EAL

FNOA: Aging Programs (2012)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To capture information from nutrition service providers on the availability of kosher meal services in their community, the need for such services, and its cost.

Inclusion Criteria:

Elderly Jewish persons on kosher meal services.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment

Several Jewish health and service organizations were contacted to obtain information on kosher meal services, including the Association of Jewish Family and Children's Agencies, B'nai B'rith, MAZON, the Association of Jewish Aging Services, and the Orthodox Union.

Design

Cross-sectional, descriptive study

A survey was developed to capture information from nutrition service providers on the availability of kosher meal services in their community, the need for such service and its cost. The survey was distributed to all State Units on Aging Nutritionists and Administrators requesting that they complete and/or distribute to Area Agencies on Aging and known providers of kosher meals. The survey was also placed on the Meals on Wheels Association of America web page and distributed to this association's e-mail distribution list with a link to the survey.

Blinding used

Not applicable

Intervention

Not applicable

Statistical Analysis

Not described

Data Collection Summary:

Timing of Measurements

One-time measurement

Dependent Variables

Identified needs and barriers

Independent Variables

Kosher meal services

Control Variables

Description of Actual Data Sample:

Initial N: 176 surveys completed
Attrition (final N): 176 surveys completed
Age: Not reported
Ethnicity: Jewish
Other relevant demographics
Anthropometrics
Location: United States.

Summary of Results:

Programs Serving Kosher Meals

The primary need for kosher meal services was in metropolitan areas where there are communities of orthodox Jews that observe kosher dietary laws including: San Francisco, San Diego, Milwaukee, Detroit, White Plains (NY), Providence (RI), and Jamaica Plains (MA)
A number of programs serving kosher meals maintained a waiting list
The total number of kosher meals reported served daily was from two to 5,000
The majority of programs (34 of 50) purchased catered meals
Average suggested contribution for meal was $2.30 while actual contribution was only $1.40
Of the 41 programs indicating their funding sources, 32 used Older Americans Act funds, 14 had private pay clients, and seven used Medicaid Waiver program funding.

Programs Not Serving Kosher Meals

126 of 176 respondents reported that they did not provide kosher meal services and 100 of these reported that there was no need or very limited request
Cost appears to be the main drawback to providing kosher meals in areas where there are limited requests as well as in areas where kosher meals are currently provided
37 providers (of 81 respondents) indicated they had no alternative if a kosher meal was requested. 23 respondents cited that they would try to accommodate kosher meals in some way. 21 respondents said they would refer the client to a kosher program.

Limitations to Providing Kosher Meal Services

The primary barriers included:

Cost of catered and purchased meals
Availability of kosher meals
A few had concerns about nutrition requirements
Some service providers indicated difficulty continuing with their present caterer due to the low number of meals ordered or the caterer was no longer able or willing to provide kosher meals.

The average meal cost was reported as $7.64

A few respondents were concerned that kosher food or meals could not meet Older Americans Act nutrition requirements.

Challenges Faced by Nutrition Providers Identified in this Survey:

Information about kosher and dietary laws
Economical sources for kosher meals
Financial support to offset the cost of purchasing or preparing kosher meals
Need for kosher meal services in their community.

Author Conclusion:

Programs should carefully assess the ethnic and religious makeup in their community and determine through dialog with faith-based and ethnic-based organizations and individuals as to what their members desire or require in order to participate in the nutrition program.

It would be beneficial for programs currently providing kosher meals to form a network for the purpose of sharing information such as menus, recipes, preparation techniques, and vendors.

Funding Source:

Other:

Funding source not disclosed

Reviewer Comments:

Sample not well described. Statistical analysis not described.

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?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	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?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	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%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	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?	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?	N/A
	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?	N/A
	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?	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)?	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?		???
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	No
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	No
	10.2.	Was the study free from apparent conflict of interest?	Yes