Chapter 3

1. 0 Chapter 3 Assessing the Target Population’s Nutritional Status © 2006 Thomson-Wadsworth

2. Learning Objectives • Describe the types of data that might be collected about the target population specified in the community needs assessment. • Describe a minimum of eight methods for obtaining data about the target population. © 2006 Thomson-Wadsworth

3. Learning Objectives • Discuss the issues of validity and reliability as they apply to data collection. • Discuss cultural issues that are considered when choosing a method for obtaining data about the target population. © 2006 Thomson-Wadsworth

4. Introduction • The purpose of the community needs assessment is to obtain answers to basic questions such as: • What is the nutritional problem of the target population? • Which factors contribute to the nutritional problem? • How can their health and nutritional status be improved? © 2006 Thomson-Wadsworth

5. Introduction • When key questions are unanswered, the community nutritionist must identify those data elements that are still needed and choose methods for obtaining them. © 2006 Thomson-Wadsworth

6. A Plan for Collecting Data • Decisions about which data to collect about the target population are made carefully following a plan laid out before the first data element is ever collected. © 2006 Thomson-Wadsworth

7. A Plan for Collecting Data • The following planning activities should be completed before data collection begins: • Step 1: Review the purpose, goals, and objectives of the needs assessment. • Step 2: Develop a set of questions related to the target population’s nutritional problem, how it developed, and/or the factors that influence it. • Step 3: Choose a method for obtaining answers to these questions. © 2006 Thomson-Wadsworth

8. A Plan for Collecting Data • At this point in the assessment process, the community nutritionist has already obtained information about the community and about the broad background issues that influence its nutritional and health status. © 2006 Thomson-Wadsworth

9. A Plan for Collecting Data • The nutritionist must now decide the following: • Which questions about the target population are most important. • Which methods can be used to obtain answers to those questions. • Whether the answers are measurable. © 2006 Thomson-Wadsworth

10. Types of Data to Collect about the Target Population • Questions should be asked about lifestyle choices, dietary patterns, working conditions, and social networks that affect the health and nutritional status of the target population. • Types of data: • Individual lifestyle factors • Living, working and social conditions © 2006 Thomson-Wadsworth

11. Individual Lifestyle Factors • Lifestyle • Physical activity level • Choice of leisure time activities • Ability to handle stress • Smoking status • Use of alcohol or drugs © 2006 Thomson-Wadsworth

12. Individual Lifestyle Factors • Diet • Diet is a key individual factor to be analyzed because nutritional status is affected directly by nutrient intake and utilization and indirectly by the food supply and a host of other factors. © 2006 Thomson-Wadsworth

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14. Individual Lifestyle Factors • The food supply determines which foods are available to the target population and this is a product of: • Geographical area • Climate • Soil conditions • Labor • Capital available for building the agricultural base © 2006 Thomson-Wadsworth

15. Individual Lifestyle Factors • Food intake is influenced by many factors, including the following: • Biological, psychosocial, cultural, and lifestyle factors. • Personal food preferences, cognitions, and attitudes. • Health beliefs and practices. © 2006 Thomson-Wadsworth

16. Individual Lifestyle Factors • Nutrient utilization is affected by: • Activity levels. • Smoking status. • Dietary supplement use. • Drug-nutrient interactions. • Physiological status. © 2006 Thomson-Wadsworth

17. 0 Living, Working, and Social Conditions • Education, occupations, and income all have powerful effects on health. • Individuals who have few or no job skills or who are poor and uneducated tend to have more health problems than those with job training and education. © 2006 Thomson-Wadsworth

18. 0 Living, Working, and Social Conditions • Low socioeconomic status is linked with: • High prevalence rates of chronic conditions. • High stress levels. • Reduced access to medical care for the diagnosis and treatment of diseases. • Poor outcomes following treatment. © 2006 Thomson-Wadsworth

19. 0 Living, Working, and Social Conditions • Poverty, even more than family structure, has the strongest association with health among children. • Primary social groups also influence health and nutritional status. • The family exerts the most influence on health and nutritional status. © 2006 Thomson-Wadsworth

20. 0 Case Study 1: Women and Coronary Heart Disease • The community nutritionist reviews the assessment’s objectives and determines a list of questions about this population’s knowledge, attitudes, and practices related to Cardiovascular Heart Disease (CHD). • Demographic data, such as age, education level, and income are collected as a matter of course. © 2006 Thomson-Wadsworth

21. 0 Case Study 1: Women and Coronary Heart Disease • Answers to questions are obtained from individuals who represent the target population, which is called the sample. • Next, the nutritionist would consider the types of data that might be collected to answer the questions and chooses a method for obtaining them. • A survey instrument is used to obtain answers to several of the questions and a 24-hour recall method is used as a separate tool. © 2006 Thomson-Wadsworth

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23. Methods of Obtaining Data about the Target Population • A variety of methods exist for collecting data related to the target population: • Survey • Screening • Focus groups • Interviews with key informants • Direct assessment of nutritional status © 2006 Thomson-Wadsworth

