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Making your nutrition education efforts worthwhile
NUTRITION
Making Your Nutrition Education Efforts Worthwhile BY
PEGGY
K.
YEN
he reading level of the average American adult is 8th
T grade or less. So why are most nutrition and health
materials written at the 10th grade level or above? Probably because the people creating these printed materials read at a high level. Unfortunately, this means that a majority of health and nutrition materials are incomprehensible to older adults who are poor readers. Nurses are highly valued as a source of health information, according to a survey of North Dakota senior citizens. Nurses (and dietitians) can make their information-giving much more effective by considering their older patients" knowledge, abilities, and reading level. When patients are not following the instructions, nurses should consider the possibility that the patient is illiterate. Functional illiterates cannot read and understand well enough to perform everyday tasks such as following instructions on a food package. Venesky I coined the term " f u n c t i o n a l literacy" to describe people who can use printed materials but only in a very limited way. Both groups have limited vocabularies, limited knowledge, and think in concrete, rather than abstract, terms. Written materials for these groups should not dwell on theories about disease, but on specific, practical steps to take to prevent or treat disease. In focus group interviews done with older adults in North Dakota, the participants asked that written materials for their use be easy to understand, simple and in large print. 2 With the general availability of personal computers, it is easy for most health professionals to create large-print materials. Large print may take up a lot of space on the page, but this creates a helpful incentive to simplify the information. PEGGY K. YEN, RN, MPH, is a nutrition consultant, Cardiovascular Disease and Nutrition Services, Local and Family Health Administration, Maryland Department of Health and Mental Hygiene in Baltimore. GERIATR NURS 1993;14:277-8. Copyright © 1993 by Mosby-Year Book, Inc. ISSN 0197-4572/93/$1.00 + .10 34/1/49046 *Source for Food Model Catalog: NASCO, 901 Janesville Ave., Fort Atkinson WI 53538-0901. *Source for Food Model Catalogue: NASCO, 901 Janesville Ave., Fort Atkinson, Wl 53538-0901.
Yen
Keep it Simple Most literacy research highlights several major points to consider when writing for poor readers: • Use short sentences and short paragraphs. • Use simple language, not technical jargon. • Use simple concepts. • Organize the information in a logical way. It sounds like common sense, but it is easier said than done. Nutrition information involves multiple concepts, such as "Foods are not 'bad' or 'good' but must be chosen in relation to one another" and "Nutrient needs are determined by considering age, size, presence of disease, and gender and therefore vary from person to person." When nutrition information is simplified, it may seem watered-down and inaccurate to a health professional and they may resist this simplification. The best approach to simplifying nutrition information is to personalize it. Make it Personal Low literate adults want information that relates to their personal experience, not general information. When nutrition researchers gave a group of low literate adults a list of foods showing serving sizes in ounces and tablespoons, their comments (such as, "I eat much more than that") showed that they could not use the information if it was not the portion that they usually consume) T h e y could not genm-alize in order to calculate the content of their serving, for example multiplying by five if their usual portion was 5 tablespoons. So not only the words used but the concepts need to be kept simple. When educating older adults about nutrition, put the information in a form they can use. Instead of a list of desserts and their calorie content, find out what desserts the client usually eats and give a shorter list that applies to his or her specific habits. Instead of giving information about how to read labels and compare the fat content of different foods, give clients a few specific foods to look for (by brand name) that meet the requirements for fat content.
