Transcript The development, implementation and results of multi

The development, implementation and
results of multi-site nutrition education
programs in the community provided by
undergraduate community health
nursing students.
Lori Pierangeli PhD, RN
Associate Professor
East Stroudsburg University
East Stroudsburg, PA
2008 ACHNE Annual Meeting, Atlanta, GA
Happy Anniversary!
ACHNE Session Objectives
Participants will learn about:
1. The development of a nutrition education project in the
community for CHN students to address the current
community health crisis in obesity and diabetes;
2. The implementation of the project in various
community sites;
3. The results/reactions to the project from
– the CHN students,
– the community agencies and
– the community participants.
Introduction
As part of course requirements senior nursing students provided
nutrition education in multiple community settings to promote the
health of populations across the lifespan.
Initially, students were given a class specific to nutrition in the
community including nutrition visual aids and learning a nutrition
bingo game.
Examples of the educational content included the following:
– Common foods containing excessive and acceptable amounts of sugar,
sodium and fat;
– Recognizing normal and abnormal food portion sizes;
– How to make up a healthy plate of food;
– Healthy alternatives to unhealthy food items.
Nutrition Bingo
– Students developed nutrition information quiz cards that were read to the
bingo participants after each bingo game was won.
– Nutritious food prizes such as low-sodium canned vegetables and no
sugar added canned fruits were awarded to the game winners.
National Youth Risk Behavior
Survey 1991-2005
According to the National Youth Risk
Behavior Survey: 1991-2005, nationally,
– 13.5% of students were overweight and
– 15.4% of students were at risk for becoming
overweight (Journal of School Health, 2004).
Overall, the prevalence of being
overweight was higher among male
(17.4%) than female (9.4%) students.
Prevalence of Overweight* Among U.S.
Children and Adolescents
(Aged 2–19 Years)
Survey Period
NHANES I
1971–1974
NHANES II
1976–1980
NHANES III
1988–1994
NHANES
2003–2004
Ages
2 through 5
5%
5%
7.2%
13.9%
Ages
6 through
11
4%
6.5%
11.3%
18.8%
Ages
12 through
19
6.1%
5%
10.5%
17.4%
Literature
“Diabetes is closely associated with obesity and the sedentary and
high-fat lifestyle of the American is thought to be largely responsible
for the epidemic sweeping the world”.
Obesity is more common in rural areas.
According to HP 2010 selected health promotion National Objectives
for reducing the risk of cardiovascular disease and diabetes include:
– Assessing and targeting modifiable risk factors beginning as early
as age 20.
– Increase the proportion of worksites that offer nutrition or weight
management classes or counseling.
Source: Rural Healthy People 2010, vol 1, pg. 110, and 133, and HP2010, Vol 2, p. 115
Literature
A structural cause of obesity includes a
lack of nutrition education.
Some studies indicate that rural caregivers
lack adequate knowledge to provide good
nutrition to children
– portion control,
– easy meal planning, and
– lack of time and money to prepare good
meals.
Literature
Concerted public health efforts are needed
to achieve the Healthy People 2010
objectives for obesity and nutrition and to
reduce racial/ethnic and socioeconomic
disparities.
Source: Overweight Status and Eating Patterns Among Adolescents:
Where Do Youths Stand in Comparison With the Healthy People 2010
Objectives? D. Neumark-Sztainer, PhD, MPH, RD, M. Story, PhD, RD, P.
J. Hannan, M. Stat and J. Croll, MPH, RD
Development -1
Initially, the purpose was to :
– Engage students in community education to promote the health
of populations across the lifespan;
– Enrich the community health nursing courses, in both the
classroom and clinical component. (Education and Service)
Larger food portions could be contributing to the
increasing prevalence of overweight and obesity,
therefore, this project presented:
– Visual models of normal food portion sizes;
– Visual models of fat, sugar and salt in common food choices
A focus on cardiac diseases, diabetes, and hypertension
Targeted participants across the lifespan
Development -2
Collaboration
Collaboration between
– Community health nursing clinical instructor
– A nutrition educator at a Pennsylvania State University Extension office in
Pennsylvania.
Penn State extension services had a grant, “Nutrition Links Program”
– Under the umbrella of the Expanded Foods and Nutrition Education
Program
– Federally funded nutrition program
Healthy Futures Program
Participants
– The United Way and Blue Cross and Blue Shield
– Purpose of the program
To teach young children and families about nutrition
– K - 12
Food models utilized
Development -3
Collaboration
The CHN students also presented to
College students
Elderly in independent living hi-rise apartments.
Benefit to PSU Extension services:
– PSU satisfied with:
The ability to increase persons reached through the collaboration.
Case-finding other persons/groups needing additional nutrition
services
Fulfilling their mission to collaborate with the community
Benefit to the University
– Cost savings by borrowing the food models
– PSU nutritionist available for consulation
Development -4
The Funding
Provost’s Office: Instructional Support Grant
– $1,000 non-competitive grant process or competitive process for additional
funding.
– Provides the money to undergraduate courses to achieve the following:
Course and/or program student learning outcomes related to
developing and supporting curricular and co-curricular programs that
promote learning;
That collaborate with the community to provide leadership and service
that enhance the educational, cultural, and economic development of
the region;
That develop and support programs that demonstrate a commitment to
human diversity.
