Community Nutrition Mid-Term Flashcards
1
Q
What influences policy makers?
A
- Laws
- Regulations
- Policies
2
Q
What are the changing social and economic trends?
A
- More immigrants;
- Aging populations;
- Rising costs, changing consumer expectations, increased competition, and greater cultural diversity;
- Downsizing, mergers, cross training, and managed health care
3
Q
What is a Community?
A
–A group of people located in a particular space who have shared values and interact within a social system •People •Location in space •Social interaction •Shared values
4
Q
What is Community/Public Health Nutrition?
A
-Discipline that strives to prevent diseases and to improve the health, nutrition, and well-being of individuals and groups within communities
5
Q
Who are the People?
A
Those who are served by and benefit from community nutrition programs
6
Q
What is a Policy?
A
-Course of action chosen by public authorities to address a given problem;
-What governments and organizations intend to accomplish through their laws, regulations, and programs
EX: Dietary Guidelines for Americans
7
Q
What are the Dietary Guidelines of Americans?
A
- 2010;
- the cornerstone of Federal nutrition policy and nutrition education activities;
- Issued and updated every 5 years by the Department of Agriculture (USDA) and the Department of Health and Human Services (HHS).
8
Q
What are the main points of the DGA?
A
- Intended for Americans ages 2 years and over, including those at increased risk of chronic disease;
- Focused on foods and beverages that help achieve and maintain a healthy weight, promote health, and prevent disease;
- 7th edition released since 1980 and remain the current edition until the 2015 Dietary Guidelines for Americans are released.
9
Q
What is MyPlate?
A
- Tool used to INTERPRET the Dietary Guidelines;
- Build a healthy plate;
- Cut back on foods high in solid fats, added sugars, and salt;
- Eat the right amount of calories for you;
- Be physically active your way
10
Q
What are Programs?
A
Instruments used by community nutritionists to seek behavior changes that improve nutritional status and health
11
Q
What is Public Health?
A
- Organized effort by society to →
- Protect, promote, restore the health of people through the application of science, practical skills, and collective action
12
Q
What is the WHO definition of “Health”?
A
“state of complete physical, mental, and social well-being, not merely the absence of disease”
→ Focus is on OVERALL well-being and health, not just about the foods and what is being eaten
13
Q
What are the Populations by stages of disease continuum?
A
- Well Population = Primary Prevention;
- At Risk = Secondary Prevention/Early Detection;
- Established Disease AND Controlled Chronic Disease = Disease Management and Tertiary Prevention
14
Q
What is the goal between Primary and Secondary Prevention?
A
- Between Well and At-Risk;
- PREVENT disease incidence
15
Q
What is the goal between Secondary and Established Disease?
A
- Between At-Risk and Diseased;
- Prevent PROGRESSION
16
Q
What is the goal between Established Disease and Controlled Chronic Disease?
A
- Both Disease Management and Tertiary Prevention;
- REDUCE complication or disability
17
Q
What is included in Primary Prevention?
A
- SCREENING;
- Individual = (Promote breastfeeding, 5-to-9 a-day campaign, Food safety training)
- Community = (Health fairs promoting low-salt cooking, Walking trails in local parks)
- System = (State requirement for daily PE)
18
Q
What is included in Secondary Prevention?
A
- DETECTION;
- Individual = (Screening of individual patients by physicians, Early diagnosis, counseling, medical nutrition therapy)
- Community = Cholesterol screening at local grocery store, Osteoporosis check at local health fair)
- System = (Insurance company reimbursement for weight loss)
19
Q
What is included in Disease Management and Tertiary Prevention?
A
- TREAT and REHABILITATE:
- Individual = (Diabetes management, Medical nutrition therapy and rehab services after a heart attack)
- Community= (Offering special diets in community feeding programs)
- System = (Legislation mandating special diets be provided in federal nutrition programs)
20
Q
What is Healthy People 2010?
A
-National Health agenda for the current decade;
-22 Nutrition and Weight Status Objectives;
-Benchmarks and monitored progress over time in order to =
Encourage collaborations across sectors.;
-Guide individuals toward making informed health decisions;
-Measure the impact of prevention activities
21
Q
Who is the Community Nutritionist?
A
Identifies the need of the community and puts into place a program or service designed to meet that need.
22
Q
What is an Entrepreneur?
A
- One who undertakes the risk of a business or enterprise;
- Enterpriser
- Innovator
- Initiator
- Promoter
- Coordinator
- Must have creativity and innovation
23
Q
What are the Leading Indicators of Change in Public Health?
A
- An aging population;
- Generational diversity;
- Increasing demands for nutrition and health care services;
- Increased ethnic diversity;
- Challenges of the twenty-first-century lifestyle;
- Increasing awareness of environmental nutrition issues;
- Global Environmental Challenges for Public Health
24
Q
What is a Policy?
A
The course of action chosen by public authorities to address a given problem;
- Anything that you feel is important and that you lobby for;
- Public policy is out profession;
- Knowing that there’s an issue that needs to be changed
25
What is the PURPOSE of a Policy?
To fashion strategies for solving public problems.
26
What is Policy Making?
- Process by which authorities decide which actions to take to address a problem or set of problems;
- “If dietetics is your practice, politics is your business” --Academy of Nutrition and Dietetics
27
What is required for a nutrition concern to become a policy?
- Scientific basis and program evaluation;
| - Supportive political climate
28
What are some Nutrition-Related Policies?
-Dietary Guidelines for Americans 2010
-National Policies Formulated by the US Congress
oFederal Food, Drug, and Cosmetic Act
oNutrition Labeling and Education Act
oDietary Supplement Health Education Act
29
What are the Steps of Policy Making?
1. Define the problem and set the agenda
2. Formulate alternatives or policy formulation
3. Adopt the policy
4. Implement the policy
5. Evaluate the policy
6. Terminate the policy
30
What is involved in Defining the Problem and Setting the Agenda (Step 1)?
- Problem is defined → You want to make it public knowledge;
- Problem is brought to the attention of the policy makers;
- Issue is put on the agenda for consideration;
- Build widespread public interest (Media!)
