Benefits, Barriers, and Motivators to Training Dietetic Interns in Clinical Settings: A Comparison between Preceptors and Nonpreceptors.

BACKGROUND: The shortage of supervised practice sites in dietetics is associated with fewer numbers of preceptors available to supervise interns, especially in the clinical setting. OBJECTIVE: To identify clinical dietitians' perceived benefits and challenges of training dietetic interns and to determine key motivators that would entice nonpreceptors to volunteer for the role. DESIGN: Registered dietitian nutritionists working in clinical settings completed a semi-structured, audiotaped interview followed by a brief questionnaire. PARTICIPANTS: Clinical dietitians working in hospitals, long-term care facilities, and outpatient clinics (n=100) participated: 54 preceptors and 46 nonpreceptors. STATISTICAL ANALYSIS: Qualitative analysis was conducted using an iterative process to identify and code common themes. T tests were used to compare mean differences between the opinions of preceptors and nonpreceptors. RESULTS: Preceptors had approximately 5 more years of experience (mean=14.27±12.09 years) than nonpreceptors (mean=8.83±9.72 years) (P< 0.01). Furthermore, preceptors reported twice as many benefits to mentoring interns (mean=6.7 mentions/participant) as nonpreceptors (mean=3.4 mentions/participant), including knowledge gains and staying current. Lack of time was consistently noted as a barrier in interviews and rated as the greatest barrier in the survey. Both groups rated receiving continuing professional education units (CPEUs) for precepting as the greatest potential motivator for taking on interns. CONCLUSIONS: Incentive programs should be developed to entice nonpreceptors to take on interns. These programs should include extensive training on the preceptor role and how to alleviate the burden of time spent supervising interns and should provide a significant number of CPEUs to make the added workload worthwhile.

Increasing access and affordability of produce improves perceived consumption of vegetables in low-income seniors.

High cost and limited access to food have been associated with lower intake of fruits and vegetables in limited-income individuals. The Veggie Mobile is a van that carries fresh produce and travels in low-income neighborhoods, selling fruits and vegetables at a fraction of regular supermarket prices. The purpose of this study was to determine whether participation in the Veggie Mobile increases fruit and vegetable intake in a group of seniors. The intervention, buying fruits and vegetables from the Veggie Mobile, was implemented between April and October 2008 in two senior housing sites that had not previously received Veggie Mobile services. Participants were asked about fruit and vegetable intake using a modified six-item questionnaire based on the Behavioral Risk Factor Surveillance System at preintervention and again at 3 to 5 months. The post-survey also included questions about perceived benefits and barriers to using the Veggie Mobile. The two cross-sections of seniors were matched using date of birth. Wilcoxon signed rank test and paired samples t tests examined change in pre- and post-intervention variables. Seventy-nine older adults completed the baseline survey and 63 completed the post-survey. Of these, 43 participants completed both surveys (70% white [n=30], mean age 69 ± 9 years). Mean intake of fruits and vegetables after using the Veggie Mobile increased by 0.37 servings/day. Vegetable intake alone increased from 1.98 ± 1.71 servings/day to 2.58 ± 1.4 servings/day (P=0.027), half of which was potatoes. Change in fruit intake was not significant (P=0.358). At post-intervention, seniors visited the supermarket less often (P=0.001) and spent an average of $14.92 less during their last visit. The majority of participants who completed the post-survey (62 of 63) indicated being satisfied with the program. The Veggie Mobile provides an example of a simple community intervention that has potential to lead to positive behavior change among low-income seniors.

Overweight trends among children enrolled in the New York State special supplemental nutrition program for women, infants, and children.

The objective of this study is to describe overweight trends in a large, multiethnic, low-income population of preschool children by race/ethnicity and examine cohort changes in body mass index (BMI) distribution. Cross-sectional data were collected January 1 through March 31, every year, from 1989 to 2003. Subjects were children aged 2 to 4 years participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in New York State. The prevalence of overweight (BMI > or =95th age- and sex-specific percentile of the 2000 Centers for Disease Control and Prevention growth charts) was calculated for each year. Least squares regression compared trends in prevalence by race/ethnicity. Changes in BMI distribution were assessed graphically. Overweight prevalence increased 33% (12% to 16%). Prevalence was highest for Hispanics and lowest for non-Hispanic whites. Rates of increase (0.28 percentage points per year) were the same for Hispanic, non-Hispanic black, and non-Hispanic white children. The BMI distribution shifted toward higher values for all children studied; for 3- and 4-year-old children, the difference increased as BMI increased, indicating that, in 2003, the heaviest children were considerably heavier than the heaviest children were in 1989.

Barriers to the use of WIC services.

OBJECTIVES: To identify barriers that deter parents/caretakers of infants and children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) from taking full advantage of the services provided by the program. SUBJECTS/SETTING: A total of 3,167 parents/caretakers at 51 New York State WIC local agency sites completed a barriers survey. DESIGN: Sixty-eight potential barriers to WIC were identified through a literature review, five focus groups with parents/caretakers of WIC participants, and an expert review panel. The barriers survey was administered person-to-person to parents/caretakers of infants and children on WIC. Statistical analysis Classification tree analysis was used to identify characteristics that best predict WIC check usage behavior. RESULTS: A small set of barriers (n=11) were identified by more than 20% of respondents. Waiting too long was the most frequently cited barrier (48%). Difficulties in bringing the infant/child to recertify and rescheduling appointments were key variables associated with failure to use (ie, pick up or cash) WIC checks. Further analyses indicated that (a) for each additional reported barrier, there was a 2% increase in failure to use WIC checks (P<.0001); (b) waiting for services was related to an increase in the number of people who failed to use checks; and (c) the longer the reported wait, the greater the number of reported barriers (P<.0001). CONCLUSIONS: Conducting this barriers research enabled the New York State WIC to improve services provided to participants and their families. A decrease in waiting times should generally reduce exposure to noisy, crowded facilities and lead to fewer reports of nothing for kids to do.

Consumers' understanding of the Dietary Guidelines for Americans: insights into the future.

The purpose of this study was to examine consumers' knowledge and understanding of the 1995 Dietary Guidelines for Americans and the sources from where consumers obtain their health information. A telephone survey was administered to 400 adults in the Twin Cities area in Minnesota. The number of guideline recommendations recalled per person was, on average, less than 2.5 of a total of 13 recommendations. Participants had difficulties interpreting the guidelines. Knowledge of the dietary fat guideline was especially poor. Only 17% of survey participants correctly stated the amount of total fat they should have in their diet. The total number of media sources used to obtain health information was the variable that best explained the variance in knowledge of the Dietary Guidelines recommendations. To effectively change dietary behavior, health educators must work effectively with the media to develop behavior-focused nutrition messages that are meaningful and clear to consumers.