EAL

AWM: Nutrition Education (2006)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To evaluate a community-based nutrition and cooking education program for senior men.

Inclusion Criteria:

Open to all men who belonged to the Evergreen Senior Center.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment

Program was advertised by the RD, through a monthly newsletter, at nutrition display boards, and at ongoing nutrition workshops.

Design

Cross-sectional survey, interview

Blinding used (if applicable)

Not applicable.

Intervention (if applicable)

Evaluation questionnaire, personal interviews.

Statistical Analysis

Analysis of the pre and post-questionnaire data involved use of descriptive statistics. Using SPSS, descriptives, frequencies and cross-tabulation, chi-square tests were calculated to provide summary data of baseline and follow-up process and outcome evaluation data and to identify changes over time. Descriptive and thematic analysis of the interview transcripts was facilitated using Nvivo for coding and data processing.

Data Collection Summary:

Timing of Measurements

RD led a Men's Cooking Group in a senior's recreation facility and met once a month for 8 months to prepare and consume a meal, each session lasting 2 hours. Written questionnaires were completed by most of the men at the beginning and end of the evaluation year. Some men participated in personal interviews.

Dependent Variables

Pre-Study Questionnaire: prior cooking experience, frequency of cooking, recipe use, self-assessed cooking skill, attitudes towards cooking, trying new foods, cooking confidence
Follow-Up Questionnaire: included many of the same questions as the pre-study questionnaire for comparison purposes as well as evaluative questions about their experiences at the group, changes in cooking habits, and changes in nutritional knowledge and eating habits
Personal Interviews: interviewed by research RD, lasted 30 - 60 min, tape recorded and transcribed, general interview structure designed to help build understanding of the men's experiences in relation to the process and outcomes of the cooking group - prior cooking experiences, cooking experiences at home after joining group, strengths and weaknesses of the program, suggestions for improvements

Independent Variables

Demographic info to determine living situation and age

Control Variables

Description of Actual Data Sample:

Initial N: Group started with 8 men.

Attrition (final N): Group grew to 15 regular attendees, 29 men participated at least once during the 2 year period. 19 men completed pre and post questionnaires. 10 men participated in interviews.

Age: All over 65 years, 60% between 75 - 85 years

Ethnicity: Not mentioned

Other relevant demographics:

Anthropometrics (e.g., were groups same or different on important measures)

Location: Guelph, Ontario

Summary of Results:

Skill	Proportion (%)
Read recipes	84.2
Wash hands and kitchen equipment to have safe food	89.5
Clean and prepare food for recipes	84.2
Mix and combine foods according to recipes	73.7
Cook food according to recipes	73.7
Make main dishes	52.6
Make dessert	52.6
Use kitchen equipment safely	73.7
Store food safely	78.9
How to reduce fat in cooking	78.9
How to reduce salt in cooking	52.6
How to make healthy food more tasty	63.2
How to add more fiber to what I eat	84.2
More variety in my meals	73.7
How to include more healthy foods in what I eat	84.2

Other Findings

The majority of participants gained cooking confidence, increased their cooking activities at home, developed healthy cooking skills and improved cooking variety through the program.

The follow-up questionnaire responses indicated that the majority of men had developed strategies to reduce fat and salt in their cooking and to increase fiber and variety. Throughout the interviews most of the men identified how much they appreciated the RD's nutrition knowledge as well as improvements they had made to their diet.

The men also identified social benefits to the program.

Members found it difficult to identify ways to improve the group, primarily because they seemed pleased and fulfilled by the program.

Author Conclusion:

These results illustrate that a community-based nutrition intervention is a useful nutrition education activity to enhance senior men's cooking abilities, cooking frequency, as well as cooking and eating habits. The majority of participants reported feeling more confident cooking, increased the variety of foods they cooked, had a better understanding of healthy cooking and had greater enjoyment of cooking after having participated in the program. Providing community based cooking classes for senior men seems to be a useful approach to nutrition education and health promotion for this unique subgroup. Further community based research on programs and outcome of nutrition education and health promotion on senior men would be beneficial to this unique subgroup of our population.

Funding Source:

University/Hospital:

University of Guelph (Canada)

Not-for-profit

Foundation associated with industry:

Reviewer Comments:

Questionnaires not tested for validity and reliability. Small sample size.

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?		???
	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?	???
	2.2.	Were criteria applied equally to all study groups?	???
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	???
3.	Were study groups comparable?		Yes
	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?	Yes
	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.)	Yes
	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?		N/A
	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%.)	N/A
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	N/A
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	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?	Yes
	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?	Yes
	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?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	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?	???
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	???
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	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)?	No
	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