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Comparison of focus groups and elicitation questionnaires to design a lowfat nutrition education program for urban African Americans
WEDNESDAY, OCTOBER 19 POSTER SESSION: COMMUNITY NUTRITION NUTRIENT ANALYSIS OF MENUS IN GEORGIA CHILD CARE CENTERS NOT INVOLVED IN THE CHILD AND ADULT CARE FOOD PROGRAM. G.I. Forsell, MPH,RD,LD. WIC Program, Floyd County Health Department, Rome, Ga. To assure that nutritional needs of children in child care centers are met the USDA Child and Adult Care Food Program (CCFP) and states have developed minimum standards. The objective of this research was to determine the nutrient adequacy of menus in licensed child care centers in Georgia not affiliated with the CCFP. A random sample of licensed child care centers,not enrolled in CCFP was obtained. A request for one weeks menus and a questionnaire were sent to sixty facilities. Fifty-Four percent (n=32) responded. Menus were then analysed based on minimum portions set by CCFP for children three to five years, A computer analysis using Food Processor II was then completed. Comparisons between the ROA for three and four year olds and facilities menus was conducted. Results indicated that 100% (n=32) of menus for four year olds did not provide adequate calories. Niacin was low in 88% (n=28) of the menus. Both three and four year olds were receiving diets low in calcium, 54% (n=19), and iron 97% (n=31). Results indicated that the dietary intake of children in child care centers falls short of childrens needs. Facilities not involved in CCFP do not have the tools, guidance or followup to help them provide better menus. Dietitians need to become involved in assisting centers in all aspects of menu planning to assure nutritional needs of children are met.
SERUM GLUCOSE PATTERNS OF HYPERGLYCEMIC PATIENTS RECEIVING DIETARY AND MEDICAL INTERVENTION IN A HOSPITAL BASED HOME CARE PROGRAM. L.A. Gant, LDN, RD, W. Fahmer, MD, D. Collins, BS, RN, and M. Kraus, RN, MS, Department of Veterans Affairs, New Orleans, LA. Hospital Based Home Care (HBHC) is a multidisciplinary teaching program offered to veterans to improve their health status. The purpose of this study was to determine the effects of nutritional and medical management of hyperglycemic veterans in a home environment. Twenty-five male veterans, middle-aged ( age = 55 years, 78% Black), low to middle income, diagnosed with non insulin dependent diabetes mellitus (NIDDM) and/or insulin dependent diabetes mellitus (IDDM) were selected from the HBHC caseload to study. The HBHC team comprised of nurses, a physician, Social Worker, and a Registered Dietitian conducted weekly and monthly follow up visits to the veteran's home to assess, teach and reinforce dietary and medical adherence. Dietitian taught veterans and/or caregivers dietary management using food models and conducted 24 hour recalls to assess dietary compliance. Weights and lab data were obtained by HBHC nurses. Monthly and quarterly chart reviews were held with the team physician for adjustment in diet and/or medication regimen. Results showed 34% decline in serum glucose levels for veterans studied the first month. After three months, 56% had serum glucose values within normal range (70-110 mg/dl). Within six months, 48% had serum glucose levels in normal range whereby 85% had normal serum glucose levels after nine months. This percentage remained the same after twelve months. The results showed a steady decline in serum glucose patterns of veterans participating in a HBHC program except during the six months follow up period. It was noted one veteran (4%) had a foot infection during this study period. The HBHC program may be a way of treating home bound veterans with hyperglycemia and requires further investigation.
RELATIONSHIP OF NUTRITION EDUCATION TO KNOWLEDGE AND FOOD CHOICES OF THIRD GRADE STUDENTS. S. A. Fryrear, BS, K.S. Kubena, PhD, RD, LD, W.A. McIntosh, PhD, A. Richter, BS, RD, LD, CDE, and C. Zawieja, BS, RD, LD, Faculty of Nutrition, Texas A&M University, College Station, TX. According to U.S. Department of Agriculture data, school lunches generally include too much fat which may increase the risk of children developing cancer, heart disease, and other chronic diseases later in life. However, other factors, including foods eaten at home, greatly influence food acceptance by children in school feeding programs. The objective of this study was to investigate nutrition knowledge and food selection in the school cafeteria of children before and after a one-week nutrition education program targeting low fat eating. The program was based upon one portion of a curriculum developed by the Texas Education Agency and was taught by one of the investigators (SAF). Reinforcement of nutrition principles using the school menu was given as a follow-up to the education program. Subjects were third grade students (n= 149) from two elementary schools in the Bryan Independent School District. Students in one of the schools participated in the nutrition education program and reinforcement activity while those in the second school did not (served as controls). In both schools, menus were modified to allow students to choose regular or low-fat food items. Pre- and post-tests for nutrition knowledge were administered to all students. Food choices and plate waste were measured before and after the education program. The education program was rated as excellent by the participants. After receiving nutrition education, the average test score of nutrition knowledge of students who received nutrition education increased by 18 points, a 37% improvement (P<.0001), while that of controls was unchanged. Program participants given food choices in the cafeteria were more likely to select lower fat foods than nonparticipants. For example, corn was chosen over french fires by 13.7% of participants but by only 1.5% of controls (P<.05). This also illustrates that knowledge of fat content of food was only one factor determining selection of foods by these subjects. Results indicate that nutrition education can be successfully incorporated into the classroom to improve nutrition knowledge and food choices of schoolaged children.
