Delivery Of Nutrition Education Research Articles

Individual, household, and community-level determinants of undernutrition among pregnant women in the northern zone of the Sidama region, Ethiopia: A multi-level modified Poisson regression analysis.

In Ethiopia, maternal undernutrition is a major public health concern. However, comprehensive evidence is lacking in the southern part of Ethiopia, specifically the household and community-level related determinants of undernutrition. Besides, the evidence about the prevalence and determinants of undernutrition is not yet documented in the current study setting. Thus, this study aimed to determine the prevalence of undernutrition and identify its determinants among pregnant women in Hawela Lida district of the Sidama region, Ethiopia. A community-based cross-sectional study was conducted on a sample of 515 pregnant women from June 1-25, 2024. A multi-stage sampling method was utilized to select eligible pregnant women. We collected data using a structured and pretested interviewer-administrated questionnaire and an anthropometric measurement. Data were collected using the Open Data Kit smart phone device and exported it to Stata version 17 for further processing and analysis. A multi-level mixed-effects modified Poisson regression analysis with robust variance was used to account for confounders and between and with cluster effects. The prevalence of undernutrition among pregnant women was 41.7% (95% CI: 37.3-45.6). The prevalence of undernutrition was associated with planned pregnancy (adjusted prevalence ratio [APR]: 0.80; 95% CI: 0.66-0.98), household food insecurity (APR: 1.64; 95% CI: 1.26-2.13), inadequate dietary diversity (APR: 1.79; 95% CI: 1.43-2.25), and women's poor knowledge of nutrition (APR: 1.68; 95% CI: 1.32-2.12) at individual levels. The identified determinants of undernutrition at the community level were low community literacy rates (APR: 4.62; 95% CI: 1.13-18.79) and low community wealth status (APR: 1.91; 95% CI: 1.10-3.31). Two in five pregnant women had an undernutrition problem in the study setting. Individual and community-level determinants contributed to the high prevalence of undernutrition. Thus, any prevention and control approaches to undernutrition should consider inter-sectorial collaboration to account for determinants at various levels. Besides, any program must emphasize the delivery of nutrition education about dietary diversity, particularly targeting pregnant mothers who have poor knowledge of nutrition and unplanned pregnancy at the individual level. Moreover, creating a small business reform for the community with low wealth status using agricultural extension workers must be considered.

The influence of nutrition knowledge, attitude, practices, and dietary diversity on obesity among market women in the Cape Coast Metropolis, Ghana: A cross-sectional study.

Obesity and overweight are major public health threat affecting many people globally. This study aimed to examine the role of nutrition knowledge (NK), attitude, practices, and dietary diversity (DD) on the prevalence of obesity among market women in Cape Coast, Ghana. This cross-sectional study was conducted at Abura and Kotokuraba markets in the Cape Coast Metropolis of Ghana. Apparently healthy female traders (n = 402) aged ≥18 years were selected randomly from the markets. DDwas assessed with dietary diversity score (DDS) using a 24hdietary recall method. NK, dietary practices, and attitudes were assessed using validated semistructured questionnaires. Body composition parameters were assessed using appropriate tools. Descriptive and binary logistic regression analysis were performed. Statistical significance was considered at p < 0.05. The prevalence of overweight was 31.84% and obesity was 39.30%. Majority of respondents had poor DDas about 91% had DDS <5. About 75% of the market women had no knowledge in nutrition. About 57% eat thrice daily and 82% take supper from 7 p.m. Knowledge in nutrition was significantly associated with body fat (OR = 0.45, 95% CI = 0.26-0.78, p = 0.004), body mass index (OR = 0.40, 95% CI = 0.28-0.71, p = 0.001), and waist-to-hip ratio (OR = 0.32, 95% CI = 0.19-0.56, p < 0.001). The prevalence of obesity and overweight was high among the market women. Poor NKand poor DDmay have influenced this. A campaign on better dietary practices and delivery of nutrition education may help to minimize the prevalence of obesity among market women.

