Multiple Perspectives on Nutrition Education Needs of Low-Income Hispanics

As part of a multi-level nutrition intervention for low-income Hispanics (LIH) and the professionals and paraprofessionals who serve them, focus groups were used to 1) identify nutrition education needs and preferred means of receiving nutrition information, 2) identify the LIH's barriers/motivators to dietary behavior change, and 3) assess the feasibility of using abuelas (Hispanic grandmothers) as educators. Nine focus groups were conducted using trained, local bilingual and bicultural moderators. Low-income Hispanics' primary concerns were their children's nutritional habits and ways to prepare quick, nutritious meals and snacks. Their major barriers to dietary change were financial limitations, lack of time, and family customs/habits. Professionals were concerned with the lack of interagency cooperation. Paraprofessionals were most interested in training on how to teach. All audiences preferred to receive nutrition education through classes with hands-on, interactive formats. Professionals and paraprofessionals noted advantages and disadvantages to using abuelas as educators. Including three populations in the needs assessment allowed comparisons of perspectives across groups and allowed the design of nutrition education programs appropriately targeted to these populations.     

Online discussions with pregnant and parenting adolescents: perspectives and possibilities

The Internet is an innovative strategy to increase public participation. It is important to include pregnant and parenting teens' perspectives when planning programs to meet their needs. This qualitative study explored online discussions as a strategy to enhance participation by this population. Findings showed that online communication was preferred over face-to-face group discussions. Being anonymous online encouraged open and honest feedback. Participants experienced various forms of social support, however, there was an overall lack of teen involvement online. Strategies to engage adolescents in online discussions and reduce barriers are discussed. Strategies included the use of teen moderators, home computer access, technical support, and engagement in naturally flowing online discussions to meet social support needs. Blending researchers' with teens' needs for social support in an online environment is encouraged. With careful planning and design, online communications can result in mutual benefits for researchers, service providers, and pregnant and parenting adolescents.     

Factors associated with attendance in a voluntary nutrition education program.

PURPOSE: This paper examines factors associated with attendance in a National Cancer Institute-funded randomized trial of nutrition education to increase fruit and vegetable consumption among women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). SETTING: The study took place at 16 WIC sites in Maryland. SUBJECTS: The participants were 1528 women who were enrolled in WIC or who had children enrolled in WIC, were > or = 18 years of age, and planned to continue enrollment at that WIC site for at least 6 months (68% of eligible women approached agreed to participate). INTERVENTION: Women received personal invitations, letters, and telephone reminders from peer educators encouraging their attendance at three bimonthly nutrition sessions. MEASURES: Demographic data were collected in a baseline survey. Attendance data and telephone and address changes were also collected. The postintervention survey included a question regarding reasons for nonattendance. Focus groups were also held to ascertain reasons for attendance or nonattendance. Chi-square tests of trend and multiple logistic regression, adjusted for within-site correlation, were used in statistical analyses. RESULTS: Fifty-four percent of enrollees attended at least one session. Multiple logistic regression analysis showed increased odds of attending with higher age, breast-feeding, and/or knowledge of the recommendation to eat five or more servings of fruits and vegetables daily. There were decreased odds of attending for pregnant women who already had children. There were nonsignificant trends toward decreased attendance among unmarried women compared with married women and among blacks compared with nonblacks. Reasons given for nonattendance included withdrawal from WIC, moving, conflicting activities, negative feelings about nutrition education, and lack of transportation or child care. CONCLUSIONS: The results suggest that numerous barriers hinder participation in nutrition programs aimed at low-income women. These barriers should be considered by health care professionals when planning intervention programs. Overcoming these barriers presents a major challenge.     

Messages from moms: barriers to and facilitators of behavior change in a lead poisoning preventive education project

Qualitative focus group data from participants of an intensive, culture-specific, lead poisoning preventive education research project were analyzed to assess success of communication strategies, and, specifically, to identify barriers to and facilitators of adopting behavior changes encouraged in the project. Effectiveness of education in preventing lead poisoning is addressed elsewhere. Education focused on housecleaning, hygiene, water, and nutrition. Ninety-five participants (89% of 107 eligible) of six ethnicities agreed to participate in focus groups. Seventy-eight (82%) actually attended. Barriers to behavior change included the effort required or unpleasantness of a prevention strategy, presentation of familiar information, denial of the problem, busyness, perceived lack of control, lack of social support, cultural traditions, and misunderstandings. Requiring one-time behavior changes; teaching simple, easy strategies; making less appealing tasks fun; demonstrating concepts; and presenting novel material that piques interest were features of the education that facilitated behavior change. Factors internal to the participant, such as love of the child or cultural practices, also served to motivate the participant to change behavior or to facilitate adoption of a prevention strategy. We offer recommendations to assist others in designing effective health education and risk communication prevention or intervention programs.     

