Use of pictures to facilitate nutrition education for low-income African American women

Pharmacists, are words enough? The case for pictograms as a valuable communication tool

Despite living in a visually saturated world, with visual content permeating seemingly every aspect of our lives, an area in which visuals are still under-represented is health communication. Written health information, including medicines information, has generally been reported as being reader-unfriendly, offering challenges and barriers to even the most literate of readers with its often lengthy, detailed documents, use of medical jargon, and densely packed small text. The inclusion of visual content in the form of pictograms offers the potential to enhance the attractiveness and reader-friendliness of the information as well as improving comprehension and recall of medicines and general health information. This commentary presents the case of pictograms as a valuable tool in medicines information, urging pharmacists to consider their adoption in practice, but also sounding a note of caution when using pictograms.

Exploring Pictorial Health Education Tools for Long-Term Home Care: A Qualitative Perspective

Regarding long-term home care needs, nurses need to communicate effectively and reasonably when teaching home caregivers. Designers can assist medical staff and develop pictorial tools to enhance communication. The purpose of this study is to explore a theoretical basis from the perspective of designers, patients’ home caregivers, and medical staff to construct a theoretical framework that can jointly develop pictorial health education tools and healthcare system. The qualitative methods, including in-depth interview and observation, are applied to this study; ground theory sets out to construct a framework from the verbatim transcript of the interviews. Based on interview results, six axial codes were extracted: (1) the method of interdisciplinary cooperation; (2) medical research ethics; (3) communication methods; (4) forms of health education tools; (5) development of health education tools; (6) home care intubation procedure. Eight groups of home caregivers offered suggestions from their experiences. The designers need to assist medical staff to solve real problems, pay attention to professional norms, and forms of cooperation. Health education tools need to meet the needs of medical staff and home caregivers and designers should pay attention to the processes of communication. This study can also assist in interdisciplinary cooperation to explore the theoretical basis of pictorial health education tools for nurses in the context of long-term care at home.

The Effectiveness of the Good Affordable Food Intervention for Adults with Low Socioeconomic Status and Small Incomes

Good Affordable Food (GAF) is a small-group nutrition education intervention for adults with low socioeconomic status and small incomes. It aims to empower participants to save money on groceries and consume healthier diets. This paper reports the short-term and longer-term effects on behavioural determinants and self-reported behavioural changes. A quasi-experimental control group design was applied with a baseline measurement, a post-test immediately after the intervention, and a follow-up measurement after six months. The study included 237 participants (intervention group: n = 131; control group: n = 106) at baseline, 197 at post-test, and 152 at follow-up. Data were collected by telephone, mostly using closed interview questions. Positive short-term and longer-term effects were found for attitude towards the costs of healthy foods, food label use, and the use of liquid butter or oil to prepare hot meals. Short-term intervention effects related to knowledge towards saving money on groceries, self-efficacy towards healthy eating, portion size awareness, and mindful eating. GAF was effective in changing some determinants and behaviours related to cost and food consumption, however, mostly in the short term. Thereby, it is an example of combining pricing and health information in nutrition education that developers of effective nutrition education for low-income groups can build on.

Effects of a nutritional intervention using pictorial representations for promoting knowledge and practices of healthy eating among Brazilian adolescents

This study aimed to evaluate the effect of a nutritional intervention involving a problem-raising approach and the use of pictorial representations on the promotion of knowledge and practices of healthy eating among adolescents. This randomized study included 461 adolescents from public schools in Brasilia, Federal District, Brazil (intervention group: 273 students from four schools; control group: 188 students from three schools). Mean age was 14.8±1.0, and 52.9% were boys. The intervention consisted of three meetings with interactive activities about principles of healthy eating, food classification, importance of reading labels and analyzing food advertising critically, and representations of healthy and unhealthy meals and their sugar, salt, and fat content. Pictorial materials consisted of food drawings, food models, and a food packaging model. Controls were not exposed to any activity. Dietary knowledge, consumption, and behaviors were the variables of interest. The intervention group showed a higher mean score of correct answers to questions about dietary knowledge than the control group (p = 0.0006), with higher odds of correctly answering questions about in natura (OR: 3.7; 95% CI: 1.9–6.6), minimally processed (OR: 3.6; 95% CI: 1.9–6.4), processed (OR: 2.2; 95% CI: 1.1–4.3), and ultra-processed foods (OR: 3.5; 95% CI: 1.8–6.6) and composition of ultra-processed foods (OR: 2.4; 95% CI: 1.3–4.4). Participants in the intervention group were also 2.5 times more likely to correctly answer questions about the importance of the dietary environment (95% CI: 1.1–5.5) and caution with food advertising (95% CI: 1.2–5.3) than controls. Increased weekly consumption of vegetables (p = 0.0077; OR: 2.4; 95% CI: 1.26–4.51) and reduced consumption of soft drinks (p = 0.0212; OR: 0.36; 95% CI: 0.15–0.86) were observed in the intervention group compared to the control group. The proposed intervention increased adolescents’ knowledge and improved some of their dietary habits. Educational activities using a problem-raising approach and pictorial representations of food appear to be effective in promoting healthy eating practices among adolescents.

