Theory-driven intervention improves calcium intake, osteoporosis knowledge, and self-efficacy in community-dwelling older Black adults.

OBJECTIVE: To assess the effectiveness of an osteoporosis education program to improve calcium intake, knowledge, and self-efficacy in community-dwelling older Black adults. DESIGN: Randomized repeated measures experimental design. SETTING: Churches and community-based organizations. PARTICIPANTS: Men and women (n = 110) 50 years old and older from 3 south Florida counties. INTERVENTION: Participants randomly assigned to either of 2 groups: Group 1 (experimental group) or Group 2 (wait-list control group). Group 1 participated in 6 weekly education program sessions immediately following baseline assessment, and Group 2 started the program following Group 1's program completion. A tested curriculum was adapted to meet the needs of the target population. MAIN OUTCOME MEASURES: Dietary calcium intake, osteoporosis knowledge, health beliefs, and self-efficacy. ANALYSIS: Descriptive and summary statistics, repeated measures analysis of variance, and regression analysis. RESULTS: Of the total participants, 84.6% completed the study (mean age = 70.2 years). Overall, an educational program developed with a theoretical background was associated with improvement in calcium intake, knowledge, and self-efficacy, with no effect on most health belief subscales. Assigned group was the major predictor of change in calcium intake. CONCLUSIONS AND IMPLICATIONS: A theory-driven approach is valuable in improving behavior to promote bone health in this population. Health professionals should consider using more theory-driven approaches in intervention studies.

Spirituality of African-American women: correlations to health-promoting behaviors.

The purpose of this study was to investigate how spirituality relates to health-promoting behaviors in African-American women. Using Burkhart's theoretical framework for spirituality, a descriptive cross-sectional correlational design was used. A group of 260 (N=260) women completed Rosenbergh's Self-Esteem Scale, the Health Promoting Lifestyle Profile II, the Spiritual Perspective Scale, the Brief Block 2000 Food Frequency Questionnaire (FFQ). These women also provided the researchers with their socio-demographic data. Canonical correlation analysis identified a significant pair of canonical variables which indicated that those individuals with good nutrition (.95), physical activity (.79), and healthy eating (.42) were positively associated with stress management (.88), health responsibility (.67), spiritual growth (.66), interpersonal relations (.50), education (.49), and self-esteem (.33). This set of variables explained 56% of the variability (p < .001). Practitioners should incorporate the message of spirituality by focusing on strategies to improve health responsibility, interpersonal relations, and self-esteem, along with health-promoting behaviors.

Aging in community nutrition, diet therapy, and nutrition and aging textbooks.

Using content analysis, this study evaluated the aging content and context in 11 nutrition sub-specialty textbooks: community nutrition (n = 3), diet therapy (n = 4), and nutrition and aging (n = 4). Pages with paragraphs on aging were identified in community nutrition and diet therapy textbooks, and 10% random samples of pages were evaluated in nutrition and aging textbooks. Paragraphs were assigned to one of four categories: gerontology, nutrition as primary, nutrition as secondary, or tertiary prevention. A total of 310 pages was qualitatively analyzed using NUD*IST 5 software and quantitatively with percentages. Only 7% of community nutrition and 2% of diet therapy pages were devoted to aging. There was little integration of aging beyond the chapters on aging. Community nutrition had the most gerontology (30%) and primary prevention (43%) content. Diet therapy and nutrition and aging had more secondary prevention (33% and 42%, respectively) and tertiary prevention (27% each) content. Some important databases and studies were absent. Of the 1,239 ageism words, 10% were positive, 53% neutral, and 36% negative. Photographs were generally positive. Women, but not minorities, reflected current older adult demographics. Future textbook editions should address aging more comprehensively and positively to better prepare dietitians for the job market. Recommendations for authors, course instructors, and publishers are given.

Continued need for increased emphasis on aging in dietetics education.

This study examined the content on aging in dietetics curricula via the Internet and a follow-up questionnaire. Only 14% to 15% of programs were not online. The 203 undergraduate and 88 graduate program Web sites listed 44 (22%) undergraduate and 39 (44%) graduate courses in aging. However, more maternal and child courses were listed. The number of undergraduate aging courses was similar to the 20% reported in 1989, although methodologies differed among the studies. Life cycle and community nutrition courses had the most aging content. More than half of program directors were not satisfied with the aging curriculum content. Integrating aging material into existing courses was the most acceptable way of increasing aging content. The common barriers were "curriculum already full" and "lack of faculty expertise." As the nation's changing demographics are reshaping the dietetics marketplace, a greater emphasis on aging would enable students to be more effective in serving this booming population.

