Evidence-based Nutrition Education Research Articles

Access to nutrition advice and knowledge, attitudes and practices of pregnant women in Ireland: A cross-sectional study.

Healthy nutritional status, appropriate gestational weight gain and a balanced diet are important predictors of perinatal health outcomes. However, gaps exist in the translation of nutrition recommendations into dietary practices of women before and during pregnancy. The present study explored the relationship between access to nutrition advice, nutrition knowledge, attitudes and practices among pregnant women. Pregnant women aged > 18 years in Ireland were eligible to complete a self-administered survey consisting of four subsections (demographics, nutrition knowledge, attitudes and practices) delivered online through Qualtrics. In this convenience sample (n = 334,median [interquartile range] gestation, 25.0 [16.0, 34.0] weeks), 85% had at least an honours bachelor degree and 88.9% planned their pregnancy. Two out of five women received nutrition advice during their pregnancy, mostly from a midwife. Based on the percentage of correct answers (of 15 questions), women with previous nutrition education (e.g., school home economics) had better median [interquartile range] nutrition knowledge than those with none (80.0% [66.7, 86.7%] vs. 73.3% [60.0, 80.0%], p < 0.001). Those who received nutrition advice during pregnancy did not score higher than those who did not (73.3% [66.7, 80.0%] vs. 73.3% [66.7, 80.0%], p = 0.6). Over three-quarters of participants considered nutritional supplement use to be very or extremely important. Although 73.6% and 92.4% took supplements prior to and during pregnancy, only 25.7% reported compliance with periconceptional folic acid supplementation guidelines. Half of respondents considered healthy eating during pregnancy as very or extremely important. Access to nutrition advice during pregnancy was inadequate with poor nutrition knowledge, attitudes and practices observed. Accessible, evidence-based nutrition education for women prior to and during pregnancy is required.

There and Back Again: A Forty-Year Perspective on Physician Nutrition Education

Medical education faces an urgent need for evidence-based physician nutrition education. Since the publication of the 1985 National Academies report “Nutrition Education in the United States Medical Schools,” little has changed. Although several key efforts sought to increase nutrition content in undergraduate medical education over the past 40 y, most medical schools still fail to include the recommended minimum of 25 h of nutrition training. Without foundational concepts of nutrition in undergraduate medical education, graduate medical education unsurprisingly falls short of meeting patient needs for nutritional guidance in clinical practice. Meanwhile, diet-sensitive chronic diseases continue to escalate, although largely preventable and treatable by nutritional therapies and dietary lifestyle changes. Fortunately, recent recognition and adoption of Food is Medicine programs across the country increasingly connect patients with healthy food resources and nutrition education as core to their medical care, and physicians must be equipped to lead these efforts alongside their dietitian colleagues. Filling the gap in nutrition training will require an innovative and interprofessional approach that pairs nutrition with personal wellness, interprofessional practice, and community service learning. The intersectional benefits of connecting these domains will help prepare future physicians to address the social, behavioral, and lifestyle determinants of health in a way that recognizes nourishing food access as a core part of clinical practice. There are numerous strategies to integrate nutrition into education pathways, including didactic and experiential learning. Culinary medicine, an evidence-based field combining the culinary arts with nutritional science and medicine, is 1 promising educational framework with a hands-on, interprofessional approach that emphasizes community engagement. Advancing the critical need for widespread adoption of nutrition education for physicians will require support and engagement across societal stakeholders, including co-leadership from registered dietitian nutritionists, health system and payor reform, and opportunities for clinical innovation that bring this essential field to frontline patient care.

Exploring the dietary practices and perceptions of African immigrants in Illinois- a qualitative study of immigrants from Nigeria and Congo

ABSTRACT Objective Previous studies suggest an increased prevalence of diet-related chronic diseases among African immigrants with increased length of stay in the U.S. The objective of the current study is to understand the dietary practices and perceptions of recent African immigrant families. Design Focus group sessions were conducted with Nigerian and Congolese immigrant parents residing in Illinois. Participants were recruited using convenience sampling methods and focus group sessions were conducted via videoconference. Participants discussed dietary practices, meal preparation, and family mealtimes for their families. They also discussed experiences with eating different kinds of foods since arrival in the U.S. Verbatim transcription of focus group sessions were completed and deductive thematic analysis of transcribed data was conducted using NVivo (QSR International Pty Ltd. [2020] NVivo [version 12]). Results Twenty African immigrant parents (Mean age: 42 years, Female: 95%) residing in Northern and Central Illinois participated in a total of five focus group sessions. Seven themes were derived from the analysis. Participants had a positive attitude toward healthy diet and had a high level of interest in receiving educational resources to make healthier food choices. Participants preferred and mostly consumed foods they were familiar with before migration. A majority of the participants perceived ‘American foods’ as unhealthy, characterizing them as containing a high amount of sugar and salt. Parents reported that their school-aged children often preferred a western diet over traditional African meals. Conclusion This study helps to understand unique diet-related practices and perceptions of recent Nigerian and Congolese African immigrants in Illinois. Findings could help to inform cultural adaptation of evidence-based nutrition education programs for these groups of African immigrants.

Scoping user needs for an online nutrition education resource for older adults

As the global population continues to age, strategies that promote health and wellbeing among older adults are urgently required. This demographic faces an increasing burden of chronic diseases linked to inflammation(1), often associated with diets that are energy dense and nutrient poor(2). Importantly, the impact of these conditions can be minimised by adopting an anti-inflammatory dietary pattern, such as the Mediterranean diet(3). While there are numerous predictors of behaviour and an individual’s capacity for behaviour change, nutrition knowledge is a fundamental influencer of eating behaviours(4). However, knowledge of anti-inflammatory diets generally and the Mediterranean diet specifically is lacking among older adults(5), highlighting the need for effective educational programs targeting this group. Digital health technologies have the potential to provide cost-effective and accessible nutrition education, however, few technologies have been developed to meet older adults unique needs and preferences. To address this gap, this study aimed to explore the specific needs and design preferences of older adults for an online nutrition education resource. A total of 20 adults aged 55 years and older participated in one of four 2-hour participatory design workshops, where prompted discussion questions were used to explore their use of technology and scope their needs and preferences for an online nutrition education resource. All participants were regularly using a range of different devices (e.g., smartphones, tablets, and computers) and reported being comfortable doing so. Participants wanted a website that could be accessed across devices (i.e., desktop and mobile friendly) that provided practical nutrition advice, recipes, and information on the link between diet and disease. A number of design principles were identified as essential to optimise the user experience, including large and simple fonts, use of dark type on a light background, and clear categories for easy navigation. To enhance engagement, participants sought a personalised resource that could be adjusted to suit their needs, provided up-to-date information, and allowed for easy content sharing with others, such as by exporting information as a PDF. Participatory design methods offer new knowledge for developing and refining existing and future digital health technologies that are appropriate and useful for the target audience. Specifically, the older adult participants were motivated to access a user-friendly web-based nutrition resource provided it was able to be personalised to their health and nutrition needs, offered practical solutions such as adaptations to portion size or in relation to cost, and was easily shareable with others. Given the limited availability of online, self-directed and evidence-based nutrition education resources for older adults, these findings provide valuable insights to shape digital health resources that cater to the needs and preferences of this population and have the potential to support healthy eating habits and contribute to reducing diet-related chronic disease burden.