COMPARISON OF FOCUS GROUPS AND ELICITATION QUESTIONNAIRES TO DESIGNA LOWFAT NUTRITION EDUCATION PROGRAM FOR URBAN AFRICANAMERICANS. V.W. Hartmuller, MS, RD, L.B. Wilder, ScD, RD, and D.M. Becker, ScD, MPH, Johns Hopkins University Medical School, Baltimore, MD A nutrition education intervention is being designed for a community-based project aimed at reducing fat intake among African American (AA) adults in East Baltimore. Two focus groups (7, 9 participants) were conducted among practicing dietitians (RD's) who work with AA clients to get input concerning the types of eating habits that should be targeted for change in community members. The transcripts from the focus groups were then compared with elicitation questionnaires completed by 15 similarly matched RD's through a mail survey. The primary objective was to define the key components that should be included in this intervention from those who work closest with the population. An additional objective was to compare the information obtained from the focus groups with the questionnaires to determine which method would yield the greatest amount of information with the least cost. Questions asked were targeted to determine specific behaviors involved in achieving a lowfat diet for this population, including purchasing and preparation of food as well as eating away from home. Barriers to adopting these behaviors and the experience of the RD with how various strategies work were also asked. Results from both focus groups and the elicitation questionnaires were essentially the same. Following are the behaviors which were most often mentioned as being important to target: a) food purchasing behaviors of reading food labels, meal planning, and selecting more fruits and vegetables; b) food preparation behaviors of learning lowfat cooking methods, choosing alternate favoring techniques besides "Southern" fats, and skimming fat from sauces, etc.; c) eating away from home eating behaviors of controlling food portions, asking questions prior to eating, and choosing appropriate restaurants. Barriers identified to accomplishing desired goals include a) inability to read, b) cost of food, c) convenience of transportation and d) tradition based cooking habits. The RD's experience agreed the intervention should include cooking demonstrations, hands on activities and involving the community peer leaders. These results suggest that both focus groups and elicitation questionnaires are equally useful in designing an intervention program to lower fat in the diets of AA adults provided a specific agenda is followed targeting specific questions. Cost comparison data from these methods show that elicitation questionnaires are considerably less costly than conducting focus groups and essentially yield the same information.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / A-59
SERUM GLUCOSE PATTERNS OF HYPERGLYCEMIC PATIENTS RECEIVING DIETARY AND MEDICAL INTERVENTION IN A HOSPITAL BASED HOME CARE PROGRAM. L.A. Gant, LDN, RD, W. Fahmer, MD, D. Collins, BS, RN, and M. Kraus, RN, MS, Department of Veterans Affairs, New Orleans, LA. Hospital Based Home Care (HBHC) is a multidisciplinary teaching program offered to veterans to improve their health status. The purpose of this study was to determine the effects of nutritional and medical management of hyperglycemic veterans in a home environment. Twenty-five male veterans, middle-aged ( age = 55 years, 78% Black), low to middle income, diagnosed with non insulin dependent diabetes mellitus (NIDDM) and/or insulin dependent diabetes mellitus (IDDM) were selected from the HBHC caseload to study. The HBHC team comprised of nurses, a physician, Social Worker, and a Registered Dietitian conducted weekly and monthly follow up visits to the veteran's home to assess, teach and reinforce dietary and medical adherence. Dietitian taught veterans and/or caregivers dietary management using food models and conducted 24 hour recalls to assess dietary compliance. Weights and lab data were obtained by HBHC nurses. Monthly and quarterly chart reviews were held with the team physician for adjustment in diet and/or medication regimen. Results showed 34% decline in serum glucose levels for veterans studied the first month. After three months, 56% had serum glucose values within normal range (70-110 mg/dl). Within six months, 48% had serum glucose levels in normal range whereby 85% had normal serum glucose levels after nine months. This percentage remained the same after twelve months. The results showed a steady decline in serum glucose patterns of veterans participating in a HBHC program except during the six months follow up period. It was noted one veteran (4%) had a foot infection during this study period. The HBHC program may be a way of treating home bound veterans with hyperglycemia and requires further investigation.
