The development, implementation and results of multi-site nutrition education programs in the community provided by undergraduate community health nursing students.

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The development, implementation and results of
multi-site nutrition education programs in the
community provided by undergraduate community
health nursing students.

• Lori Pierangeli PhD, RN
• Associate Professor
• East Stroudsburg University
• East Stroudsburg, PA
• 2008 ACHNE Annual Meeting, Atlanta, GA
• Happy Anniversary!

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ACHNE Session Objectives

• Participants will learn about
• 1. The development of a nutrition education
  project in the community for CHN students to
  address the current community health crisis in
  obesity and diabetes
• 2. The implementation of the project in various
  community sites
• 3. The results/reactions to the project from
• the CHN students,
• the community agencies and
• the community participants.

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Introduction

• As part of course requirements senior nursing
  students provided nutrition education in multiple
  community settings to promote the health of
  populations across the lifespan.
• Initially, students were given a class specific
  to nutrition in the community including
  nutrition visual aids and learning a nutrition
  bingo game.
• Examples of the educational content included the
  following
• Common foods containing excessive and acceptable
  amounts of sugar, sodium and fat
• Recognizing normal and abnormal food portion
  sizes
• How to make up a healthy plate of food
• Healthy alternatives to unhealthy food items.
• Nutrition Bingo
• Students developed nutrition information quiz
  cards that were read to the bingo participants
  after each bingo game was won.
• Nutritious food prizes such as low-sodium canned
  vegetables and no sugar added canned fruits were
  awarded to the game winners.

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National Youth Risk Behavior Survey 1991-2005

• According to the National Youth Risk Behavior
  Survey 1991-2005, nationally,
• 13.5 of students were overweight and
• 15.4 of students were at risk for becoming
  overweight (Journal of School Health, 2004).
• Overall, the prevalence of being overweight was
  higher among male (17.4) than female (9.4)
  students.

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Prevalence of Overweight Among U.S. Children and
Adolescents(Aged 219 Years)
Survey Period Survey Period Survey Period Survey Period Survey Period
NHANES I19711974 NHANES II19761980 NHANES III19881994 NHANES20032004
Ages 2 through 5 5 5 7.2 13.9
Ages 6 through 11 4 6.5 11.3 18.8
Ages 12 through 19 6.1 5 10.5 17.4
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Literature

• Diabetes is closely associated with obesity and
  the sedentary and high-fat lifestyle of the
  American is thought to be largely responsible for
  the epidemic sweeping the world.
• Obesity is more common in rural areas.
• According to HP 2010 selected health promotion
  National Objectives for reducing the risk of
  cardiovascular disease and diabetes include
• Assessing and targeting modifiable risk factors
  beginning as early as age 20.
• Increase the proportion of worksites that offer
  nutrition or weight management classes or
  counseling.
• Source Rural Healthy People 2010, vol 1, pg.
  110, and 133, and HP2010, Vol 2, p. 115

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Literature

• A structural cause of obesity includes a lack of
  nutrition education.
• Some studies indicate that rural caregivers lack
  adequate knowledge to provide good nutrition to
  children
• portion control,
• easy meal planning, and
• lack of time and money to prepare good meals.

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Literature

• Concerted public health efforts are needed to
  achieve the Healthy People 2010 objectives for
  obesity and nutrition and to reduce racial/ethnic
  and socioeconomic disparities.
• Source Overweight Status and Eating Patterns
  Among Adolescents Where Do Youths Stand in
  Comparison With the Healthy People 2010
  Objectives? D. Neumark-Sztainer, PhD, MPH, RD, M.
  Story, PhD, RD, P. J. Hannan, M. Stat and J.
  Croll, MPH, RD

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Development -1

• Initially, the purpose was to
• Engage students in community education to promote
  the health of populations across the lifespan
• Enrich the community health nursing courses, in
  both the classroom and clinical component.
  (Education and Service)
• Larger food portions could be contributing to the
  increasing prevalence of overweight and obesity,
  therefore, this project presented
• Visual models of normal food portion sizes
• Visual models of fat, sugar and salt in common
  food choices
• A focus on cardiac diseases, diabetes, and
  hypertension
• Targeted participants across the lifespan