Messages From Moms: Barriers to and Facilitators of Behavior Change in a Lead Poisoning Preventive Education Project

Qualitative focus group data from participants of an intensive, culture-specific, lead poisoning preventive education research project were analyzed to assess success of communication strategies, and, specifically, to identify barriers to and facilitators of adopting behavior changes encouraged in the project. Effectiveness of education in preventing lead poisoning is addressed elsewhere. Education focused on housecleaning, hygiene, water, and nutrition. Ninety-five participants (89% of 107 eligible) of six ethnicities agreed to participate in focus groups. Seventy-eight (82%) actually attended. Barriers to behavior change included the effort required or unpleasantness of a prevention strategy, presentation of familiar information, denial of the problem, busyness, perceived lack of control, lack of social support, cultural traditions, and misunderstandings. Requiring one-time behavior changes; teaching simple, easy strategies; making less appealing tasks fun; demonstrating concepts; and presenting novel material that piques interest were features of the education that facilitated behavior change. Factors internal to the participant, such as love of the child or cultural practices, also served to motivate the participant to change behavior or to facilitate adoption of a prevention strategy. We offer recommendations to assist others in designing effective health education and risk communication prevention or intervention programs.     

Practicing Preventive Health: The Underlying Culture Among Low-Income Rural Populations

Context: Health disparities on the basis of geographic location, social economic factors and education levels are well documented. However, even when health care services are available, there is no guarantee that all persons will take preventive health measures. Understanding the cultural beliefs, practices, and lifestyle choices that determine utilization of health services is an important factor in combating chronic diseases. Purpose: The purpose of this study was to investigate personal, cultural, and external barriers that interfered with participating in a community-based preventive outreach program that included health screening for obesity, diabetes, heart diseases, and hypertension when cost and transportation factors were addressed. Methods: Six focus groups were conducted in a rural community of Louisiana. Focus groups were divided into 2 categories: participants and nonparticipants. Three focus groups were completed with Dubach Health Outreach Project (DUHOP) participants and 3 were completed with nonparticipants. The focus group interviews were moderated by a researcher experienced in focus group interviews; a graduate student assisted with recording and note-taking during the sessions. Findings: Four main themes associated with barriers to participation in preventive services emerged from the discussions: (1) time, (2) low priority, (3) fear of the unknown, and (4) lack of companionship or support. Health concerns, free services, enjoyment, and free food were identified as motivators for participation. Conclusions: The findings of this study indicated that the resulting synergy between low-income status and a lack of motivation regarding health care prevention created a complicated practice of health care procrastination, which resulted in unnecessary emergency care and disease progression. To change this practice to proactive disease prevention and self care, a concerted effort will need to be implemented by policy makers, funding agents, health care providers, and community leaders and members.     

Experiences of food insecurity among urban soup kitchen consumers: insights for improving nutrition and well-being

Adequate nutrition is an essential determinant of health. Disadvantaged individuals within the cities of developed countries continue to have poor health, yet the role of food insecurity in such groups is poorly understood. This cross-sectional study describes such experiences among 22 randomly selected participants who participated in interviews at a charity-run soup kitchen in urban Sydney, Australia. Interviews explored four constructs of food insecurity (quantitative, qualitative, psychological, and social), identifying related barriers and coping strategies. Reliable access to food was limited. Low income; high rents; poor health; and addictions to cigarettes, alcohol, illicit drugs, and gambling were associated with dependence on charities. Poor dentition and lack of food storage and cooking facilities were important barriers to adequate nutrition. Meals were missed and quantities restricted as a coping strategy. Participants demonstrated adequate knowledge and a desire to eat healthful food. Opportunities for social interaction and trust in soup kitchen staff were important motivators of attendance. Strategies to reduce food insecurity among seriously disadvantaged city dwellers should focus less on education and more on practical solutions, such as accessing affordable healthful food for those without kitchen facilities, improving dentition, and reducing addictions. It is also important to facilitate social networks with trusted support organizations.     

