Current Practices and Priority Issues Regarding Nutritional Assessment and Patient Satisfaction with Hospital Menus.

PURPOSE: Patient satisfaction with hospital food enhances consumption and adequate intake of nutrients required for recovery from illness/injury and maintenance of health; accordingly, the nutrient content of the menu must balance patient preferences. This study of Ontario hospital foodservice departments collected data on current practices of analyzing the nutritional adequacy and assessing patient satisfaction with menus, and it explored perceptions of priority issues. METHODS: Foodservice managers/directors from 57 of 140 (41%) hospitals responded to cross-sectional in-depth telephone interviews. Deductive analysis of responses to open-ended questions supplemented quantitative data from closed-ended questions. RESULTS: The hospitals without long-term care facilities (LTCFs) assessed regular (58%), therapeutic (53%), and texture-modified (47%) menus for nutritional adequacy. This differed from hospitals governing LTCFs where there was a higher frequency of assessment of regular (75%), therapeutic (75%), and textured-modified (66%) menus. Most departments (86%-94%) obtained patient satisfaction feedback at the departmental/corporate levels. Many identified budget and labour issues as priorities rather than assessing menus for nutritional adequacy and patient satisfaction. CONCLUSIONS: Hospital menus were not consistently assessed for nutritional adequacy and patient satisfaction; common assessment methodologies and standards were absent. Compliance standards seem to increase the frequency of menu assessment as demonstrated by hospitals governing LTCFs.

Evaluating the Impact of Diabetes Self-Management Education Methods on Knowledge, Attitudes and Behaviours of Adult Patients With Type 2 Diabetes Mellitus.

OBJECTIVES: Diabetes self-management refers to all activities patients undertake to care for their illness, promote health and prevent the long- and short-term effects of diabetes. This study compared the effectiveness of 2 diabetes self-management education methods by examining changes in glycated hemoglobin (A1C) levels and knowledge, attitudes and behaviours (KABs) after traditional group education (TE) or with diabetes conversation maps (CMs). The CMs group was postulated to show greater decrease in A1C levels and improved KABs scores compared to the TE group. METHODS: A sample of 21 eligible clients from Diabetes Care Guelph were randomly assigned into 2 groups: 10 receiving education through CMs and 11 through TE. Changes in knowledge and attitude were determined by using questionnaires and repeated-measures pretest and post-test design before and after the education sessions. Changes in A1C levels were determined by comparing values at baseline and at 3 months after receiving diabetes education. Two focus groups were conducted to obtain participants' perceptions of the education methods and self-reported KAB changes. RESULTS: Significant differences in knowledge and attitude score changes were observed from baseline/initial education and after 3 months. Both groups had significant decreases in A1C levels from baseline to 3 months afterward. Focus groups revealed themes common to both groups, such as benefits of early education, the need for multiple lifestyle behaviour changes and feelings about social support. CONCLUSIONS: CMs had a significant impact and are effective for group education. The changes observed may lead to improved diabetes self-management, thus reducing costly health complications related to poorly controlled diabetes.

Environmentally friendly health care food services: a survey of beliefs, behaviours, and attitudes.

PURPOSE: There is increasing global interest in sustainability and the environment. A hospital/health care food service facility consumes large amounts of resources; therefore, efficiencies in operation can address sustainability. Beliefs, attitudes, and behaviours about environmentally friendly practices in hospital/health care food services were explored in this study. METHODS: Questionnaires addressed environmentally friendly initiatives in building and equipment, waste management, food, and non-food procurement issues. The 68 participants included hospital food service managers, clinical dietitians, dietary aides, food technicians, and senior management. Data analysis included correlation analysis and descriptive statistics. RESULTS: Average scores for beliefs were high in building and equipment (90%), waste management (94%), and non-food procurement (87%), and lower in food-related initiatives (61%) such as buying locally, buying organic foods, buying sustainable fish products, and reducing animal proteins. Average positive scores for behaviours were positively correlated with beliefs (waste management, p=0.001; food, p=0.000; non-food procurement, p=0.002). Average positive scores for attitude in terms of implementing the initiatives in health care were 74% for building and equipment, 81% for waste management, 70% for non-food procurement, and 36% for food. CONCLUSIONS: The difference in food-related beliefs, behaviours, and attitudes suggests the need for education on environmental impacts of food choices. Research is recommended to determine facilitators and barriers to the implementation of green strategies in health care. As food experts, dietitians can lead changes in education, practice, and policy development.

Using photovoice methodology to investigate facilitators and barriers to food acquisition and preparation by rural older women.

This research investigates facilitators and barriers that rural women aged 65 to 75 years in Southwestern Ontario experience in acquiring and preparing food through the use of photovoice methodology. Eighteen participants in five rural communities used a camera and log book to document their experiences and perspectives relating to the acquisition and preparation of food, and they each participated in two focus groups to engage in critical dialogue and knowledge sharing regarding the meaning and significance of the pictures they took. Analysis of photographs, log books, and focus group data revealed 13 themes, 3 emerging as facilitators to food acquisition and preparation (availability of food, social networks and values, personal values and resources), 5 as barriers (adjusting to changing family size, winter weather, food labeling issues, grocery shopper resources, limited physical capacity), and 5 as both facilitators and barriers (economics, valuing a healthy diet, technology changes, transportation, location and nature of grocery stores). Data also revealed rurality, age, and gender as foundationally influential factors affecting rural older women's food acquisition and preparation.

Nutrition and food skills education for adults with developmental disabilities.