GERIATRIC NURSING Volume14. Number5 277
Alternatives to Printed M a t e r i a l s
W h e n nutritionists were asked a b o u t m e t h o d s of teaching nutrition, they r a t e d p h a m p l e t s as t h e least effective w a y o f c o m m u n i c a t i n g n u t r i t i o n i n f o r m a t i o n , even t h o u g h they were not being asked a b o u t low l i t e r a c y clients. W h a t did they find to be most effective? F o o d m o d els, t e l e v i s i o n , a n d v i d e o s - - a l l v i s u a l m e t h o d s . 4 F o o d models can be very effective and a r e not prohibitively expensive. T h e average cost is 3 to 5 dollars per model, with j u s t a b o u t every typical food available.* T h e r e is nothing m o r e effective to patients than seeing a model serving of m e a t on a plate taken from their own home, as a w a y of c o m m u n i c a t i n g a b o u t portion size. A n o t h e r useful m e t h o d o f teaching is food d e m o n s t r a tions. T h e y do not have to be elaborate, a n d the most imp o r t a n t p a r t is the tasting. R e s e a r c h shows t h a t tasting a food m a k e s a person m o r e likely to buy it and eat it. Food m a n u f a c t u r e r s know this, a n d h e a l t h e d u c a t o r s should t a k e a d v a n t a g e of it. A h e a l t h professional can p r e p a r e b e a u t i f u l written m a t e r i a l s c l a i m i n g t h a t r e d u c e d fat or n o n - f a t cheese is h e a l t h f u l , b u t t h e s e m a t e r i a l s will be w o r t h l e s s if t h e o l d e r c l i e n t is c o n v i n c e d t h a t l o w - f a t
PROGRAM
cheese does not taste good. Discussions with o t h e r elders m a y b e v e r y e d u c a t i o n a l , too. In w o r k i n g w i t h lowi n c o m e groups in B a l t i m o r e , I have found t h a t they have a lot to offer one a n o t h e r . It is v a l u a b l e to have a group m e m b e r describe a w a y o f cooking greens t h a t does not use fat, for e x a m p l e . I t m e a n s much m o r e to the participants to know that s o m e o n e whose life is like theirs can enjoy foods cooked in a h e a l t h f u l way. T h e s e teaching m e t h o d s require extra time, s o m e t h i n g nurses have in short supply. But the c o m b i n a t i o n o f easyt o - r e a d written m a t e r i a l s a n d selected use o f m o r e visual t e a c h i n g m e t h o d s c a n i n c r e a s e n u r s e s ' effectiveness in t e a c h i n g their older patients a b o u t diet. • REFERENCES I. VeneskyRL, WagnerDA, CiliberteBS, eds. Toward definingliteracy.Newark: InternationalReadingAssociation,1990:2. 2. CrockettSJ, HollerKE, MerkelJMi Peterson JM. Assessingbeliefsof older rural Americansabout nutritioneducation:use of the focusgroupapproach.J Am DieteticAssoc 1990;90:563-7. 3. Ruud J, Botts NM, Dirkx J. Developingwritten nutrition informationfor adults with low literacyskills.J Nutr Ed 1993;25:11-16. 4. MettgerW. Communicatingnutrition informationto low-literateindividuals: an assessmentof methods.Chicago:AmericanPublicHealth AssociationReport, 1989.
CALENDAR
Ill "21st Century Nursing-Politics & llealth": Public Policy Conference, October 14 and 15,
1993---Grand Hyatt tIotel, Washington, D.C. Contact: The American Nurses Association, 600 Maryland Ave., SW, Suite 100 W, Washington, DC 20024-2571, telephone (202) 5544444, ext. 446. Eighth Annual National Education Conference for Gerontological Nurses and Annual Meeting of the National Gerontological Nurses Association, October 10-12, 1993--Orlando, Flor-
ida. Contact: Mosby-NGNA, 7250 Parkway Drive, Suite 510, Hanover, hiD 21076, (800) 723-0560. "Practical Dilemmas: Li~ing with Alzheimer's Disease," November 4-5, 1993--Los Angeles,
California. Sponsor: Los Angeles Chapter of the Alzheimer's Association. Contact: Dr. Laura Dungan, Alzheimer's Association, 5979 W. Third St., ~'200, Los Angeles, CA 90036, (213) 938-3379. AGS/AFAR Annual Meeting, November 1519, 1993---New Orleans, Louisiana. Contact: The American Geriatrics Society, 770 Lexington Ave., Suite 300, New York, NY 10021, telephone (212) 308-1414.
278
"Advances in Home Infusion Therapy," November 17, 1993--Boston, Massachusetts. Sponsor: Deaconess Home Health Care. Contact: Tanya Joblon at (617) 278-1593.