31
What is involved in the Formulation of Alternatives (Step 2)?
- Discussion of possible solutions to a problem;
- Policy Formulated at the…
- National (federal), state, and local levels by the;
- Legislative, executive, and judicial branches of government
32
What is involved in Policy Adoption?
- Select tools or instruments to achieve a given policy;
- Tools are wielded by federal, state, and municipal departments and agencies that are responsible for implementing policy
33
What are the TOOLS for policy adoption?
- Regulations
- Cash grants
- Loans
- Tax breaks
- Certification
- Fines
- Price controls
- Quotas
- Public promotion
- Public investment
- Government-sponsored programs
34
Who are the Administrative Agencies Responsible for Nutrition Policy Implementation at the FEDERAL LEVEL?
- DHHS – Department of Health and Human Services;
| - USDA
35
What is the role of the DHHS?
- Protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves;
- Over 300 programs: health research, preventing outbreaks of infectious disease, ensuring food and drug safety, providing financial assistance to low income and older Americans (CDC, NIH, FDA)
36
What is the role of the USDA?
-Provide leadership on food, agriculture, natural resources, and related issues
37
What is involved in Policy Implementation?
- Process of putting a policy into ACTION;
- “Just do it.”
- Millions of policies on state, local, and federal levels working w private organizations and interest groups to carry out government policy
- ‘BUGS’
38
What are BUGS?
-Bridging Urban Society = Helps create greening projects such as organic gardens on unused, littered, vacant lots
39
What is involved in Policy Evaluation?
-Evaluation process begins as soon as the agenda is set; Is it working?;
Determines...
-If the program is ACHIEVING its stated goals,
-if the program is REACHING the intended audience;
-if the program is ACCOMPLISHING what it intended to accomplish, and who is benefiting from the program
40
What are the reasons for Policy Termination?
- Public need was met
- Nature of the problem changed
- No longer mandated by the government
- Policy lost public support
- Private agency relieved the need
- Political system or sub-government ceased to function
- Too costly
41
WHO is involved in making policies?
- Everyone is involved in policy making but typically it is thought of as something accomplished by elected officials;
- Administrators, executives, committees w/I an organization, bureaucrats, community nutritionist..(those working directly with people);
- Even those people who volunteer at a food bank. -These people are the ones that get it going.
42
How are Laws and regulations related?
- Laws tend to be vague and broad in scope;
| - Administrative agencies interpret the law and provide detailed regulations or rules
43
What are Law Makers?
ARE NOT POLICY makers → It would take the public out of the policy making.
44
What are Legislators?
-Legislators ARE LAW MAKERS. “representation democracy.” We can now put the public back into the argument.
45
What re Judges?
NEITHER policy or law makers
46
How do Policies related to Laws?
- Implement the law and make them real. And we all make public policies happen;
- They’re the TOOLS of our gov’t.
47
What is a Budget?
- Provided funds to enforce the laws and regulations;
- Notes income and expenditure and describes intentions for future spending intended to control and shape activities of government agencies
48
What is involved in a Federal Budget?
- Receipts or Revenue
- Budget authority
- Budget outlays
- Mandatory spending
- Discretionary Spending
49
What is Receipt or Revenue?
-Amount govt expects to raise through taxes/fees.
50
What is Budget Authority?
-Amount govt agencies are allowed to spend in implementing their program
51
What is Budget Outlay?
-Amounts paid out by govt agencies
52
What is Mandatory Spending?
-Entitlements = Programs that require the payment of benefits to all eligible people as established by law (i.e. SNAP)
53
What is Discretionary Spending?
- Budget choices that can be made after money is allocated to the entitlement programs (i.e. WIC);
- In the program’s discretion on how they spend the money.;
- They have to be able to account for all spendings
54
What is the Federal Budget Year?
- Begins October 1st;
- Ends September 30th
- U.S. fiscal year is named for the year in which it ends Oct 1, 2012 - Sept 30, 2013 = FY 2013
55
What is initiates political process?
- Contacting your congressman or congresswomen (U.S.)
| - Contacting your legislature member (Louisiana)
56
What are some emerging political issues?
- State Licensure laws
- Bioterrorism and food safety
- Biotechnology
- Complementary and alternative medicine
- Functional foods and neutraceuticals
- Herbal and dietary supplements
- Human genome project
57
What are the ways to influence the Political Process?
-Become directly involved;
-Join an interest group;
-Work to influence the political process;
Take political ACTION =
-Write effective letters or e-mail messages – p. 196-197
-Make effective telephone calls
-Email
-Media
58
What are the National Nutrition Issues?:
- Obesity;
- Hunger;
- Malnutrition;
- Food safety;
- Food labeling;
- Food fortification;
- Nutrition research
59
What is National Nutrition Policy?
A set of nationwide guidelines that specify how the nutritional needs of the population will be met;
-NO one federal nutrition policy office responsible for overall policy
60
What areas policy areas does nutrition policy cross?
- Agriculture
- Exports
- Imports
- Commerce
- Foreign relations
- Public health
- National defense
61
How does the US Nutrition Policy manifest itself?
- Food assistance program rules and requirements
- National food and nutrition objectives (Healthy People 2020: Nutrition and Weight Status)
- Regulations to safeguard the food supply and safe handling of food → Food safety must always be monitored!
- Dietary guidance systems → Must always meet guidelines for all individuals involved and served
- Monitoring and surveillance program directives and mandates
- Food labeling legislation
62
What are the areas of Nutrition Policy?
- Monitoring;
- Research;
- Policy Making
63
What is involved in National Nutrition Monitoring?
- Screening = Identify individuals AT RISK;
- Assessment = Measurement of indicators of dietary and nutrition-related health status;
- Monitoring = Assessment of dietary or nutritional status at intermittent times → Over time;
- Surveillance = CONTINUOUS collection of nutritional assessment data, especially on high-risk populations
64
What is the National Nutrition Monitoring and Related Research Program?
