FNOA: Aging Programs (2012)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
  • To evaluate a pilot test of five education modules to be used in the Elder Nutrition and Food Safety Program (ENAFS).
  • To promote healthful eating behaviors through interactive learning among elders attending Congregate Nutrition Sites in Florida.
Inclusion Criteria:

Older adults attending a rural congregate nutrition site.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment

Participants in the study consisted of a sample of attendees at a congregate nutrition site in a rural community in north-central Florida. Invitees were encouraged to attend the educational programs but were free to decline.  

Design

Descriptive, comparative study. 

Intervention

Five lesson plans were developed and delivered to participants at a congregate nutrition site. The lesson plans were peer-reviewed and developed using components of the expanded Health Belief Model and Stages of Change theory. Modules were designed to engage the learner using interactive discussions and hands-on activities. After the lesson plans were delivered, a simple evaluation questionnaire was completed by clientele. Two months after the last lesson, five of the older adults who attended all or most of the five lessons were interviewed for their impressions of the lesson plans and activities.  

Statistical Analysis: Results of the lesson post-test evaluations were tabulated and summarized using descriptive statistics. No statistical analysis was conducted.

 

Data Collection Summary:

Timing of Measurements

The pilot modules were conducted over a six-week time period on Tuesdays. Month and year were not specified. Follow-up interviews occurred two months after the pilot study was conducted. 

Dependent Variables

  • Knowledge gained
  • Behavior change. 

Independent variables

Five-lesson theory-driven older adult nutrition module.

Description of Actual Data Sample:
  • Initial N: Between 36 and 52 seniors at the congregate nutrition site attended the five lessons, and an average of 20 (17 to 23) completed the questionnaires. N for those who completed questionnaires following each of the five lessons were:
    • Lesson 1: N=19
    • Lesson 2: N=17
    • Lesson 3: N=28
    • Lesson 4: N=18
    • Lesson 5, n=22
  • Attrition (final N): No information available. It was not specified why all of those who attended the lessons did not complete the evaluation.
  • Age: Clients at the congregate nutrition site ranged from 55 to 103 years of age. No information is available on the exact ages of those who attended the pilot study sessions or completed the surveys. Those who were interviewed two months after the lessons were piloted were at least 60 years old.
  • Ethnicity: No information was provided on ethnicity of participants in the pilot. Those who were interviewed consisted of two black females, one white female and two white males.
  • Location: Florida.
Summary of Results:
  • For three out of four of the lessons, approximately 80% of the participants reported that they learned a lot from the modules
  • For all five of the lessons, at least 61% of the participants indicated that they planned to make changes in their eating behaviors as a result of participating in the lessons
  • For three out of the five lessons, participants checked a specific behavior change they planned to make
  • For three out of the five lessons, 58% to 68% reported that they would share what they had learned with a family member or friend.
Author Conclusion:
  • Based on the written evaluations, the lessons were effective in promoting knowledge gain and encouraging behavior change among program participants at one CNS
  • Based on evaluations, interviews, and observations by CNS personnel, the ENAFAS program design was successful in engaging the older persons in the learning experience and promoting an intent to change behavior.
Funding Source:
Government: State of Florida
Reviewer Comments:
  • It is unclear to the reviewer why not all of those who participated in the lessons completed the evaluation questionnaire. Participants were allowed to decline but it is not clear if that invitation was extended before or after the lessons. Those who declined may have skewed the results.
  • No statistical analysis was completed so it is unclear if the results obtained were statistically significant
  • The authors used observations of the participants by CNS personnel to draw conclusions about how engaged they were in the lessons. There was no information provided about what criteria were used to reach those conclusions.
  • Little information was provided about the questions in the follow-up interview
  • The modules were determined to be successful based on observation, evaluation and interviews. All three of these methods are subject to error.  
  • The reviewer felt that the research question was not clearly stated other than "to evaluate a pilot study." In addition, it was unclear to the reviewer as to what specific criteria were used to evaluate success of the pilot modules.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
 
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? No
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? No
  2.2. Were criteria applied equally to all study groups? N/A
  2.3. Were health, demographics, and other characteristics of subjects described? No
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? No
  4.1. Were follow-up methods described and the same for all groups? N/A
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) No
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? No
  4.4. Were reasons for withdrawals similar across groups? ???
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? N/A
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? ???
  7.1. Were primary and secondary endpoints described and relevant to the question? No
  7.2. Were nutrition measures appropriate to question and outcomes of concern? ???
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? ???
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? ???
  7.5. Was the measurement of effect at an appropriate level of precision? No
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? No
  8.1. Were statistical analyses adequately described and the results reported appropriately? No
  8.2. Were correct statistical tests used and assumptions of test not violated? No
  8.3. Were statistics reported with levels of significance and/or confidence intervals? No
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? No
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes