Understanding Carbohydrates. St. Joseph s Community Center 2/9/2017. Helen Jang. ARAMARK Dietetic Internship

Transcription

1 Understanding Carbohydrates St. Joseph s Community Center 2/9/2017 Helen Jang ARAMARK Dietetic Internship 1

2 Overview Two sisters of Carondelet founded St. Joseph s center in 1976 in Venice, California with the mission of serving those in need. In 1987, they became a non-profit organization serving over 6,500 people annually. Currently, they provide a wide variety of services including a food pantry for the low-income community, learning programs to develop skills to obtain employment, day care services, and counseling services. The food pantry serves zip codes from the Santa Monica region all the way inland to the Beverly Hills region. The majority of the ethnic population St. Joseph s serves are Latinos, specifically Mexican Americans. A diabetic education workshop was conducted to 28 recipients of the food pantry. Results from this workshop revealed that a majority of them do not have diabetes but attended the class wanting to know more. There was an 89% increase in knowledge of 3-5 serving sizes in a diabetic meal and a 54-64% increase in knowledge of the serving sizes of various carbohydrates. All education materials are listed in the appendices. Nutrition Assessment: Client History: Personal History (1), Personal Data (1.1), Social History (3), Social History 3.1) St. Joseph s center is a nonprofit community organization that provides tools and services to both the low income and the homeless population to empower them to become self-supporting members of the community. They provide a culinary training program to obtain skills to work in the restaurant industry, an early learning center for children, food pantry for the low income, a coding program for low income women, mental health 2

3 counseling, temporary housing for homeless veterans, and a community run café serving up to 120 homeless people a day. The food pantry provides a variety of toiletries, dry foods, fruits, vegetables, and canned goods from local farmers markets, Whole Foods, and other supermarket donations. Through the assistance of the food pantry, over 147,000 nutritious meals were provided to low-income households. One of the stipulations to qualify for the food pantry, are for the clients to attend four annual workshops with topics including diabetes awareness, fitness classes, general nutrition education classes, juicing, and financial management classes. Venice has a population of 27,803 people as of December 2016, with about 17.83% of those being of Latin descent. 6 The predominant culture of the community St. Joseph s center serves is Latinos, specifically Mexican Americans. Since 2014, about 43.5% of Mexican Americans ages 20 and older are obese with 12% having type 2 diabetes. 2, 4 Approximately 27% of Mexican Americans ages 65 and older do not have health insurance. 2 Because of poor socioeconomic factors such as language barriers, lack of education, fear of deportation for some illegal immigrants, they often do not seek health care until absolutely necessary. 2 And with the rising Latino population, estimated to be about 1 in 4 people in the year 2050, it is imperative to combat diabetes with prevention and nutrition education. 1 The ethnic groups St. Joseph s center serves are 45% Latinos, primarily Mexican Americans, 30% Caucasians, 10% Russian Americans, 5% African American, and 5% Asian American, 5% mixed races. The predominant gender is female. The age group of community serves are anywhere between late 20 s to early 90 s year old. To qualify for the food pantry, the recipients must be of the low-income category at $17,820 for one 3

4 individual, with approximately $6000 extra income for each additional household member. Knowledge/ Beliefs/ Attitudes Beliefs and attitudes (4.2) Traditional Latin American culture about health and illness believes illnesses are a result of God s will, where they will seek healers or curanderos to treat their ailments, along with herbal teas. It is also culturally accepted for males to be slightly overweight which signifies masculinity. 5 Due to a certain degree of cultural acceptance of being overweight, lack of education and adequate health care, all leads to a later diagnosis and exacerbation of health diagnoses. In terms of social cues, respect is a big factor. In the elderly Latino community, it is not accepted to be overly familiar with them upon the first meeting; they prefer being called Mr. or Mrs. as a sign of respect. 5 It is also common for them to be nonverbal and avoiding eye contact with authority figures as a sign of respect. 5 Understanding cultural practices, religious, and traditional beliefs is an effective way to deliver the appropriate nutrition care process. Majority of Mexican Americans follow Catholicism but are not as strict as Catholicism in Mexico. 5 In Catholicism, they believe in abstaining from meat or other forms of self-denial for penance on certain days like Ash Wednesday and Good Friday. 5 Food and nutrition related history: Food Intake (1.2.1) 4