- Measures the health and nutritional status, food consumption, dietary knowledge, and attitude about diet and health of the U.S. population;
- Measure food consumption and the quality of the food supply
65
Who are the PRIMARY Federal Sponsors of the National Nutrition Monitoring and Research Program?
- U.S. Department of Health and Human Services (DHHS);
| - U.S. Department of Agriculture (USDA)
66
What are the major components of the National Nutrition Monitoring and Research program?
- Nutritional status and nutrition-related health measurements;
- Food and nutrient consumption;
- Knowledge, attitudes, and behavior assessments;
- Food composition and nutrient databases;
- Food-supply determinants
67
What is "What We Eat in America (WWEIA)"?
- NHANES is a national food survey conducted as a partnership between the U.S. Department of Health and Human Services (DHHS) and the U.S. Department of Agriculture (USDA);
- USDA's Continuing Survey of Food Intakes by Individuals (CSFII) and HHS' NHANES;
- Combined in 2002;
- DHHS = gathering information and doing the monitoring;
- USDA = development and analysis of the program
68
What is the 2008 Farm Bill?
-Nutrition Monitoring =
“Requires Secretaries of Agriculture and Health and Human Services to jointly monitor, conduct research on, and disseminate to the public information on diet, nutrition, physical activity, and related issues.”
69
What are the Mission areas of the USDA?
- Farm and Foreign Agricultural Services
- Food, Nutrition and Consumer Sciences
- Food Safety
- Marketing and Regulatory Programs
- Natural Resources and Environment
- Research, Education, and Economics
- Rural Development
70
What are some uses of National Nutrition Monitoring Data?
- Health planning
- Program management and evaluation
- Timely warning and intervention efforts to prevent acute food shortages
- Directions for research activities
- Used to make policy decisions regarding food assistance programs, nutrition labeling, nutritional recommendations, and education.
71
What are the Nutrition INTAKE Standards?
- Dietary Reference Intakes (DRIs)
| - Dietary recommendations of other countries and groups
72
What are the Dietary Guidance Systems?
- Dietary Guidelines with MyPlate food plan
73
What are the DRIs?
- Estimated Average Requirement (EAR)
- Recommended Dietary Allowance (RDA)
- Adequate Intake (AI)
- Estimated Energy Requirement (EER)
- Acceptable Macronutrient Distribution Range (AMDR)
- Tolerable Upper Intake Level (UL)
74
What is the World Health Organizations view on health?
Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social services
75
What is lacking with health care policy?
- Needs to be a national obsession;
- Lack of interrelationship between the science behind successful diets and the public putting them to use;
- Health care for all citizens
76
Why is there a lack of PREVENTATIVE care?
- Reimbursement for preventive services provided by the present health care system is LIMITED:
- Increased encouragement of preventative care;
- Dietetics gets little reimbursement;
- Affordable Care Act of 2010 attempts to address
77
How much of the population has Private Insurance?
~ 65% of the nonelderly population;
- 92% of private coverage w/ employers;
- Indemnity or Traditional fee-for-service plans (~8%) → USED to be the majority;
- Group contract insurance (~92%)
78
How much of the population has government insurance?
~27.8% of the population;
- Federal (Medicare, Medicaid, Military Health Care)
- State/Federal partnership (State Children’s Health Insurance Program SCHIP)
79
What is Private Indemnity or Traditional fee-for-service plans?
- Charges a fee for EACH SERVICE rendered;
- Provided by BOTH commercial insurance companies and not-for-profit organizations such as Blue Cross and Blue Shield and independent employee health plans
80
What is Private Managed Health Care Insurance?
- Prepaid group practice plans that offer health care services through groups of practitioners;
- Health Maintenance Organization (HMOs) → Set group of providers
- Preferred Provider Organization (PPOs) → A little more flexibility with choosing physician
- Point of Service Plan (POSs) → Much more traditional; More choice and more expensive
81
Who are providers of government or public insurance?
- Medicare
- Medicaid
- SCHIP → LACHIP in Louisiana
- Workers compensation
- Medical care for US military veterans (VA System)
- Public Health Service and Indian Health Service
- Department of Defense Military Health Services (TRICARE)
- Department of Justice Federal Bureau of Prisons;
* *Physicians decide which plans to APPLY for and must meet requirements of that plan to be accept as a qualified provider
82
What is Medicare?
(> 43 million enrolled);
- Based on age; People ages 65 and older or the disabled
- Administered by the Centers for Medicare and Medicaid Services (CMS) which is an agency in the DHHS
83
What is Part A of Medicare?
- Hospitalization insurance;
- Inpatient charges reimbursed according to a prospective payment system (PPS) known as diagnostic-related groups (DRG’s)
84
What is Part B of Medicare?
- Medical insurance;
- Optional medical insurance;
- Financed through premiums paid by enrollees and contributions from federal funds;
- Supplemental medical insurance benefits
85
What is Medicaid?
(> 47 million);
Based on lower socioeconomic status;
Federal/state funded and state administered;
Entitlement program to provide medical benefits for certain LOW-INCOME persons
86
What is LaCHIP?
- Partnership between the federal government and Louisiana to provide health coverage for children from birth until age 19 years;
- Program for qualifying families which provides total health care for the children;
- East Baton Rouge Parish → 11,592
- State Total → 123,070
87
What is LaMOMS?
- Expansion of Medicaid coverage;
| - Provides health benefits for low-income pregnant women who qualify
88
Who are the Uninsured population in the US?
2009 50.7 million nonelderly people were uninsured (16.7%);
- Working poor
- Small business who can't afford;
- Self-employed, part-time employees, seasonal workers
- Early retirees
- Young adults are most likely to be uninsured.
- People in the south and west are more likely to be uninsured than those in the northeast and Midwest.
- Most uninsured are in families with at least one full time worker.
- Hispanics have the highest rates of uninsured, but the largest share of the uninsured by far is white Americans.
89
What is Maslow's Hierarchy of Needs?
- Physiological
- Safety
- Belonging/Love
- Esteem
- Self-Actualization
90
What areas need to be addressed for health care reform to provide everyone affordable health care?
