Health Disparities

HD: Effectiveness of Nutrition Intervention Methods (2010)

Assessment
Which nutrition intervention methods have been shown to be effective in improving nutrition outcomes among overweight or obese adults with varying socio-economic status, racial/ethnic groups or geographic locations?
- Conclusion
  Six studies (five randomized controlled trials, and one non-randomized trial) evaluated various nutrition interventions to determine methods for improving nutrition outcomes among overweight or obese adults with varying socio-economic status, racial/ethnic groups or geographic locations. One of the studies found that motivational interviewing, although found effective in other studies with other target groups, was not effective in improving outcomes among African American women in a weight management intervention. Tailoring the intervention to the culture and language of the target population was a key feature of effective programs.
  
  Characteristics of effective interventions included the following:
  - Methods
    
    Group or one-on-one personal interaction, including education, counseling and support
    
    Faith-based interventions such as group prayer and Bible study
    
    Following completion of the study, delayed interventions were provided to control groups
    
    Skills teaching such as cooking classes and exercise classes
    
    Enhancing access to fresh fruits and vegetables, gym facilities and exercise equipment
    
    Addressing barriers such as provision of child care during the intervention and transportation
    
    Enhancement of self-efficacy and self-management skills, including methods for eliciting family and social support
    
    Use of community outreach workers and lay health leaders
    
    Communication tools including video technology (including exercise videos and videotaped interviews with role models from the culture), telephone follow-up and written materials
  - Providers
    
    Registered Dietitian case managers and educators, registered nurses, psychologists
    
    Peer educators and peer counselors
    
    Trained lay health leaders from community churches
    
    Exercise instructors
  - Frequency and Duration
    
    Interventions utilizing multiple sessions over extended time periods ranging from eight weeks to 12 months
  - Settings
    
    Public health clinics, community centers, community health clubs and churches
    
    Follow-up in clinic or community settings or by telephone.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: Which nutrition intervention methods have been shown to be effective in improving nutrition outcomes among overweight or obese adults with varying socio-economic status, racial/ethnic groups or geographic locations?
- Search Plan and Results: HD: Nutrition Intervention Methods 2009
Which nutrition intervention methods have been shown to be effective in improving nutrition outcomes among breastfeeding women with varying socio-economic status, racial/ethnic groups or geographic locations?
- Conclusion
  Twelve studies (six randomized controlled trials, four cross-sectional, one before-and-after and one qualitative) evaluated various nutrition intervention strategies to determine methods for improving nutrition outcomes among breastfeeding women with varying socio-economic status, racial or ethnic groups or geographic locations. Tailoring the intervention to the culture and language of the target population was a key feature of effective programs.
  
  Characteristics of effective interventions included the following:
  - Methods
    
    Group or one-on-one personal interaction, including ongoing education
    
    Skills teaching, support and counseling
    
    Advocacy by community coalitions
    
    Breast pump loans
    
    Communication tools including video technology, telephone follow-up and written materials.
  - Providers
    
    Lactation consultants
    
    Registered dietitians
    
    Registered nurses
    
    Peer counselors.
  - Frequency and Duration
    
    Perinatal, delivery and postpartum periods
    
    Ongoing promotion efforts by community coalitions.
  - Settings
    
    Hospital-based or located in Women, Infants and Children (WIC) clinics
    
    Public health clinics or physician offices
    
    Follow-up in professional settings or during home visits.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: Which nutrition intervention methods have been shown to be effective in improving nutrition outcomes among breastfeeding women with varying socioeconomic status, racial/ethnic groups or geographic locations?
- Search Plan and Results: HD: Nutrition Intervention Methods 2009
Which nutrition intervention methods have been shown to be effective in improving nutrition outcomes among adults with diabetes with varying socio-economic status, racial/ethnic groups or geographic locations?
- Conclusion
  Twelve studies (seven randomized controlled trials, two before-and-after studies, two cohort studies and one cross-sectional study) evaluated various nutrition interventions to determine methods for improving nutrition outcomes among adults with diabetes at different socio-economic levels and from various racial/ethnic groups or geographic locations. Tailoring the intervention to the culture and language of the target population was a key feature of effective programs.
  
  Characteristics of effective interventions included the following:
  - Methods:
    
    Group or one-on-one personal interaction, including education
    
    Skills teaching such as cooking classes and exercise interventions
    
    Enhancement of self-efficacy and self-management skills
    
    Group and individual support and counseling
    
    Community advocacy including transportation services
    
    Recruitment and retention efforts
    
    Use of community outreach workers, such as Promotoras
    
    Communication tools including video technology, automated telephone messages, telephone follow-up and written materials
  - Providers:
    
    Certified diabetes educators, registered dietitians, registered nurses
    
    Community health workers and peer counselors
  - Frequency and Duration:
    
    Interventions utilizing multiple sessions over extended time periods
    
    Ongoing education and support in the post-intervention periods
  - Settings:
    
    Public health clinics, community centers and physician offices
    
    Follow-up in professional settings or during home visits.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: Which nutrition intervention methods have been shown to be effective in improving nutrition outcomes among adults with diabetes with varying socio-economic status, racial/ethnic groups or geographic locations?
- Search Plan and Results: HD: Nutrition Intervention Methods 2009
Which nutrition intervention methods have been shown to be effective in improving nutrition outcomes among adults with cardiovascular disease with varying socio-economic status, racial/ethnic groups or geographic locations?
- Conclusion
  Seven studies (six randomized controlled trials and one descriptive study) evaluated various nutrition interventions to determine methods for improving nutrition outcomes among adults with cardiovascular disease with varying socio-economic status, racial/ethnic groups or geographic locations. Tailoring the intervention to the culture and language of the target population was a key feature of effective programs.
  
  Characteristics of effective interventions included the following:
  - Methods
    
    Group or one-on-one personal interaction, including education, counseling and support
    
    Enhancement of self-efficacy and self-management skills, including methods of self-monitoring, problem-solving and eliciting family and social support
    
    Use of community outreach workers and lay health leaders
    
    DASH dietary approaches
    
    Communication tools including audio CDs, computer-based presentations, computer-based education models, learning aids with culturally appropriate health messages, telephone follow-up and written materials
  - Providers
    
    Registered dietitians, registered nurses
    
    Peer educators and peer counselors
    
    Trained interventionists
  - Frequency and Duration
    
    Interventions utilizing multiple sessions over extended time periods ranging from two weeks to 18 months
  - Settings
    
    Public health clinics, community centers
    
    Community colleges
    
    Follow-up in clinic or community settings or by telephone.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: Which nutrition intervention methods have been shown to be effective in improving nutrition outcomes among adults with cardiovascular disease with varying socio-economic status, racial/ethnic groups or geographic locations?
- Search Plan and Results: HD: Nutrition Intervention Methods 2009