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Impact and Sustainability Outcomes of a Skills-Building Intervention for a Malawi Nutrition Education Program
TUESDAY, OCTOBER 20
POSTER SESSION: WELLNESS AND PUBLIC HEALTH Impact and Sustainability Outcomes of a Skills-Building Intervention for a Malawi Nutrition Education Program
Development of an Intervention Tool to Facilitate Food Choice and Self-Monitoring among Low-Income Women
Author(s): J. Fahreddin,1 C. Fields-Gardner,2 M. Schmitz,2 A. Wagle,1 C. Hollenbeck1; 1Nutrition and Food Science, San Jose State University, San Jose, CA, 2TCE Consulting, Chicago, IL
Author(s): B. Olendzki,1 L. Clifford,2 S. Lemon,1 M. Rosal1; 1Preventive and Behavioral Med, Umass Medical School, Worcester, MA, 2Nutrition, UMass Amherst, Amherst, MA
Learning Outcome: To evaluate impact and sustainable features on knowledge, perceptions and reported practices from a skills-building intervention supporting communication of nutrition messages to communities of southern Malawi.
Learning Outcome: Participant will recognize the necessity of tailoring messages to target populations.
Education and training-based community nutrition interventions can achieve sustainable impacts. This study evaluated the impacts of a skillsbuilding, training of trainers intervention focused on choosing and delivering community nutrition messages as a part of a nutrition education program in Malawi. Changes and maintenance of knowledge, perceptions, and practices for utilizing low literacy techniques to teach nutrition messages were analyzed using surveys administered prior to the training intervention, post, and three months follow-up. Comparison and analysis of results consisted of descriptive frequencies, paired t-tests, and Wilcoxon signed ranks test. Skills-based knowledge scores (n⫽195) from an eight item, multiple choice test increased from 7.5 correct at baseline to 7.9 at post intervention (p⬍0.001). At three months follow-up (n⫽163), though scores declined slightly, the significant level of impact was maintained (7.8, p⫽0.006). Participants (n⫽157) reported an overall increase of use and variety of low literacy methods for teaching nutrition messages, such as songs, discussions, and debates from prior to the training to three months follow-up, suggesting an impact on practices. Using a 5-point Likert scale, the trainer subset of participants (n⫽31) showed high scores for perceptions of confidence to deliver nutrition messages to the communities prior to the training intervention, with no significant change at post (n⫽31) or follow-up surveys (n⫽26). A refresher course at intervals following the initial intervention may optimize sustainability of program outcomes, especially knowledge scores. Community-based nutrition education programs in developing countries should emphasize the importance of long-term program monitoring to determine sustained impact on knowledge, perceptions, and practices. Funding Disclosure: None
Background: Post-partum weight retention is prevalent among lowincome women and is associated with obesity in later life. Principles of evidence-based weight loss interventions shown efficacious in other populations (such as the Diabetes Prevention Program) need significant modifications such as tailoring of messages to motivations for dietary change, appealing support materials, and literacy-appropriate revisions. Objective: To develop a foods guide to aid healthy food choices and selfmonitoring among a diverse group of young, low-income, post-partum women. Methods: Qualitative data were collected from area nutritionists to identify commonly eaten foods by the target population, and additional foods frequently consumed by the general population. The subsequent foods guide is organized into chapters (e.g. beverages, vegetables, snacks) with a simplified points system based on caloric content to facilitate food choice and self-monitoring. To determine the point value of any food or meal, total calories consumed are divided by 100. Individuals can set daily point goals based on BMI by determining calories needed for weight maintenance, subtracting 500 calories to lose one pound per week, and dividing by 100 (e.g. 2000-500/100⫽15). Further, a color-coded classification system aids understanding of dietary quality based on glycemic index, saturated fat, fiber and sodium, and preparation methods, drawn on information from the USDA Nutrient Database. These concepts are illustrated with examples comparing healthy and unhealthy choices, portrayed in written and pictorial form to engage lower literacy groups. Relevance: Literacy-appropriate tools such as this simplified foods guide are essential to facilitate healthy dietary choices of low-income postpartum women. Funding Disclosure: UMMHC Community Benefits Program; Postpartum Weight Loss Program
Perceived Needs, Interests, and Practices in Weight Management of Faculty, Staff, and Students from an Academic Health Science Center
Tailored Lifestyle Interventions on Cardiovascular Disease Values, Diet and Exercise: The Peak Wellness Program
Author(s): L. Wong,1 D. Rigassio-Radler,1 R. Touger-Decker,1 H. Khan,2 J. O’Sullivan-Maillet1; 1Dept of Nutritional Sciences, School of Health Related Professions, University of Medicine and Dentistry of New Jersey, Newark, NJ, 2 Dept of Health Informatics, School of Health Related Professions, University of Medicine and Dentistry of New Jersey, Newark, NJ
Author(s): S. Decker, R. Foster, S. Russell Rodriguez, T. Ghosh; Tri County Health Department, Englewood, CO
Learning Outcome: Identify the needs and interests for weight management resources of faculty, staff, and students at an academic health science center; as well as identify their personal and professional weight management practices. Objective: To identify the perceived needs and interests for weight management (WM) resources and personal and professional WM practices of faculty, staff, and students within an academic health science center. Methodology: A prospective internet-based survey using the Dillman Tailored Design Method. An email with an embedded link was sent to a systematic, random sample of 4000 faculty, staff, and students from the 2008-09 academic year. Descriptive and inferential statistics were used. Results: Of the valid e-mails distributed (n⫽3921), there was a 15.6% response rate (n⫽612). The mean age of respondents⫽39.2 years (SD⫽12.7); the mean calculated BMI⫽26.6 kg/m2 (SD⫽6, range⫽15.5-51.2 kg/m2); 51.0% were overweight/obese. Staff had the greatest frequency of obesity (n⫽111, 33.5%). Forty-six percent of respondents reported getting ⱖ30 minutes of physical activity most days, 79.0% limit fast-food to ⱕ3 times weekly; 50.3% felt it necessary and important to have campus WM resources. The most frequent WM resources requested were an on-site fitness center (79.5%) and healthy dining options (78.5%). Among respondents who provide patient care (37.4%), obese participants were significantly more likely not to screen for overweight/obesity (2 ⫽8.927, p⫽0.012) nor to provide WM counseling (2 ⫽8.885, p⫽0.012) than those who were normal or overweight. Application/Conclusions: The incidence of overweight/obesity in this academic health sciences center is less than that reported for U.S. adults. Weight-status was associated with professional practices regarding WM. Most respondents want WM resources in the workplace. Further research is needed to examine the relationships between weight status, personal, and professional practices. Funding Disclosure: None
A-82 / September 2009 Suppl 3—Abstracts Volume 109 Number 9
Learning Outcome: Participants will be able to describe examples of lifestyle interventions that have a measurable impact on physical activity and diet. A large local health department modeled a cardiovascular disease (CVD) screening program after the Centers for Disease Control and Prevention’s WISEWOMAN program, named the Peak Wellness Program. This program employs multifaceted lifestyle interventions aimed to reduce CVD values, improve diet, and increase exercise. The Peak Wellness Program provides low-income, uninsured men and women, aged 40-64 years with annual screenings for blood pressure, body mass index, cholesterol, and glucose. A registered dietitian (RD) and health educator (HE) provide lifestyle interventions which include one-on-one counseling, individualized goal setting, one and six month follow-up phone calls, tailored letters and newsletters. The RD and HE have been utilizing the Nutrition Care Process and Standardized Language in documentation for the counseling sessions and follow-up calls. From 9/1/2006 to 12/31/2008, 1769 clients were seen in the program; 1729 (98%) clients received one-on-one counseling, 1495 (85%) set a diet or exercise related goal. Of the 985 clients who were eligible to return for a second visit, 305 (31%) have returned. Overall, 254 (83%) repeat clients reported making at least one positive lifestyle behavior change. One hundred twenty-four (41%) reported increasing their fruit intake; 87 (28%) reported increasing their vegetable intake; and 110 (36%) reported increasing their exercise by at least one day per week. Although not meeting the level of significance, clients were more likely to lose weight (p⫽.09) and make at least one positive lifestyle change (p⫽.10) if one follow-up phone call was completed. The program was successful at improving the client’s CVD lifestyle risk factors. Funding Disclosure: Colorado Department of Public Health and Environment and Tri County Health Department
POSTER SESSION: WELLNESS AND PUBLIC HEALTH Impact and Sustainability Outcomes of a Skills-Building Intervention for a Malawi Nutrition Education Program
Development of an Intervention Tool to Facilitate Food Choice and Self-Monitoring among Low-Income Women
Author(s): J. Fahreddin,1 C. Fields-Gardner,2 M. Schmitz,2 A. Wagle,1 C. Hollenbeck1; 1Nutrition and Food Science, San Jose State University, San Jose, CA, 2TCE Consulting, Chicago, IL
Author(s): B. Olendzki,1 L. Clifford,2 S. Lemon,1 M. Rosal1; 1Preventive and Behavioral Med, Umass Medical School, Worcester, MA, 2Nutrition, UMass Amherst, Amherst, MA
Learning Outcome: To evaluate impact and sustainable features on knowledge, perceptions and reported practices from a skills-building intervention supporting communication of nutrition messages to communities of southern Malawi.
