. Lamb5. Veal6. Fish7. Shellfish8. Duck9. Goat10. Kangaroo11. Turkey

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17.What is stated in the Australian Dietary Guidelines as the size of one serve of

lean red meat? (please circle corresponding number)

1. Less than 65 g2. 65 g3. 100 g4. 135 g5. 170 g6. 205+ g7. Unsure

18.What, if any, is the maximum number of serves of red meat suggested by the

Australian Dietary Guidelines? (please circle corresponding number)

1. No recommendation2. 3 serves3. 7 serves4. 11 serves5. 15 serves6. Unsure

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Health outcomes related to red meat consumption

19. Red meat has been shown to be a good provider of which of the following

nutrients? (please circle corresponding number for all that apply)

1. Protein2. Carbohydrate3. Fatty acids4. Vitamin A5. Vitamin D6. Vitamin E7. Vitamin K8. Iron9. Niacin10. Riboflavin11. Zinc12. Vitamin B1213. Magnesium14. Calcium15. Unsure

39

Please evaluate the following statements by circling the number

corresponding to how you feel about each comment:

20. The following conditions can be linked to consuming red meat above

recommended levels:

Condition Strongly Agree

Agree Neutral Disagree Strongly Disagree

1. Obesity 1 2 3 4 5

2. Bowel Cancer 1 2 3 4 5

3. Asthma 1 2 3 4 5

4. Colon Cancer 1 2 3 4 5

6. Arthritis 1 2 3 4 5

7. Prostate Cancer 1 2 3 4 5

21.Red meat in the diet is essential for the following :

Conditions Strongly Agree

Agree Neutral Disagree Strongly Disagree

1. Muscle Size 1 2 3 4 5

2. Muscle Mass 1 2 3 4 5

3. Muscular Endurance

1 2 3 4 5

4. Brain Function 1 2 3 4 5

5. Heart Health 1 2 3 4 5

40

22.The following conditions can be improved by the regular consumption of red meat

within Australian Dietary Recommendations:

Conditions Strongly Agree

Agree Neutral Disagree Strongly Disagree

1. Anaemia 1 2 3 4 5

2. Asthma 1 2 3 4 5

3. Muscle wastage 1 2 3 4 5

4. Iron Deficiency 1 2 3 4 5

5. Arthritis 1 2 3 4 5

Thank you for your time

41