Chapter 3 Notes
Chapter 3 Notes NUTR 4334 Community Nutrition
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This 6 page Class Notes was uploaded by Chelsy Ethridge on Sunday February 1, 2015. The Class Notes belongs to NUTR 4334 Community Nutrition at University of Houston taught by Tracey Ledoux in Spring2015. Since its upload, it has received 212 views. For similar materials see Community Nutrition in Nutrition and Food Sciences at University of Houston.
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Clutch. So clutch. Thank you sooo much Chelsy!!! Thanks so much for your help! Needed it bad lol
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Date Created: 02/01/15
Chapter 3 Assessing Nutritional Status of A Population Steps in Assessing Nutritional Status 1 Make a plan to determine what questions to ask What are the pieces of information that you want to gather from the nutritional assessment Step 1 review purpose goals and objectives of needs assessment If the purpose is to learn about someone s diabetes then you don t need to ask questions about their selenium intake because it s unrelated Step 2 develop a set of questions related to target population s nutritional problem how it developed andor factors that in uence it What are the things that you want to find out about the problem how it developed and all the factors related to it Step 3 Choose a method for obtaining answers to these questions 2a Identify Data on factors that in uence nutrient absorption and utilization Consider how well a person is able to digest absorb and utilize nutrients Individual fixed factors ex gender genetics May have a genetic predisposition to absorb nutrients more quickly Example women are genetically inclined to absorb alcohol at a slower rate than men Individual Lifestyle Factors Lifestylephysical activity leisure activities ability to handle stress smoking habits use of alcohol or drugs For example physical activity slows digestion while you are exercising may need more nutrients because you are physically active Sociocultural Factors related to society culture that surrounds individuals 0 Social groups culture and religious beliefs great in uence on what how much and type of food people eat Religious beliefs may in uence or prohibit certain types of foods 0 Norms and values example belief systems heritage religion and lifestyle In one culture it may be normal to snack between meals but in other cultures this may be abnormal In uences the totality of what people eat overall diet and overall nutrient intake 0 Social group people who are interdependent and share norms beliefs values or behaviors Some people are more in uential and persuasive than others trendsetters for eating certain foods following types of diets So some people look to trendsetters to get tips on diet 0 Families exert the most in uence on health and nutritious status make our social group embody norms and values that we live by Especially for children 2b Identify Data on Food Choice Determinants 0 Social ecological model posits food choices are in uenced by biological psychosocial ex attitudes cognitions cultural norms and values systems ex government policies and programs and lifestyle factors People make over 200 food choicesday Determinants are found through research these are the things that in uence what people eat We can begin to think about people as members of a system The government policies govern us and in uence our food choices certain policies make certain foods more available than others Ex food and vegetables aren t encouraged not many choices higher in price Food Supply and Food Availabilitv Food distribution system types of imported foods facilities for food processing and production and the regulatory environment Our food distribution system is going to in uence the type of foods people eat What is on the market what is available what are the regulations enforced If you require more elaborate facilities to process and package some foods those foods may not be as widely available as others Income and Food Prices Higher incomes have more money to spend on food and choose whatever foods they want regardless of price Lowincome households are more likely to have limited food budgets and to be concerned w price and value POVERTY is the NUMBER ONE indicator of nutrition and health status particularly among children It interferes w the number of food choices we have more concerned about budgets Food Preferences Cognitions and Attitudes Shaped mostly by family and regional tastes We are born w an innate preference for sweet foods salty avors and fat but our preference for cakes vs cookies is not programmed that specifically We learn from repeated exposure to prefer certain foods People enjoy different types of foods because of what they grew up eating Consumers do not always practice what they have learned Ex they may know that certain foods are healthy but they are still going to be in uences by preference and cost The strongest determinant of food choice is preference we will first and foremost buy what we like Rarely going to see someone eating foods that they don t like but are healthy and cheap Preference can be modified and changed through repeated exposure Ex teach clients to develop of an acquired taste for broccoli if they hate that food Health Beliefs and Practices Can be cultural difference For some people more than others they place a really high value on health but for others health really doesn t matter that much The overall message is that you want to consider how important health is to a person when you are assessing their nutritional status Living and Working Conditions Education occupation and income especially poverty strongly related to the food choices people make Social Groups and Networks Of all individuals in one s life family exerts the most in uence on health status Social groups are interdependent and share a set of norms beliefs values or behaviors Individuals whose beliefs biological characteristics or other features represent a larger population are a sample Going to assess the nutritional status of a smaller sample when you are assessing the nutritional status of a community You are never going to do an assessment of the entire population The smaller sample will help represent the themes that you would find in the larger population Select a small group of people that represent the larger population and give them your questionnaires 3 Identify methods for collecting Data the first step w any method is to determine the purpose How are you going to measure cultural beliefs biological lifestyle factors that relate to food choices and what people eat 0 Survey systematic study of a cross section of individuals who represent the target population Telephone questionnaires inperson interviews IneXpensive not continued over a long period of time Limitations never know if the status of one of the factors is a constant or just occurred on the day you were interviewing them 0 Health Risk Appraisal Can be used in clinics Widely used in community settings like worksites government agencies