20th Annual Meeting of The Association for Gerontology in Higher Education: "Aging Reconsidered: Challenges to Inquiry and Education," March 10-13--Cleveland, Ohio. Con-
46th Annual Scientific Meeting of the Gerontological Society of America, November 19-23,
tact: The Association for Gerontology in Higher Education, c/o Scripps Gerontology Center, Miami University, Oxford, OH 45056.
1993---New Orleans, Louisiana. Contact: The Gerontological Society of America, 1275 K Street, NW, Suite 350, Washington, DC 20005-4006, (202) 842-1275. "The Critical Link: Building Supportive Environments for Low-Income Elderly": AAHA Seminar Series. December 2, 1993 (Wilmington, Del.); December 6, 1993 (St. Louis, Mo.); January 7, 1994 (Tampa, Fla.); January II, 1994 (Denver, Colo.). Sponsor: American Association of Homes for the Aging. Contact: The Office of Educational Services at (202) 508-9434.
Third International Family Nursing Conference, May 25-28, 1994--Montreal, Quebec,
Canada. Contact: Family Nursing Secretariat, Conference Office, McGill University, 550 Sherbrooke St., West, West Tower, Suite 490, Montreal, Quebec, Canada H3A I B9, telephone (514) 398-3770, fax (514) 398-4854. R N / L P N Rehabilitation Nursing Course: "Concepts and Techniques", January 24-28
--Puyallup, Washington. Fee: $375. Contact: Karen Chraska, Good Samaritan Hospital, P. O. Box 1247, Puyallup, WA 98371-0192, telephone (206) 848-6661 ext. 1522.
Sigma Theta Tau International 32nd Biennial Convention, November 29-December 3, 1993
Annual Meeting of The Society of Behavioral Medicine: "Cross-Cutting Dimensions of Behavioral Medicine: Visions for the Future"April 13-16, 1994, Boston, Massachusetts.
--Indianapolis Convention Center, Indianapolis, Indiana. Contact: Sigma Theta Tau International, 550 W. North St., Indianapolis, IN 46220, (317) 634-8171.
Contact: Laura L. ttayman, The Society of Behavioral Medicine, 103 South Adams Street, Rockville, MD 20850, telephone (301) 251-2790.
GERIATRICNURSING September/October1993
Yen
Making Your Nutrition Education Efforts Worthwhile BY
PEGGY
K.
YEN
he reading level of the average American adult is 8th
T grade or less. So why are most nutrition and health
materials written at the 10th grade level or above? Probably because the people creating these printed materials read at a high level. Unfortunately, this means that a majority of health and nutrition materials are incomprehensible to older adults who are poor readers. Nurses are highly valued as a source of health information, according to a survey of North Dakota senior citizens. Nurses (and dietitians) can make their information-giving much more effective by considering their older patients" knowledge, abilities, and reading level. When patients are not following the instructions, nurses should consider the possibility that the patient is illiterate. Functional illiterates cannot read and understand well enough to perform everyday tasks such as following instructions on a food package. Venesky I coined the term " f u n c t i o n a l literacy" to describe people who can use printed materials but only in a very limited way. Both groups have limited vocabularies, limited knowledge, and think in concrete, rather than abstract, terms. Written materials for these groups should not dwell on theories about disease, but on specific, practical steps to take to prevent or treat disease. In focus group interviews done with older adults in North Dakota, the participants asked that written materials for their use be easy to understand, simple and in large print. 2 With the general availability of personal computers, it is easy for most health professionals to create large-print materials. Large print may take up a lot of space on the page, but this creates a helpful incentive to simplify the information. PEGGY K. YEN, RN, MPH, is a nutrition consultant, Cardiovascular Disease and Nutrition Services, Local and Family Health Administration, Maryland Department of Health and Mental Hygiene in Baltimore. GERIATR NURS 1993;14:277-8. Copyright © 1993 by Mosby-Year Book, Inc. ISSN 0197-4572/93/$1.00 + .10 34/1/49046 *Source for Food Model Catalog: NASCO, 901 Janesville Ave., Fort Atkinson WI 53538-0901. *Source for Food Model Catalogue: NASCO, 901 Janesville Ave., Fort Atkinson, Wl 53538-0901.
