Creating potential for common ground and communication between early childhood program staff and parents about young children's eating.

OBJECTIVES: To explore child care staff and parent perspectives and communications about children's eating in child care. DESIGN: Focus groups (FGs) conducted with child care staff and parents. SETTING: Four Western states in the United States. PARTICIPANTS: Thirty-nine child care staff in 7 FGs and 25 parents in 6 FGs. PHENOMENON OF INTEREST: Thoughts and concerns about children's eating and opportunities to improve communication between staff and parents. ANALYSIS: Content analysis (FG coding inter-rater reliability: staff = 0.74; parents = 0.81) and identification of meta-themes. RESULTS: Three meta-themes were identified: (1) recognition of positive influences of the child care setting in children's development of healthy eating; (2) concerns about children's eating in child care and at home; and (3) strategies to improve communications and transactions related to children's eating. CONCLUSIONS AND IMPLICATIONS: Staff reported that their roles included informing parents about food at mealtimes in child care (eg, menus, recipes) but also educating parents about child nutrition and feeding. Parents valued daily information about their child's eating to adjust home mealtimes and to feel connected to their child. Barriers to effective communication included limited time and concerns regarding parent reactions and defensiveness. Staff requested training about child nutrition and feeding and about sensitive communications with parents.

Attitudes, concerns, and likelihood for action related to young children's overweight among early childhood program staff.

For obesity prevention planning in early childhood programs, attitudes and actions of staff related to communicating with parents about young children's eating and weight need to be assessed. Early childhood program teachers (n = 271) working with children aged 3 to 5 years were surveyed by mail. Factor analysis provided patterns of response for multi-item questions. Respondents reported different levels of agreement and comfort regarding communicating concerns to parents about their child's weight and eating versus observations about the child's daily eating. Feelings about parent communication varied (worried, hesitant, responsible, and willing). Findings suggest opportunities for communication between program staff and parents.

Goal setting education and counseling practices of diabetes educators.

PURPOSE: The purpose of this study was to identify goal setting education practices used by diabetes educators working with type 2 diabetes patients. METHODS: Data were collected by a mail questionnaire with 179 diabetes educators purposively selected from the 2008 American Association of Diabetes Educators membership listing. RESULTS: Many diabetes educators (52%) reported that more than 75% of their patients set goals for diabetes control. Independent factor patterns for the frequency of information collected from the patient for the first diabetes education session showed that educators either focused on patients' self-management practices (exercise and dietary practices, knowledge, and social impacts of diabetes) or issues with learning about self-management, such as understanding the patient's learning style and motivation for managing diabetes. Factor patterns overall showed diverse approaches to working with patients, including strategies used with patients struggling with dietary goals and the importance of tasks to complete during the first patient session. CONCLUSION: Although most educators reported practices that were largely patient centered as promoted by the American Diabetes Association (ADA) and models of chronic disease management, patterns of practice suggest that diabetes educators vary considerably in how they apply education practices, especially with dietary self-management education.

Perceptions of diabetes symptoms and self-management strategies: a cross-cultural comparison.

PURPOSE: The purpose of this research was to compare and contrast perceived symptoms of type 2 diabetes mellitus and self management strategies between Russian-speaking Slavic immigrant American women and non-Hispanic, nonimmigrant White American women. METHODS: The qualitative­descriptive study design was conducted with a convenience sample of Slavic immigrant women 50 years of age and older with type 2 diabetes (n = 10), and non-Hispanic, nonimmigrant White American women 50 years of age and older with type 2 diabetes (n = 10). RESULTS: Slavic immigrants reported more global holistic symptoms of diabetes, whereas nonimmigrants reported more specific physiological somatic symptoms. The nonimmigrant women used more complex diabetes self-management techniques compared with the Slavic group. A lack of education and awareness of hypoglycemia may contribute to less medication adherence in Slavic immigrants and may prevent them from being motivated to participate in diabetes self-management. DISCUSSION AND CONCLUSIONS: Health care providers caring for Slavic immigrant women with diabetes need to be aware that these women may fail to recognize the symptoms of hypoglycemia and seldom acknowledge depression, although depressive symptoms are often present. Culturally congruent health care will increase adherence and improve health outcomes for Slavic immigrant women.

Assessing diabetes dietary goals and self-management based on in-depth interviews with Latino and Caucasian clients with type 2 diabetes.