A nutrition education service learning programme: Development, implementation and impact on participants

Objective: The aim of this study was to investigate the perceptions of university students who served as outside facilitators for evidence-based nutrition education for elementary-age children. Design: Qualitative case study. Methods: Thirteen undergraduate university students facilitated four nutrition education sessions for elementary-age students in an after-school programme using the Choice, Control, Change model as part of service learning curriculum. University students completed pre- and post-participation surveys. Elementary-age participants completed surveys after each session. Results: University students saw the benefit of this type of experiential learning with the following themes: knowledge application, learning about diverse perspectives and having a positive impact. Before the first nutrition education session, the university students felt excited, nervous and/or enthusiastic, and during and immediately after the sessions reported they felt confident. Participant engagement was low/mixed and classroom management was challenging, which may be linked to the university students’ perceptions that they were underprepared to work in a distracting social environment, and with behaviour typical to elementary-age children. The education session recipients reported they gained knowledge about healthy behaviours and believed that eating healthy foods is important. Conclusion: There are gaps in nutrition education programme theory and implementation by outside facilitators. These findings are relevant to those who provide health education services for surrounding communities. This study provides information about implementation barriers when outside facilitators lead nutrition education, alongside recommendations to improve these types of programmes in the future.

OR07-06-23 Feasibility of Instagram to Engage Low-Income Individuals With Evidence-Based Nutrition Education

OR07-06-23 Feasibility of Instagram to Engage Low-Income Individuals With Evidence-Based Nutrition Education

557-P: Effect of MyPlate Nutrition and Diabetes Education Delivered by Promotoras de Salud in Low-Income Latinx Adults Living in Rural Communities

Background: Latinx individuals have over a 50% chance of developing type II diabetes within their lifetime compared to 40% of the general population1,2. Further, a lack of diabetes education significantly contributes to poor health literacy surrounding diabetes treatment and management among ethnic minorities3. Methods: The study utilized a pre and posttest design using the General Nutrition Knowledge Questionnaire-Revised to assess changes in the nutrition knowledge of individuals 18 years or older, after receiving a tailored nutrition education presentation based on U.S. Department of Agriculture MyPlate's dietary guidelines. The difference between pre and posttest nutrition knowledge scores was measured using paired samples t-test for the overall survey and separately for three questions that assessed the diet-diabetes relationship. Results: Most participants were Spanish-speaking Latinx/Hispanic females between the ages of 40-49, where 66% reported middle school education or lower, 26.4% reported being diagnosed with diabetes, and 56% had a family history of diabetes. The paired t-test of the pre and posttests (n=82) resulted in one and two-sided p-values &amp;lt; 0.001. The comparative pre versus posttest analysis for the diabetes knowledge-related questions showed that the diabetes-related questions one, two, and three resulted in p-values &amp;lt;0.227, &amp;lt;0.02, and &amp;lt;0.03, respectively. Conclusion: Latinx individuals in rural communities face systemic barriers, including poor medical coverage, low health literacy rates, language and immigration barriers4. Our study brought together promotoras to create and deliver culturally-conscious, evidence-based nutrition education material through platicas. Increased access to nutrition and diabetes education contributes to improved patient health knowledge and addresses negatively impactful social determinants of health among rural Latinx American populations. Disclosure S.C.Marin: None. I.Marquez: None. R.R.Flores: None. D.Lee: None. D.Wraich: None. H.Duran: None. A.M.Cheney: None. Funding University of California, Riverside School of Medicine

“Ancestral recipes”: a mixed-methods analysis of MyPlate-based recipe dissemination for Latinos in rural communities

