© 2006 thomson-wadsworth chapter 3 assessing the target population’s nutritional status

© 2006 Thomson-Wadsworth

Chapter 3

Assessing the Target Population’s Nutritional Status


Learning Objectives

• Describe the types of data that might be collected about the target population specified in the community needs assessment.

• Describe a minimum of eight methods for obtaining data about the target population.


Learning Objectives

• Discuss the issues of validity and reliability as they apply to data collection.

• Discuss cultural issues that are considered when choosing a method for obtaining data about the target population.


Introduction

• The purpose of the community needs assessment is to obtain answers to basic questions such as:– What is the nutritional problem of the target

population?– Which factors contribute to the nutritional

problem?– How can their health and nutritional status

be improved?


Introduction

• When key questions are unanswered, the community nutritionist must identify those data elements that are still needed and choose methods for obtaining them.


A Plan for Collecting Data

• Decisions about which data to collect about the target population are made carefully following a plan laid out before the first data element is ever collected.



• The following planning activities should be completed before data collection begins:– Step 1: Review the purpose, goals, and

objectives of the needs assessment.– Step 2: Develop a set of questions related

to the target population’s nutritional problem, how it developed, and/or the factors that influence it.

– Step 3: Choose a method for obtaining answers to these questions.



• At this point in the assessment process, the community nutritionist has already obtained information about the community and about the broad background issues that influence its nutritional and health status.



• The nutritionist must now decide the following:– Which questions about the target

population are most important.– Which methods can be used to obtain

answers to those questions.– Whether the answers are measurable.


Types of Data to Collect about the Target Population

• Questions should be asked about lifestyle choices, dietary patterns, working conditions, and social networks that affect the health and nutritional status of the target population.

• Types of data:– Individual lifestyle factors– Living, working and social conditions


Individual Lifestyle Factors

• Lifestyle– Physical activity level– Choice of leisure time activities– Ability to handle stress– Smoking status– Use of alcohol or drugs



• Diet– Diet is a key individual factor to be

analyzed because nutritional status is affected directly by nutrient intake and utilization and indirectly by the food supply and a host of other factors.



• The food supply determines which foods are available to the target population and this is a product of:– Geographical area– Climate– Soil conditions– Labor– Capital available for building the agricultural

base



• Food intake is influenced by many factors, including the following:– Biological, psychosocial, cultural, and

lifestyle factors.– Personal food preferences, cognitions,

and attitudes.– Health beliefs and practices.



• Nutrient utilization is affected by:– Activity levels.– Smoking status.– Dietary supplement use.– Drug-nutrient interactions.– Physiological status.


Living, Working, and Social Conditions

• Education, occupations, and income all have powerful effects on health.

• Individuals who have few or no job skills or who are poor and uneducated tend to have more health problems than those with job training and education.



• Low socioeconomic status is linked with:– High prevalence rates of chronic

conditions.– High stress levels.– Reduced access to medical care for

the diagnosis and treatment of diseases.

– Poor outcomes following treatment.



• Poverty, even more than family structure, has the strongest association with health among children.

• Primary social groups also influence health and nutritional status.

• The family exerts the most influence on health and nutritional status.


Case Study 1: Women and Coronary Heart Disease

• The community nutritionist reviews the assessment’s objectives and determines a list of questions about this population’s knowledge, attitudes, and practices related to Cardiovascular Heart Disease (CHD).

• Demographic data, such as age, education level, and income are collected as a matter of course.


Case Study 1: Women and Coronary Heart Disease

• Answers to questions are obtained from individuals who represent the target population, which is called the sample.

• Next, the nutritionist would consider the types of data that might be collected to answer the questions and chooses a method for obtaining them.

• A survey instrument is used to obtain answers to several of the questions and a 24-hour recall method is used as a separate tool.


Methods of Obtaining Data about the Target Population

• A variety of methods exist for collecting data related to the target population:– Survey– Screening– Focus groups– Interviews with key informants– Direct assessment of nutritional status


Methods of Obtaining Data about the Target Population

• Survey– A survey is a systematic study of a

cross-section of individuals who represent the target population.

– It is a relatively inexpensive method of collecting information from a large group of people.


Methods of Obtaining Data – Surveys

• Surveys can be used to collect qualitative or quantitative data in formal structured interviews and they can be used by phone, mail, or online.

• They can be used with individuals and groups and they can be either self-administered or administered by a trained interviewer.



• Survey design and analysis is a discipline in itself.

• The first step is to determine the purpose of the survey.



• Most nutrition surveys are carried out to:– Assess the food consumption of

households or individuals.– Evaluate eating patterns.– Estimate the adequacy of the food

supply.– Assess the nutritional quality of the

food supply.



