EAL

FNOA: Aging Programs (2012)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To determine the effectiveness of the senior nutrition program in promoting the health and well-being of its clients across age, gender and ethnic lines
To compare persons from home-delivered sites and congregate sites
To contribute baseline data that may be used to modify existing programs or develop new ones.

Inclusion Criteria:

Senior Citizens Nutrition and Activities Program (SCNAP) participants
Those who had meal delivered to their homes had to be physically able to participate.

Exclusion Criteria:

Physical inability to participate.

Description of Study Protocol:

Recruitment

Participants were not recruited to participate.

Design

Cross-sectional study
Two groups of participants were provided with questionnaires. One was those who attended a congregate meal site. These were distributed by the site manager and placed in a box after completion.
Those participants who received home-delivered meals were given a questionnaire by the the meal delivery person on a Monday or Tuesday and picked up the following Friday.

Statistical Analysis

Cross-tabular analysis were formed on the collected data
Analysis of variance appears to be the analysis used but this is not specified.

Data Collection Summary:

Timing of Measurements

Data was collected in 1991.

Dependent Variables

Health of Senior Citizens Nutrition and Activities Program (SCNAP) participants as measured by a survey and disability status
Well-being on Senior Citizens Nutrition and Activities Program (SCNAP) participants as measured by a survey.

Independent Variables

Participation in Senior Citizens Nutrition and Activities Program (SCNAP).

Description of Actual Data Sample:

Initial N

Samples were selected from two sites, 888 from congregate meal sites and 415 from those who had meals delivered to their residences, for a total of 1,313 participants.

Attrition (final N)

A total of 1,071 surveys were returned, 307 from home-delivered participants and 764 from congregate site participants. 243 participants did not return questionaires.

Age

Congregate meal sites: 51% were 75 years old or less, 49% were 76 years old or older
Home-delivered meals: 41% were 75 years old or less, 59% were 76 years old older.

Ethnicity

Congregate meal sites: 86% were white, 14% non-white
Home-delivered meals: 79% were white, 21% non-white.

Other Relevant Demographics

Congregate meal sites: 72% were female, 28% male
Home-delivered meals: 72% were female, 28% male.

Location

26 congregate meal sites in Hillsborough County, Florida.

Summary of Results:

Almost 100% of participants felt the meals were well-balanced, 94% liked the meals provided, 69% felt they ate a greater variety of food than they would have otherwise, 14% indicated that SCNAP provided their only meal each day and 72% said they felt healthier due to their participation in the program
A greater percentage of of home meal participants said they felt healthier due to their participation in the program than the congregate diners (84% vs. 67%)
Home meal participants experienced greater loneliness than did their congregate meal counterparts.

Health and Economic Condition and Emotional Condition by Meal Site

Variables	Congregate Meal Site	Home-delivered Meal Site	Statistical Significance of Group Difference
Self-rated Health (N=663)
Fair/Poor	50	82	x² = 79.86; 1 df
Good/Excellent	50	18	Ø = 0.29
Comparative Health Status (N=637)
Worse	7	23	x = 68.70; 2 df
Same	50	58	Ø = 0.28
Better	43	20	N=637
Disability Status (N=533)
Disabled	44	85	x² = 131.21; 1 df
Not Disabled	56	15	Ø = 0.42
Comparative Economic Situation (N=637)
Worse
Same			x² = 38.69; 2 df
Better			Ø = 0.21
Poverty Status (N=533)
In poverty	62	63	x² = 0.01; 1 df
Not in poverty	38	27	Ø = 0.00
Loneliness (N=555)
More lonely	22	38	x² = 20.64; 1 df
Less lonely	78	62
Need for Opportunity for Nurturance (N=619)
More need	72	79	x² = 5.63; 1 df
Less need	28	21
Need for Social Integration (N=603)
More need	58	79	x² = 13.59; 1 df
Less need	42	21	Ø = 0.13
Need for Attachment (N=608)
More need	53	57	x² = 1.19; 1 df
Less need	47	43	Ø = 0.04
Need for Enhancement of Worth (N=547)
More need	58	60	x² = 0.18; 1 df
Less need	42	40	Ø = 0.02

Comments on SCNAP Participation by Meal Site

Variables	Congregate Meal Site	Home-delivered Meal Site	Statistical Significance of Group Difference
Well-balanced Meals (N=640)
No	9	2	x² = 1.14; 1 df
Yes	97	98	Ø = 0.01
Like Meals (N=631)
No	5	7	x² = 1.22; 1 df
Yes	95	93	Ø = 0.04
Only Meal Each Day (N=653)
No	87	85	x² = 0.96;1 df
Yes	13	15	Ø = 0.03
Feel Healthier (N=627)
No	23	16	x² = 6.36; 1 df
Yes	67	84	Ø = 0.08
Eat Greater Variety (N=628)
No	33	28	x² = 2.06; 1 df
Yes	67	72	Ø = 0.05
Participate in Activities (N=633)
No	28	87	x² = 265.47; 1 df
Yes	72	13	Ø = 0.55
More Friends (N=637)
No	15	62	x² = 178.96; 1 df
Yes	85	38	Ø = 0.46

Author Conclusion:

The authors conclude that this study shows that the SCNAP program remains an essential service in providing both physical and emotional support to older individuals. SCNAP is also reaching its target population, those with greatest financial and social need.

Funding Source:

University/Hospital:

University of South Florida

Reviewer Comments:

The type of statistical analysis used in this study was not specified other than cross-tabular analysis. Based on the reporting it appears that an Analysis of Variance was completed, but it is difficult to evaluate the appropriateness of the testing performed without more specific information.
1,071 surveys were returned but most of the Ns for different survey questions were only 500 to 650. It is unclear to the reviewer why so many who returned the survey did not answer some of the questions.
Questions related to health and well-being were all based on questionnaires. No actual measurements of health or well-being were taken other than looking at disability status.
The reviewer believes that there was bias inherent in this study based on who returned questionnaires. Those who did not return questionnaires may have been in poorer health or unable to read or understand the survey.
It is unclear to the reviewer how long those who were studied had participated in the home-delivered or congregate meal programs. Length of participation could have had a significant effect on how participants answered the questionnaire.

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?	???
	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?	Yes
	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?		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?	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%.)	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?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	N/A
	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?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		???
	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?	???
	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)?	???
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	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?	No
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