Nutrition Education in congregate and home delivered meal program settings

12/11/18

What do we know?

Nutrition Education in Congregate and Home delivered meal program settings: what do we know?

Christina Riccardo, EdD, RD

Rowan University

Glassboro, NJ

Overview

Learning Objectives

Background

Purpose of Research

Methodology

Description of Survey Participants & Findings

Overview of Nutrition Education Materials

Implications for Practice

Learning objectives

Describe the current state of nutrition education delivered to congregate and home delivered meal program participants;

Discuss the differences in education provided by non-dietetics professionals and dietetics professionals;

Explain how to incorporate theory-based and behaviorally focused nutrition education into nutrition education sessions.

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Background

Adequate nutrition is a key component of aging well.

Congregate and home-delivered meal programs are an ideal setting in which to provide nutrition education for older adults that can lead to increases in successful aging.

Additional impetus for conducting this research came from my personal experience as a nutrition educator.

Purpose of research

Purpose

To identify the type and frequency of education; lessons theory-based and behaviorally-focused; if credentials mattered; evaluation of nutrition education efforts.

Method

Cross-sectional, national study;

Survey of nutrition educators.

Professional Credentials of Survey Participants
| Dietetics Professionals (n = 189) | Non-Dietetic Professionals (n = 152) |
|-----------------------------------|--------------------------------------|
| Registered Dietitian              | Health and Human Services degree     |
| Licensed Dietitian                | Certified Dietary Manager            |
| Dietetic Intern                   | Registered Nurse                     |
|                                   | Licensed Practical Nurse             |
|                                   | Social Worker                        |
|                                   | Licensed Social Worker               |

Thank you to those of you who participated in this research!

We surveyed a total of 341 nutrition educators in congregate and home delivered meal sites

Explain the breakdown of dietetic vs. non-dietetic professionals

7

Survey Participant characteristics

Almost 70% in profession for 10+ years;

Almost 1⁄2 worked with older adults for 10+ years.

59% dietetics professionals had master’s degree;

27% non-dietetic health professionals had a master’s degree;

Almost 60% of participants were over the age of 50;

89% of the participants were female.

NUTRITION EDUCATION SESSIONS CHARACTERISTICS

More than 80% worked in both home delivered and congregate meal settings;

More dietetic professionals were responsible for ≥ 10 sites than non-dietetic health professionals (56% vs. 35%);

Most common group size for nutrition education was 10-20 (28.8%);

Most common length for education session was between 15-20 minutes (50%).

?

9

% EDUCATORS COVERING TOPICS IN PAST TWO YEARS

Explain the topics covered

10

% Educators Covering Topic in Past 2 Years

% EDUCATORS COVERING TOPICS IN PAST TWO YEARS

Poll Question:how often do you develop your own nutrition education materials/sessions vs. use off-the-shelf curricula?-Usually-sometimes-rarely-never

Integrating educator expertise (skills obtained through practice and experience) with the best available external evidence from systematic research about nutrition education outcomes.

CRITERIA USED FOR CHOOSING MATERIALS

29% choose materials that focus on specific behavior change;

32.5% choose materials based on nutrition risk assessment;

82.5% choose materials that cover topic clients are interested in;

73.4% choose materials that are targeted.

This Photo by Unknown Author is licensed under CC BY-NC-ND

Explain why focusing on behavior change is important

When broken down, 35% of dietetics professionals and 24%  of non-dietetic health professionals focus on specific behavior changes 

Nutr risk assessment- 31.7% dietetic prof and 34.1% non- dietetic prof

Interest- 92.5% dietetic and 74.4% non-dietetic

Targeted meaning specific topics for older adults- 81.7% dietetic and 65.9% non dietetic

Criteria used for choosing materials (cont.)

Delivery considerations:

Interesting activities (41.3%)

Easy to teach/implements (56%)

Can teach in allotted time (34.9%)

Provides all teaching materials needed (38.9%)

Materials already familiar with (14.3%)

Organization selected for me (8.3%)

Simple messages (63.1%)

Practical (63.5%

Cost (29%)

This Photo by Unknown Author is licensed under CC BY

Activities- 43.3% diet, 40.3% non-diet

Easy 65.8% diet,47.3% non-diet

Time – 43.4% diet, 26.4% non-diet

providesMaterials 36.7% diet 41.1% non-diet

Familiar 16.7% diet, 12.4% non-diet

Organization 3.3% diet 12.4 non-diet

Simple messages 72.5% diet 55% non-diet

Practical 72.5% diet 55% non-diet

Cost 28.3% diet 295% non diet

Methods of delivery

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METHODS OF DELIVERY

Materials used for Nutrition education

SNAP-ED/County extension materials

State Department on Aging Nutrition education materials

State University extension programs

Company materials

Eat Smart, Live Strong

MyPlate

DASH diet

Chef Charles/Fresh Conversations

Eat Better & Move More

Cooking Matters

Healthy Eating for Successful Living in Older Adults

Participants in the survey rated each of these materials on a scale that ranged from do not use to use extensively

Materials used the least were Chef Charles/ Fresh conversations and Eat Better & Move more ; 

The materials used the most were MyPlate materials which participants reported they use components of MyPlate for education

All other materials were rated as familiar with but do not use

Many of these items are theory-based and behaviorally focused as well as evidence based 

Satisfaction with nutrition education materials

Question: Are you satisfied with the nutrition education materials you use?

