Nutrition education among low-income older adults: a randomized intervention trial in Congregate Nutrition sites

Enhancing Patient Literacy on Calcium Supplementation: A Quality Improvement Initiative

OBJECTIVE

This study aims to assess patients' knowledge and identify barriers in interpreting calcium on supplement and nutrition labels and to determine whether education would be beneficial.

METHODS

Patients with conditions requiring calcium supplementation were included in this study. Participants were first given a 9-question pre-education survey. They were then taught how to read calcium on labels using the educational cards developed. This was followed by a 7-question posteducation survey. Endocrinologists were surveyed to assess their experience in treating patients who required calcium supplementation.

RESULTS

Before education, 31 (33%) and 37 (40%) of the participants felt that the supplement and nutrition labels, respectively, were confusing. After education, only 2 (2%) and 6 (6%) of the participants, respectively, still felt the same. There was a significant improvement in the interpretation of calcium citrate (Citracal) and calcium carbonate (TUMS) labels, with a trend of improvement in reading a milk label. Of the 47 endocrinologists surveyed, only 5 (11%) felt that their patients often or always knew the correct amount of calcium to be taken. Two-thirds 30 (64%) of the endocrinologists always or often explained to their patients how to interpret calcium labels. About half 23 (49%) of the endocrinologists always or often needed to take time to look up the calcium content of supplements. For most endocrinologists 29 (62%), this took at least 2 to 4 minutes.

CONCLUSION

Our patients had trouble interpreting calcium labels, and the use of educational cards was effective in improving calcium literacy.

Behavior change factors and retention in dietary interventions for older adults: scoping review

BACKGROUND AND OBJECTIVES

Although poor diet is a major driver of morbidity and mortality in people 60 and older, few dietary interventions are widely implemented for this population. We mapped behavior change theories, agents, and techniques in dietary interventions for adults 60+ and explored relationships between these factors and ability to retain at least 80% of the study participants.

RESEARCH DESIGN AND METHODS

We conducted a scoping review using MEDLINE, CINAHL, and Web of Science through April 2021 for dietary interventions in adults 60 and older. We collated, summarized, and calculated frequency distributions of behavior change theories, behavior change agents, and behavior change techniques (BCTs) using BCTv1 taxonomy with regard to participant retention across 43 studies.

RESULTS

Only 49% and 30% of the studies reported behavior theory and change agents respectively. Of the studies reporting on theory and agents, the most common were social cognitive theory and the related mechanism of self-efficacy. The most common BCTv1 were "shaping knowledge" and "goals and planning." Several BCTv1 such as "antecedents" and "reward and threat" and evidence for concordance between BCTs and change agents were more common in interventions with higher retention rates.

DISCUSSION AND IMPLICATIONS

Mechanistically concordant studies with BCTs that involve resource allocation and positive reinforcement through rewards may be advantageous for retention in dietary intervention for older adults. Future studies should continue developing theory and mechanism-oriented research. Furthermore, future studies should consider diversifying the portfolio of currently deployed BCTs and strengthening a concordance between BCTs and mechanisms of change.

Implementing Nutrition Education Programs in Congregate Dining Service Settings: A Scoping Review

BACKGROUND AND OBJECTIVES

Nutrition education programs implemented in congregate dining service (CDS) settings have the potential to improve healthy eating behaviors among older adult populations. However, little is understood about the types of nutrition education programs that are implemented at CDS sites and the factors that impede or promote implementation efforts. The purpose of this scoping review was to examine the characteristics of CDS nutrition education programs, barriers and supports to program implementation, and opportunities to enhance implementation of programming.

RESEARCH DESIGN AND METHODS

We adopted a scoping review methodology to assess the relevant literature published January 2000 - January 2020 by accessing CINAHL, SocINDEX, MEDLINE, AgeLine, and Academic Search Complete.

RESULTS

We identified 18 studies that met our inclusion criteria. The majority of nutrition education programs were led by trained facilitators, included the use of interactive activities, and also incorporated written or video materials. Programs that were adapted to the needs of older participants were perceived as supports to implementation whereas participants' needs and resources (e.g., lack of resources, lower health literacy) were occasionally found to limit effective implementation of programming.

DISCUSSION AND IMPLICATIONS

As the older adult population continues to access CDS sites to address their health and nutritional needs, purposeful efforts are needed to examine the specific approaches that can support nutrition education program implementation. Future research is needed to assess strategies that are effective for mitigating barriers to implementing nutrition education programming in the CDS setting.

Systematic review of control groups in nutrition education intervention research

Background

Well-designed research trials are critical for determining the efficacy and effectiveness of nutrition education interventions. To determine whether behavioral and/or cognition changes can be attributed to an intervention, the experimental design must include a control or comparison condition against which outcomes from the experimental group can be compared. Despite the impact different types of control groups can have on study outcomes, the treatment provided to participants in the control condition has received limited attention in the literature.

Methods

A systematic review of control groups in nutrition education interventions was conducted to better understand how control conditions are described in peer-reviewed journal articles compared with experimental conditions. To be included in the systematic review, articles had to be indexed in CINAHL, PubMed, PsycINFO, WoS, and/or ERIC and report primary research findings of controlled nutrition education intervention trials conducted in the United States with free-living consumer populations and published in English between January 2005 and December 2015. Key elements extracted during data collection included treatment provided to the experimental and control groups (e.g., overall intervention content, tailoring methods, delivery mode, format, duration, setting, and session descriptions, and procedures for standardizing, fidelity of implementation, and blinding); rationale for control group type selected; sample size and attrition; and theoretical foundation.