BackgroundThe Latinx population experiences some of the highest rates of chronic disease, including obesity and type II diabetes. Such conditions may be especially burdensome in rural Latinx communities that often face barriers to accessing disease prevention resources and public health programs.MethodsDiverse stakeholders (i.e., patients, community members, system of healthcare clinics, community food bank) tailored an existing cookbook, based on the U.S. Department of Agriculture MyPlate healthy eating and dietary guidelines, for local ingredients, health literacy, and language for rural Latinx and Indigenous Latin Americans. The cookbook recipes were disseminated widely via virtual cooking demonstrations, food distribution events, and social media. Pre- and posttest surveys were used to assess changes in diabetes knowledge measured by the 24-item American Diabetes Association Diabetic Knowledge Questionnaire and confidence in dietary behavior change over time measured by 4 questions of the 17-item Mediterranean Diet Index. A mixed effects, repeated measures analysis was conducted with gender ID, age range and educational attainment included as covariates and assessment interval as the predictor (pretest vs posttest) and change in confidence about adhering to four specific components of the Mediterranean diet. Focus groups elicited information on participants’ motivation and ability to use the recipes and eat healthy foods following the virtual cooking demonstration participation.ResultsA total of 20 virtual cooking demonstrations were conducted and 60 participants completed a pretest survey and 54 a posttest survey, a subsample (n = 19) participated in one of three focus groups. Most participants were female, identified as Latinx/Hispanic, were between the ages of 40-49, and spoke Spanish. 17% identified as Indigenous Latin American specifically as Purépecha, an indigenous group from Michoacán, Mexico. Survey and focus group findings indicated at posttest an increase in diabetes knowledge among participants with no prior diagnosis of chronic health conditions and more confidence in limiting sugary beverages and refined wheat pasta/white rice among indigenous participants. Focus group discussions explicated the quantitative findings.ConclusionThis study brought together patients and key stakeholders committed to addressing the social determinants of health and it mobilized the community to develop culturally vetted health education materials. The findings indicate the need for increased access to evidence-based nutrition education and to culturally appropriate food products that can be easily incorporated into daily food preparation.

Impact of malnutrition management e-learning module on GPs' knowledge: a pilot study.

Malnutrition is underdiagnosed in primary care. GPs are key healthcare contacts for older adults at risk of protein-energy malnutrition; however, lack of knowledge and confidence in its diagnosis and treatment is often reported. To evaluate the impact of a bespoke online education module on GP malnutrition knowledge and management. A prospective pre-post pilot study with 23 GPs and eight GP trainees in the Republic of Ireland. The module included units on the following: 'malnutrition definition, prevalence, and latest evidence'; 'identifying malnutrition in clinical practice'; 'food-first advice'; 'reviewing malnutrition'; and 'oral nutritional supplements'. Participant knowledge was measured using a multiple choice questionnaire (MCQ) before and after the module (n = 31), and 6 weeks following completion (n = 11). Case studies assessing identification and management of malnutrition were evaluated by a clinical specialist dietitian with expertise in managing malnutrition. Changes in assessment performance were calculated using paired t-tests. Acceptability was evaluated using a questionnaire. Post-training, 97% of GPs increased MCQ scores from baseline (+25%, P<0.001), with the greatest improvement in 'identifying malnutrition in clinical practice' (mean increase 47%, P<0.001). Eleven GPs completed the 6-week MCQ with scores remaining significantly higher than baseline (mean increase 15%, P = 0.005); 'identifying malnutrition in clinical practice' remained the most highly scored (mean increase 40%, P<0.001). Seventeen GPs completed the case studies; 76% at baseline and 88% post-module correctly calculated malnutrition risk scores. Appropriate malnutrition management improved for 47% of GPs after module completion. This e-learning module improved malnutrition knowledge, with good short-term retention in a small cohort. Development of online evidence-based nutrition education may improve GP nutrition care.

Collaborative Strategies to Improve Nutrition Security and Education: Lessons Learned During a Pandemic.

The COVID-19 pandemic intensified disparities for underserved populations as accessing resources became more difficult. Dairy Council of California launched the Let's Eat Healthy initiative to address nutrition security through collaborative solutions in the school environment. To ensure nutrition security for children and families, nutritious food and nutrition education must go hand-in-hand. Improving access to high quality food can help address the health disparities that exist for people who are at increased risk for food insecurity. Nutrition education supports students' holistic learning and social and emotional learning skills. Nutrition education models must be increasingly flexible in the face of ongoing challenges. Collaborative efforts to connect food access hubs, such as schools, with support and resources to provide evidence-based nutrition education and agricultural literacy can equip individuals and communities with the knowledge, skills, and ability to make nutrient-rich food choices. Investments and strategies in nutrition security that utilize the Individual plus Policy, System, and Environmental (I + PSE) model, such as the Let's Eat Healthy initiative, will effectively influence positive behavior change and improve community health. Navigating challenges in a rapidly changing environment requires people and organizations to work together, across disciplines, to leverage knowledge, experience, resources, expertise, and creative thinking. Improving access to healthy food and nutrition education will be most effective when done through collaboration.

