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Eat Smart, Live Strong:Eat Smart, Live Strong:Nutrition Education for Older AdultsNutrition Education for Older Adults
Donna Johnson-BaileyUSDA Food and Nutrition Service
American Public Health Association Annual ConferenceNovember 7, 2006
Programs Serving Older AdultsPrograms Serving Older Adults
Food Stamp ProgramSenior Farmer’s Market Nutrition ProgramCommodity Supplemental Food Program Child and Adult Care Food ProgramNutrition Assistance Program in Puerto RicoFood Distribution Program on Indian Reservations. Food pantries Programs specific to local communities
AgeAge
The average older adult participant is 71. (2004)
0 %
1 0 %
2 0 %
3 0 %
4 0 %
A g e
6 0 - 6 4 6 5 - 6 9 7 0 - 7 9 8 0 +
PurposePurpose
Understand the characteristics of older adults Identify interventions with some promise in addressing target behaviorsDevelop a concept to improve eating and physical activity among older adults participating in FNS programs
StepsSteps
Formative ResearchResearch, literature, and resource reviewPromising practices reviewInput from stakeholdersRecommendations for intervention
Promising PracticesPromising Practices ReviewReview
One source for intervention developmentIncreasingly used to develop national interventions and programs Challenge ------ how to guide and organize findings?
What is a What is a Promising Practice? Promising Practice?
An individual program component or activity?An integrated program with many components?A general principle based on many intervention studies?
Sources of DataSources of Data
Published evaluations of interventions (18)
Rated based on 12 criteria
Unpublished descriptions from interviews with program managers (21)
Evaluation data not available
Published review articles (4)Summarized principles – not activities
Recommendations from Recommendations from FindingsFindings
Priority Group (WHO)All needed to be
Low-income, 60 to 74Basically healthy
Test concepts with White, African-American Rural and urbanMajority female Majority living alone
FindingsFindings
Behavior (WHAT)Primary… to eat at least 5 servings of fruits and vegetables every day (at the time research was conducted, 2000 Dietary Guidelines were in effect and this was a successful and prevalent message)
Secondary … to participate in a physical activity on most days of the week
Key Factors/Determinants:Key Factors/Determinants:Eating FV Every DayEating FV Every Day
PsychosocialGive up traditional food; f&v are boring
EnvironmentalLack of social networks – why eat healthy??
Antecedent behaviorsHesitancy to try new food
Key Factors/Determinants:Key Factors/Determinants:Participate in Physical ActivityParticipate in Physical Activity
PsychosocialAnxiety about injuryDoctors recommend
EnvironmentalNo one to show me how Lack of resources
Antecedent behaviorsMake a public commitment Participate in intervention
Formative Research Findings Formative Research Findings Activities (HOW)Activities (HOW)
Didactic sessions and materialsOn benefits of the behaviorsImportant at any ageInformation on ways to exercise safely
Key recommendation from providers: Do MORE than just
didactic health education!!!!!!!!!
Formative Research FindingsFormative Research FindingsActivities (HOW)Activities (HOW)
Individualized goal setting with professional involvement
Motivational content tailored to the audience and theory-based
Tailored program based on readinessIndividual counseling about benefits and ways to overcome barriers
Formative Research FindingsFormative Research FindingsActivities (HOW)Activities (HOW)
Feedback and monitoring activities
Color coding to record progressSubmit minutes walked
Rewards Coupons at sessionsIncentives for attaining goals
Formative Research FindingsFormative Research FindingsActivities (HOW)Activities (HOW)
Empowerment and self-efficacy building activities
Recipes and demonstrationsSessions to learn exercise
Active participationGames and contests Role-playingTasting
Formative Research FindingsFormative Research FindingsActivities (HOW)Activities (HOW)
Social support from professionals
Reminders (phone calls and magnets)Telephone supervision
Social support from peersGroup exercise sessionsMeetings planned by participants
Formative Research FindingsFormative Research FindingsActivities (HOW)Activities (HOW)
Changes in the environment for long-term change
Meal and congregate eating programsWalking trails
Addressing barriers Food provided through intervention Accident prevention session
PurposePurpose
To develop concepts for a behavior focused intervention for able
bodied, low-income older adults 60-74 years of age.
Key BehaviorsKey Behaviors
Increase fruit and vegetable consumptionParticipate in 30 minutes of physical activity most days of the week
Review Panel Site VisitsMaterials TestingField Review
Concept Development and Concept Development and TestingTesting
3 3 ½½ Cups & 30 MinutesCups & 30 Minutes
Message is based on…
1600 calorie dietFemaleSedentaryHave at least 1 chronic conditionRelatively easy to rememberAccurately reflects current DGA recommendations for a significant majority of the target audience
LeaderLeader’’s Guides Guide
• using the sessions• motivating older adults • adapting the materials
for people with physical limitations
• identifying resources for older adults
• promoting the behaviors and the intervention to participants and their communities
Provides guidance and tips about:
Session 2Session 2
Reviews challenges and solutions specific to this populationEncourages health provider support –SMART Card
Session 3Session 3
Trying new foods through classic recipes Make something old new again; promoting self-efficacy
Session 4Session 4
Addresses cost of fruits and vegetablesPromotes nutrition assistance programs for the older adultsHelps promote awareness about local resources
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