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Development -2Collaboration

• Collaboration between
• Community health nursing clinical instructor
• A nutrition educator at a Pennsylvania State
  University Extension office in Pennsylvania.
• Penn State extension services had a grant,
  Nutrition Links Program
• Under the umbrella of the Expanded Foods and
  Nutrition Education Program
• Federally funded nutrition program
• Healthy Futures Program
• Participants
• The United Way and Blue Cross and Blue Shield
• Purpose of the program
• To teach young children and families about
  nutrition
• K - 12
• Food models utilized

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Development -3Collaboration

• The CHN students also presented to
• College students
• Elderly in independent living hi-rise apartments.
• Benefit to PSU Extension services
• PSU satisfied with
• The ability to increase persons reached through
  the collaboration.
• Case-finding other persons/groups needing
  additional nutrition services
• Fulfilling their mission to collaborate with the
  community
• Benefit to the University
• Cost savings by borrowing the food models
• PSU nutritionist available for consulation

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Development -4The Funding

• Provosts Office Instructional Support Grant
• 1,000 non-competitive grant process or
  competitive process for additional funding.
• Provides the money to undergraduate courses to
  achieve the following
• Course and/or program student learning outcomes
  related to developing and supporting curricular
  and co-curricular programs that promote learning
  
• That collaborate with the community to provide
  leadership and service that enhance the
  educational, cultural, and economic development
  of the region
• That develop and support programs that
  demonstrate a commitment to human diversity.
• Strategic directions in the grant addressed
• Learning and Service to the Community

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Development -5Use of the Funding

• A variety of tactile and visual aid nutrition
  teaching items
• Nutrition bingo game
• Portion Distortion posters
• Handy Portion poster and tear-off sheets
• Food replica packages
• Included food items common to many cultural
  groups
• Visual tubes of sugar, salt and fats
• Common food items
• 5 lb. fat form
• Poster boards for student use
• Bingo prizes canned fruits and vegetables, and
  tuna
• Refreshments for participants at each site
• Storage containers for the food replicas

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Implementation
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Sample of Individuals Served through the
ProjectEvent Presenter Participant
Health promotion project in class 29 Senior-level students All senior nursing students
North Pocono High School Health Fair. University-wide Health Fair 29 Senior-level students 32 Junior level students 350 senior high students, teachers and staff, and community participants. 201 students, staff and faculty. An additional 3000-4000 daily observers to the displays in the university center. (Duration was 2 wks.)
Fitness Quest (community fitness center). Elderly independent living apartments Faculty Students and Faculty 46 participants of various ages and fitness levels. 80 participants throughout a variety of facilities.
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A Wide Variety of Nutrition Activities

• Nutrition Bingo
• One-on-one counseling
• Surveys
• Lecture

• Demonstrations
• Fat content in fast-foods
• Gaming
• Portion size calorie guessing games
• Lets Make a Meal
• Quizzes
• Desktop Publishing
• Pamphlets on Nutrition
• developmentally appropriate

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Student Learning/Assessment Strategies

• Apply nutrition knowledge in the clinical setting
• Group Work with other students and with diverse
  aggregates in the community
• Writing assignment relating the experience to
  course/clinical objectives and aggregating
  participant responses
• Identifying research questions related to the
  project
• In-class discussions related to project
  effectiveness and modifications
• Developing pre-post test surveys in collaboration
  with their research class
• Developing program participant evaluation tools

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Results/Reactions to the Project
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Overall the project was well received by students
and the community it served.
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Benefit to the CHN Students, to the University
and to the Faculty