On a 4 point scale:

0 = not satisfied

1 = neutral

2 = somewhat satisfied

3 = satisfied

4 = very satisfied

Average Score = 2.2

Score- so participants indicated they were somewhat satisfied with nutrition education materials available. This is similar for dietetics prof and non-dietetic prof with diet prof being slightly more satisfied (perhaps because they are more aware of the materials available)

Satisfaction with nutrition education materials (cont.)

Question: Would you like more resources to provide education?

Scale 0-4

0 = definitely not

1 = probably not

2 = might or might not

3 = probably yes

4 = definitely yes

Average Score = 2.84

Overall, participants were between might or might not and probably yes to needing more resources to provide nutrition education

- This was higher for non-diet than diet prof – non-diet prof want more resources 

Barriers to conducting nutrition education with older adults
|                                                   | Total (%) | Dietetics Professionals | Non-Dietetic Health Professionals |
|---------------------------------------------------|-----------|-------------------------|-----------------------------------|
| Lack of materials available                       | 23.0      | 19.1                    | 27.1                              |
| No budget for nutrition education activities      | 52.8      | 49.5                    | 56.8                              |
| No promotion of nutrition education sessions      | 21.4      | 26.6                    | 16.9                              |
| Staff unaware of visits/unprepared                | 7.4       | 9.2                     | 5.7                               |
| Competitive events scheduled                      | 16.6      | 18.3                    | 14.4                              |
| No incentives                                     | 26.6      | 27.5                    | 26.3                              |
| Clients/participants not interested               | 47.6      | 44.0                    | 51.7                              |
| Lack of time                                      | 38.4      | 40.4                    | 37.3                              |
| No access to cooking resources                    | 17.5      | 24.8                    | 11.0                              |
| No computer/projector                             | 19.2      | 21.1                    | 16.7                              |
| Difficulty getting/maintain participant attention | 48.0      | 44.0                    | 52.5                              |

Facilitators to conducting nutrition education with older adults
|                                                               | Total (%) | Dietetics Professionals | Non-Dietetic Health Professionals |
|---------------------------------------------------------------|-----------|-------------------------|-----------------------------------|
| More nutrition education materials available                  | 49.6      | 44.5                    | 55.3                              |
| Larger budget for nutrition education                         | 57.5      | 52.7                    | 63.2                              |
| Promotion of nutrition education sessions                     | 35.0      | 37.3                    | 33.3                              |
| Congregate meal site staff/participants prepared for visit    | 28.3      | 34.5                    | 22.8                              |
| Decrease in competing events                                  | 18.6      | 21.8                    | 14.9                              |
| Increased participant interest                                | 51.3      | 43.6                    | 58.8                              |
| More time for preparation and delivery of nutrition education | 32.4      | 32.1                    | 33.3                              |
| Access to cooking resources (i.e., hot plates)                | 20.8      | 30.0                    | 12.3                              |
| Access to projector, computer                                 | 21.2      | 24.5                    | 17.5                              |

Revised Model for Nutrition Education for Older Adults

Talk about what ways this has been revised .

Why choose theory-based, behaviorally focused education materials?

Required for behavior change to occur and be sustainable; 

Involves lessons that target specific dietary behaviors;

Example: Eat more vegetables at dinner

Includes goal setting

Helps participants identify barriers to achieving goals

Strategies to overcoming barriers 

Goal of nutrition education

The goal of nutrition education is to change behavior. Creating or selecting a nutrition education curriculum that can aid in this effort is key.

Health behavior change is critical but challenging to do. Public health practitioners have developed theories to understand how behavior change can occur.

A theory is a systematic approach to understanding events, behaviors and/or situations.

Theories are supported through understanding how behavior change occurs in real life – in day to day work settings or via research evidence.

Willingness to Use evidence-based materials
|                                                                   | Total (mean) | Dietetics Professionals | Non-Dietetic Health Professionals |
|-------------------------------------------------------------------|--------------|-------------------------|-----------------------------------|
| Would use evidence-based nutrition education program if available | 3.01 (0.91)  | 3.01 (0.87)             | 3.03 (0.94)                       |
| Have funding for reasonably priced evidence based materials       | 1.80 (1.1)   | 1.91 (1.0)              | 1.69 (1.1)                        |

No significant difference between those surveyed!

Be sure to state that most evidence-based materials are FREE

Examples of Theory-based and behaviorally focused nutrition programs

Theory-based and behaviorally focused nutrition programs

Fresh Conversations

Newsletter-based nutrition education;

Includes a section intended to facilitate discussions;

Funded by SNAP and can be accessed online;

Video and  free training guide are available.