24. Methods of Obtaining Data about the Target Population • Survey • A survey is a systematic study of a cross-section of individuals who represent the target population. • It is a relatively inexpensive method of collecting information from a large group of people. © 2006 Thomson-Wadsworth

25. Methods of Obtaining Data – Surveys • Surveys can be used to collect qualitative or quantitative data in formal structured interviews and they can be used by phone, mail, or online. • They can be used with individuals and groups and they can be either self-administered or administered by a trained interviewer. © 2006 Thomson-Wadsworth

26. Methods of Obtaining Data – Surveys • Survey design and analysis is a discipline in itself. • The first step is to determine the purpose of the survey. © 2006 Thomson-Wadsworth

27. Methods of Obtaining Data – Surveys • Most nutrition surveys are carried out to: • Assess the food consumption of households or individuals. • Evaluate eating patterns. • Estimate the adequacy of the food supply. • Assess the nutritional quality of the food supply. © 2006 Thomson-Wadsworth

28. Methods of Obtaining Data – Surveys • Nutrition surveys are carried out to: • Measure the nutrient intake of a certain population group. • Study the relationship of diet and nutritional status to health. • Determine the effectiveness of an education program. © 2006 Thomson-Wadsworth

29. Methods of Obtaining Data – Surveys • Decisions must be made about who will design the survey, who will conduct it, and how it will be carried out. • Surveys must be designed and carried out carefully to provide valid and reliable information. © 2006 Thomson-Wadsworth

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31. Methods of Obtaining Data – Surveys • Health Risk Appraisal • The health risk appraisal (HRA) is a type of survey instrument used to characterize a population’s general health status. • It is used in different settings as a health education or screening tool. © 2006 Thomson-Wadsworth

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33. Methods of Obtaining Data – Surveys • The HRA consists of three parts: • A questionnaire. • Certain calculations that predict risk of disease. • An educational message or report to the participant. • HRAs are used to alert people about their risky health behaviors and how such behaviors might be modified through a lifestyle modification program. © 2006 Thomson-Wadsworth

34. Methods of Obtaining Data – Screening • Screening • Screening is an important preventive health activity designed to reverse, retard, or halt the progress of a disease by detecting it as soon as possible. © 2006 Thomson-Wadsworth

35. Methods of Obtaining Data – Screening • Screening can be conducted in clinical and community settings and examples include: • Blood pressure checks • Blood cholesterol checks • Height and weight • Screening programs are not meant to substitute for a health care visit but they do have educational value and serve to identify high-risk persons. © 2006 Thomson-Wadsworth

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37. Methods of Obtaining Data – Focus Groups • Focus Groups • Focus groups are informal groups of about 5 to 12 people who are asked to share their concerns, experiences, beliefs, opinions, or problems. © 2006 Thomson-Wadsworth

38. Methods of Obtaining Data – Focus Groups • Focus groups can be used to: • Obtain advice and insights about new products and services. • Research data and information about key variables used in quantitative studies. • Obtain opinions about products or creative concepts such as advertising campaigns or program logos. © 2006 Thomson-Wadsworth

39. Methods of Obtaining Data – Focus Groups • Focus groups are led by a trained moderator and listening is the most important skill used during focus groups. • Information from a focus group is used to provide direction for the needs assessment or change a marketing strategy, product, or existing program. © 2006 Thomson-Wadsworth

40. Key Focus Group Questions © 2006 Thomson-Wadsworth

41. Methods of Obtaining Data – Focus Groups • Focus groups provide qualitative information that helps nutritionists understand: • How the nutritional problem developed • Whether the target population perceives a problem © 2006 Thomson-Wadsworth

42. Methods of Obtaining Data – Interviews • Interviews with Key Informants • Interviews with key informants, or people in the know about the community, can also provide information about the target population. © 2006 Thomson-Wadsworth

43. Methods of Obtaining Data – Interviews • Informant interviews can be used to: • Complete a cultural assessment of the target population. • Provide insights about whether the target population perceives a nutritional problem and which actions for addressing the problem are culturally appropriate. • Key informants may have worked with the target population in the community or conducted research on the population. © 2006 Thomson-Wadsworth

44. Methods of Obtaining Data – Direct Assessment • Direct Assessment of Nutritional Status: An Overview of Methods • There are several methods for conducting a direct assessment of nutritional status. © 2006 Thomson-Wadsworth

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48. Methods of Obtaining Data – Direct Assessment • Dietary assessment methods are used to determine an individual’s or population’s usual dietary intake and to identify potential dietary inadequacies. • The primary methods of measuring food consumption of individuals include: • Diet History Method • Twenty-four-Hour Recall Method • Diet Record Method • Food Frequency Method © 2006 Thomson-Wadsworth

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50. Methods of Obtaining Data – Direct Assessment • Additional methods of assessing nutritional status include: • Other Diet Assessment Methods © 2006 Thomson-Wadsworth