Learning Outcome: Participant will recognize the necessity of tailoring messages to target populations.
Education and training-based community nutrition interventions can achieve sustainable impacts. This study evaluated the impacts of a skillsbuilding, training of trainers intervention focused on choosing and delivering community nutrition messages as a part of a nutrition education program in Malawi. Changes and maintenance of knowledge, perceptions, and practices for utilizing low literacy techniques to teach nutrition messages were analyzed using surveys administered prior to the training intervention, post, and three months follow-up. Comparison and analysis of results consisted of descriptive frequencies, paired t-tests, and Wilcoxon signed ranks test. Skills-based knowledge scores (n⫽195) from an eight item, multiple choice test increased from 7.5 correct at baseline to 7.9 at post intervention (p⬍0.001). At three months follow-up (n⫽163), though scores declined slightly, the significant level of impact was maintained (7.8, p⫽0.006). Participants (n⫽157) reported an overall increase of use and variety of low literacy methods for teaching nutrition messages, such as songs, discussions, and debates from prior to the training to three months follow-up, suggesting an impact on practices. Using a 5-point Likert scale, the trainer subset of participants (n⫽31) showed high scores for perceptions of confidence to deliver nutrition messages to the communities prior to the training intervention, with no significant change at post (n⫽31) or follow-up surveys (n⫽26). A refresher course at intervals following the initial intervention may optimize sustainability of program outcomes, especially knowledge scores. Community-based nutrition education programs in developing countries should emphasize the importance of long-term program monitoring to determine sustained impact on knowledge, perceptions, and practices. Funding Disclosure: None
Background: Post-partum weight retention is prevalent among lowincome women and is associated with obesity in later life. Principles of evidence-based weight loss interventions shown efficacious in other populations (such as the Diabetes Prevention Program) need significant modifications such as tailoring of messages to motivations for dietary change, appealing support materials, and literacy-appropriate revisions. Objective: To develop a foods guide to aid healthy food choices and selfmonitoring among a diverse group of young, low-income, post-partum women. Methods: Qualitative data were collected from area nutritionists to identify commonly eaten foods by the target population, and additional foods frequently consumed by the general population. The subsequent foods guide is organized into chapters (e.g. beverages, vegetables, snacks) with a simplified points system based on caloric content to facilitate food choice and self-monitoring. To determine the point value of any food or meal, total calories consumed are divided by 100. Individuals can set daily point goals based on BMI by determining calories needed for weight maintenance, subtracting 500 calories to lose one pound per week, and dividing by 100 (e.g. 2000-500/100⫽15). Further, a color-coded classification system aids understanding of dietary quality based on glycemic index, saturated fat, fiber and sodium, and preparation methods, drawn on information from the USDA Nutrient Database. These concepts are illustrated with examples comparing healthy and unhealthy choices, portrayed in written and pictorial form to engage lower literacy groups. Relevance: Literacy-appropriate tools such as this simplified foods guide are essential to facilitate healthy dietary choices of low-income postpartum women. Funding Disclosure: UMMHC Community Benefits Program; Postpartum Weight Loss Program
Perceived Needs, Interests, and Practices in Weight Management of Faculty, Staff, and Students from an Academic Health Science Center
Tailored Lifestyle Interventions on Cardiovascular Disease Values, Diet and Exercise: The Peak Wellness Program
Author(s): L. Wong,1 D. Rigassio-Radler,1 R. Touger-Decker,1 H. Khan,2 J. O’Sullivan-Maillet1; 1Dept of Nutritional Sciences, School of Health Related Professions, University of Medicine and Dentistry of New Jersey, Newark, NJ, 2 Dept of Health Informatics, School of Health Related Professions, University of Medicine and Dentistry of New Jersey, Newark, NJ
