EAL

FNOA: Aging Programs (2012)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To report findings from a study that was conducted to identify perceived barriers to racial/ethnic minority elders' participation in an elderly nutrition program in a large metropolitan area and effective strategies for reaching out to them.

Inclusion Criteria:

Staff and volunteers of program's 17 centers; each center has a manager and an average of two paid staff, as well as four to five long-term volunteers.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment

Data were collected from a survey with the Elderly Nutrition Program's staff and volunteers and three focus group discussions with professionals working with minority elders and minority community leaders.

Design

Cross-sectional study

Blinding used

Not applicable

Intervention

Not applicable

Statistical Analysis

Answers to questions were compiled and entered into a computer in preparation for content and qualitative analysis.

Data Collection Summary:

Timing of Measurements

Dependent Variables

Survey included open-ended questions asking the respondents to:

Describe activities, services and strategies that their centers have effectively employed to recruit and retain participants, especially racial/ethnic minorities, in congregate dining programs
Provide their ideas about how improvement in outreach and services could be made in the future to attract and retain more minority elders.

Focus group discussions were semistructured and addressed:

Barriers to racial/ethnic minority elders' participation in the Elderly Nutrition Program
Effective outreach strategies for racial/ethnic minority elders.

Independent Variables

Racial/ethnic minorities

Control Variables

Description of Actual Data Sample:

Initial N: 100 surveys distributed to staff and volunteers of 17 program centers
Attrition (final N): 74 completed surveys returned and analyzed, 77% female
Age: Majority of volunteers were aged 60 years and older
Ethnicity: Multiethnic focus groups were based on African American, Hispanic, Asian American, Eastern European and native American participants
Other relevant demographics:
- 1/3 of respondents were paid center staff
- 2/3 of respondents were volunteers
Anthropometrics
Location: Pacific Northwest United States.

Summary of Results:

Key Findings

The study participants identified as their perceived barriers:
- The lack of information or misinformation about the program
- Culturally driven reluctance to ask for outside help
- Fear and distrust of formal systems
- Lack of ethnic foods or menus in the program
- Discomfort due to cultural differences
- Other responsibilities, such as having to take care of their grandchildren
- Inaccessibility and inadequacy of transportation
Recommended outreach strategies included:
- Involvement of family members in the information dissemination process
- Establishment of good working relationships with community leaders and contact with key older persons
- Diversification of menus and increased use of food enhancements
- Increase in cultural activities or programs in congregate dining centers
- Solicitation of input from current participants
- Provision of intergenerational programs
- Recruitment of volunteer drivers from the minority community
- Location of the program in ethnic enclaves or places where minority elders can easily congregate
- Improvement in transportation services.

Author Conclusion:

The survey and focus groups that are reported in this paper were conducted in an effort to identify effective and efficient outreach strategies and improve the accessibility and acceptability of an Elderly Nutrition Program among racial/ethnic minority elders. The impetus for the survey and the focus groups was the combination of a large increase in the minority population, especially Hispanics and Asian Americans, in the area and the small number of minority participants in the program. In the face of rapid population aging and the increasing share of racial/ethnic minorities among older persons, other Elderly Nutrition Programs in the country are also likely to need to employ more active outreach efforts and strategies to attract more minority elders to the programs. It is hoped that the findings of this needs assessment study help inform other Elderly Nutrition Programs of potentially useful strategies for attracting more minority elders.

Funding Source:

University/Hospital:

University of Texas at Austin

Not-for-profit

Loaves and Fishes, Inc.

Other non-profit:

Reviewer Comments:

High response rate but small sample size. Inclusion/exclusion criteria for survey respondents and focus group participants not well 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)	N/A
	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)	N/A

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?	No
	2.2.	Were criteria applied equally to all study groups?	???
	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?		???
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	No
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	???
	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?	???
	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.)	???
	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?		No
	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.)	No
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	No
	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?	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?	???
	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?	N/A
	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?	???
	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?	No
	10.2.	Was the study free from apparent conflict of interest?	Yes