PURPOSE: Individuals with developmental disabilities have poor eating habits and are at increased risk for cardiovascular disease, obesity, and osteoporosis. Needs and preferences for a nutrition education and foods skills program were explored in adults with developmental disabilities, agency managers, and support workers. METHODS: Twenty-eight adults with mild to moderate developmental disabilities participated in individual interviews; seven managers and 21 support workers took part in three focus group discussions. Concurrent data collection and analysis, data saturation, and a constant comparative method guided the research. RESULTS: All participants indicated a need for nutrition education and cooking programs for this population. Seven major themes emerged: poor eating habits, safety concerns, low transferable skills, social relationships, staff training needs, resource needs, and limited funding. Individuals with developmental disabilities also expressed feelings of self-efficacy in learning to cook healthy food. CONCLUSIONS: There is a strong interest in and need for nutrition education and food skills programs for adults with developmental disabilities. The collaboration of multiple community partners in program implementation and delivery is essential. At the policy level, the needs of individuals with aging caregivers must be addressed and access to registered dietitians must be improved for this population.

'Going green' in food services: Can health care adopt environmentally friendly practices?

Sustainability and the environment are issues influencing individual and organizational choices on purchasing, waste management, and energy-saving practices. The food service industry and related stakeholders have reported active pursuit of initiatives to reduce environmental impacts. We examine reported environmentally friendly practices being implemented in the food service industry and consider ways in which health care or hospital food services can adopt some of these programs. Building and equipment, waste management, food, and non-food supplies and procurement are considered. Suggestions are made for small changes to start the green initiative in each of these areas. A health care food service department is a large consumer of resources, and therefore food service workers, managers, dietitians, and administrators can make a significant difference by supporting and adopting environmentally friendly practices. Further studies are needed to determine which practices are currently being implemented in health care facilities in Canada, as well as perceived facilitators and barriers to these practices in the food service area.

Perceived facilitators of and barriers to healthful eating among university students.

PURPOSE: Photovoice, an innovative qualitative research method in health care, has not been used to its full potential in nutrition/dietetics. We explored the use of Photovoice to determine perceived facilitators of and barriers to healthful eating among university students. METHODS: The study included 28 students enrolled in a 2008 introductory nutrition class. The students participated in a camera orientation session to review ethics and privacy issues. They took photographs and selected two for discussion in a focus group moderated by a graduate student who used a semi-structured facilitation guide. Researchers coded the transcripts, analyzed the pictures and students' written comments about the project, and ensured data trustworthiness through credibility, dependability, confirmability, and transferability of data and methods. RESULTS: Six major themes emerged as facilitators and/or barriers: environment, nutrition knowledge, convenience foods, time, media influence, and food cost. More than one-third of the students thought the study "stimulated their critical thinking." They felt more empowered in sharing their perceptions and "getting their voices heard." CONCLUSIONS: Photovoice was a useful, "motivating," and "engaging" method for research on nutrition knowledge and dietary patterns of university students. Registered dietitians and other health professionals may benefit from the use of the Photovoice method when they are working with students.

Photovoice and its potential use in nutrition and dietetic research.

Photovoice is an innovative qualitative method of participatory action research based on health promotion principles; however, it has not been used to its full potential in health care, particularly in nutrition and dietetics. Photovoice is also based upon the theoretical literature on education for critical consciousness, feminist theory, and community-based approaches to documentary photography. Participants take photographs representing their views on a specific topic and discuss them in a group process of critical reflection. Originally designed for research with rural women, Photovoice has been used with a variety of population groups throughout the lifespan, such as adolescents, nurses and nursing students, professional groups, Aboriginal women, the elderly, immigrant and low-income groups, and patients with a variety of diseases. The use of Photovoice as a research method is not restricted by health conditions, financial situation, employment status, or literacy level. It is used in community settings, professional practice, or institutional learning environments to explore participants' views and opinions. We review studies in which Photovoice has been used, as well as the impacts, advantages, limitations, and ethics of its use. Gaps in knowledge and its potential use in nutrition and dietetic research are identified.

Dietary and activity profiles of selected immigrant older adults in Canada.

In Canada, the population of older adults is becoming ethnically diverse. However, our understanding of the health behaviors including diet and physical activity among this group is limited. The purpose of this study is to examine the dietary and physical activity profiles, and the factors that influence these behaviors, among older immigrants. The sample included 54 participants (mean age = 68 +/- 6 years) from Cambodian, Latin-American, Vietnamese and Polish groups. Measures included background questionnaire, nutrition screening tool, 24-hour dietary recall, and physical activity assessment. Results showed that 72.5% were at moderate to high risk for poor nutrition. Identified dietary issues were related to food preparation, nutrition management for diseases, and nutritional needs of the elderly. Although 83.3% reported to be physically active, the level was less than optimal, and barriers to physical activity were identified. The results are further discussed in light of health promotion and nutrition education among immigrant older adults.

Community Participation in Nutrition Communication: Models and Linkage Systems for Management.

New models of community participation, nutrition communication, and management linkages have been proposed. Changes in the health care sector have forced a major restructuring of facilities and a shifting of focus from traditional institution-based health care to a more community-based delivery of services, and from treatment to health promotion and disease prevention. These changes have also led to a redefinition of community clients and a review of the social processes whereby community members can participate actively in their health care. Challenges for health and nutrition professionals are to create manageable environments for meaningful dialogues, and to communicate action-oriented nutrition messages that reflect the community's values and realities. Some theories on learning and behaviour change can be applied to and aid in nutrition communication. At the same time, facilitators of and barriers to community participation in nutrition communication programs must be identified and addressed. In addition, during this time of health care transition, dietitians and nutritionists must position themselves as leaders in health and nutrition communication so that the community will act on their messages. Partnerships or linkages between organizations at the local, national, and international levels can assist in the effective delivery of nutrition information.