Pictorial instrument of food and nutrition education for promoting healthy eating

ABSTRACT To trace the course of building a pictorial instrument that explores semiotic resources about food and nutrition education. The instrument is directed at the treatment and prevention of obesity, considering the food and nutrition problems of the Brazilian population. The criteria for photo production were: images that could cause visual impact and transmit applied nutrition information, insinuating positive and negative eating practices for promoting healthy eating, and preventing and treating obesity. Themes were created to guide photo production, and preparations, food composition tables, and food labels were used for composing the images. Focus groups were conducted with nonobese and obese women, and dietitians to evaluate image comprehension. The pictorial instrument totaled to 20 photos, with 5 photos in each of the following themes: 'Sweet life, being aware of sugar', about sugar content in sweets and drinks; 'Tasty food with little fat', about fat content in foods; 'Eating well by making the best choices', about food replacements; and 'I take care of myself by eating healthy food, about encouraging fruit and vegetable intakes. The photos contain food, meals, and semiotic resources. The pictorial instrument describes four relevant themes to approach food problems in the Brazilian population. It can easily be used for both preventing and treating obesity, and for promoting healthy eating.

Older adults' perceptions of pictograph-based discharge instructions after hip replacement surgery

Current text-based discharge instructions are unsuitable for low-literate older adults who have difficulty following written action-based instructions. To address this issue, we developed discharge instructions for low-literate older adults after hip replacement surgery using pictographs (i.e., simple line drawings with stick figures showing explicit care actions). The aim of this focus group study was to examine the acceptability and comprehension of these instructions to 15 low-literate older adults. Participants perceived that the pictograph-based discharge instructions helped them understand the intended health care messages, especially for step-by-step procedures of discharge actions. The black-and-white line drawings were well received by all participants of various race/ethnicity. A pictograph-based approach is an effective strategy for developing discharge instructions not only for patients with low literacy skills in acute health care settings, but also for immigrants with significant communication challenges. Future research is suggested to compare the effects of pictograph-based and text-based instructions on adherence to instructions and health outcomes.

Improved nutrition knowledge and practice through intensive nutrition education: a study among caregivers of mildly wasted children on Nias Island, Indonesia

BACKGROUND

Inappropriate nutrition knowledge and feeding practices of caregivers are among several important causes of persistent malnutrition problems in young children. Thus, it is essential to provide caregivers with the necessary knowledge to help them modify their feeding practices.

OBJECTIVE

To examine the effectiveness of two different nutrition education methods, weekly intensive nutrition education (INE) and monthly nonintensive nutrition education (NNE), designed for caregivers of mildly wasted children (weight-for-height z-score ≥ -1.5 to < -1) aged ≥ 6 to < 60 months on Nias Island, Indonesia.

METHODS

To assess the impact of the two different nutrition education approaches on nutrition knowledge and practice of caregivers with their children, respondents were assigned to receive either weekly INE (n=114) or monthly NNE (n=96). The knowledge and practice levels of the mothers in each group were assessed and compared using a pretested validated questionnaire at admission and after the intervention period.

RESULTS

At admission, the knowledge and practice levels of caregivers in both groups were not statistically significantly different. After participating in the nutrition education program, the percentage of correct answers on nutrition knowledge and practice in the INE group was significantly higher than that in the NNE group. Significant improvement in knowledge and practice scores was observed in the INE group after the intervention (p < 0.001), whereas only a significant improvement in knowledge was found in the NNE group (p < .05).

CONCLUSIONS

In comparison with NNE, the INE approach was significantly better in bringing about a positive change in knowledge and practice of caregivers of mildly wasted children in the study area.