RELATIONSHIP OF NUTRITION EDUCATION TO KNOWLEDGE AND FOOD CHOICES OF THIRD GRADE STUDENTS. S. A. Fryrear, BS, K.S. Kubena, PhD, RD, LD, W.A. McIntosh, PhD, A. Richter, BS, RD, LD, CDE, and C. Zawieja, BS, RD, LD, Faculty of Nutrition, Texas A&M University, College Station, TX. According to U.S. Department of Agriculture data, school lunches generally include too much fat which may increase the risk of children developing cancer, heart disease, and other chronic diseases later in life. However, other factors, including foods eaten at home, greatly influence food acceptance by children in school feeding programs. The objective of this study was to investigate nutrition knowledge and food selection in the school cafeteria of children before and after a one-week nutrition education program targeting low fat eating. The program was based upon one portion of a curriculum developed by the Texas Education Agency and was taught by one of the investigators (SAF). Reinforcement of nutrition principles using the school menu was given as a follow-up to the education program. Subjects were third grade students (n= 149) from two elementary schools in the Bryan Independent School District. Students in one of the schools participated in the nutrition education program and reinforcement activity while those in the second school did not (served as controls). In both schools, menus were modified to allow students to choose regular or low-fat food items. Pre- and post-tests for nutrition knowledge were administered to all students. Food choices and plate waste were measured before and after the education program. The education program was rated as excellent by the participants. After receiving nutrition education, the average test score of nutrition knowledge of students who received nutrition education increased by 18 points, a 37% improvement (P<.0001), while that of controls was unchanged. Program participants given food choices in the cafeteria were more likely to select lower fat foods than nonparticipants. For example, corn was chosen over french fires by 13.7% of participants but by only 1.5% of controls (P<.05). This also illustrates that knowledge of fat content of food was only one factor determining selection of foods by these subjects. Results indicate that nutrition education can be successfully incorporated into the classroom to improve nutrition knowledge and food choices of schoolaged children.
COMPARISON OF FOCUS GROUPS AND ELICITATION QUESTIONNAIRES TO DESIGNA LOWFAT NUTRITION EDUCATION PROGRAM FOR URBAN AFRICANAMERICANS. V.W. Hartmuller, MS, RD, L.B. Wilder, ScD, RD, and D.M. Becker, ScD, MPH, Johns Hopkins University Medical School, Baltimore, MD A nutrition education intervention is being designed for a community-based project aimed at reducing fat intake among African American (AA) adults in East Baltimore. Two focus groups (7, 9 participants) were conducted among practicing dietitians (RD's) who work with AA clients to get input concerning the types of eating habits that should be targeted for change in community members. The transcripts from the focus groups were then compared with elicitation questionnaires completed by 15 similarly matched RD's through a mail survey. The primary objective was to define the key components that should be included in this intervention from those who work closest with the population. An additional objective was to compare the information obtained from the focus groups with the questionnaires to determine which method would yield the greatest amount of information with the least cost. Questions asked were targeted to determine specific behaviors involved in achieving a lowfat diet for this population, including purchasing and preparation of food as well as eating away from home. Barriers to adopting these behaviors and the experience of the RD with how various strategies work were also asked. Results from both focus groups and the elicitation questionnaires were essentially the same. Following are the behaviors which were most often mentioned as being important to target: a) food purchasing behaviors of reading food labels, meal planning, and selecting more fruits and vegetables; b) food preparation behaviors of learning lowfat cooking methods, choosing alternate favoring techniques besides "Southern" fats, and skimming fat from sauces, etc.; c) eating away from home eating behaviors of controlling food portions, asking questions prior to eating, and choosing appropriate restaurants. Barriers identified to accomplishing desired goals include a) inability to read, b) cost of food, c) convenience of transportation and d) tradition based cooking habits. The RD's experience agreed the intervention should include cooking demonstrations, hands on activities and involving the community peer leaders. These results suggest that both focus groups and elicitation questionnaires are equally useful in designing an intervention program to lower fat in the diets of AA adults provided a specific agenda is followed targeting specific questions. Cost comparison data from these methods show that elicitation questionnaires are considerably less costly than conducting focus groups and essentially yield the same information.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / A-59