Nutrition Education and Counselling - Key Notes

Course Description

• Equips learners with nutrition counselling techniques.
• Covers interpersonal skills and psychological handling of patients.
• Addresses dietary habits requiring change at various levels.
• Includes theories for understanding human dietary behavior and counselling guidelines.

Objectives

• Demonstrate effective counselling skills for individuals and groups.
• Appreciate data in evaluating and adjusting nutrition plans.
• Describe different techniques used in nutrition counselling.

Definition of Terms

• Behavior: A person's response to stimuli/situations, observed directly or indirectly.
• Counselling: Direct contacts to assist in changing attitudes and behavior.
• Education: Formal process to instruct/train to manage or modify behaviors.
• Communication: Transmitting and receiving messages.
• Model: Descriptive process of how something occurs.
• Theory: Idea(s) explaining facts or events; interrelated concepts to explain relationships.

History of Nutrition Counselling

• Early Greek physicians recognized food's role in disease management.
• 1800s: Thomas Jefferson's diet records.
• Post-WWII: Study of nutrient patterns related to age, sex, and activity.
• 1945: Selling and Ferraro recommended unconventional views including:
  • Knowing the client’s personality and psychological surroundings.
  • Eliminating emotional stress.
  • Assisting the client in knowing his own limitations.
  • Encouraging the client.
  • Allowing for occasional cheating on the diet.
• 1900s: Frances Stern's nutrition clinic.
• 1940s: Selling and Ferraro stressed psychological factors.
• 1973: Margaret Ohlson emphasized creating a free-responding atmosphere.

Models and Theories of Human Behaviour

• Explain behavior and suggest effective influence methods.
• Help understand why people do/don't practice health-promoting behavior.
• Provide insight into designing successful programs.
• Categories: explanatory and change theories.
• Successful interventions target individual, interpersonal, organizational, and environmental factors.

Key Models

• The Health Belief Model (HBM)
• Trans-Theoretical Model/Stages of Change (TTM)
• Social Cognitive Theory (SCT)
• The Social Ecological Model (SEM)

The Health Belief Model (HBM)

• People's beliefs about risk and benefits influence action.
• Core constructs:
  • Perceived susceptibility and severity.
  • Perceived benefits and barriers.
  • Cues/prompts to action.
  • Self-efficacy.
• Applied for asymptomatic prevention-related health concerns.

The Trans-Theoretical Model/Stages of Change (TTM)

• People are at different readiness stages.
• Stages:
  • Pre-contemplation.
  • Contemplation.
  • Preparation.
  • Action.
  • Maintenance.
• Change is not always linear.

Social Cognitive Theory (SCT)

• Three-way dynamic: personal factors, environmental influences, and behavior interact.
• How people learn by observing others.
• Key constructs:
  • Observational learning.
  • Reinforcement.
  • Self-control.
  • Self-efficacy.

The Social Ecological Model (SEM)

• Multiple levels of influence: individual, interpersonal, organization, community, and public policies.

Other Models

• Self-management approach
• Behavior modification theory
• Cognitive-behavioral theory and rational-emotive therapy (RET)
• Social learning theory
• Standard behavioral therapy
• Person-centered therapy
• Theory of planned behavior and theory of reasoned action
• Gestalt therapy
• Family therapy
• Developmental skills training

Factors Influencing Behavior

• Biological factors
• Social environment
• Physical environment
• Culture
• Situational factors

Communication in Nutrition Education and Counselling

• Transmitting and receiving information to elicit specific actions.

Importance of Communication

• Instruction, teaching, influencing
• Providing information, building knowledge
• Evaluation of effectiveness
• Direction for decision making
• Demystifying myths
• Creating awareness
• Advocacy for funding

Components of Communication

• Context
• Sender (Encoder)
• Message
• Medium
• Receiver (Decoder)
• Feedback

Levels/Categories of Communication

• Intrapersonal
• Interpersonal
• Organizational
• Community
• Public/Mass

Introduction to Nutrition Education and Counselling

• Nutrition counselling and nutrition education are different concepts.

Definition of Nutrition Counselling

• Identifying and solving nutrition problems through planned discussion.
• Counsellor facilitates, transfers knowledge, and involves the client actively.
• Follow-up action is a major component.