- Cost
- Quality
- Access
91
How is Cost Containment for health care reform implemented?
- Movement away from traditional fee-for-service plans to HMOs, PPOs, & POSs;
- Cost shifting & self-insured health plans;
- Payers are actively setting reimbursement restrictions and limitations → People who pay the providers and give them reimbursements and establish how many visits or meetings are allowed
- People are not allowed total access to health care due to growing expense;
- Copayments
92
What is the Prospective Payment System (PPS)?
* Cost containment;
- Federal government implemented as a result of the 1983 Social Security Amendments;
- Based on knowing the amount of payment in advance;
- Cost are PRESET
93
What is a Diagnostic Related Groups? (DRGs)
-System of classifying hospital admissions for Medicare reimbursement;
~10,000 possible reasons for hospital admission
-23 major categories divided into 490 DRGs
94
What is the benefit of preventative care through optimal nutrition?
- Optimal nutrition is cost effective;
- Preventive = good nutrition → good health → less illness → less cost;
- good nutrition → improved patient outcome → reduced recovery time → reduced cost
95
What is Nutrition Intervention?
- Increase in knowledge, skills, and motivation;
- Changes in food habits;
- Altered risk factors;
- Positive outcomes;
- Decreased health costs
96
What are the stages of Nutrition Intervention?
1. SCREENING is preventative
2. ASSESSMENT is the patients health and status
3. COUNSELING is implement steps to improve health
97
What are Medical Nutrition Therapy CPT codes?
```
Current procedural terminology codes =
- Codes for medical nutrition therapy;
Either for...
-Private insurance companies or
-Medicare MNT benefits provided by RD providers who perform MNT services for diabetes and non-dialysis kidney disease
```
98
What are Diagnosis Codes?
- Describe an individual’s medical condition and are required on claims submitted by healthcare providers to third party payers.
- Service has a specific code
- Provider/office has a code
- Doctors of medicine and osteopathy are the legal entities trained and licensed to perform a medical diagnosis.
99
Medicare MNT providers can bill Medicare Part B for clients with what conditions?
- Type I diabetes
- Type II diabetes
- Gestational diabetes
- Non-dialysis kidney disease
- Post-transplant kidney disease.
* A physician’s referral for MNT is required.
100
What is the Patient Protection and Affordable Care Act of 2010 (PPACA)?
- Comprehensive federal care reform law;
- Private health insurance more affordable;
- Made pricing of insurance more predictable and fair;
- Promotes competition based on price and quality
- Provides additional oversight of insurer practices;
- Some changes began in 2010 and 2011
- Others will not take effect until 2014
101
What is the goal of PPACA?
- Stem the decline in private health insurance
| - Expand it for those currently uninsured
102
What are the changes of PPACA?
- Eligibility for private coverage as a dependent will be extended age of 26;
- Lifetime benefits limits and restrictions on permissible annual benefits limits will be controlled.;
- Preventive health care coverage will be available without cost sharing.
- Share of premiums that are devoted to expenses other than paying claims will be limited;
- Tax credits will be offered to small businesses to help them purchase health insurance for their workers and early retirees
103
What is a Community Needs Assessment?
-Evaluates the health and nutritional status of the community
-Needs of the community and examines where needs are not being met and resources available;
Examines =
-Quality of life and physical and psychosocial functioning
-Nutritional influences and intakes/utilization of nutrients and non-nutrients
104
What else is involved in a community analysis and diagnosis?
- Money
- People
- Problems
- Resources
- Assets
- Health education planning
- Mapping
105
Why Conduct a Community Needs Assessment?
-Need for new data on a community’s health
-Mandated by a government agency
-New research findings and awareness of a problem
-Money available to examine the community
= Must do a community needs assessment in order to get funded and gain permission to establish policies and take action in a community
106
What are the Steps in a Community Needs Assessment?
1. Define the nutritional problem
2. Set the parameters
3. Collect the data
4. Analyze and interpret
5. Share the findings
6. Set priorities
7. Plan of action
107
What is Step 1: Defining the Nutrition Problem?
-Concise statement of the problem that is of concern stating who is affected and how many people are affected;
-Developed from secondary and primary data
= Secondary data - data collected by someone else and available in a database
= Primary data – new data you collect yourself
108
What is Step 2: Set parameters?
- Define the community – people or place.
- Determine the purpose of the needs assessment (Problem)
- Target population
- Set goals and objectives
109
What are Goals in a Community Assessment?
BROAD statement or statements that indicates what the assessment intends to accomplish
110
What are Objectives in a Community Assessment?
- Statements of outcomes and activities needed to reach a goal;
- A community needs assessment should contains strong “assessment” verbs such as identify, describe, count (NOT change verbs such as increase, improve, etc.);
- Each objective states a single purpose.
111
What is Step 3: Collect Data?
```
Types of data =
-QUALITATIVE (opinions & insights)
•Key informants
•Stakeholders
-QUANTITATIVE
•Numerical data
•Community, environmental, & socioeconomic characteristics
```
112
What are the Community Characteristics needed when collecting assessment data?
- Community Organizational Power and Structures (qualitative, political);
- Demographic data
- Community health: Infant mortality rates, etc. causes and rates of disease, key life stages
- Existing services and programs
113
What are the Environmental Characteristics needed when collecting assessment data?
- Food Systems: Food distribution, locally grown food, grocery stores, restaurants
- Geography and climate
- Health Systems: hospitals, clinics, long term care facilities
- Housing
- Recreation
- Transportation
114
What are Socioeconomic Characteristics needed when collecting assessment data?
- Family Income
- Number of families receiving public assistance
- Education level
- Literacy rate
- Major industries and occupations
115
How do the types of data collected move from specific to broad?
Target population status:
- Individual lifestyle factors;
- Living, working, social conditions';
- Community conditions (Community, environment, SES)
- Background conditions (Policies, culture)
116
What is incidence?
- Number NEW cases during a specific time period in a defined population;
- identify a group of susceptible people who are initially free of disease.