5 A food frequency questionnaire conducted through the National Health and Human Services (NHHS) found that the majority of the Mexican diet consists of their traditional foods and refined foods and sweets. 3 Of the traditional food category: 47% consists of maize and maize type foods and 4% of beans. 3 Of the refined foods and sweets category: 9.4% consists of alcohol, 9.4% consists of soft drinks, 7.7% consists of white bread, fast food, and desserts, and 8% consists of whole fat dairy products. 3 Due to these eating patterns, there is a 14-17% increased risk of being overweight and 20% of being obese. 3 A study conducted on the food acculturation found that Mexican Americans born in the US had less vegetable and fruit consumption than Mexican Americans born in Mexico. This diet shift can be seen as a culture acclimation to the American diet, because Mexican Americans born in Mexico s uses a variety of vegetables in their soups and dishes. The study also found that women of Mexican descent had higher consumption of vegetable and fruit juices after migration. 1 A main benefit of the food pantry is having the option of choosing the produce to minimize food waste rather than having to receive a box of preselected groceries. Of the foods provided at the food pantry, beans, corn, tortillas, bell peppers, onions, bananas, lemons, limes, and tomatoes is some of the preferred food with our Mexican Americans clients. Factors affecting food access Food/nutrition program participation (6.1) 5

6 The age of our clients ranges from late 20 s to early 90 s and they should be able to qualify for food assistance programs such as Supplemental Nutrition Assistance Program (SNAP), Women, Infants and Children (WIC), and Meals on Wheels along with Medicare since the qualification to obtain assistance from the food pantry is to be low income. Nutrition Diagnoses: Food and nutrition related knowledge deficit (NB 1.1) related to lack of prior diabetic diet education as evidenced by pre-survey results indicating 93% have not had formal diabetic diet education and 0% do not know the recommend carbohydrate serving sizes per meal. Nutrition Intervention Nutrition Education Content (1), Purpose of the Nutrition Education (E-1.1), Nutrition relationship to health/disease (E-1.4), Recommended modifications (E-1.5) The nutrition diagnosis shows that the majority of the clients at the food pantry do not know what the recommended serving sizes per meal are, let along serving sizes of carbohydrates. Since a majority of the clients are Mexican Americans (45%) and 12% of the US population of Mexican Americans has type 2 diabetes; it is essential that diabetic diet education be provided. The relationship between diabetes and uncontrolled blood sugars related to carbohydrate serving sizes were discussed. Recommendations of 3-5 serving sizes of carbohydrates were encouraged and strengthened with the My Plate food building activity. 6

7 Healthy People 2020 Healthy People 2020 are a 10-year national objective for improving the health statuses of Americans. They explore and provide a list of health topics with specific measurable goals and objectives. The overall goal with diabetes is to reduce the disease burden and improve the quality of life for all persons who have, or are at risk for, diabetes mellitus. To achieve that goal, specific objectives were put into place. (D-14) is to increase the proportion of persons with diagnosed diabetes who receive formal diabetes education. These objectives utilize SMART (specific, measurable, attainable, realistic, timely) goals. The specific population is those with diagnosed diabetics. The measurable part of the goal is to increase the proportion from 56.8% of adults to 62.5% by The timely part of the goal is spanning 10 years making the overall objective realistic. This nutrition workshop qualifies under two of the emerging trends in dietetics to incorporate innovative health and wellness initiative into practice by (ETD 5.1) evaluating emerging trends for application in dietetic practice such as Healthy People 2020 and (ETD 5.5) demonstrating leadership through coordination in development, marketing, implementation, and evaluation of a health and wellness initiative. Lesson Plan A 1-hour nutrition workshop was conducted at St. Joseph s center to the clients receiving assistance from the food pantry, focusing on Mexican Americans. The goal of the nutrition education was to reduce the number of diagnosed diabetes by educating what diabetes is, what is a serving size relative to different carbohydrates, and how many 7

8 servings are recommended for one diabetic meal. Special focus was provided educating the Mexican American audience on the serving size of a 6-inch tortilla, rice, and beans along with other foods. Nutrition handouts were provided in both English and Spanish. A pre-workshop questionnaire and post-workshop survey was completed. Evaluation methods include pre and post-test surveys and the food building activity. Refer to appendix A for the Lesson Plan. 5 minutes were allotted for the pre-test questionnaire. A discussion of what diabetes is including symptoms, statistics, demographics, and treatments were introduced for 10 minutes. An interactive food building activity utilizing food models with reference to the My Plate recommendations were conducted for 30 minutes. 5 minutes were also allotted for the post-test survey. A healthy snack prize incentive activity was conducted to answer the post-test survey questions for 5 minutes. Closure of workshop includes a discussion and questions segment for 5 minutes for a total of a 1-hour diabetic diet workshop session. Marketing The promotion of the workshops is through fliers located at the food pantry. To continue receiving food assistance, the clients must attend a total of four workshop sessions every year. All workshops are free, conducted at the conference room at St. Joseph s center, with handouts and education materials. Unfortunately, a diabetic diet workshop was not on the schedule. However, through reaching out to the food pantry coordinator, a last minute diabetic diet education workshop was created through word of mouth. Refer to appendix E for the workshop flier. 8