Hungry for more: Australian medical students’ competence, attitudes and preferences towards nutrition education

BackgroundInadequate nutrition education in medical training is a prevailing global challenge. This study assessed Australian medical students’ self-perceived competencies in nutrition and preferences regarding nutrition education in medical training.MethodsWe conducted a national cross-sectional online survey between September 2019 and January 2020. Our survey collected sociodemographic characteristics and assessed nutrition competency according to a validated assessment tool. All Australian medical students aged over 18 were eligible to participate.ResultsOne hundred ninety-five medical students representing 20 Australian medical schools completed the survey and reported moderate nutrition knowledge (17·6 ± 4.1 out of 35, 50%) and skills (29.8 ± 7.6 out of 55, 54%). Students demonstrated positive attitudes towards nutrition training/education (35·9 ± 4.0 out of 40, 90%). Most medical students (n = 148, 72%) reported they had sought some form of nutrition education outside of their degree. Students showed preference for practical, evidence-based nutrition education that is integrated in and prioritised throughout medical training.ConclusionsAustralian medical students express positive attitudes towards nutrition but report only low to moderate nutrition knowledge and skills. There is an opportunity to incorporate practical, regular nutrition learning activities into Australian medical curriculums to equip future doctors to adequately address non-communicable disease. Such initiatives are likely to be well received by students.

Extending the Together, We Inspire Smart Eating Curriculum to Intergenerational Nutrition Education: A Pilot Study.

The COVID-19 pandemic has made accessing nutritious foods difficult for older adults and children living in low-income households. The evidence-based preschool nutrition education curriculum Together, We Inspire Smart Eating (WISE) can be used to encourage children to try healthy foods. Written as a single generation curriculum, inviting older adult community members to WISE programming for an intergenerational experience may provide further supports and mutual benefits as participants cooperate towards a common goal. While creators have evaluated implementation of WISE, research has yet to explore factors that influence WISE adoption within an intergenerational setting. We conducted a pilot study using the implementation evaluation framework to explore WISE implementation within single generation and intergenerational settings by measuring five implementation outcomes (fidelity, acceptability, appropriateness, feasibility, and sustainability) through three methods: (1) direct assessment of program fidelity via video coding; (2) indirect assessment of stakeholders’ perceptions of WISE implementation, and (3) a directed qualitative content analysis on annual interview data. Fidelity scores were comparable between the two settings and stakeholder ratings of appropriateness, acceptability, and feasibility of WISE were high. Qualitative data revealed that aspects of WISE are less appropriate for older participants and reiterated known logistical barriers of intergenerational programming that may challenge program sustainability.

O02 Social Media Nutrition Education Integrated With a Home Food Delivery Assistance for Low-income Pregnant Women: A Pilot Study