universities for screening or health education Safe simple inexpensive Many to choose from Alerts people to risks for disease Can be administered by a wide variety of healthcare providers and even laypersons that are trained EX blood pressure heart rate body mass index Can be checked at health fairs etc Table 32 When you are designing a survey or questionnaire for a survey study there are certain things you want to ask yourself during the process 1 Is the survey valid and reliable Does it reproduce the same results every time you ask the questions Should stay the same Is it measuring what it is intended to measure 2 Are there norms available That is are reference data or population standards available against which the data from your target group can be compared EX comparing growth charts for young girls between ages 1116 3 Is the survey suitable for the target population A survey designed to obtain health and nutrition data on freeliving older adults may not be appropriate for institutionalized older adults 4 Are the survey questions easy to read and understand Survey questions must be geared to the target pop and its level of literacy reading comprehension and 4gts ssgtwzgt uency in the primary language Having a readable survey is especially important if it is to be selfadministered Is the format of the questionnaire clear If the questionnaire is not laid out carefully respondents may become confused and inadvertently skip questions or sections Are the responses clear Filling in blanks yesno tf answers Others may ask respondents to rankorder their responses from seldomnever use to use oftenalways Choose one that allows you to discriminate between responses but doesn t provide so many categories that respondents are overwhelmed Is the survey comprehensive but brief With long questionnaires respondents are likely to answer questions hurriedly and mark the same answer to most questions Does the survey ask socially loaded questions Each survey question should be evaluated for how it is likely to be interpreted Questions that imply certain value judgments or socially desirable responses should be rewritten This is especially important when dealing w respondents from cultures other than your own Screening sometimes want to assess individuals that are particularly at risk or meet some sort of basic criteria Used in both clinical practice and community settings to reverse retard or halt disease progress Value is compared with predetermined cut point or risk level BMI Community setting nutrition status indicators Health risk appraisal is common BP Cholesterol checks Clinical practice nutrition status indicators Medical history Htwt TB Vision test Focus Groups qualitative data is collected here Informal qualitative tool in which attitudes are drawn from group discussion Consisting of 512 people in sessions of 13 hours Obtain advice and insight about new products and services options about creative concepts We use in healthcare to learn about peoples subjective experiences with particular diets disease state healthcare resources and barriers to treatment why people behave a certain way Ask openended questions for free owing information Qualitative Requires good listening skills Nonverbal communication is importantfacial expressions gestures touch want to convey nonjudgment attention trust You want to encourage the person and make them feel comfortable opening up Interviews w key informants people in the know harbor information that you want to know Don t always know what you are looking for in qualitative data People in the know in the community Can find out whether the target population perceives a problem Target population needs to acknowledge that there is a problem For ex with children childhood obesity is a problem children in the 90th percentile may not look overweightobese so a lot of parents don t perceive this to be true for their child Is it because of denial Is it because they don t care Which actions are culturally appropriate Direct Assessment of Nutritional Status overweight under nutrition Want to assess dietary intake and compare to standards using my pyramid for example Types Dietary assessment methods ex FFQ Laboratory methods ex albumin Albumin is the protein in your blood that is a strong nutritional status indicator when your body is needing fuel which is the first to go Can detect clinical and subclinical deficiencies Anthropometric methods ex htwt WC Clinical methods ex visible wasting known by touch physical exam cracking at sides of mouth hair loss discoloration 0 Considerations in selection of Dietary Assessment method Age literacy language skill cost interviewer training needs availability of intake forms sample size and type of data needed 0 Types Food Frequency Questionnaire assesses household level food consumption checklist of foods and how often number you have eaten in a given time frame lowcost drawbacks horrible validity and reliability Diet record is considered gold standard maintain a food diary of everything that you ate types of foods brands condiments additives in the food preparation serving sizes 24 hr recallinterview style one of the stronger methods most frequently performed Ask the person what they ate in the past 24 hours 4 Collect Data Issues in Data Collection 0 Practical Issues Choice of assessment method in uenced bynumber of staff available amount of time needed cost of administering test Ex how many staff do you have doing dietary recalls vs FFQ Readability can be assessed with FOG index SMOG or word processing program 0 At the community level the method chosen should be Simple to administer Take only a few minutes to complete Inexpensive and safe 0 Scienti c Issues 0 Sensitivity vs Specificity Sensitivity IDs most individuals w the disease or condition Ex We know most individuals with a BMI of over 23 are going to be overweight Make a cutoff point at 23 to try and get as much people as you can Specificity IDs most without the disease or condition Label a lot of people that are overweight or obese that are not 0 Validity and Reliability 0 Validity accuracy of assessing instrument 0 Reliability repeatability or precision 0 Cultural Issues 0 Appropriate and inappropriate behaviors Ex consider appropriateness of hand gestures typical greeting used extent to which eye contact is appropriate 0 Survey questions must be culturally appropriate Cannot use the same questions on different cultures that are different in terms of data for ex using bmi measurements for white women on African American womenhave different body compositions so will get overin ated or underin ated estimation of body fat After the data are collected 0 Analyze using acceptable statistical methods dietician may need someone to help them with this 0 Choose reference data for comparison ex looking at fiber intake compare everyone s intake to the standard fiber intake 0 Statements drawn from analysis and interpretation are organized and added to final report of community assessment The more people that know your results the better
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