A Qualitative Study of Motivators,Strategies, Barriers,and Learning Needs Related to Healthy Cooking during Pregnancy

Nutrition during pregnancy has lifelong impacts on the health of mother and child. However, this life stage presents unique challenges to healthy cooking and eating. Cooking interventions show promising results, but often lack theoretical basis and rigorous evaluation. The objective of this formative, qualitative study was to explore motivators, strategies, and barriers related to healthy cooking during pregnancy. Pregnant individuals’ preferences for a cooking education program were also explored. We conducted five focus groups with pregnant individuals (n = 20) in Southeast Michigan in 2019. Focus groups were audio-recorded and transcribed verbatim, then double coded by two members of the research team. Mean gestational age was 18.3 ± 9.6 weeks. Common motivators included feeding other children, avoiding pregnancy complications, promoting fetal growth, and avoiding foodborne illness. Challenges included pregnancy symptoms, navigating nutrition recommendations, mental energy of meal planning, family preferences, and time constraints. Strategies employed were meal planning and including a variety of foods. Participants identified organizational strategies, recipes, nutrition information, and peer support as important components of a cooking intervention during pregnancy. This study characterized multiple challenges to healthy home cooking during pregnancy, providing novel insight to inform the development of cooking skills education programs during this important life stage.     

Barriers to and Suggestions for a Healthful,Active Lifestyle as Perceived by Rural and Urban Costa Rican Adolescents

ObjectiveTo assess the perceptions of rural and urban Costa Rican adolescents regarding which barriers and motivators affect their adoption of an active lifestyle.DesignData were collected in focus group discussions.Participants108 male and female adolescents aged 12 to 18 from the 7th to 11th grades.SettingTwo urban and 1 rural high school in San José, Costa Rica.Phenomena of InterestActive lifestyle; barriers and motivators for active life.AnalysisData were reviewed for emerging themes, and themes were coded using content analysis procedures.ResultsMajor barriers: (a) physical education curriculum was focused on competitive sports; (b) lack of facilities in the school and community environments; (c) family did not provide good role models and reinforced the socially expected gender roles. Key motivators: (a) changed the physical education curriculum to focus on leisure and recreational activities; (b) increased the availability of facilities both in the school and in the community; and (c) provided a strong social support network.Conclusions and ImplicationsThe school, community, and family environments are potential targets for physical activity interventions for adolescents. Future studies should explore in depth the influence of adolescent socialization patterns (particularly for females) in the establishment of an active lifestyle.     

Teenagers and food choices: The impact of nutrition education

We examined changes in food-choice behavior, nutrition knowledge, and attitudes of junior and senior high school students in a three-year national study of nutrition education integrated into home economics, health, science, and social studies. Key findings useful in understanding the impact of nutrition education on adolescent food choices were that 1) study participants' nutrition knowledge improved, 2) their attitudes toward nutrition—positive before instruction—became more positive, and 3) their intentions to include more high-nutrient foods in their diet increased significantly. Our results suggest that teacher experience and commitment to nutrition education are important factors in influencing teenagers to change food consumption patterns in positive directions. Variables in the school setting most closely related to positive change included support from within the school system and from external forces encouraging the teaching of nutrition. Also important to policy makers are the findings that nutrition education for adolescents can be effective under a broad range of conditions.     

Food Standards Agency multidisciplinary workshop: children's food choice in the family setting

Summary   There has been relatively little research on public health nutrition interventions for families and children, compared with, for example, work in schools. In Spring 2007, the UK Food Standards Agency held a multidisciplinary workshop on food choice in families and children, bringing together researchers from psychology, social sciences, public health and nutrition. The objectives of the workshop were to form an up-to-date view of the influences on children's and young people's food choice within the family, and identify future research needs. The participants identified six key areas for future research: multidisciplinary collaboration; using mixed research methods; developing new research methods; identifying family-related diversity and tailoring interventions towards this; understanding the effects of different parenting styles and the relevance of these to implementing interventions; and developing a more sophisticated understanding of barriers and motivators to food-related change in families.     

