Translational Research A Framework for Nutrition Education

1. Translational ResearchA Framework for Nutrition Education Nadine Sahyoun, PhD, RD University of Maryland 4th State Units on Aging Nutritionists & Administrators Conference August 2006

2. Translational Research Source: National Cancer Institute

3. Healthy Diet Scientific basis (DRI) Policy (DG) Educational Tool (FGP)

4. Healthy Diet General Guidelines: • Fruit and Vegetables • Whole grains • Types of fat • Fish intake Age-specific guidelines: • Calcium/vitamin D • Vitamin B12 • Protein

5. Evidence-based Programs • The development, implementation, evaluation of effective programs and policies in public health

6. Depression Nutritional Security Cognitive Function Social Support Physical Function Dietary Intake Health Status Nutritional Status Anthropometry Biochemical Clinical Health Care Costs & Quality of Life

7. Myths • Aging is a disease– • Aging is a biological process that may lead to chronic diseases • Older adults are resistant to change • Studies have shown most success among older adults • Making dietary changes later in life will not influence morbidity and mortality

8. Evaluation • What have we done? • How well have we done it? • Whom have we done it to? • How much have we done? • How effective has our program been? • What could we do better or differently?

9. Outcomes • Outcomes that define success in nutrition • Self-efficacy • Food Choice behaviors • Dietary intake (foods or nutrients) • Biochemical measures • Clinical/anthropometric measures • Effects on health (decreased morbidity and mortality)

10. Dietary Interventions • Literature Search: • Date: January 1990-April 2003 • Key Words: elderly, older adults, nutrition intervention, nutrition education • Inclusion criteria: community-based, measurable outcome, evaluation component, age 55+

11. Dietary Interventions Limitations: • Convenience samples • Insufficient/short duration • Limited market segmentation • High attrition rate • Limited outcome measures

12. Dietary Interventions Positive Study Components • Messages • Limited to 1 or 2 • Simple • Practical • Targeted • Reinforced Marcus et al 2001, Barr et al 2000, Campbell et al 1999

13. Dietary Interventions Positive Study Components • Use of theories of behavioral change • 8 different models used • Social cognitive theory • Transtheoretical model • Perception of control and social support Patterson et al 2003, Miller et al 2002 Marcus et al 2001, Campbell et al 1999 Whelton et al 1998

14. Dietary Interventions Positive Study Components • Incentives– • Cues to action, money • Hands-on activities- • Gardening project • Use of computer Bernstein et al 2002, Miller et al 2002, Hackman et al 1990 Dennison et al 1991, Hackman et al 1990

15. Dietary Interventions Positive Study Components • Regular contact with health professionals Taylor-Davis et al 2000

16. Dietary Interventions Positive Study Components • Active involvement of participants in determining goals of intervention Grace et al 1994, Hackman et al 1990 • Modify environment in which people live. Campbell et al 1999

17. A framework for designing a nutrition education intervention for older adults Active involvement in determining goals of intervention Regular contact with health professionals Focus on behavior modification based on theoretical models • Process measures: • degree of participation • adherence to program • attrition rate Incentives Hands-on activity • Messages that are: • limited in number • simple • targeted • practical • reinforced • Outcome measures: • knowledge • dietary/behavioral • biochemical • anthropometric • physical fitness Individual within group of older adults with specific health, socioeconomic or other status Social environment(e.g., family, friends) Physical environment (e.g., home, neighborhood) Sahyoun et al 2004