NUFD 107 Exam 2

Advantages of documenting nutrition counseling sessions

1. Evidence of care

2. Basis for evaluation

3. Legal protection

4. Communication tool for health care team - continuity of care

5. Justification for third party reimbursement

ADIME steps of the Nutrition Care Process

1. Nutrition assessment/re-assessment - anthropometric, biochemical, clinical, dietary, environment

2. Diagnosis - naming the problem

3. Intervention - should resolve or improve identified nutrition “problem”

4. Monitoring and Evaluation - monitor progress and determine if goals are met, measure and compare to client’s previous status, nutrition goals, or reference standards

5 categories of nutrition assessment

1. Anthropometric: height, weight, BMI

2. Biochemical: hematocrit/hemoglobin, cholesterol/TGs, glucose/Hbg A1c

3. Clinical - diseases, physical conditions: hypertension, cleft palate

4. Dietary: food and liquid intake, food preferences, food allergies, food sensitivities, swallow restrictions

5. Environment: family dynamics, homeless, lead paint

Determinants of food choice

1. Food - taste, preference

2. Personal - culture, beliefs, knowledge, motivations

3. Environment - availability, advertising, economic

What is the biggest influence on diet?

Taste

What are the six constructs of the Health Belief Model?

1. Perceived susceptibility

2. Perceived severity

3. Perceived benefits

4. Perceived barriers

5. Cues to action

6. Self-efficacy

Perceived Susceptibility

One’s opinion of chances of getting a condition

Application: define population at risk, risk levels; personalize risk based on a person’s behavior

Perceived Severity

One’s opinion of how serious a condition

Application: specify consequences of the risk and the condition

Perceived Benefits

One’s opinion of the efficacy of the recommendation to reduce risk or seriousness of impact

Application: define action to take; how, where, when; clarify the positive effects to be expected

Perceived Barriers

Opinion of the tangible and psychological costs of the advised action

Application: identify and reduce barriers through reassurance, incentives, assistance, practice, taste-testing

Cues to Action

Strategies to activate “readiness”

Application: provide how-to information, promote awareness, reminders

Self-Efficacy

Confidence in one’s ability to take action

Application: provide skills training, guidance in performing action, goal setting, contracting

Ways to enhance self-efficacy regarding food-related behaviors

Provide step-by-step instructions and demonstration of behavior by credible role models. Engage in direct experience such as food preparation. Provide positive reinforcement on achievements and successful performance.

Theory of Planned Behavior

Individual’s health behavior is directly influenced by intention to engage in the behavior

Theory of Planned Behavior constructs

1. Behavioral intention

2. Attitudes

3. Social norms

Behavioral intention

Self-efficacy (how-to knowledge + skills)

Barriers

Attitudes

Anticipated outcomes

Value of the outcomes

Social norms

Peer pressure

Motivation to comply

Social Cognitive Theory

People learn by observing social interactions and media. Personal factors, behavior, and environment interact continuously and influence each other

Social Cognitive Theory constructs

1. Behavioral capability

2. Reinforcements

3. Observational learning

4. Social support

Behavioral Capability

Knowledge and skill to perform behavior

Reinforcements

Rewards

Affirm accomplishments

Observational Learning

Demonstrations, role models

Social Support

Relationships and social network

Practice using the Social Cognitive Theory to develop a nutrition education intervention

Use PowerPoint presentations, visuals, and cooking demonstrations to teach food and nutrition-related knowledge and skills to enact behavior. Provide step-be-step demonstration of food preparation and cooking skills

Goals

(know, value, learn, believe)

Broadly stated learning outcomes

Overall intent of the intervention

i.e. Participants will increase physical activity

Objectives

(compare, list, identify, differentiate)

Specific learning outcomes

What the participant will have done after the intervention

i.e. by the end of the lesson, parents will compare high fiber and low fiber breakfast items

Who, What, How of learning objectives

Who - are the learners?

What - knowledge, skills (behaviors), attitudes?

How - what materials do they need to do this? (list of resources, sample materials)

KAB Model

(Knowledge, Attitude, Behavior)

K: information dissemination - knowledge accounts for 4-8% of variance in eating behavior

A: attitude change - more effective

Example of a learning objective

Given several vegetables, pickling brine, spices, and jars (how)…the attendees of the Robinson Center nutrition class (who)…will practice making at least 6 different vegetables and choose the one or two they are most likely to try at home (what)

ABC’s of Learning Objectives (example)

By the end of the program, college students will have identified 3 quick breakfast options they can prepare at home

ABCs of Learning Objectives

Audience - who?

Behavior - will do what?

Condition - by when, where, and with what?

Nutritional Genomics

Interaction between human genes, nutrition, and health

Nutrigenetics

The study of effect of genetic variation on dietary response

Nutrigenomics

The study of the effects of food on gene expression

Epigenetics

The study of mechanisms that will switch genes on and off, ie. epigenetic determines the specialization of cells a fetus develops through gene expression or silencing, and environmental stimuli

Possible ways to positively influence your microbiome

1. Breastfeed infants at least 6 months

2. Eat a variety of foods - whole grains fruit/veg, high fiber sources

3. Fermented foods - kimchi, miso tempeh

Goal vs. Objective

Goal - big picture, distant

Objective - smaller

Guidelines for developing and evaluating education materials

1. Content

2. Readability

3. Layout/graphics/visuals

Content

Nutrition content accurate and current, clear messages, focused on action - what to do, free of sponsor/product bias, culturally sensitive

Readability

Simple, plain language, familiar vocabulary, common short words, minimal jargon, short sentences (8-10 words) and short paragraphs or bullets, information clustered using headings, type size 12-14 point, use capital and lower case letters, avoid all caps and italics, avoid abbreviations, contractions, acronyms, quotation marks, hyphens, reading level about 5th-6th grade or below as appropriate for audience, conversational, personal, positive tone

Layout/graphics/visuals

Attractive and appropriate, near relevant text, lots of white space to balance the text and illustrations, simple and realistic to help explain the messages, positive, related to the audience, age, culture, avoid stereotyping, include space for personalizing