• Nutrition surveys are carried out to:– Measure the nutrient intake of a

certain population group.– Study the relationship of diet and

nutritional status to health.– Determine the effectiveness of an

education program.



• Decisions must be made about who will design the survey, who will conduct it, and how it will be carried out.

• Surveys must be designed and carried out carefully to provide valid and reliable information.



• Health Risk Appraisal– The health risk appraisal (HRA) is a

type of survey instrument used to characterize a population’s general health status.

– It is used in different settings as a health education or screening tool.



• The HRA consists of three parts:– A questionnaire.– Certain calculations that predict risk of

disease.– An educational message or report to the

participant.

• HRAs are used to alert people about their risky health behaviors and how such behaviors might be modified through a lifestyle modification program.


Methods of Obtaining Data – Screening

• Screening– Screening is an important preventive

health activity designed to reverse, retard, or halt the progress of a disease by detecting it as soon as possible.


Methods of Obtaining Data – Screening

• Screening can be conducted in clinical and community settings and examples include:– Blood pressure checks– Blood cholesterol checks– Height and weight

• Screening programs are not meant to substitute for a health care visit but they do have educational value and serve to identify high-risk persons.


Methods of Obtaining Data – Focus Groups

• Focus Groups– Focus groups are informal groups of

about 5 to 12 people who are asked to share their concerns, experiences, beliefs, opinions, or problems.



• Focus groups can be used to:– Obtain advice and insights about new

products and services.– Research data and information about

key variables used in quantitative studies.

– Obtain opinions about products or creative concepts such as advertising campaigns or program logos.



• Focus groups are led by a trained moderator and listening is the most important skill used during focus groups.

• Information from a focus group is used to provide direction for the needs assessment or change a marketing strategy, product, or existing program.


Key Focus Group Questions



• Focus groups provide qualitative information that helps nutritionists understand: – How the nutritional problem

developed – Whether the target population

perceives a problem


Methods of Obtaining Data – Interviews

• Interviews with Key Informants – Interviews with key informants, or

people in the know about the community, can also provide information about the target population.


Methods of Obtaining Data – Interviews

• Informant interviews can be used to:– Complete a cultural assessment of the

target population.– Provide insights about whether the target

population perceives a nutritional problem and which actions for addressing the problem are culturally appropriate.

• Key informants may have worked with the target population in the community or conducted research on the population.


Methods of Obtaining Data – Direct Assessment

• Direct Assessment of Nutritional Status: An Overview of Methods– There are several methods for

conducting a direct assessment of nutritional status.



• Dietary assessment methods are used to determine an individual’s or population’s usual dietary intake and to identify potential dietary inadequacies.

• The primary methods of measuring food consumption of individuals include:– Diet History Method– Twenty-four-Hour Recall Method– Diet Record Method– Food Frequency Method



• Additional methods of assessing nutritional status include:– Other Diet Assessment Methods



• Additional methods (continued):– Laboratory methods can be used to

identify individuals at risk of a nutrient deficiency and to detect subclinical deficiencies.



• Additional methods (continued):– Measurements of the body’s physical

dimensions and composition, called anthropometric methods, are used to detect degrees of malnutrition and chronic imbalances in energy and protein status. • The most common growth indices include

measures of stature (height and length), weight, and circumference of the head.



• Additional methods (continued): – Clinical methods consist of a

medical history and physical examination to detect physical signs and symptoms associated with malnutrition.



• Clinical methods– The history includes a description of factors

such as living situation, existing clinical conditions, smoking status, medications, and usual level of physical activity.

– In the physical exam the clinician evaluates the major organ systems and examines the hair, face, eyes, lips, tongue, teeth and gums, and nails for signs of malnutrition.


Issues in Data Collection

• Practical Issues– The number of staff available to collect and

analyze the data.– The cost of administering the test.– The amount of time needed to identify and

interview or sample members of the target population.

– The assessment method chosen should be simple to administer, take only a few minutes to complete, be inexpensive, and be safe.


Issues in Data Collection

• Scientific Issues– Sensitivity versus specificity– Validity and reliability


Issues in Data Collection – Scientific

• Sensitivity - the proportion of subjects with the disease or condition who have a positive test for the disease or condition.– A sensitive test rarely misses people with

the disease or condition.– It is often used in screening situations in

which the purpose of the test is to detect a disease or condition in people who appear to be asymptomatic.



• Specificity - the proportion of subjects without the disease or condition who have a negative test.– Specific tests are used to confirm a

diagnosis.– The oral glucose tolerance test is a highly

specific test for diagnosing diabetes mellitus.