Yen
Keep it Simple Most literacy research highlights several major points to consider when writing for poor readers: • Use short sentences and short paragraphs. • Use simple language, not technical jargon. • Use simple concepts. • Organize the information in a logical way. It sounds like common sense, but it is easier said than done. Nutrition information involves multiple concepts, such as "Foods are not 'bad' or 'good' but must be chosen in relation to one another" and "Nutrient needs are determined by considering age, size, presence of disease, and gender and therefore vary from person to person." When nutrition information is simplified, it may seem watered-down and inaccurate to a health professional and they may resist this simplification. The best approach to simplifying nutrition information is to personalize it. Make it Personal Low literate adults want information that relates to their personal experience, not general information. When nutrition researchers gave a group of low literate adults a list of foods showing serving sizes in ounces and tablespoons, their comments (such as, "I eat much more than that") showed that they could not use the information if it was not the portion that they usually consume) T h e y could not genm-alize in order to calculate the content of their serving, for example multiplying by five if their usual portion was 5 tablespoons. So not only the words used but the concepts need to be kept simple. When educating older adults about nutrition, put the information in a form they can use. Instead of a list of desserts and their calorie content, find out what desserts the client usually eats and give a shorter list that applies to his or her specific habits. Instead of giving information about how to read labels and compare the fat content of different foods, give clients a few specific foods to look for (by brand name) that meet the requirements for fat content.
GERIATRIC NURSING Volume14. Number5 277
Alternatives to Printed M a t e r i a l s
W h e n nutritionists were asked a b o u t m e t h o d s of teaching nutrition, they r a t e d p h a m p l e t s as t h e least effective w a y o f c o m m u n i c a t i n g n u t r i t i o n i n f o r m a t i o n , even t h o u g h they were not being asked a b o u t low l i t e r a c y clients. W h a t did they find to be most effective? F o o d m o d els, t e l e v i s i o n , a n d v i d e o s - - a l l v i s u a l m e t h o d s . 4 F o o d models can be very effective and a r e not prohibitively expensive. T h e average cost is 3 to 5 dollars per model, with j u s t a b o u t every typical food available.* T h e r e is nothing m o r e effective to patients than seeing a model serving of m e a t on a plate taken from their own home, as a w a y of c o m m u n i c a t i n g a b o u t portion size. A n o t h e r useful m e t h o d o f teaching is food d e m o n s t r a tions. T h e y do not have to be elaborate, a n d the most imp o r t a n t p a r t is the tasting. R e s e a r c h shows t h a t tasting a food m a k e s a person m o r e likely to buy it and eat it. Food m a n u f a c t u r e r s know this, a n d h e a l t h e d u c a t o r s should t a k e a d v a n t a g e of it. A h e a l t h professional can p r e p a r e b e a u t i f u l written m a t e r i a l s c l a i m i n g t h a t r e d u c e d fat or n o n - f a t cheese is h e a l t h f u l , b u t t h e s e m a t e r i a l s will be w o r t h l e s s if t h e o l d e r c l i e n t is c o n v i n c e d t h a t l o w - f a t
PROGRAM
cheese does not taste good. Discussions with o t h e r elders m a y b e v e r y e d u c a t i o n a l , too. In w o r k i n g w i t h lowi n c o m e groups in B a l t i m o r e , I have found t h a t they have a lot to offer one a n o t h e r . It is v a l u a b l e to have a group m e m b e r describe a w a y o f cooking greens t h a t does not use fat, for e x a m p l e . I t m e a n s much m o r e to the participants to know that s o m e o n e whose life is like theirs can enjoy foods cooked in a h e a l t h f u l way. T h e s e teaching m e t h o d s require extra time, s o m e t h i n g nurses have in short supply. But the c o m b i n a t i o n o f easyt o - r e a d written m a t e r i a l s a n d selected use o f m o r e visual t e a c h i n g m e t h o d s c a n i n c r e a s e n u r s e s ' effectiveness in t e a c h i n g their older patients a b o u t diet. • REFERENCES I. VeneskyRL, WagnerDA, CiliberteBS, eds. Toward definingliteracy.Newark: InternationalReadingAssociation,1990:2. 2. CrockettSJ, HollerKE, MerkelJMi Peterson JM. Assessingbeliefsof older rural Americansabout nutritioneducation:use of the focusgroupapproach.J Am DieteticAssoc 1990;90:563-7. 3. Ruud J, Botts NM, Dirkx J. Developingwritten nutrition informationfor adults with low literacyskills.J Nutr Ed 1993;25:11-16. 4. MettgerW. Communicatingnutrition informationto low-literateindividuals: an assessmentof methods.Chicago:AmericanPublicHealth AssociationReport, 1989.