Aging in introductory and life cycle nutrition textbooks.

The aging content in 11 undergraduate nutrition textbooks (8 introductory, 3 life cycle) was evaluated using content analysis. Repeated measures ANOVAs with Bonferroni post hoc procedures and t- tests were used. The 259 relevant pages largely focused on geriatrics (physiological decline, chronic diseases). Gerontological aspects were underemphasized. Mean number of pages on aging was significantly higher in life cycle (M = 37) than in introductory textbooks (M = 18), t (9) = 3.42, p < .008. In introductory textbooks, mean percentage of pages on aging (M = 3.2%) was significantly less than for maternal (M = 4.6%) and childhood topics (M = 6.2%), p < .05. Overall, topic omissions included discussion of ageism, death, dying, and dignity; and end-of-life decisions related to nutrition and hydration. Women and minorities were proportionately represented in generally positive photographs. Aging terminology was 81% neutral (older, aging), 14% negative (impaired, senile), and 5% positive (active, independent). These textbooks may not help students acquire the broad knowledge needed to work with older adults or develop positive attitudes about aging. Recommendations for authors, publishers, and instructors are provided.

The professional development portfolio process: setting goals for credentialing.

Professional Development Portfolio (PDP), the new credentialing system for dietetics professionals, places the responsibility for learning, professional development, and career direction on the individual practitioner. This study used questionnaires and focus group interviews to determine whether dietitians engage in reflection, self-assessment, and goal setting, the critical components of PDP recertification. Volunteers (n = 132) participated in 16 focus groups held during 8 state dietetic association meetings. Content analysis was conducted. Some subjects reflected using an informal non-structured process (42 text units), almost half (41%) performed annual self-assessments, and 25% set goals. Job availability, new practice areas, family obligations, and employer needs were key factors in goal formulation. Opportunities for self-direction, independent decision-making, and application of technical expertise were also considered in career choices and goal setting. Although few participants were currently performing PDP critical components, we conclude dietetic practitioners can gain the necessary skills for professional development with the newly available PDP Guide to support the portfolio process. We recommend that dietitians (a) allow sufficient time for the reflection process, including the use of additional tools; (b) develop personal mission statements to drive the goal-setting process; and (c) use effectiveness criteria to critique their goals.

Dietetics students' low knowledge, attitudes, and work preferences toward older adults indicate need for improved education about aging.

OBJECTIVE: This study examined students' knowledge and attitudes about aging and their interest in working with the older adult population in the United States. DESIGN: A 97-item questionnaire included demographic items, a ranking section on work preferences by age groups, and two validated scales: the Palmore Facts on Aging Quiz, and the Oberleder Attitude Scale. SUBJECTS: Those surveyed were enrolled in the 10 largest universities in the 5 states with the largest population of older adults: California, Florida, New York, Texas, and Pennsylvania. Of 555 questionnaires that program directors requested for their class(es), 299 completed questionnaires were returned. This 54% return rate was affected by program directors requesting more questionnaires than needed. Of the 299 dietetics/nutrition students who completed the survey, 65% were in the 18 to 22 year age range, 91% were women, 81% were non-Hispanic white, and 81% were seniors in college. STATISTICAL ANALYSES: Pearson's correlation was applied to test for relationships between knowledge and attitudes; t tests for differences in knowledge, attitudes, and work preferences by age, gender, and experience with older adults; and Tukey's multiple comparison test for differences in knowledge, attitudes, and work preferences by state. RESULTS: Students had low knowledge about aging (Palmore, mean percent correct +/- standard deviation = 40.1%+/-13.0%) and neutral attitudes toward older adults (Oberleder, mean score = 69.1+/-8.2). When asked which of 10 age groups they preferred to work with, respondents ranked the 3 oldest age groups (65 to 74, 75 to 84, 85 and older) lowest on average (6.0, 7.3, 8.6, respectively). APPLICATIONS/CONCLUSIONS: More didactic instruction about aging and more positive experiences with older adults through fieldwork may be needed to prepare future practitioners to provide nutrition services to this increasing population segment.