• Ideally, the assessment method should be both highly sensitive and highly specific.



• Validity - the ability of the instrument to measure what it is intended to measure.– Another word for validity is accuracy.– An instrument’s validity can be affected by

many factors including the characteristics of the respondent, the questionnaire design, the adequacy of reference data, and the accuracy of data input and management.



• Reliability - the ability of an assessment instrument to produce the same estimate of dietary intake, for example, on two separate occasions.– Other terms for reliability are precision,

repeatability, and reproducibility.– It is different from validity and it is possible

for an instrument to give reproducible results that are incorrect.


Issues in Data Collection – Cultural

• Cultural Issues– A cultural assessment of the target

population is needed before data collection begins.

– A cultural assessment is undertaken to identify appropriate and inappropriate behaviors within the target population’s culture.


Issues in Data Collection – Cultural

• The manner in which people greet each other, the types of questions that are appropriate to ask, body language, and customs differ among cultures.

• Survey questions must also be culturally appropriate.


Case Study 2: Nutritional Status of Independent Elderly Persons

• Before collecting data about the target population, the nutritionist reviews the purpose, goals, and objectives of the assessment and then develops a set of questions aimed at measuring the nutritional status of this target group.

• The nutritionist might consider a standard measure of health or nutritional status which is called a nutrition status indicator.



• A nutrition status indicator is a quantitative measure used as a guide to screen, diagnose, and evaluate interventions in individuals.



• Nutrition status indicators are often used to:– Estimate the magnitude of a nutrition

problem.– Its distribution within the population.– Its cause.– The effects of the programs and

policies designed to alleviate the problem.



• Several indicators, such as these, might be used in the nutritional status of the elderly.– A weight loss of 5 percent or more of

body weight in 1 month.– Being underweight or overweight.– Having a serum albumin below 3.5

grams per deciliter.


The Project L.E.A.N. Nutrition Campaign

• L.E.A.N. = Low-fat Eating for America Now

• Campaign of Orange County Head Start, Inc. target audience:– Over 3,500 low-income 3- and 4-year-old

children and their families– Enrolled at the 40 OCHS centers throughout

Orange County, CA – 76% of were members of the Hispanic

community



• Goals and Objectives– Improve the quality of life– Reduce the incidence of nutrition-

related chronic diseases– Means: low-fat eating and regular

physical activity



• Methodology– Nutrition lesson plan and food activity were

developed – Lesson emphasized low-fat food choices and

physical activity• Examples of low-fat foods• Food activities

– Obstacle course was developed to encourage physical activity

– Nutrition specialists conducted workshops for parents



• Results– Lesson/food activity was conducted in

at least 34 OCHS classrooms– Reached over 700 children– Nearly 2/3 of OCHS teachers reported

that children were able to name 2-4 low-fat and high-fat foods

– All students understood the importance of physical activity



• Results (continued)– 207 OCHS parents and families

participated in workshops– > 90% of the parents stated that they

gained new knowledge and found the workshop they attended to be worthwhile and easy to follow



• Lessons Learned– Students modeled their behavior to match

that of their teachers.– Factors to consider when offering services to

the parents of a culturally diverse, low-income preschool population:

• Limited income• Lack of transportation• Child care needs• Work schedule• Culture• Language


Putting It All Together

• This phase of the community needs assessment focuses on obtaining data about the target population.

• It is designed to find answers to questions about how extensive the nutritional problem is and how it developed.



• Once the data are analyzed the nutritionist must choose reference data against which the assessment’s outcomes can be compared.– Nutrient intake data are usually compared

with the Dietary Reference Intakes (DRIs).– Other data might be compared with

standards derived by the U.S. National Center for Health Statistics or the NHANES survey.



• Statements drawn from the data collected about the target population and from comparisons with reference data are then organized and added to the final report.

• The final report contains information about the target population and about the community in which it lives and works.


Lighten Up—Be Willing to Make Mistakes and Risk Failure

• What would our world be like if the following individuals had given up on their goals?– Florence Nightingale– Thomas Alva Edison– Fred Smith (founder of FedEx)



• The Secret of Success– Do your homework.– Write down your options and the

potential outcome of each.– Learn from your mistakes or failures.– Be committed to your goal.



• Words to Work By– “A great master teacher once said, ‘In

order to learn how to draw you have to make two thousand mistakes. Get busy and start making them.’”• R. Bateman, The Art of Robert Bateman

(Ontario: Penguin Books Canada, 1981), p. 19.

© 2006 thomson-wadsworth chapter 3 assessing the target population’s nutritional status

Documents

types of data

target populationquestions

data collection

data elements

lifestyle choices

community needs assessment

community nutritionist

health status