- Examine them periodically over time to count new cases that develop
117
What is prevalence?
The number of EXISTING cases of a disease or other condition in a given population
118
What is Step 4: Analyze the Data?
- Diagnosis of all info gathered;
- Interpret the state of health of the target population;
- Interpret the pattern of health care services and
- Interpret the relationship between the target population’s health status and health care in the community;
- Summarize the evidence linking the target population’s major nutritional problem to their environment (s it the cause?)
- Prepare an executive summary → Captures 3 or 4 key points that have emerged from the assessment
119
What is Step 5: Share the finding?
- Cost effective
- Reduced duplication of effort
- Promotes cooperation among organizations and agencies
- Enlarges the sphere of awareness
- Increases the likelihood that more than one agency will address the problem
* Used for grant, getting new policies, changing standards, etc
120
What is Step 6: Setting Priorities?
- The health outcome is the effect of an intervention;
- Community priorities, preferences, and concerns should be given priority.
- Higher priority should be given to COMMON problems;
- Higher priority should be given to SERIOUS problems;
- The health problems of MOTHERS and CHILDREN that can EASILY be prevented should have a higher priority than those that are more difficult to prevent.
- Higher priority should be given to health problems whose FREQUENCIES ARE INCREASING over time
121
What is Step 7: Plan of Action?
- Do something!
- Share key findings
- Change public policy
- Organize a workshop
- Alter an existing program
- Develop a new program
122
What needs to be assessed about a target population?
- Factors that influence dietary habits, values, attitudes, and beliefs;
- How they related to health and vary across populations and cultures;
- What is the nutritional problem experienced by the target population?
123
What is the plan for assessing the status of the target population?
1. Review goals and objectives
2. Develop questions that can assess the nutritional problem and its development/factors
3. Choose method for obtaining those answers
124
What are the types of DATA to collect about the target population?
- Individual lifestyle factors = Lifestyle is a key determinant of nutritional status!
- Dietary patterns;
- Nutrient Utilization;
- Working conditions (Shift work, on the road, at a desk, etc);
- Social networks;
- Nutritional mentality of the groups
125
What are the methods for obtaining data?
- Survey
- Screening
- Focus groups
- Interview with key informants
- Direct assessment of nutritional status
126
What is a Survey?
A systematic study of a cross section of individuals who represent the target population;
- Quantitative or qualitative information
- Administered as a paper questionnaire or as a formal, structured interview by telephone, by mail, or on-line;
- Person or persons conducting the survey must be trained using a standard protocol
127
What is a Nutrition Survey?
Administered in a structured manner using a standard protocol =
- Food consumption (Eating patterns, values, preferences, etc);
- Adequacy of the food supply (Plenty , food banks, on campus, Meals on Wheels, WIC, EBT,)
- Nutritional quality;
- Relationship of diet and health;
- The effectiveness of an education program
128
What scales are used to determine the readability of a survey?
- SMOG Readability Scale
| - Word Readability Scale
129
What is a Health Risk Appraisal?
-Survey that characterizes a population’s general
-3 components:
oA questionnaire
oCertain calculations that predict disease risk
oEducational message or report to the participant
130
What happens during the SCREENING process?
- Important PREVENTATIVE health activity designed to reverse, retard, or halt the progress of a disease by detecting it as soon as possible
- Secondary – aimed at catching the problem at the early stages and preventing progression of the disease
- Settings = Clinical or Community;
- Procedures = Safe, Simple, Inexpensive
131
What are Focus Group Interviews?
- Group (typically 5-12) to talk about concerns, experiences, beliefs, or problems (lasts 1-3 hours);
- Obtain advice and insights, information about key variables, and opinions.
- Trained moderator;
- Pay attention and notice how people interact with one another and how they react to the topics being discussed;
- Provide QUALITATIVE data
132
How is nutritional health status directly assessed?
- Anthropometric
- Biochemical
- Clinical
- Dietary
133
What are the Antrho measurements?
1. Height, weight (charts), BMI, BMI percentile;
-BMI = weight in kg/ht2 in meters
2. Waist circumference (adults)
-HIGH RISK =
> 40 inches (> 102 cm) for men
> 35 inches (> 88 cm) for women
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What are Biochemical or lab assessment methods?
- Look for nutrient deficiencies;
- Examine reserve tissue stores
- Examine level in body fluids
- Measure nutrient-dependent enzymes
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What are the Clinical methods of assessment?
- Medical history (Symptoms, Physical findings)
| - Blood pressure
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What are the Dietary methods of assessment?
- Diet history
- 24-hour recall
- Diet record
- Food frequency questionnaire
- Digital photography of food
- Remote food photography
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What are types of possible issues with data collection?
- Practical
- Scientific
- Cultural
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What are the Scientific issues?
Sensitivity vs. specificity =
•Sensitivity – proportion of people with disease that get a positive test result;
•Specificity – people WITHOUT the disease that get a negative test result
Validity vs. reliability =
•Validity – accurately displays the data you want;
•Reliability – repeatability; can be done over and over again
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What are some Cultural issues?
- Religion (beliefs and rituals);
- Etiquette and customs (greetings, customs);
- Nonverbal communications (gestures, tones, eye contact)
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What is Epidemiology?
- Focuses on health problems of POPULATIONS rather than of individuals;
- Concerned with processes of health and disease;
- Cornerstone methodology of public health research;
- Highly regarded for identifying risk factors and optimal treatments
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What is Distribution?
Who gets the disease, where it’s found, when did it occur, etc… → PEOPLE, PLACE, TIME
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What are Determinants?
- Host factors = age, sex, race, genetic makeup, physiological status, etc…;
- Environmental factors = living conditions, occupation, geographical location, lifestyle, etc...
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What are the Epidemiological Concepts?
- Case = study of ONE person;
- Risk – the likelihood people without the disease and with certain risk factors WILL DEVELOP the disease;
- Vital Stats – used to calculate the risk of dying before a certain age
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What is the Epidemiological Method of data collection (Hypothesis Testing)?