Altering the perceptions of WIC health professionals about childhood obesity using video with facilitated group discussion

OBJECTIVE: To determine if viewing a documentary video, followed by facilitated group discussion, could alter the perceptions of those providing public health nutrition services about the barriers and solutions to addressing the problem of obesity in low-income preschoolers. DESIGN: Before-after trial to determine how often study participants could identify any of the 17 barriers and seven solutions targeted in the video and during the facilitated group discussion. SUBJECTS/SETTING: One hundred fifty-five attendees of the 2001 Kentucky Maternal and Child Health Conference participated in the study. Sixty percent were nurses, 24% were dietitians or nutritionists, and 64% had Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) counseling experience. INTERVENTION: Participants first viewed a 20-minute documentary video about three families enrolled in WIC. A 40-minute facilitated group discussion followed to highlight the 17 barriers (eg, WIC families are struggling with many demands in their lives that make nutrition a low priority and WIC health professionals "lecture" clients on what they "need to know") and seven solutions (eg, adjusting WIC counseling to assess parenting skills and to increase sensitivity to clients' life context and stresses). MAIN OUTCOME MEASURES/ANALYSES: Participants responded before and after the intervention to the same two open-ended questions, one about barriers and one about solutions. Participant responses were coded to count instances of identifying any of the 17 barriers and seven solutions. RESULTS: At baseline, 51% of participants were unable to record any of the barriers, and 91% could not identify any of the solutions. After the intervention, 37% could identify at least one more of the target barriers than they did at baseline, and 24% could identify at least one more of the target solutions. CONCLUSIONS: A documentary-style video, used with facilitated group discussion, can produce a short-term change in the perceptions of those providing public health nutrition services about addressing the problem of obesity in low-income preschool children.     

Knowledge, Attitudes, and Behaviors of Low-Income Women Considered High Priority for Receiving the Novel Influenza A (H1N1) Vaccine

The primary purpose of this qualitative study was to explore the knowledge, attitudes, and behaviors of low-income women considered high priority for receiving the novel influenza A (H1N1) vaccine to improve communication in emergency preparedness and response. Researchers sought to identify the factors that affect this high priority population’s ability to successfully comply with vaccination recommendations. By utilizing an existing communication framework through the special supplemental nutrition program for women, infants, and children (WIC) they were able to document the systems and infrastructure needed to foster constructive responses in a sustainable manner in the future. Six focus group discussions with WIC clients (n = 56) and 10 individual interviews with staff members were conducted at two WIC clinics in Georgia (1 urban and 1 rural). Data were collected after the 2009–2010 influenza season and analyzed using thematic analysis. Knowledge and attitudes regarding H1N1 differed among participants with regard to perceived severity and perceived risk of influenza illness. Participants identified several barriers and motivators to receiving the vaccination, as well as information needs, sources, and information-seeking behaviors. Similarities emerged among both WIC clients and staff members regarding impressions of H1N1 and the vaccine’s use, suggesting that while the information may be provided, it is not effectively understood or accepted. Comprehensive education, policy and planning development regarding pandemic influenza and vaccine acceptance among low-income women is necessary, including improvements in risk communication messages and identifying effective methods to disseminate trusted information to these high priority groups.     

Adherence to medication regimens among low-income patients with multiple comorbid chronic conditions

This qualitative study sought to explore facilitators and barriers to adherence to multiple medications among low-income patients with comorbid chronic physical and mental health conditions. The 50 focus group participants identified personal/contextual and health system factors as major impediments to adherence to multiple medications. These factors included medication side effects, fear of harm from medication, fear of dependence on medication, complex instructions, suboptimal communications with doctor, suspicion about doctors' and pharmaceutical companies' motives in prescribing medication, and the high cost ofmedications. Participants also identified motivators, both internal (self-initiated) and external (initiated by family, doctor, support groups),to ensure adherence to multiple medications. These motivators included self-discipline, sense of personal responsibility, faith, support from family members and doctors, and focused health education and self-management support. Three themes emerged that enhanced understanding of the complexity of adherence to multiple medications: (1) reaching one's own threshold for medication adherence, (2) lack of shared information and decision making, and (3) taking less than the prescribed medication. Further analysis of the data revealed that the patients perceived a lack of shared decision making in the management of their comorbid chronic conditions and their medication regimen.     

Design of an intervention addressing multiple levels of influence on dietary and activity patterns of low-income,postpartum women

Low-income, multi-ethnic women are at elevated risk for obesity and chronic diseases, yet influences at different levels may act as barriers to changing risk behaviors. Following the birth of a child, childrearing and social isolation can exacerbate these influences. The social ecological framework integrates behavior-change strategies at different levels, providing a strong theoretical base for developing interventions in this high-risk population. The primary purpose of this randomized controlled trial is to test the efficacy of an educational model delivered by community-based paraprofessionals in improving diet, activity and weight loss among new mothers over a 12-month postpartum period and a 6-month maintenance period. This model fosters institutional change to support behavior changes influenced at intrapersonal and interpersonal levels, through collaboration with federal programs for low-income families: the Special Supplemental Food Program for Women, Infants and Children (WIC), and the Expanded Food and Nutrition Education Program (EFNEP). Participants are randomized to the Usual Care, e.g. WIC nutrition and breastfeeding education, or Enhanced EFNEP intervention arm, consisting of Usual WIC Care plus a sustained, multi-component intervention including home visits, group classes and monthly telephone counseling. If shown to be efficacious, this program will be readily sustainable through existing federal agencies.     