CALENDAR
Ill "21st Century Nursing-Politics & llealth": Public Policy Conference, October 14 and 15,
1993---Grand Hyatt tIotel, Washington, D.C. Contact: The American Nurses Association, 600 Maryland Ave., SW, Suite 100 W, Washington, DC 20024-2571, telephone (202) 5544444, ext. 446. Eighth Annual National Education Conference for Gerontological Nurses and Annual Meeting of the National Gerontological Nurses Association, October 10-12, 1993--Orlando, Flor-
ida. Contact: Mosby-NGNA, 7250 Parkway Drive, Suite 510, Hanover, hiD 21076, (800) 723-0560. "Practical Dilemmas: Li~ing with Alzheimer's Disease," November 4-5, 1993--Los Angeles,
California. Sponsor: Los Angeles Chapter of the Alzheimer's Association. Contact: Dr. Laura Dungan, Alzheimer's Association, 5979 W. Third St., ~'200, Los Angeles, CA 90036, (213) 938-3379. AGS/AFAR Annual Meeting, November 1519, 1993---New Orleans, Louisiana. Contact: The American Geriatrics Society, 770 Lexington Ave., Suite 300, New York, NY 10021, telephone (212) 308-1414.
278
"Advances in Home Infusion Therapy," November 17, 1993--Boston, Massachusetts. Sponsor: Deaconess Home Health Care. Contact: Tanya Joblon at (617) 278-1593.
20th Annual Meeting of The Association for Gerontology in Higher Education: "Aging Reconsidered: Challenges to Inquiry and Education," March 10-13--Cleveland, Ohio. Con-
46th Annual Scientific Meeting of the Gerontological Society of America, November 19-23,
tact: The Association for Gerontology in Higher Education, c/o Scripps Gerontology Center, Miami University, Oxford, OH 45056.
1993---New Orleans, Louisiana. Contact: The Gerontological Society of America, 1275 K Street, NW, Suite 350, Washington, DC 20005-4006, (202) 842-1275. "The Critical Link: Building Supportive Environments for Low-Income Elderly": AAHA Seminar Series. December 2, 1993 (Wilmington, Del.); December 6, 1993 (St. Louis, Mo.); January 7, 1994 (Tampa, Fla.); January II, 1994 (Denver, Colo.). Sponsor: American Association of Homes for the Aging. Contact: The Office of Educational Services at (202) 508-9434.
Third International Family Nursing Conference, May 25-28, 1994--Montreal, Quebec,
Canada. Contact: Family Nursing Secretariat, Conference Office, McGill University, 550 Sherbrooke St., West, West Tower, Suite 490, Montreal, Quebec, Canada H3A I B9, telephone (514) 398-3770, fax (514) 398-4854. R N / L P N Rehabilitation Nursing Course: "Concepts and Techniques", January 24-28
--Puyallup, Washington. Fee: $375. Contact: Karen Chraska, Good Samaritan Hospital, P. O. Box 1247, Puyallup, WA 98371-0192, telephone (206) 848-6661 ext. 1522.
Sigma Theta Tau International 32nd Biennial Convention, November 29-December 3, 1993
Annual Meeting of The Society of Behavioral Medicine: "Cross-Cutting Dimensions of Behavioral Medicine: Visions for the Future"April 13-16, 1994, Boston, Massachusetts.
--Indianapolis Convention Center, Indianapolis, Indiana. Contact: Sigma Theta Tau International, 550 W. North St., Indianapolis, IN 46220, (317) 634-8171.
Contact: Laura L. ttayman, The Society of Behavioral Medicine, 103 South Adams Street, Rockville, MD 20850, telephone (301) 251-2790.
GERIATRICNURSING September/October1993
Yen