- Observing
- Counting cases or events
- Relating cases or events to the population at risk
- Making comparisons
- Developing the hypothesis
- Testing the hypothesis
- Drawing scientific inferences
- Conducting experimental studies
- Intervening and evaluating
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What are the ways to explain research observations?
- Bias
- Chance (randome);
- Truth (valid and reliable facts)
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What are the forms of Bias?
- Selection – NOT a varied population; your selection processes caters to one group over another and has nothing to do with your particular study parameters;
- Measurement – Not consistently using statistical analysis;
- Confounding – outside factors that can affect the data that have nothing to do with the actual research
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What are the types of Epidemiological studies?
- Ecological or Correlational
- Cross-Sectional or Prevalence
- Cohort
- Case-Control Studies
- Controlled Trials
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What are Ecological/Correlation Studies?
- Best used to generate hypothesis
- Does NOT show cause and effect
- Provides evidence of the relationship or association between variables
- Descriptive study
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What are Cohort Studies?
- Group free of disease or condition is identified and examined;
- Followed through time to assess their later disease or outcome status → Moving “picture” of the disease;
- Possible causal factor under investigation is called the EXPOSURE;
- Assumed that the cohorts are comparable in all relevant factors other than the exposure;
- Prospective and analytical study → Following groups into the future
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What are Case-Controlled studies?
- Enrollment is based upon the presence (case) OR absence (control) of disease = Specific;
- Exposure status is assessed after disease status is known;
- Go back and look at the possible factors that lead to that disease!;
- Comparison groups are formed on the basis of disease or outcome status, either with disease diagnosis (cases) or without disease diagnosis (controls)
- Retrospective and analytical study
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What are Experimental/Controlled Trial Studies?
- Most rigorous evaluation of a research hypothesis;
- Demonstrate a cause and effect
- Analytical and experimental study
- Typically double blind
- Placebo-controlled
- Much better at controlling confounding factors
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What is Nutritional Epidemiology?
```
Study food consumption at the national;
Challenges=
-Complexity of diets
-Ingredients and composition
-Variations in consumption
-High levels of observation needed
-Getting accurate diet intake records
```
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Examples of Epidemiology Studies
- NHANES
- Nurses’ Health Study – women’s health
- Bogalusa Heart Study – most comprehensive biracial study of children; started in 1972
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What is the role of the Community Nutritionist?
- Identify the nutritional problem
| - Interpret the scientific literature
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What are the Systematic Scientific Reviews?
- USDA Nutrition Evidence Library;
- ADA Evidence Analysis Library;
- Cochrane Database of Systematic Reviews;
- DHHS Agency for Healthcare Research and Quality National Guideline Clearinghouse
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What is the point of program planning?
- Designing an intervention
| - Evaluating the intervention
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What are precipitating events that cause program changes?
- New identified community need
- Mandate from an organization’s national office
- New research findings
- Community leader or coalition agenda
- Available funding for new programs
- Government policy change
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What is a Mission Statement?
- A broad statement or declaration of an organization’s purpose;
- Your organization’s mission statement should MATCH the purpose of the educational program
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What are the steps of Program Planning?
1. Review the findings of the community needs assessment report;
2. Establish intervention program goals and objectives;
3. Develop an intervention program plan;
4. Describe the management system → Personnel, who will do what;
5. Identify funding sources;
6. Implement the program;
7. Evaluate program elements and effectiveness
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Step 1: Review the results of the community needs assessment:
(Programs)
- Examine the data regarding the target population’s nutritional problem or need.
- Identifies gaps in services.
- Suggests places where interventions are needed.
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Step 2: Write program goals and objectives:
| Programs
-Goal =BROAD STATEMENT of desired changes or outcomes which provide a general direction for a program
EX: Healthy People 2020, Nutrition and Weight Status → Promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights
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What should be described in well-written objectives?
- Specific action or activity to be undertaken
- Target population
- Way success will be measured or evaluated
- TIme frame in which the objective will be met
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What are SMART Objectives?
- Specific
- Measurable
- Achievable
- Realistic
- Time bound
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What are the types of Objectives?
1. Impact (immediate change) or Outcome (long- term change in health status)
2. Process
3. Structure
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What are IMPACT Objectives?
-More immediate change (increase knowledge)
-Outcome objectives are for changes in a health or nutritional outcome;
-Action Verbs – achieve, choose, decrease, maintain, identify, list, etc.
EX: Healthy People 2020, Nutrition and Weight Status (NWS-8) Outcome Objective → By 2020 increase the proportion of U.S. adults who are at a healthy weight to 33.9 percent.
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What are PROCESS Objectives?
- Measurable activities carried out by the community nutritionist and other team members in implementing the program;
- Advise, assess, build, conduct, demonstrate, develop, instruct, train, screen
- EX: Each of the four community nutritionists will conduct two 30-minute nutrition lectures per week over a three-month period
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What are STRUCTURE Objectives?
-Measurable activities surrounding the budget, staffing patterns, management systems, use of the organization’s resources and coordination of program activities.
EX: Each of the four community nutritionists will spend no more than five hours preparing and no more than $50 on program materials for the 3-month program
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Step 3: Develop a Program Plan:
| Programs
- First review program goals and objectives
| - Using these goals and objectives develop the program plan and intervention strategy
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What is included in an Intervention Strategy?
A plan for achieving the programs goals and objectives =
-Who is the target group? (individual, group, community)'
-What level of intervention?
oLevel 1: Build Awareness
oLevel 11: Change Lifestyle
oLevel 111: Create a Supportive Environment
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How do you design the Nutrition Education Component of an Intervention program?
- Set a goal and objectives;
- Specify program format → how will you go about initiating and implementing the program
- Choose program identifiers → What are the questions or key components
- Tag line = simple, short message that conveys a key intervention message and is used on
- Marketing plan (can't exist w/o marketing!)
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Step 4: Develop a management system:
| Programs
The WHO and WHAT of the program =
-Personnel (employees responsible for overseeing the program)
-Data (manner in which data about clients, their use of the program, and the outcome measures are recorded and analyzed)
-Cost:
oDirect costs: salaries, materials, travel, equipment
oIndirect costs: rental, janitorial, utilities
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What is a Logic model?