Mixed method approaches to understanding cancer-related dietary risk reduction among public housing residents

Improving diet is one important pathway for addressing cancer disparities. We conducted mixed-method analyses of 468 24-h dietary recalls from 156 African-American women residents of Washington DC public housing to better understand dietary patterns. Recalls were rated for five cancer-related preventive characteristics (adequate fruits/vegetables, moderate fat, moderate calories, no alcohol, and adequate Healthy Eating Index score), combined as a scale. Bivariate and multivariate analyses identified psychosocial and dietary characteristics associated with scale scores. Qualitative analyses of dietary records identified contextual aspects of food patterns within and across score groups. Sixty-one percent of respondents met zero or one dietary goal; alcohol abstention was most common (64%). Only 12% achieve either three (6%), four (4%), or all five (<1%) goals; five fruit and vegetable servings were least common (15%). The underlying scalar structure of responses suggests that fruit and vegetable consumption is seldom achieved in this population without other scale components. Poorer scores were associated with younger age, depressive symptoms, stressful life events, smoking, and food-purchasing practices. Qualitative analyses identified eight themes related to differences between dietary patterns. Findings reinforce the value of nonreductionist approaches to cancer-related nutrition intervention.

Overcoming educational barriers for advance care planning in Latinos with video images

BACKGROUND

Studies of end-of-life care have shown that Latino patients want more aggressive care compared to white patients. While this has been attributed to aspects of ethnicity, national origin, and religion, it is possible that limited education might obscure the true relationship between Latino patients and their end-of-life care preferences.

METHODS

Spanish-speaking subjects presenting to their primary care doctors were asked their preferences for end-of-life care before watching a video of advanced dementia. Subjects then viewed a 2-minute video of a patient with advanced dementia and were asked again about their preferences. Unadjusted and adjusted logistic regression models were fit using stepwise algorithms to examine factors related to preferences.

RESULTS

A total of 104 subjects completed the interview. Before seeing the video, 42 (40%) subjects preferred comfort care; 43 (41%) desired life-prolonging care; 11 (11%) chose limited care; and 8 (8%) were unsure of their preferences. Subject preferences changed significantly after the video: 78 (75%) of the subjects chose comfort care; 8 (8%) desired life-prolonging care; 14 (13%) chose limited care; and, 4 (4%) were unsure of their preferences (p < 0.001). Unadjusted and adjusted analyses revealed a statistically significant difference regarding prevideo preferences based on educational level. After the video, differences in preferences based on educational level disappeared.

CONCLUSIONS

Educational level was an independent predictor of end-of-life preferences after hearing a verbal description of advanced dementia. After viewing a video of a patient with advanced dementia there were no longer any differences in the distribution of preferences according to educational level. These findings suggest that educational level is an important variable to consider in research and in patient care when communicating about end-of-life care preferences. While attention to patients' culture is important, it is also important to avoid ascribing choices to culture that may actually reflect inadequate comprehension. Attention to communication barriers with techniques like the video used in the current study may help ensure optimal end-of-life care for Latino patients irrespective of educational level.

The relationship of body size to participation and success in a fruits and vegetables intervention among low-income women

We examined participation and dietary change among women participants in a community-based nutrition education program, to determine whether intervention results differed by participant body size. Four dietary indicators (daily servings of fruits and vegetables, total calories, calories from fat, and Healthy Eating Index score) were assessed from 24-h recalls taken before, immediately after, and 4 months after a seven-session nutritional education program, from 156 African-American women age 20-50, in Washington, D.C. public housing. Knowledge, attitudes and practices related to nutritional behavior change were collected at three time points as well. Random effect models were used to examine dietary patterns, and compare change by body size and class attendance. Results showed that obese women (BMI > or = 30) had more psychosocial barriers to dietary change and poorer baseline diets, but stronger program attendance. Post-intervention, both groups consumed approximately 250 fewer calories and 2.5% fewer calories from fat. At follow-up, non-obese women consumed significantly fewer calories; obese women consumed significantly fewer calories from fat, and showed significant improvement in HEI. Given the prevalence of obesity in low resource communities, nutritional interventions should tailor strategies to participant body size and related psychosocial needs.

Nutrition-related cancer prevention attitudes in low-income women

OBJECTIVE

To investigate the nutrition-related cancer prevention attitudes of low-income African American women, determine whether a nutrition education program can alter these attitudes, and determine whether these attitudes are related to diet and dietary changes.

METHOD

One-hundred and fifty-seven African American women from Washington, D.C. public housing communities participated in a nutrition education program from 2001 to 2003. They completed questionnaires assessing their attitudes about the role of nutrition in cancer prevention at baseline, post-intervention, and 4 months later. They also completed 24-hour food recalls at baseline, post-intervention, and 4 months later.

RESULTS

Women agreed that good nutrition prevents cancer, especially women with higher literacy, women with fewer children living at home, women who had not had experience with cancer, and women who were worried about their health. Participation in the program increased agreement that good nutrition prevents cancer over 4 months. Women whose agreement increased over the intervention were able to maintain dietary changes they made over 4 months.

CONCLUSION

Nutrition-related cancer prevention attitudes were strong and were strengthened by a nutrition education program. These attitudes may contribute to people's ability to maintain dietary changes.