<h3>Background</h3> Poor diet quality during pregnancy is associated with adverse health outcomes. As a remote nutrition intervention may benefit pregnant women, especially during the COVID-19 pandemic, we adapted the Cooking Matters curriculum that uses the social cognitive theory and converted it to a social media intervention integrated with healthy pregnancy and food assistance components. <h3>Objective</h3> To examine the feasibility and preliminary effects of a nutrition education intervention implemented through a social media platform for low-income pregnant women. <h3>Study Design, Setting, Participants</h3> One-group pretest/posttest study. A 6-week nutrition intervention was implemented through a private Facebook group. Cooking ingredients were home-delivered every week by the local food bank. Pregnant women living in low-income neighborhoods of the Hillsborough County, FL who were in their first or second trimester participated in the study (n = 27). <h3>Measurable Outcome/Analysis</h3> Mixed-methods were utilized. Participant engagement was measured weekly with the number of ‘likes' on Facebook posts, goal setting, and engagement questions. Outcomes were measured with validated Food Behavior Checklist, and the Perceptions of Meal Planning and Cooking questionnaires. At post-intervention, qualitative semi-structured interviews were conducted. Descriptive statistics and t-tests were used for quantitative data and emergent themes were analyzed for qualitative data. <h3>Results</h3> Cooking demo videos received most frequent ‘likes'. Participants significantly decreased sweetened beverage intake (<i>P =</i> 0.035); increased using food labels (<i>P =</i> 0.046); and improved overall eating habits (<i>P =</i> 0.015) after the intervention. Perceptions of meal planning (<i>P =</i> 0.023) and shopping and cooking (<i>P =</i> 0.018) were significantly improved. Sixteen emergent themes under 6 broad categories were identified from the qualitative data. Participants indicated that they enjoyed the intervention and reported meaningful behavior changes. They wanted the program to be longer as it would have provided them the opportunity to continue their behavior changes. <h3>Conclusions</h3> Findings indicate that a social media can be a useful tool to remotely implement evidence-based nutrition education interventions for pregnant women in low-income neighborhoods. Further research with a longer intervention duration is warranted to sustain behavioral changes. <h3>Funding</h3> Humana; Feeding Tampa Bay.

Design and Implementation of a Nutrition and Breastfeeding Education Program for Black Expecting Mothers and Fathers

ObjectiveTo describe the intervention and research methods of Project Dads in Nutrition Education, an intervention that adds nutrition and breastfeeding education to the existing Healthy Start program in Georgia for Black expecting mothers and fathers to improve nutrition literacy, health outcomes, and breastfeeding rates. DesignThis 2-year community-based participatory research study employs a cluster randomization factorial design. SettingSix Healthy Start program sites (3 intervention and 3 control sites) in Georgia counties with high infant and maternal mortality rates. ParticipantsApproximately 480 Black, expecting, Healthy Start program participants (20 couples [mother and father] and 40 single mothers from each site) will be enrolled over the study period. Intervention(s)Project Dads in Nutrition Education will strengthen the capacity of the Georgia Healthy Start program to integrate an evidence-based nutrition education program, breastfeeding education, and father engagement into its routine services. Main Outcome Measure(s)Changes in prepost survey assessment of participants’ nutrition literacy and eating behaviors; changes in prepost survey assessment of participants’ breastfeeding knowledge, attitudes, intent, initiation, and duration; and health and food diary collected 3 times (ie, at baseline, 3 months, and 6 months after enrollment). AnalysisProcess evaluation throughout the study to document implementation. Generalized linear mixed modeling will be used to determine the impact of the intervention.

Technology-based nutrition interventions using the Mediterranean diet: a systematic review.

Over the past 2 decades, overweight and obesity rates have increased exponentially, along with related comorbidities including type 2 diabetes, hypertension, cardiovascular disease, and some cancers. The Mediterranean Diet (MDiet) has been suggested as a potential way to mitigate the health burdens related to overweight and obesity. For this review, the literature on MDiet-focused digital interventions was examined to determine efficacy, best practices, and potential limitations. The search was conducted across 15 databases for relevant publications published through April 2020 in English, French, Spanish, Arabic, or Italian. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using a combination of keywords and phrases and evaluated independently for relevance, merit, and inclusion and exclusion criteria. The systematic literature review resulted in 15 articles that met the search criteria. Ten interventions were delivered online, and 5 were delivered via smartphone using an app. The majority of online MDiet-focused interventions were effective, particularly when modeled after evidence-based and best-practice online nutrition education interventions. Such interventions also are effective for promoting positive health behaviors and health outcomes, such as increased physical activity, increased levels of high-density lipoprotein cholesterol, and a lower total high-density lipoprotein cholesterol ratio. Technology-based interventions to educate and promote adherence to the MDiet are successful in helping individuals achieve the stated outcomes. More research is needed to determine the efficacy of MDiet interventions delivered via smartphone apps.