Will explain more

Theory-based and behaviorally focused nutrition programs (2)

Eat Better and Move More (EBMM)

Developed by the National Policy and Resource Center on Nutrition and Aging at Florida International University

12 weekly sessions

Mini talks and activities for group nutrition and physical activity sessions 

Guidebook is available to educators 

Designed to be just 30 minutes for each session

Will explain more

Theory-based and behaviorally focused nutrition programs (3)

Eat Smart Live Strong: Nutrition Education for Older Adults

Developed to increase fruit and vegetable intake and physical activity.

Free online resources

Includes leader’s guide;

Interactive education sessions;

Ready-to-go participant handouts;

Marketing flyers. 

This Photo by Unknown Author is licensed under CC BY-NC-ND

Will explain more

Theory-based and behaviorally focused nutrition programs (4)

Cooking Matters

Empowers resource-limited families to eat better for less. 

6-week cooking classes.

In-store educational curricula available.

Will explain more

Q & A Question:What resources would enable you to provide theory-based, behaviorally focused nutrition education?

Implications: what do we know?

Create a repository of materials and programs:

Track the nutrition education curricula you use;

Stay informed on availability of new materials and programs. 

This Photo by Unknown Author is licensed under CC BY-NC-ND

Almost 50% of total survey participants indicated that one factor that could facilitate their nutrition education efforts is higher availability of education materials. A central repository of nutr ed materials is helpful since many of these programs and resources, even at the local county and state level, appear to be underutilized ; might also help save time 

Title III D program has a document with a table that lists various health promotion and disease prevention evidence –based programs, along with information on websites, program descriptions and goals, target audiences, costs, training requirements and who should deliver the program. No such list or table exists for the title III-C nutr programs to help educators find and utilize high- quality education materials and programs 

Dietetics vs Non-dietetics Credentialed educators: conducting TBBF Nutrition education
| Rationale                     | Total (mean) | Dietetics Professionals (mean) | Non-Dietetic Health Professionals(mean) | T     | p         |
|-------------------------------|--------------|--------------------------------|-----------------------------------------|-------|-----------|
| Enhance Motivation            | 2.80 (0.76)  | 2.96 (0.68)                    | 2.67 (0.80)                             | -3.36 | 0.001     |
| Facilitate Action             | 2.33 (0.71)  | 2.96 (0.68)                    | 2.18 (0.74)                             | -3.24 | 0.001     |
| Create Supportive Environment | 1.90 (0.93)  | 2.13 (0.91)                    | 1.72 (0.90)                             | -3.54 | <0.001 |
| Delivery Considerations       | 2.11 (0.95)  | 2.29 (0.87)                    | 1.97 (0.97)                             | -2.75 | <0.001 |
| Total                         | 2.29 (0.68)  | 2.49 (0.62)                    | 2.11 (0.70)                             | -4.29 |           |

When dietetics prof were compared to non-diet prof, diet prof scored sig higher on each individ component and higher on overall score, indicating they are conducting more TBBF nutrition education

Implications: what do we know? (cont.)

More training and resources at the local and national levels are needed for all educators, especially non-dietetic professionals focusing on: 

Theory-based, behaviorally focused nutrition education:

What it is,

Why it matters, and 

How to incorporate it into nutrition lessons

Program administrators are encouraged to develop training manuals and how-to guides to support  provision of high-quality nutrition education.

Is this an implications slide? if so, please make this more clear. To whom are the implications directed - program managers? practitioners? ACL? Please specify.

More training for all educators by qualified practitioners/higher level RDs on TBBF nutrition education

ACL could maybe develop a training manual to educate program managers and practitioners on what TBBF nutrition education is and how to incorporate it into lessons- along with resources.

Take home messages

Theory-based, behaviorally focused nutrition education is recommended;

Theory-based, behaviorally focused nutrition education is available;

Many evidence-based programs are available for free or low cost;

More awareness raising and training on availability of materials needed:

Especially for non-dietetic professionals.

references

Fresh Conversations training: https://idph.iowa.gov/inn/fresh-conversations/coordinators/training-materials

Fresh conversations resources: https://idph.iowa.gov/inn/fresh-conversations/coordinators/resources

Eat Smart, Live Strong manual and resources: https://snaped.fns.usda.gov/nutrition-education/fns-curricula/eat-smart-live-strong

Cooking Matters website and resources: https://cookingmatters.org/

Eat Better and Move More resources: http://nutrition.fiu.edu/You_Can/index.asp

Thank you!Christina riccard0, EDD, RDriccardo@rowan.edu

New tools and resources

Upcoming webinar

Nutrition education webinar: Part 2

Nutrition Education In Congregate And Home-Delivered Meal Program Settings

Where Do We Go?

Date: December 13, 2018

Time: 3:30pm ET

To Register: Visit the National Resource Center On Nutrition And Aging’s Website

Join Us!

Thank you!

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