Latino (n = 10) and Caucasian (n = 8) clients with type 2 diabetes receiving care at a community health clinic participated in individual in-depth interviews assessing diabetes dietary self-management goal behaviors. Themes from interviews were identified using content analysis, which revealed current and future goals, influencing factors, and motivators and barriers to dietary modification for diabetes management. Implications for practice include simplifying goal setting to those goals with the greatest potential clinical impact or the greatest significance to the patient, in a socially supportive environment. Results contribute to future survey development and understanding how to optimize diabetes education for these populations.

Slavic women's understanding of diabetes dietary self-management and reported dietary behaviors.

BACKGROUND: Slavic women with type 2 diabetes are an understudied group for issues related to dietary self-management for diabetes and heart health. METHODS: A single home or extension office visit was conducted with ten Slavic women for an individual in-depth interview, clinical and physical assessment, and a survey questionnaire. RESULTS: Participants were in poor diabetes control. They reported changes in traditional foods to better support diabetes control and heart health. Most appeared responsive to their health care provider's recommendations and valued cooking classes from a Russian-speaking educator. Barriers included perceived expense of a healthy diet. Cultural bridges between patients and their caregivers were critical supports for self-management. DISCUSSION AND CONCLUSIONS: Support of Slavic women with diabetes should include health care providers knowledgeable about Slavic dietary and health concepts, Russian-speaking educators who can bridge between traditional foodways and the U.S. food system, and appropriate involvement of the patient's social support network.

Metabolic syndrome in a multiethnic sample of school children: implications for the pediatric nurse.

There is lack of translational work that may assist the pediatric nurse in identifying the child who is at risk for metabolic syndrome. Early identification of the syndrome could assist pediatric health care providers in intervening and in lowering child health risks. Fasting serum insulin, metabolic syndrome criteria, and dietary intake were examined in a multiethnic sample of children aged 9-15 years. Forty-seven percent had two or more risk factors for metabolic syndrome, and 28% had three or more risk factors. Insulin levels were negatively correlated with the recommended dietary allowance. A regression model, including gender, age, race, body mass index, serum glucose, high-density lipoprotein cholesterol, triglycerides, and blood pressure, explained 48% of insulin variance.

Understanding patient experiences with goal setting for diabetes self-management after diabetes education.

Diabetes educators need to understand self-care experiences of patients with diabetes in the early stage after diagnosis and education. A survey assessed patient-generated measures of experiences with goals (self-care behaviors) after diabetes education among patients with type 2 diabetes (N = 97) between 6 months and 1.5 years since diagnosis. Most patients set goals during diabetes education and thought that the goals were useful. There is evidence suggesting that patients experiencing difficulty with traditional self-care behaviors may use approaches to evaluate their diabetes control that are not encouraged in diabetes education, such as monitoring their physical and emotional feelings. Implications for diabetes education and counseling practices are suggested.

Application of a five-step message development model for food safety education materials targeting people with HIV/AIDS.

Individuals with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome have an increased risk of contracting foodborne illnesses and need to take special precautions regarding food safety. We implemented a five-step model to assess the needs of people with HIV, develop education materials targeted to their needs, and evaluate acceptance of the materials. Needs assessment focus groups (n=8) with HIV-infected people (n=65) and interviews with health care providers (n=18) were conducted to determine motivators and barriers to adopting food safety recommendations. Education materials were developed using needs assessment data, literature on foodborne illnesses, and the Health Belief Model. Acceptability of materials was evaluated by focus groups (n=4) with HIV-infected people (n=32) and a survey of health care providers (n=25). Needs assessment focus group participants expressed resistance to and confusion about many recommendations. Prototype materials were designed to address barriers and motivators. HIV-infected people who reviewed the prototype materials in evaluation focus groups expressed positive attitudes about the materials, and most indicated willingness to follow recommendations. Health care providers were interested in distributing the education materials to their clients. Carefully listening to HIV-infected people and their health care providers, as well as detailed investigation of the literature on foodborne illnesses, contributed to acceptance of the education materials.

The meaning of mealtimes: connection to the social world of the nursing home.