Results

The search yielded 43 publications; about one-third of these had an inactive control condition, which is considered a weak study design. Nearly two-thirds of reviewed studies had an active control condition considered a stronger research design; however, many failed to report one or more key elements of the intervention, especially for the control condition. None of the experimental and control group treatments were sufficiently detailed to permit replication of the nutrition education interventions studied.

Conclusions

Findings advocate for improved intervention study design and more complete reporting of nutrition education interventions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0546-3) contains supplementary material, which is available to authorized users.

Malnutrition self-screening by using MUST in hospital outpatients: validity, reliability, and ease of use

BACKGROUND

Although nutritional screening with a tool such as the Malnutrition Universal Screening Tool (MUST) is recommended for outpatients, staff are under pressure to undertake a variety of other tasks. Little attention has been paid to the validity of patient self-screening with MUST.

OBJECTIVE

This study in 205 outpatients with a mean (±SD) age of 55 ± 17 y (56% male) assessed the practicalities of self-screening, its agreement with screening undertaken by a trained health care professional (HCP), and its test-retest reliability.

DESIGN

After the participants provided consent, screening was undertaken by the patients themselves and then by a trained HCP who was unaware of the self-screening results. All patients completed an ease-of-use questionnaire. Test-retest reliability of self-screening was established in a subset of 60 patients.

RESULTS

A total of 19.6% of patients categorized themselves as "at risk" of malnutrition (9.8% medium, 9.8% high). For the 3-category classification of MUST (low, medium, high), agreement between self-screening and HCP screening was 90% (κ = 0.70; SE = 0.058, P < 0.001). For the 2-category classification (low risk, medium + high risk), agreement was 93% (κ = 0.78, SE = 0.057, P < 0.001). Disagreements were not systematically under- or overcategorized. Test-retest reliability was almost perfect (κ = 0.94, P < 0.001). Most patients (71%) completed self-screening in <5 min. Patients found the tool easy or very easy to understand (96%) and complete (98%), with 94% reporting that they were happy to screen themselves.

CONCLUSION

Self-screening involving MUST in outpatients is acceptable to patients, user-friendly, reliable, and associated with good agreement with HCP screening. This trial was registered at clinicaltrials.gov as NCT00714324.

Determining knowledge and behaviour change after nutrition screening among older adults

Two education interventions involving personalized messages after nutrition screening in older adults were compared to determine changes in nutrition knowledge and risk behaviour. Of 150 older adults randomly selected from a local seniors' centre, 61 completed baseline screening and a demographic and nutrition knowledge questionnaire and were randomized to one of two groups. Group A received personalized letters plus an educational booklet, and Group B received personalized letters only. All materials were sent through the mail. Forty-four participants completed post-test questionnaires to determine change in knowledge and risk behaviour. Both groups had reduced nutrition risk scores and increased knowledge scores at post-test. After the intervention, a significant difference was observed in knowledge change by treatment group. Group A participants experienced greater gains in knowledge, with a mean gain of 5.43 points, than did those in Group B, who had a mean gain of 1.36 points (p=0.018). Screening and education with print materials have the potential to change risk behaviour and nutrition knowledge in older adults. A specially designed booklet on older adults' nutrition risk factors plus a personalized letter provide an effective education strategy for older adults after screening.

Systematic literature review of randomized control trials assessing the effectiveness of nutrition interventions in community-dwelling older adults

OBJECTIVE

Nutrition interventions may play an important role in maintaining the health and quality of life in community-dwelling older adults. To the authors' knowledge, no systematic literature review has been conducted on the effectiveness of nutrition interventions in the community-dwelling older adult population.

DESIGN

Systematic literature review followed by descriptive data extraction and critical appraisals for studies meeting inclusion criteria.

SETTING

Medical Literature and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) search for randomized controlled trials (RCTs) assessing nutrition interventions in community-dwelling older adults.

PARTICIPANTS

Fifteen RCTs involving nutrition-related outcomes in community-dwelling older adults.

ANALYSIS

Descriptive data extraction and critical appraisals using the Jaded scale. Outcome measures included study blinding, allocation concealment, intention-to-treat analysis, and a priori calculations.

RESULTS

Ten RCTs involved nutrition counseling, education, or dietary advice, whereas 5 involved nutrition supplements. Jaded scores ranged from 1 (n = 8) to 2 (n = 4) to 4 (n = 3). Ten RCTs reported positive results post-intervention.

CONCLUSIONS AND IMPLICATIONS

Nutrition counseling interventions involving active participation and collaboration showed the most promise in affecting positive nutrition-related outcomes in community-dwelling older adults. Future research should determine which nutrition interventions will benefit community-dwelling older adults with less active participation and health perceptions, and lower educational attainment.

The changing face of food and nutrition in Canada and the United States: opportunities and challenges for older adults

Science and technology are modernizing the field of nutrition and are consequently increasing its complexity. New food developments such as fortified foods and functional foods are evidence of its modernization. The increased specificity of nutrient- and food-intake recommendations and the breadth of claims on food packages are evidence of nutrition's growing complexity. Unfortunately, research on the consumer acceptability of new food developments and nutrition education initiatives has not kept pace with advancements in the field. This is especially true for older adults, a subgroup of the population that appears to be under-researched and not commonly targeted with education initiatives. Older adults are the fastest growing segment of the North American population. Research and education aimed at this demographic is warranted to ensure older adults have the right knowledge and skill set to optimize their food selections and dietary patterns with the possibility of improving health and the quality and longevity of life.