Strategic directions in the grant addressed
– Learning and Service to the Community
Development -5
Use of the Funding
A variety of tactile and visual aid nutrition teaching items:
–
–
–
–
Nutrition bingo game
Portion Distortion posters
“Handy” Portion poster and tear-off sheets
Food replica packages
Included food items common to many cultural groups
– Visual tubes of sugar, salt and fats
Common food items
5 lb. fat form
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Poster boards for student use
Bingo prizes: canned fruits and vegetables, and tuna
Refreshments for participants at each site
Storage containers for the food replicas
Implementation
Sample of Individuals Served through the Project
Event
Presenter
Participant
Health promotion
project in class
29 Senior-level
students
All senior nursing students
North Pocono High
School Health Fair.
29 Senior-level
students
350 senior high students,
teachers and staff, and
community participants.
201 students, staff and
faculty. An additional 30004000 daily observers to the
displays in the university
center. (Duration was 2 wks.)
32 Junior level
University-wide Health students
Fair
Fitness Quest
(community fitness
center).
Elderly independent
living apartments
Faculty
46 participants of various
ages and fitness levels.
Students and
Faculty
80 participants throughout a
variety of facilities.
A Wide Variety of Nutrition Activities
Demonstrations
– Fat content in fast-foods
Nutrition Bingo
One-on-one counseling Gaming
– Portion size calorie
Surveys
guessing games
Lecture
– Let’s Make a Meal
Quizzes
Desktop Publishing
– Pamphlets on Nutrition
developmentally
appropriate
Student Learning/Assessment
Strategies
Apply nutrition knowledge in the clinical setting
Group Work: with other students and with diverse aggregates in the
community
Writing assignment relating the experience to course/clinical objectives and
aggregating participant responses
Identifying research questions related to the project
In-class discussions related to project effectiveness and modifications
Developing pre-post test surveys in collaboration with their research class
Developing program participant evaluation tools
Results/Reactions to the Project
Overall the project was
well received by students
and the community it
served.
Benefit to the CHN Students, to the
University and to the Faculty
Students were able to:
Plan, develop, implement, and evaluate an interactive highly visual presentation to
students their own age which made them feel more confident before presenting to the
general public.
Increase their knowledge in nutrition especially related to portion control, and fats,
sugars and salts in food.
–
Most surprising was the amount of sugar in soda!
Learn about resources in the community.
Identify and understand primary, secondary and tertiary aspects of nutrition
education.
University and Faculty
Initially, savings to the University not having to purchase nutrition teaching aids.
Collaboration opportunities
Service-learning benefit to the community
Faculty service opportunities
Who? and How?
Participants and Benefits -1
Elders in High Rises (Independent Living)
– Frequently eat out at fast-food restaurants because of budget
constraints and to socialize with friends
learning about fast food content and correct portion sizes; better food
choices
Disadvantaged Youth
– A university –based summer sports camp
learning about fast food fat and sugar content and correct
portion sizes; better food choices
Members of a Fitness Club
– Members who were overweight
– Participating in a weight loss challenge over the winter
– Realized the benefits of even minimal weight loss
Who? and How?
Participants and Benefits -2
High School Seniors: Yearly Health Fair on the
morning of the PROM
– Focus on getting ready for college or life after high
school
– Controlling eating in an all you can eat cafeteria
setting.
College Spring Break Health Fairs and Family
Health Fairs
– Reached the faculty, Staff
– Students at all levels
– Family members across the lifespan
Responses from the CHN Students
to the Experience
Nursing students were surprised:
– That the college students they saw were not
concerned about their nutrition health.
– At how much sugar is in one can of soda.
– At the lack of knowledge and/or interest in
correct portion sizes
– At the imbalance between how much
participants reported eating compared with
the recommended serving sizes.
Responses of Participants -1
Using a 5 lb fat model:
– Women thought it was 20 lbs.
– Men viewed it as 5-7 lbs.
Participants were very interested in
learning about
– The content of fat, sugars and salt in common
foods, and
– What a proper portion size should be.
Responses of Participants
as Noted by the Students -2
“The participants where very surprised to see
the models of foods in their correct serving size”.
“Most of the parents’ thought the serving sizes of
food resembled an adequate meal for a child
rather than an adult”.
“Before providing the teaching session I quizzed
each participant about portion sizes and asked
them to guess how much they thought a
particular food item was in cups or ounces.
– None of the participants answered correctly and each
under-estimated the portion size”.
Responses of Participants
as Noted by the Students -3
“All of the parents were astounded by the amount of fat
in the quarter pound burger”.
“When presented with the tubes of fat one woman
commented “Oh my, my husband eats those all the
time….. I can’t believe that”.
“The sugar content in the soda was also a big surprise to
many of the parents especially for those that drink more
that 3 glasses of soda per day”.
“One woman did say that she would try to split her
portion size in half when eating out. She would have a
take home bag prepared for her before she was served
her meal to avoid over eating when dining out”.
Other/Future Uses of the
Nutrition Visual/Tactile Aids
Takes on a life of it’s own!
Junior level Pediatric and Maternal-Child
Health Student Projects
Freshman Seminar Class
Balance Workshops (Adjusting to
College) for new Students
Healthy food portion displays and
demonstrations within the cafeteria
Future Plans
Continuing Efforts
Programs to
– Elders involved in special programs (silver sneakers) in fitness centers, and
through Area Agency on Aging programs.
– Grade schools
– Collaboration with the local hospital Wellness Program
– Low-income housing projects
– College freshman workshops
– Developmentally disabled populations and their parents involved in
vocational training facilities
– Projects utilizing inter-department student groups
Research
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Dining Halls
Dormitories
Precede-Proceed Model
Stages of Change Model
Questions?
Thank You!
You were a GREAT Audience!
Contact Information
Dr. Lori Pierangeli
Department of Nursing
East Stroudsburg University
200 Prospect Street
East Stroudsburg, PA 18301
[email protected]
1- 570- 422-3564