Author(s): S. Decker, R. Foster, S. Russell Rodriguez, T. Ghosh; Tri County Health Department, Englewood, CO
Learning Outcome: Identify the needs and interests for weight management resources of faculty, staff, and students at an academic health science center; as well as identify their personal and professional weight management practices. Objective: To identify the perceived needs and interests for weight management (WM) resources and personal and professional WM practices of faculty, staff, and students within an academic health science center. Methodology: A prospective internet-based survey using the Dillman Tailored Design Method. An email with an embedded link was sent to a systematic, random sample of 4000 faculty, staff, and students from the 2008-09 academic year. Descriptive and inferential statistics were used. Results: Of the valid e-mails distributed (n⫽3921), there was a 15.6% response rate (n⫽612). The mean age of respondents⫽39.2 years (SD⫽12.7); the mean calculated BMI⫽26.6 kg/m2 (SD⫽6, range⫽15.5-51.2 kg/m2); 51.0% were overweight/obese. Staff had the greatest frequency of obesity (n⫽111, 33.5%). Forty-six percent of respondents reported getting ⱖ30 minutes of physical activity most days, 79.0% limit fast-food to ⱕ3 times weekly; 50.3% felt it necessary and important to have campus WM resources. The most frequent WM resources requested were an on-site fitness center (79.5%) and healthy dining options (78.5%). Among respondents who provide patient care (37.4%), obese participants were significantly more likely not to screen for overweight/obesity (2 ⫽8.927, p⫽0.012) nor to provide WM counseling (2 ⫽8.885, p⫽0.012) than those who were normal or overweight. Application/Conclusions: The incidence of overweight/obesity in this academic health sciences center is less than that reported for U.S. adults. Weight-status was associated with professional practices regarding WM. Most respondents want WM resources in the workplace. Further research is needed to examine the relationships between weight status, personal, and professional practices. Funding Disclosure: None
A-82 / September 2009 Suppl 3—Abstracts Volume 109 Number 9
Learning Outcome: Participants will be able to describe examples of lifestyle interventions that have a measurable impact on physical activity and diet. A large local health department modeled a cardiovascular disease (CVD) screening program after the Centers for Disease Control and Prevention’s WISEWOMAN program, named the Peak Wellness Program. This program employs multifaceted lifestyle interventions aimed to reduce CVD values, improve diet, and increase exercise. The Peak Wellness Program provides low-income, uninsured men and women, aged 40-64 years with annual screenings for blood pressure, body mass index, cholesterol, and glucose. A registered dietitian (RD) and health educator (HE) provide lifestyle interventions which include one-on-one counseling, individualized goal setting, one and six month follow-up phone calls, tailored letters and newsletters. The RD and HE have been utilizing the Nutrition Care Process and Standardized Language in documentation for the counseling sessions and follow-up calls. From 9/1/2006 to 12/31/2008, 1769 clients were seen in the program; 1729 (98%) clients received one-on-one counseling, 1495 (85%) set a diet or exercise related goal. Of the 985 clients who were eligible to return for a second visit, 305 (31%) have returned. Overall, 254 (83%) repeat clients reported making at least one positive lifestyle behavior change. One hundred twenty-four (41%) reported increasing their fruit intake; 87 (28%) reported increasing their vegetable intake; and 110 (36%) reported increasing their exercise by at least one day per week. Although not meeting the level of significance, clients were more likely to lose weight (p⫽.09) and make at least one positive lifestyle change (p⫽.10) if one follow-up phone call was completed. The program was successful at improving the client’s CVD lifestyle risk factors. Funding Disclosure: Colorado Department of Public Health and Environment and Tri County Health Department