Food that reflects our family backgrounds is a source of comfort that can play an important part in recovery from illness or adaptation to the nursing home, especially for older individuals. However, no studies could be found that explored residents' perspectives on how their food and food service preferences are, or are not, met in nursing homes. This exploratory qualitative study examined dietary preferences acquired during the course of a lifetime, and the meaning of mealtimes to 20 nursing home residents, and attempted to connect that meaning with their social world. Exploring the meaning of food and food service to nursing home residents could furnish insights for improving nutritional status, adaptation to the nursing home, and quality of life through promotion of individualized nutritional care.

Organizational issues related to satisfaction with food and food service in the nursing home from the resident's perspective.

This paper reviews organizational factors that potentially affect food quality and food service in the nursing home. A model is proposed for assessing the influence of organizational technology on resident satisfaction with food and food service from the resident's perspective. Findings from an exploratory phenomenological case study applying the model are presented. Staff knowledge of how to prepare and serve food properly, and staff availability to serve food on time, were key constructs. Resident-staff interactions appeared to moderate resident control over food and food service. Recommendations are suggested for improved communication between residents and staff to address certain limitations and enhance empowerment of residents.

Resident coping strategies in the nursing home: an indicator of the need for dietary services change.

Inadequate food intake leading to malnutrition impacts up to 85% of nursing home residents. Malnutrition can result in compromised quality of life and lead to chronic disability, functional decline, increased health care utilization and costs, and death. This article examines organizational structure (Perrow, 1979) and person-environment fit (Lawton, 1982) as factors in nutritional care of nursing home residents. The strategies used by residents to cope with organizational food and food service issues, competence, and environmental press in the nursing home can alert nurses to the need for changes in dietary services to increase food intake and quality of life.

Homocysteine in a multi-ethnic sample of school-age children.

Cardiovascular disease is a major cause of morbidity and mortality in the United States and other developed countries; arterial lesions that are precursors of disease begin during childhood. Homocysteine levels have been associated with cardiovascular disease rates in adults, but information about levels in and impact on children is limited, particularly among various ethnic groups. This study examined the cardiovascular risk factors of a multi-ethnic sample of 100 9-15 year-old Native American, Hispanic, White, and mixed race children in rural central Washington. The mean fasting homocysteine level was 5.82 micromol/l (+/- 1.47), with no significant differences noted among ethnic groups. Mean dietary intake of folate, vitamin B6, and vitamin B12 exceeded current Recommended Dietary Allowances. Homocysteine levels did not show statistically significant correlations with cardiovascular risk factors. Homocysteine levels were not found to be a cardiovascular risk factor of importance, nor were significant ethnic differences found, in Native American, Hispanic and White children consuming adequate diets.

Evaluation of a Five-A-Day recipe booklet for enhancing the use of fruits and vegetables in low-income households.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) needs to evaluate appropriate nutrition education for its at risk audience, including Five-A-Day for Better Health educational material that promotes consumption of five servings a day of fruits and vegetables. An evaluation was conducted of a Five-A-Day recipe booklet for use with mothers having a child or children enrolled in WIC. Three clinic sites in eastern Washington State tested the booklet using a pretest (n = 225)/post-test (n = 167) design and an intervention protocol based on preliminary focus group data. The booklet featured information on fresh produce and was accordingly tested over the summer months. Participants were on average 28 years of age and mostly White (77%). After receiving the booklet, many WIC mothers reported feeling more confident about choosing good quality fresh produce (70%) and storing fruits and vegetables appropriately (68%), and also felt that it was easier to include fruits and vegetables in their family's meals (74%). Many mothers reportedly served more fruits and vegetables to their families after receiving the booklet. Notably, this occurred at numerous meals and snack times with both fruits and vegetables, and was independent of a reported trend to consume more fruits and vegetables in the summer. Mothers also favorably evaluated the format and content of the booklet. However, mothers' barriers related to fruits and vegetables did not change, and their estimated intake of fruits and vegetables decreased slightly over the intervention period. Adjustments to the protocol are suggested that may enhance the booklet's effect on WIC mothers' attitudes and behaviors.

Coping strategies and nutrition education needs among food pantry users.

In response to unexpectedly high rates of household food insecurity in Washington State, focus groups were conducted with food pantry users in nine locations across the state to explore access and barriers to food, strategies for coping with food insecurity, and nutrition education needs. All respondents had children and spoke English. Participants reported household food insecurity and concerns about feeding children and getting through the month. Stretching food dollars was the most requested topic for nutrition education. Nutrition educators need to be responsive to people's educational needs and the emotional demands associated with food insecurity at the program and community levels.