Beyond ADA Accessibility Requirements: Meeting Seniors' Needs for Toilet Transfers.

PURPOSE: To identify the optimal spatial and dimensional requirements of grab bars that support independent and assisted transfers by older adults and their care providers. BACKGROUND: Although research has demonstrated that toilet grab bars based on the Americans with Disabilities Act (ADA) Accessibility Standards do not meet the needs of older adults, the specific dimensional requirements for alternative configurations are unknown. METHODS: A two-phased study with older adults and care providers in residential facilities was conducted to determine the optimal requirements for grab bars. Seniors and caregivers in skilled nursing facilities performed transfers using a mock-up toilet. In Phase 1, participants evaluated three grab bar configurations to identify optimal characteristics for safety, ease of use, comfort, and helpfulness. These characteristics were then validated for using ability-matched samples in Phase 2. RESULTS: The optimal configuration derived in Phase 1 included fold-down grab bars on both sides of the toilet (14" from centerline [CL] of toilet, 32" above the floor, and extended a minimum of 6" in front of the toilet) with one side open and a sidewall 24" from CL of toilet on the other. Phase 2 feedback was significantly positive for independent and one-person transfers and somewhat lower, albeit still positive, for two-person transfers. CONCLUSION: The study provides substantial evidence that bilateral grab bars are significantly more effective than those that comply with current ADA Accessibility Standards. Findings provide specific spatial and dimensional attributes for grab bar configurations that would be most effective in senior facilities.

The acceptability of dietary tools to improve maternal and child nutrition in Western Kenya.

OBJECTIVE: Dietary practices in Kenya often fail to provide adequate nutrition during the first 1000 days of life, from conception to 2 years of age. We developed and qualitatively assessed the acceptability of easy-to-use dietary tools consisting of a marked bowl, slotted spoon and illustrated counselling card to support appropriate dietary practices during pregnancy, exclusive breast-feeding and complementary feeding of children aged 6-24 months. DESIGN: We conducted qualitative research to assess community acceptability and obtain feedback on the design of the dietary tools. SETTING: This research took place in urban and rural communities in Western Kenya. SUBJECTS: We conducted twelve focus group discussions with community members (mothers, husbands, mothers-in-law, community leaders) and five interviews with government nutritionists to assess acceptability and obtain recommendations on design and delivery of the tools. We conducted 24-28 d of user testing with fourteen pregnant women, fourteen breast-feeding women and thirty-two mothers with infants aged 6-18 months. RESULTS: Tools were positively received by communities. Mothers perceived improvements in their own and their children's food intakes including quantity, frequency, consistency and diversity. Many attributed perceived own and child's weight gain and/or increased energy to tool use. A minority reported using the bowl for other activities (n 9) or not using the bowl due to food insecurity (n 5). CONCLUSIONS: Results suggest that such tools have the potential to positively impact maternal and child dietary practices. Future work should quantitatively assess the impact on diet and nutrition outcomes and the underlying behavioural domains associated with changes.

Acceptability and utility of an innovative feeding toolkit to improve maternal and child dietary practices in Bihar, India.

BACKGROUND: Dietary practices in India often fail to provide adequate nutrition during the first 1,000 days of life. OBJECTIVE: To explore the acceptability and utility of a low-cost and simple-to-use feeding toolkit consisting of a bowl with marks to indicate meal volume and frequency, a slotted spoon, and an illustrated counseling card to cue optimal dietary practices during the first 1,000 days. METHODS: In Samastipur District, Bihar, India, we conducted 16 focus group discussions and 8 key informant interviews to determine community acceptability and obtain feedback on design and delivery of the feeding toolkit. We conducted 14 days of user testing with 20 pregnant women, 20 breastfeeding women 0 to 6 months postpartum, and 20 mothers with infants 6 to 18 months of age. RESULTS: The toolkit, which is made of plastic, was well accepted by the community, although the communities recommended manufacturing the bowl and spoon in steel. The proportion of pregnant and breast-feeding women taking an extra portion of food per day increased from 0% to 100%, and the number of meals taken per day increased from two or three to three or four. For children 6 to 18 months of age, meal frequency, quantity of food consumed during meals, and thickness of the foods increased for all age groups. Children 6 to 8 months of age who had not yet initiated complementary feeding all initiated complementary feeding during the testing period. CONCLUSIONS: Simple feeding tools are culturally acceptable and can be appropriately used by families in Bihar, India, to improve dietary practices during the first 1,000 days of life. Research is needed to assess whether the tools promote dietary and nutritional improvements over and above counseling alone.