Purpose of Nutrition Counselling

• Improve health through behavior change.
• Provide ongoing support.
• Develop strategies and overcome barriers.
• Enable appreciation of better health.
• Assist acceptance of dietary needs.
• Provide dietary treatment and preventive measures.

Components of Nutrition Counselling

• Nutrition Assessment and diagnosis: Problem, Etiology, Symptoms (PES).
• Goal setting: Agreed goals based on assessment and diagnosis.
• Planning and intervention: Identifying, prioritizing, and implementing solutions.
• Follow-up: Tracking progress and revising plans.

Planning the Nutrition Counselling Session

• Ensure adequate time and a comfortable, intrusion-free place.
• Crucial materials:
  • Counselling cards
  • Job aids, guidelines, and reference manuals/charts
  • Food demonstration models & photos
  • Functioning weighing scale & height board
  • Meal serving plan/food and drug plan
  • Calorie intake guide
  • Handouts
  • Data/information collection forms
  • Referral forms
  • Appointment record
  • Counsellor’s notes

Nutrition Counselling Techniques

Establishing Rapport

• Create and sustain counsellor-counselee relationship.
• Methods: greeting, offering a seat, introducing self, leaning forward, eye contact, interest, professional conduct.

Formulation of objectives

• Objectives should be SMART: Specific, Measurable, Achievable, Realistic, Time-bound.

Information control

• Master content; avoid information overload.
• Move from known to unknown, simple to complex.

Information as a motivator

• Provide rationale based on learner understanding.

Learner performance

• Organized interaction between patient and counselor
• bridges the mental gap between receiving information and applying the skills

Reinforcement/Instilling of confidence

• Positive statements/confidence building; avoid scorn.

Questioning, clarifying and responding

• Clear, concise, unbiased, non-threatening questioning.
• Techniques: open-ended questions, closed-ended questions (sparingly), active listening.

Listening

• Hear, identify sounds, understand meaning.
• Employ creative listening skills focusing on closeness
• The SOLER approach: Sit squarely, Open space, Lean forward, Eye contact, Relax

Empathy

• Feel with the client; reflect statements, show understanding.

Finding solutions

• Counsellor and counselee work together.

Observation

• Gather information (anthropometrics, signs, behavior, environment).

Recording the counselling session (counsellor's notes)

• Limited note-taking during interview; complete notes later.

Terminating the counselling session and Summarizing

• Leave the client feeling wanted/valued.

Follow-up

• Check progress, address new issues, review assignments, provide further education and handouts.

Nutrition Counselling Tools

• Medical history form
• Anthropometric information form
• Weight charts
• Diet history forms (food frequencies, 24-hour recall)
• Laboratory referral forms

Organizing Space/Room for Counselling

• Comfortable, non-threatening environment.

Qualities of a good Nutritionist or Dietitian Counsellor

• Trustworthy, honest, reliable
• Good listener and communicator
• Caring, knowledgeable, empathetic
• Able to build relationships, competent
  Resources for the Nutrition Counsellor
• Official Agencies
• Professional and research institutions
• Other agencies (WHO, UNICEF, FANTA
• Internet exploration
• Other people

NUTRITIONAL EDUCATION

Planned information exchange designed to improve or maintain nutritional well-being of individuals, groups, and populations.

Purpose of Nutrition Education

• To increase knowledge related to nutrition and its importance in health maintenance.
• To improve skills in the preparation and selection of nutritious foods.

Principles of Nutrition Education

Consonance – Degree of fit between program and objectives.
Relevance - The degree to which intervention is geared to the clients
Individualization, Allows the clients to have personal questions answered according to learning progress.
Facilitation Provides actions to accomplish desired actions for example using a food diary

Roles of Nutrition Counsellor

1. To establish rapport between counsellor and patients

2. To plan for interventions and recommendations through monitor and evaluation of counselling strategies.

   Vulnerable At Risk Groups

   The pregnant and lactating mothers Infants and children including teens ,The elderly. Vegetarians

NUTRITION EDUCATION AND COUNSELLING IN HIV & AIDS

The Link between Nutrition and HIV

Malnutrition can weakened the body’s immune system making the body be susceptible to opportunistic infections
Malnutrition may affect drug utilization that would worsen the body effects if the ARV drugs are utilized with deficiencies.
Explain that HIV increases energy. So, the patient has to eat lots of food to gain energy.