Impact of a Nutrition Education Intervention on Salt/Sodium Related Knowledge, Attitude, and Practice of University Students.

BackgroundSalt reduction strategies help reduce the risk of cardiovascular diseases (CVDs) by reducing high blood pressure. This study aimed to assess salt related knowledge, attitude, and practices (KAP) before and after administering an evidence-based nutrition education workshop.MethodsNinety non-medical university students were recruited to investigate KAP related to dietary salt intake. The KAP components were assessed before, immediately after, and 4-weeks after administering an evidence-based educational workshop and leaflet.ResultsKnowledge and attitudes related to salt improved significantly immediately post-intervention but were not fully retained after 4-weeks. Five of the 13 evaluated practices improved after 4-weeks: trying to buy low-salt foods increased from 10 to 19% (P = 0.022), rarely adding salt to food during cooking increased from 5 to 16% (P = 0.019), rarely adding salt to food at the table increased from 29 to 42% (P = 0.011), tried to reduce salt intake increased from 26 to 41% (P = 0.014), and tried to use spices to reduce salt increased from 31 to 45% (P = 0.044).ConclusionsThe educational intervention had a positive impact on salt-related knowledge, attitudes, and practices, but the effect was not fully retained on the long-term. Periodic educational interventions should be considered to refresh knowledge and reinforce practices.

Nutritional education and counseling program for adult cancer patients during radiotherapy: a cluster-randomized clinical trial.

Nutrition education andcounseling is the first-line approach in nutritional support for adult cancer patients; however, it is not well implemented in many clinical settings. This study aims to determine the effect of an evidence-based nutrition education and counseling (NEC) program on nutrition status among cancer patients receiving radiotherapy. This cluster-randomized clinical trial enrolled cancer patients receiving radiotherapy from ten radiotherapy units in three hospitals. Randomization was conducted at the unit level (five units into the NEC group and five units into the usual care group). The primary outcome was nutrition status after radiotherapy measured by the Patient-Generated Subjective Global Assessment (PG-SGA). Secondary outcomes included nutrition-related blood biomarkers after radiotherapy and the use of artificial nutrition and treatment interruption during radiotherapy. A total of 468 patients were enrolled (241 in the NEC and 227 in the usual care group); 196 patients were female with a mean age (SD) of 59.8 (11.9). No difference was found between the NEC and usual care groups in nutrition status and blood biomarkers at baseline. After radiotherapy, patients in the NEC group had lower PG-SGA scores (5.6 vs 6.9; MD = -1.3, p < 0.001) and lower malnutrition rate (56.0% vs 70.5%; OR = 0.5; p = 0.004) compared with the usual care group. The usages of artificial nutrition and treatment interruption during radiotherapy and the level of blood biomarkers after radiotherapy did not differ between groups. Nutrition education and counseling is an effective approach in reducing malnutrition and can be generalized to multiple radiotherapy settings. REGISTERED UNDER CLINICALTRAILS. None.

Nutrition integration across the nursing curriculum: A novel teaching model within a pre-licensure program

Across the healthcare spectrum, the provision of evidence-based nutrition education is critical in supporting optimal patient care and health outcomes. Nurses are uniquely positioned to deliver nutrition-focused patient education related to health promotion and disease management; yet widespread evidence of sufficient nutrition instruction in nursing curricula is not available. Although lifestyle and nutrition recommendations have historically been the domain of registered dietitians, interprofessional collaboration requires that nurses are prepared to reinforce and support the dissemination of accurate nutrition education. Interdisciplinary teaching approaches are therefore imperative for consistent communication and execution of nutrition guidance. At a private nursing college, an innovative model for nutrition integration across a nursing curriculum has been developed and implemented. This model features an ongoing instructional partnership between registered dietitian faculty and nurse educators. This integrative model enhances nutrition-related nursing competencies demonstrated by undergraduate nursing students and aims to produce graduates who are confident in the delivery of nutrition-related nursing care.