Codesigned recommendations for increasing engagement in structured physical activity for people with serious mental health problems in Australia

People with mental health problems are at higher risk of physical health comorbidities and early mortality. A key risk factor for poor health outcomes is a lack of regular physical activity. Mental health services have typically responded by focusing on screening and promoting lifestyle programmes within secondary care mental health settings. The aim of this study was to better understand the barriers and enablers for Australian mental health consumers to participate in physical activity or exercise programmes from the perspectives of consumers and exercise practitioners. Interviews with 15 consumers experiencing serious mental health problems and five exercise practitioners were undertaken, followed by two focus groups (involving eight consumers and two exercise practitioners) to gain consensus on themes from the interviews, and codesign a set of recommendations for services to support and increase the engagement of mental health consumers in regular community‐based exercise. Barriers that impacted on engagement in physical activity included: lack of social support, insufficient knowledge and information, difficulties with work/life balance, impact of physical and mental health issues, fear and lack of confidence, and financial cost. Enablers or motivators assisting engagement in community‐based physical activity programmes included: social support, access to person‐centred individualised exercise options, connection and a sense of belonging, and access to information and education. Recommendations and a checklist were developed to assist services to increase the involvement of mental health consumers in community‐based exercise and to ensure that exercise practitioners and their employing organisations are adequately equipped to work with this population.     

Qualitative Study on WIC Program Strategies to Promote Breastfeeding Practices in Puerto Rico: What do Nutritionist/Dietician’s Think?

The purpose of this study is to better understand Nutritionist-Dietician opinions concerning WIC Program strategies to promote breastfeeding in Puerto Rico. Four groups of nutritionists-dietitians were recruited to take part in focus group discussions. Each focus group lasted for approximately 1 h and the researchers completed a debriefing sheet after each meeting. The group discussions were taped and transcribed. The participants identified hospital barriers, lack of family support and problems related to the mother as the three principal reasons that Puerto Rican mothers do not breastfeed their babies or stop breastfeeding early. An individual meeting was the most frequently mentioned WIC strategy that was meant to convince mothers to breastfeed their infants. Nevertheless, the focus group participants recognized that the effort and time available for such meetings is limited. From these groups, one theme that emerged is that the WIC Program in Puerto Rico should collaborate with hospitals to arrange for WIC-sponsored nutritionist-dietitians to visit the WIC participants during their maternity hospital stay, and in their homes.     

Referrals of participants in an urban WIC program to health and welfare services.

The Special Supplemental Food Program for Women, Infants, and Children (WIC) provides supplemental food, nutrition education, and referrals to available health and welfare services. Recipients are income-eligible pregnant and postpartum women, their infants, and their children who are younger than 5 years of age. Although studies have documented the nutritional benefits of the program, the extent to which WIC nutritionists help eligible women to obtain available health and welfare services, and the degree to which this referral activity promotes health, is largely unknown. The researchers examined the referral activity at one urban WIC clinic, but did not evaluate the outcomes. Of 1,850 persons seen, there were 762 referrals by WIC nutritionists for 597 persons at the Lawrence, MA, clinic during a 2-month period. Of the 597 persons, 494 (83 percent) were WIC participants and 103 (17 percent) were nonparticipants. The rate of referrals for WIC participants was 27 percent. Multiple referrals were common, with 127 people receiving more than one referral. WIC nutritionists at this site offered a variety of referrals to their clients. The majority of referrals (61.7 percent) were for supplemented food. Nonnutrition-related referrals were to medical and dental services (20.5 percent), developmental and educational services (12.5 percent), and social services (5.4 percent). Nonnutrition-related referrals for women included referrals for family planning, substance abuse, job training, teenaged parenting, and high school equivalency programs. Infants and children were referred for dental care, growth failure, the Head Start Program, kindergarten enrollment, early intervention, and protective services.(ABSTRACT TRUNCATED AT 250 WORDS)