Critical Nutrition Practices in the Management of HIV

Have periodic nutrition appointments done especially weight.
Drink about 8 glasses of clean and safe drinking water a day.
It is a great importance to prevent infecting new healthy relationship in sex life.

Nutritional management for common problem with Food Intake in HIV AND AIDS

Minimize intake of food with strong odor.
For patient with change taste use trails of error approach to find which foods taste good.
For manage of anorexia consider the counselling or psychological session with psychiatrist.

NUTRITION EDUCATION AND COUNSELLING IN PREGNANCY AND LACTATION

Routine physical examination to include weight and height
Monitor weight during pregnancy period.
Hemoglobin (Hb) level is an indicator if the Hb level bellow 11.0gms/dl.
Key points messages for pregnant positive HIV is to know safe sex life and delivery to health facility.

Points to Note

Foetal growth and lactation impose high nutritional demands on the mother which influence of the risk factor transmission of HIV.
Pregnancy and HIV infection leads to a higher risk of malnutrition and also may cause morality too.

PEDIATRIC AND TEEN NUTRITION COUNSELLING

The practice of infant feeding occurs in 3 overlapping stages; Nursing, Transitional and Modernized adopted stage.
The full term infant’s stomach can hold 30 – 90 mls.
There is a depletion of Fe resulting a need to supplement through complimentary foods.
Nutrition for HIV kids need 10% more energy is the baby is asymptomatic.
Nutrition for symptomatic needs to by 20-30 % more. The last case in case of weight losses is up to nutrition intake is 50-100 energy intake.
Teen Counselling must be carried out effectively due to the facts that they can take they’re own.
Mothers needs to show how to keep dietary checklist records, food diaries and also take 24 – hour recalls.

ADULT AND GERIATRIC NUTRITION COUNSELLING

In adult stage results with problem of heart attack, cancer , stress, and also poverty.
For the elderly lose interest in food, financial, and diseases.
During assessment of old stage to be assess from different way
Food for the elderly should e cook so that the food would be easy to eat. Avoid Fatty and Grease foods due to delay capacity to absorb foods contents.
The processes of nutrition due to aging diminished and that make to utilize nutrients due to less metabolic functioning in the body.

NUTRITION COUNSELLING FOR VEGETARIANS

Diets has to plan well since is deficient in proteins and other nutrition to and that is because the level of avoiding different factor that include from poverty, health reason or any other causes.
Diets flavor should be provided well in the meals and the nutrients value.
During interviews should include extent of vegetarian’s habits , what that make to be vegetarians and what nutrition meal they take.

NUTRITION EDUCATION AND COUNSELLING IN SPORTS

There is recommendation from doctor before doing any exercise those who show; high heart-rate, obese, old age, and pregnancy cases.
High intake energy results is increasing for energy output.
The great advice need is to for fluid intake increases with increases results causes dehydration so more water is need to take.
Fluid is to be used to replace water intake to loss energy and from sweats activities.
Athletes should to know what type of food is to intake for the best results especially those participating in long race competition etc.

NUTRITION EDUCATION AND COUNSELLING IN VARIOUS DISEASE CONDITIONS

Most effective in diet in diabetes includes that they must have consistent timing of meals and exercise will improve diabetes a lots.
Diabetic counseling is a complex process that it includes effective communication, empathy,

Renal Disorders

Common disorders resulting on kindey. Goals is to control and take diet for the diseases to improve. Diet intake, is recommended during consultation to the patient so that that no protein and lots of fluid, veggies.
Important aspects in diabetes is to take balance intake and lots of veggies, less cholesterol and that helps to enhance body

Patients with cirrhosis strictly prohibit smoking and there intake is to have good balance and is effective in controlling diseases

Coronary heart attack results in obesity , inactivity and some stress that the patients encounter
Drug should be taken properly so that if no body results will be met