Increasing Disability Inclusion in Health Programming Using NCHPAD's inclusive Community Implementation Process: a Case Study

<h3>Research Objectives</h3> To examine the feasibility of using NCHPAD's inclusive Community Implementation Process (NiCIP) to select and implement disability inclusion solutions to increase inclusion of people with disabilities in an evidence-based nutrition education program. <h3>Design</h3> This case study follows the NiCIP to select and implement disability inclusion solutions related to implementing an inclusive evidence-based nutrition education program within the community. <h3>Setting</h3> A community in South Carolina. <h3>Participants</h3> A local inclusive health coalition (IHC) of stakeholders (n=12) representing public health, disability-serving organizations, community organizations, self-advocates with disability, healthcare, and local government. <h3>Interventions</h3> The NiCIP aims to increase disability inclusion by providing a framework to identify and address gaps to disability inclusion. The process was led by local stakeholders, is data-driven, and guides planning and implementation processes to select and implement disability inclusion solutions. <h3>Main Outcome Measures</h3> Selection of data-driven inclusion solutions and evaluation of a pilot test of selected inclusion solutions. <h3>Results</h3> Results from accessibility assessments led the IHC to implement the following inclusion solutions: creation of disability inclusive promotional materials, disability etiquette training for program staff, creation of an accessibility checklist, and additional program adaptations to ensure inclusivity of the evidence-based curriculum. Inclusion solutions were pilot tested through a 6-week class which included Participants with disability and support persons (n=30). Key findings from the pilot test indicated that with the inclusion solutions, a disability inclusive program was completed within a community setting. However, additional training for instructors, limited class sizes, and more concise and understandable participant follow-up are needed within scale-up efforts to ensure program effectiveness. <h3>Conclusions</h3> Using the NiCIP process led by local stakeholders to select and implement data-driven disability inclusion solutions can result in inclusive community-based health programming. <h3>Author(s) Disclosuress</h3> None.

P106 Evidence-Based Extension Education: Self-Reported Knowledge, Practice, and Attitudes of Nutrition Educators

<h3>Background</h3> Excellence in nutrition education requires a strong base in research evidence. While evidence-based practice is recognized as essential for nutrition education programming, little research in this area has targeted nutrition educators. <h3>Objective</h3> The aim of the study was to evaluate the perceived knowledge, skills, abilities, attitudes, and activities of nutrition extension educators related to evidence-based practice. <h3>Study Design, Settings, Participant</h3> Family and consumer sciences (FCS) extension agents in Florida were surveyed using an online, modified version of the Evidence-based Practice Questionnaire (EBPQ) through Qualtrics. <h3>Measurable Outcomes/Analysis</h3> Evidence-based practice activities over the past year (1 = never to 7 = frequently), attitudes towards evidence-based practice (1 = very negative to 7 = very positive agreement), and knowledge, skills and abilities related to evidence-based practice (1 = poor to 5 = excellent) were rated. Preferred sources of evidence-based nutrition information also were queried. <h3>Results</h3> Of the 85 nutrition educators surveyed, 20 FCS agents completed the survey. Regarding undertaking evidence-based practice activities to address gaps in knowledge, participants reported a rating of 5.2 ± 1.5 (mean ± SD). Attitudes were rated at 5.7 ± 1.5 and perceived knowledge, skills and abilities averaged 3.6 ± 0.8. Sources of evidence-based information included professional organizations (American Diabetes Association, American Heart Association, Academy of Nutrition and Dietetics, and the Society of Nutrition Education and Behavior), government departments (U.S. Department of Agriculture), university-approved curriculum and online resources, reputable domain names (.edu, .org, and .gov), nutrition journals, and state extension specialists. <h3>Conclusion</h3> FCS extension agents reported applying evidence-based practice activities to support their nutrition extension programming and very positive attitudes towards evidence-based nutrition education. However, lower ratings of perceived knowledge, skills and abilities suggest a need for professional development opportunities related to evidence-based practice.