Framework for planning, implementing, managing & evaluating community nutrition projects
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Step 6: Implement the program:
| Programs
- IMPLEMENTATION is the set of activities directed toward putting a program into effect.
- “active phase.”
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How can you enhance program participation?
- Understand the needs and interests of the target population;
- Use evaluation research to improve the program;
- Use incentives for participating – be motivating!;
- Build ownership of the program – make it your own;
- Create ways for people to identify and want to become and feel passionate about the program;
- Promote, promote, promote – Marketing is a must!!
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Step 7: Evaluate program elements and effectiveness:
| Programs
-EVALUATION is the use of scientific methods to judge and improve the planning, monitoring, effectiveness, and efficiency of health, nutrition, and other human services
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Why do programs need to be evaluated?
- Gather info to make decisions;
- Improve the program;
- Justify the program or show accountability;
- Document the program
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What are the types of Evaluation?
- Formative
- Process
- Impact
- Outcome
- Structure
- Fiscal or Efficiency
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What is Formative Evaluation?
- Tests and assesses elements of a program before it is fully implemented
- Allows for modification of the program before it is fully implemented.
- Tests the understandability and applicability of materials and methods prior to initiation of the program
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What is Process Evaluation?
- Examines the program’s activities or efforts;
| - Meet objectives?
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What is Impact Evaluation?
- Determine whether the program’s methods and activities resulted in the desired IMMEDIATE changes in the client;
- Focuses on the immediate indicators of a program’s success (beliefs, attitudes, decision-making skills, self-esteem, self-efficacy, and knowledge)
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What is Outcome (Summative) Evaluation?
- Examines a programs effectiveness in changing ONE OR MORE aspects of the nutritional or health status of the target population;
- Designed in the planning stage but is conducted at the END
- Provides information about the effectiveness and improvements;
- Evaluates participants’ reaction
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What is Structure Evaluation?
-Examines the personnel and environmental factors related to program delivery (money, time, staff, facility and resources)
183
What is Fiscal or Efficiency Evaluation?
Determining a program’s benefits relative to its costs =
-Cost-benefit analysis
EX: For every $1 spent on the program $4 is saved in health care costs yields a ratio of 1:4
-Cost-effectiveness analysis
EX: Relates the effectiveness of reaching the program’s goals to the monetary value of the resources going into the program
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How do you communicate evaluation findings?
- Communicate to the appropriate potential users;
- Ensure the report addresses the issues that users perceive to be important;
- Deliver report on time and in a form that is easily understood
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What is included in a successful Health Message?
Has a favorable impact on the target audience by getting them to =
- Examine their beliefs system
- Evaluate the consequences of a certain behavior
- CHANGE THEIR BEHAVIORS
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What makes an Effective Nutrition Intervention?
- Integrates good instructional design and learning principles;
- Considers the learning style and motivation of the target population;
- Includes methods promoting a high degree of individualization
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What are the 6 basic Educational Principles?
1. Consonance
2. Relevance
3. Individualization
4. Feedback
5. Reinforcement
6. Facilitation
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What is Consonance?
having the right fit between the program and what is trying to be accomplished
189
What is Relevance?
Geared toward the client specifically:
- Background
- Reading Level
- Concerns
- Lifestyle
- Religion
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What is Individualization?
- Client feels like they have some sort of connection with the dietician/counselor;
- Feeling comfortable; individual contact within the program
191
What is Feedback?
providing information about progress or current status
192
What is Reinforcement?
rewards or consequences that promote/divert behavior
193
What is Facilitation?
make the change possible; getting rid of barriers
194
What is the approach for a Child/Adolescent Learner?
- Message short, clear, and simple (HOW, not why);
- Emphasize positive points
- Relate the message to interests
- All about their friends!
- Make practical, concrete suggestions
- Involve the child/adolescent
- Tie teaching concepts to concerns
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What is the approach for a Adult Learner?
- Use a problem-centered approach
- Provide concrete information
- Engage in collaborative learning
- Encourage dialog and participation
- Ask open-ended questions
- Seize “teachable moments”
- Enhance learner’s sense of self-worth with positive feedback
- Establish a positive learning environment
- Recognize and accept individual and cultural differences
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What is the approach for a Older Adult Learners?
- Address anxieties and concerns associated with isolation, chronic disease, and economic constraints;
- Consider the impact on chronic conditions on his or her ability to communicate and attention span;
- Relate to a client’s needs with EMPATHY
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What are the types of Instructional Objectives?
- Impact [short-term]
| - Outcome [long-term]
198
What is a Tag Line or Program Identifier?
A short, simple message that conveys a key intervention message and is used on promotional materials
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Steps of Nutrition Education
1. Conduct a Formative Evaluation
2. Implement the program
3. Conduct a Summative Evaluation
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What is Social Marketing?
“comprehensive effort to influence the acceptability of social ideas in a population, usually for the purpose of changing behavior.”
- Programs are consumer driven and targeted to serve a defined group of people
- Health ideas are “sold” in the same way as commercial products.
201
What is the goal of Social Marketing in health?
- Cognitive change – thoughts
- Action change
- Behavior change
- Value change
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What is the Marketing Plan for Health Promotions?
- Determine the needs of the target population;
- Identify benefits of the product or service;
- Conduct a situational analysis;
- Develop a marketing strategy;
- Develop a budget and time line;
- Implement the marketing strategy.;
- Evaluate the marketing plan.
203
What is a Situational Analysis?
- Assessment of the environment, potential market, competition of your product;
- Selecte the TARGET MARKET (distinct focus group);
- SWOT analysis;
- Analyze the environment for trends
204
What is a SWOT analysis?
- Strengths
- Weaknesses
- Opportunities
- Threats
205
What is a Marketing Strategy?