9 Materials Through the generosity of the nutrition department at Providence St. John s, food models were borrowed for the education workshop. Educational handouts were accessed through the nutrition care manual and American Diabetes Association. Pens and paper were provided by St. Joseph s center. The costs of the healthy snack prizes are variable, but for the purpose of this education came out to $2. The poster-board purchased for educational purposes was $5. Total budget for this workshop is $7. No equipment and extra personnel was needed for this workshop. Nutrition Monitoring and Evaluation The anticipated participants were originally at 15 people; however, this workshop had the highest turn out with 28 participants. Of the participants, there were various ethnicities including 11 Mexican Americans, 9 Russian Americans, 7 Caucasians, and 1 African American. All participants were engaged and actively listened providing questions and input about diabetes. A prize incentive review activity of the post-test was conducted after collection of the post-test. Everyone was very receptive to the prizes, which included a banana, an orange, a packet of organic peanut butter, and an avocado. Evaluation of the nutrition education was conducted in the form of a preworkshop questionnaire and a post-workshop survey. The evaluation of the pre-test determined that 3 people (11%) of the participants had diabetes, 2 people (7%) had prediabetes. Out of all the participants, 2 people (7%) have had formal diabetic diet education. With the pre-test, 0% knew how many serving sizes are recommended for one meal. 9

10 With the post-test survey, 25 participants (89%) answered all the questions correctly with 3-5 servings of carbohydrates per meal. 18 participants (64%) answered correctly with 1-cup carb serving size of dairy, 17 participants (61%) answered correctly with 1-cup serving size of fruit, 18 participants (64%) answered correctly with 1-cup serving size of vegetables, and 15 participants (54%) answered correctly with 1/2-1/3 cup of grains. The goal of increasing knowledge about diabetic education was successful in reference to the Healthy People 2020 objectives. 89% increase in knowledge of 3-5 serving sizes of carbohydrates per meal % of participants were able to identify carbohydrate-serving sizes. Future plans for conducting this nutrition education session would be to have a raise of hands for pre-test and post-test surveys to facilitate the evaluation method quicker. Majority of the participants understand how many carbohydrates servings are recommended for one meal after the workshop. However, there was a language barrier with the Russian American participants because many of them did not answer serving sizes of carbohydrates correctly. There should also be Russian translated handouts for future workshops. Food models provided did not include foods the participants normally consumed. Food models can range from approximately $150-$300. If proper funding and a proper budget were allowed, ethnic food models would better facilitate the learning process. However, the workshop without food models can be feasible as well. An early disclaimer about healthy snack prizes should be specified early on to motivate active listening. 10

11 Appendix A: Lesson Plan Lesson Title: Understanding Carbohydrates General Objective of Class Goal: To provide awareness of carbohydrate serving sizes and to be able to build a healthy plate with various carbohydrates Target Audience: Clients served by St. Joseph s center Date: 2/9/17 Duration: 1 hour: 5 min pre-test, 10 min explanation, 30 min activity, 5 min post-test, 5 min Q & A, 5 min ending discussion Specific Objectives: 1. By the end of the session through the use of a post-test survey, clients will know the servings sizes of carbohydrates such as fruits, dairy, vegetable, and grains S: This objective is specific to the clients of St. Joseph s center. M: This objective is measureable from the post-test. A: This objective is achievable through the 1-hour session. R: This objective is realistic in that clients are able to identify serving sizes of various carbohydrates. T: This objective is timely in that clients will be able to know the various serving sizes by the end of the session. 2. By the end of the session, participants will know how many servings sizes for a diabetic meal. S: This objective is specific to the clients of St. Joseph s center M: This objective is measureable by through the post-test. A: This objective is achievable through the 1-hour session. R: This objective is realistic in that clients will know 3-5 serving sizes for one meal. T: This objective is timely in that clients will be able to know how many serving sizes by the end of the session. 3. By the end of the session through the interactive My Plate building activity with food models, clients will be able to build a healthy diabetic plate with 3-5 serving sizes. S: This objective is specific to the clients of St. Joseph s center M: This objective is measureable from by the 3-5 serving sizes. A: This objective is achievable through the 1-hour session. R: This objective is realistic in that clients will be able to build a plate with 3-5 carbohydrate food models. T: This objective is timely in that clients will be able to know what a healthy plate looks like with 3-5 serving sizes of carbohydrates by the end of the session. 11