• Students were able to
• Plan, develop, implement, and evaluate an
  interactive highly visual presentation to
  students their own age which made them feel more
  confident before presenting to the general
  public.
• Increase their knowledge in nutrition especially
  related to portion control, and fats, sugars and
  salts in food.
• Most surprising was the amount of sugar in soda!
• Learn about resources in the community.
• Identify and understand primary, secondary and
  tertiary aspects of nutrition education.
• University and Faculty
• Initially, savings to the University not having
  to purchase nutrition teaching aids.
• Collaboration opportunities
• Service-learning benefit to the community
• Faculty service opportunities

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Who? and How?Participants and Benefits -1

• Elders in High Rises (Independent Living)
• Frequently eat out at fast-food restaurants
  because of budget constraints and to socialize
  with friends
• learning about fast food content and correct
  portion sizes better food choices
• Disadvantaged Youth
• A university based summer sports camp
• learning about fast food fat and sugar content
  and correct portion sizes better food choices
• Members of a Fitness Club
• Members who were overweight
• Participating in a weight loss challenge over the
  winter
• Realized the benefits of even minimal weight loss

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Who? and How?Participants and Benefits -2

• High School Seniors Yearly Health Fair on the
  morning of the PROM
• Focus on getting ready for college or life after
  high school
• Controlling eating in an all you can eat
  cafeteria setting.
• College Spring Break Health Fairs and Family
  Health Fairs
• Reached the faculty, Staff
• Students at all levels
• Family members across the lifespan

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Responses from the CHN Students to the Experience

• Nursing students were surprised
• That the college students they saw were not
  concerned about their nutrition health.
• At how much sugar is in one can of soda.
• At the lack of knowledge and/or interest in
  correct portion sizes
• At the imbalance between how much participants
  reported eating compared with the recommended
  serving sizes.

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Responses of Participants -1

• Using a 5 lb fat model
• Women thought it was 20 lbs.
• Men viewed it as 5-7 lbs.
• Participants were very interested in learning
  about
• The content of fat, sugars and salt in common
  foods, and
• What a proper portion size should be.

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Responses of Participantsas Noted by the
Students -2

• The participants where very surprised to see the
  models of foods in their correct serving size.
• Most of the parents thought the serving sizes
  of food resembled an adequate meal for a child
  rather than an adult.
• Before providing the teaching session I quizzed
  each participant about portion sizes and asked
  them to guess how much they thought a particular
  food item was in cups or ounces.
• None of the participants answered correctly and
  each under-estimated the portion size.

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Responses of Participantsas Noted by the
Students -3

• All of the parents were astounded by the amount
  of fat in the quarter pound burger.
• When presented with the tubes of fat one woman
  commented Oh my, my husband eats those all the
  time.. I cant believe that.
• The sugar content in the soda was also a big
  surprise to many of the parents especially for
  those that drink more that 3 glasses of soda per
  day.
• One woman did say that she would try to split
  her portion size in half when eating out. She
  would have a take home bag prepared for her
  before she was served her meal to avoid over
  eating when dining out.

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Other/Future Uses of theNutrition Visual/Tactile
Aids

• Takes on a life of its own!
• Junior level Pediatric and Maternal-Child Health
  Student Projects
• Freshman Seminar Class
• Balance Workshops (Adjusting to College) for new
  Students
• Healthy food portion displays and demonstrations
  within the cafeteria

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Future PlansContinuing Efforts

• Programs to
• Elders involved in special programs (silver
  sneakers) in fitness centers, and through Area
  Agency on Aging programs.
• Grade schools
• Collaboration with the local hospital Wellness
  Program
• Low-income housing projects
• College freshman workshops
• Developmentally disabled populations and their
  parents involved in vocational training
  facilities
• Projects utilizing inter-department student
  groups
• Research
• Dining Halls
• Dormitories
• Precede-Proceed Model
• Stages of Change Model

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Questions? Thank You! You were a GREAT
Audience!
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Contact Information

• Dr. Lori Pierangeli
• Department of Nursing
• East Stroudsburg University
• 200 Prospect Street
• East Stroudsburg, PA 18301
• Lpierangeli_at_po-box.esu.edu
• 1- 570- 422-3564