-Ensures a good fit between the goals and resources of the organization and the needs and wants of the target population;
-Specifies a target market and five distinct elements =
oProduct:
oPlace:
oPrice
oPromotion
oPublicity tools
*Successful marketers get the right product to the right place at the right time for the right price
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What are some Publicity Tools?
- Articles in print
- Informational brochures and newsletters
- Interviews on radio or TV
- Thank you notes
- Public service announcements
- Branding
207
What is a Budget?
Cost of implementing the marketing strategy
208
What is a Timetable?
Specifies the marketing activities to be done each month both before and after the launch of the product or service
209
What are JC Levinson: 10 Truths you must never forget?
- The market is continually changing
- People forget quickly
- Your competition won’t quit
- Marketing strengthens your identity
- Marketing is essential to survival and growth
- Marketing enables you to keep your customers.
- Marketing maintains morale.
- Your marketing program gives you an advantage over competitors who have ceased to market.
- Marketing allows your business to continue operating.
- You stand to lose out on the money, time, and effort you’ve invested
210
What are functions of Management?
- Planning
- Organizing
- Leading
- Controlling
211
Strategic Planning
Overall goals, , long term, upper level management, strategies for handling future problems
212
Operational Planning
- Short-term
- Activities and actions required to meet the organization’s goals;
- Specific actions regarding expenditures and controls
- Conducted by mid-level management
213
Project Planning
- Coordinates a limited set of activities
- Typically involves one program or intervention
- Path and timeline – steps toward completing a program
214
What are Organization Structures?
-Formal pattern of interactions and activities designed by management to link the tasks of employees to achieve the organization’s goals
215
What is Span of Control?
- # of subordinates who report directly t a specific manager
- Most management experts recommend only 3-7 subordinates
- Delegation – assignment of part of the manager’s work to another
216
What is a Job Description?
Formal outcome of a job analysis is a job description (Figure 19-5)
- Job title
- Immediate supervisor
- Job summary
- Job duties
- Job specifications
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What is Leading?
- Influencing others to carry out the work required to reach the organizations goals;
- Motivating employees
- Set high standards and stick to them
- Put the right person in the right job
- Keep employees informed about their performance
- Allows employees to be apart of the process
- Communicating with employee
218
What is Controlling?
Regulate the organizational activities to ensure that they meet established standards and goals
- Determine which activities need control
- Establish standards
- Measure performance
- Correct deviations
219
What is Financial Control?
- Balance sheets
| - Income statements
220
What is an Operating Budget?
- Plan for the accomplishments of programs related to objectives and goals within a definite time period;
- Budgeting is closely linked with planning
221
What is Grantsmanship?
Combines good writing skills with perseverance
222
What are the main steps of Grant Writing?
1. Lay the foundation
2. Build the grant proposal
3. Assemble and submit the final product
4. Grant reviewers review the grant proposal
5. Put the proposal into action if funded or revise and resubmit in hopes
223
```
#1 Lay the Solid Foundation:
(Grants)
```
- Develop the idea for your proposal
- Review the literature
- Describe your goals and objectives → Your goals should match the goals of your agency and those of the funding agency
- Identify a funding source = Generating an idea in response to a grant sponsor’s request
224
What are the types of Sponsor invitations?
- RFP = Request for Proposals
- RFQ = Request for Quotation
- RFA = Request for Applications
225
Who are Private Donors?
Usually located within the region and often have a specific interest
226
What are the most common types of grants?
- Project grant: supports a specified project;
- Research grant: supports investigation or experimentation;
- Block grant: supports broad purposes as authorized by legislation
227
What are the types of Funding Agencies?
- Federal (NIH, NCI, NIA, USDA, FDA) - Research
- State and Local (LA Dept of Ed)
- Foundations (Pennington, Kellogg's)
- Nonprofit organizations (ADA, AHA)
- Industry (Pharmaceutical companies)
- Institutional (LSU grants)
228
Who are Collaborators?
Adds to the expertise needed to complete a proposed project;
- Select collaborators carefully
- Involve them as early as possible in the grant writing process
- Collaborators should know and agree to perform the duties required
229
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#2 Building the Grant Proposal:
(Grants)
```
Write the project
- Be candid
- Be brief
- Be on target
* Get to the point within the first two sentences.
230
What makes a winning proposal?
- States clearly defined needs and describes how those needs were identified
- Describes what will be done
- Logical
- Positive terms
- Does not overuse jargon
- Presents a detailed budget
- Gives something back
- Follows the guidelines specified in the Request for Proposal
- Professional
- Is not too short or too long
231
What are the Components of a Proposal?
- Letter of intent (may or may not be required)
- Transmittal letter
- Title page
- Abstract
- Grant narrative
- Budget
- Evaluation
232
What is the Letter of Intent?
Submit prior to submitting a full proposal;
- Some funding agencies use these letters of intent to gather an idea of how many proposals will be submitted and do not respond to them
- Some agencies read and respond to these proposals indicating whether the seeker should submit a full proposal
233
What is an Abstract?
- Summary of the project
| - Offers a concise view of what is proposed
234
What is a Grant Narrative?
- Needs statement
- Goals and objectives
- Methods (Project Design, Participants, Evaluation plan, Measurement);
- Data Analysis (evaluation)
- Dissemination
- Time and activity chart
- Capability
235
What is the Budget of a grant?
Types of Costs =
- Direct costs = Salaries, Fringe benefits
- Indirect costs = Use of existing resources
236
what is Cost Sharing?
Occurs when the grant-seeking organization agrees to pay certain costs of the project (by contributing cash or in-kind goods or services)
237
What is the Budget Narrative?
Describes how money will be spent for every item in the budget
238
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#3 Assemble and submit the final product:
(Grants)
```
- Have someone else read it and give feedback
- Check grammar and spelling
- Submit EARLY → Grants submitted 1-2 weeks prior to the deadline are the ones most likely to be funded
239
What are the 4 Essentials of Grants?
- DILIGENCE in researching funding sources
- CREATIVITY in matching your project’s goals with those of the funding agency
- ATTENTION to detail in proposal preparation
- PERSISTENCE in revising and resubmitting proposals to potential funding sources