12 Specific Objectives Procedure Learning Activity Evaluation Introduction Introduce self to participants and explain the purpose of diabetic education for the class Evaluate participant s knowledge about diabetes Verbal introduction to presentation Discuss why diabetes is important to participants Pre-test 1. Through the use of a post-test, participants will be able to identify serving sizes of carbohydrates Body of Lesson Overview & Explanation of Diabetes 1. Explain what diabetes is Demographics Statistics Symptoms Poster board Handouts Verbal Q&A Post-test 2. Explain how servings sizes are of importance to blood sugar regulation High Blood Sugar Diabetes 2. By the end of the session participants will be able to know how many serving sizes for a diabetic meal 3. By the end of the session participants will be able to build their own healthy General Carbohydrate Counting 1. Explain carbohydrate serving sizes Grains (~1/2 to 1/3 cup) Fruit (1 cup) Milk (1 cup) Vegetables (1 cup) 2. Explain how many serving sizes in one meal 3-5 carb servings My Plate Building Activity 1. Create a sample My Plate using the Poster board display Verbal teaching Nutrition Handouts Verbal teaching Nutrition Handouts My Plate building activity using 3-5 carb servings Verbal Q&A Post-test Food plate building activity Post-test 12

13 plate utilizing food models in reference to the My Plate method. food models 3-5 servings 2. Pass food models basket around for activity Have the audience build their own version of a healthy plate Answer the post-test questions with healthy snack prize incentive Conclusion Summarize workshop education Thank participants for attending Verbal conclusion Additional Questions Diabetic Handout includes: a. Eat right with My Plate b. Type 2 Nutrition Therapy from Nutrition Care Manual c. 20 ways to increase more fruits and vegetables from Nutrition Care Manual d. Label reading from Nutrition Care Manual 13

14 Appendix B: Pre test Workshop Questionnaire What is your age? What is your gender? Female Male What is your race/ethnicity? Have you ever taken a course or class in how to manage your diabetes yourself? 1. Yes 2. No 3. Don't know / Not sure 4. Refused Have you ever been told by a doctor that you have diabetes? [If "Yes" and respondent is female, ask:] Was this only when you were pregnant? 1. Yes 2. Yes, but only during pregnancy [females only] 3. No 4. No, pre-diabetes or borderline diabetes 5. Don't know/not stated 6. Refused How many servings of carbohydrates are recommended for one meal? a. 1-2 servings b. 3-5 servings c. 4-5 servings d. 5-6 servings 14

15 Appendix C: Post Test Ending Workshop Questionnaire How many servings of carbohydrates are recommended for one meal? e. 1-2 servings f. 3-5 servings g. 4-5 servings h. 5-6 servings What is the carb serving size of a dairy product? a. 1 cup b. ½ cup c. 1/3 cup d. 2 cups What is the carb serving size of vegetables? a. 1 cup b. ½ cup c. 1/3 cup d. 2 cups What is the carb serving size of fruit? a. 1 cup b. ½ cup c. 1/3 cup d. 2 cups What is the carb serving size of grains? a. 1 cup b. ½- ⅓ cup c. 1/3 cup d. 2 cups 15

16 Appendix D: Poster Board 16

17 Appendix E: Nutrition Flier 17

18 References: 1 Batis C, Hernandez-Barrera L, Barquera S, Rivera JA, Popkin BM. Food acculturation drives dietary differences among Mexicans, Mexican Americans, and Non-Hispanic whites123. The Journal Of Nutrition. 2011;141(10). Accessed February 10, CDC. Health of Mexican American population. Center for Disease Control and Prevention. Accessed January 27, Flores M, Macias N, Rivera M, et al. Dietary patterns in Mexican adults are associated with risk of being overweight or obese. The Journal of Nutrition. 2010;140(10): doi: /jn Accessed February 10, Juckett G. Caring for Latino patients. American Family Physician. Accessed January 27, Medina, C. Belief and Traditions that impact the Latino Healthcare. LSU School of Public Health. t%20impact%20the%20latino%20healthcare.pdf. Accessed January 28, People. Sperling s Best Places. Accessed February 06,