How Competent are Health Professionals in Delivering Nutrition Education? A Cross-Sectional Study in Ebonyi State, Nigeria

BACKGROUND: The World Health Organization recognises nutrition as the basis for good health and the leading edge of disease prevention. Nutrition education is also key in facilitating healthy habits in all spheres of life. Health professionals are central to informing good dietary habits through nutrition education since they are seen as reliable sources for nutritional information. This study assessed health professionals’ competencies in nutrition education in Ebonyi State, Nigeria. METHODOLOGY: A health facility-based cross-sectional study among health professionals was conducted in three selected hospitals from three Local Government Areas in Ebonyi State, Nigeria. A total of 421 health professionals selected by multistage sampling were surveyed. Data analysis was done using IBM SPSS version 25. Chi-square test and multivariate analysis using binary logistic regression were used in the analysis, and the level of statistical significance was determined by a p-value of &lt;0.05. Overall adequate competence of health professionals on nutrition education was derived by the proportion of respondents who had good knowledge, good perception, and good practice of nutrition education. RESULTS: The mean age of the respondents was 32.4 ± 8.9 years, and the majority, 67.5% (283), were females. The highest proportion of respondents, 59.4% (249), were nurses. Less than one-tenth of respondents, 7.4%, had good knowledge of nutrition. A higher proportion of respondents, 85.9% (360), had good practice of nutrition education while less than half, 42.5% (178), had a good perception of nutrition education. A minor proportion of respondents, 43.0% (180), had adequate competency in nutrition education. Predictors of health professionals’ competencies included having postgraduate level of training (AOR= 0.4; 95% CI = 0.2 - 0.8), being a physiotherapist (AOR = 17.2; 95% CI = 1.1 - 267.5), being &lt; 39 years (AOR = 5.8; 95% CI = 2.1 – 16.3) and 40 - 49 years (AOR = 4.8; 95% CI = 1.6 – 14.6). CONCLUSIONS: A minor proportion of respondents had adequate competency in nutrition education. The knowledge of nutrition among health professionals is also poor. The health professionals may require nutrition training for proper delivery of nutrition education. There is a need to incorporate regular in-service training as a strategy for improving health professionals’ nutritional competency.

Associations of dietetic care and pregnancy outcomes in women with gestational diabetes

Abstract Background Gestational diabetes mellitus (GDM) is a significant, global public health problem. Subsequent strain on healthcare systems is widespread and multidisciplinary care may be inadequate. We assessed current nutrition management of GDM in a large, metropolitan maternity hospital in Melbourne, Australia and associations between the model of dietetic care and maternal and neonatal health outcomes. Methods Hospital medical record data from The Women’s Hospital, Melbourne for women with GDM (n = 1,185) (July 2105-May 2017) was retrospectively analysed. Adjusted linear and logistic regression were used to assess associations between the number of dietitian consultations and maternal and neonatal health outcomes. Results Half of all women received two consultations with a dietitian. Nineteen percent of women received three or more consultations and of these women, almost twice as many were managed by medical nutrition therapy (MNT) and pharmacotherapy (66%) compared with MNT alone (34%). Odds of maternal complications increased with number of consultations (p = 0.008). Lower odds of infant admission to the Neonatal Intensive Care Unit were observed among women receiving one (OR = 0.38 [95% CI: 0.18, 0.78], p = 0.008), two (OR = 0.37 [95% CI: 15 0.19, 0.71], p = 0.003), or three+ dietitian consultations (OR = 0.43 [95% CI: 0.21, 0.88], p = 0.020), compared to no consultations. Conclusions The optimal schedule of dietitian consultations for women with GDM in Australia is unclear. Alternative delivery of nutrition education for women with GDM such as telehealth and utilisation of technology may assist in relieving public health and healthcare system pressures and ensure optimal pregnancy outcomes. Key messages • Delivering medical nutrition therapy through individual consultations does not deliver a linear benefit to women with GDM and their offspring. • Alternative delivery modes are needed to optimise outcomes for healthcare services and their patients.

Covid-19 Prevention Behaviors in a Cooperative Extension Audience: Findings from a Nutrition Education Study

The COVID-19 pandemic has dramatically impacted the delivery of nutrition education through Cooperative Extension. This study aimed to identify a Cooperative Extension audience’s attitudes towards virus prevention behaviors, preferred sources of information regarding COVID-19, and nutrition education preferences during the pandemic. We distributed an online survey to 477 potential nutrition education participants including questions about behaviors like mask wearing, preferences for virtual nutrition lesson delivery, and attitudes towards sources of information about COVID-19. Attitudes towards mask wearing and preferred sources of information differed significantly by race, income, and age. These differences have serious implications for future outreach and program delivery.

ATTITUDES, WORK ROLES AND BARRIERS TO NUTRITION CARE - INTERVIEWS WITH AUSTRALIAN AND UK-BASED MEDICAL DOCTORS.

Poor diet is implicated in multiple chronic diseases. Although doctors may be well placed to facilitate nutrition care, nutrition remains a low priority in medical education internationally. Consensus is required on nutrition competencies as a benchmark for education with a regulatory framework to ensure implementation. The aim of this qualitative study was to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care among a cohort of Australian and UK doctors. Semi-structured interviews were conducted with primary care doctors/general practitioners (n = 14) and medical specialists (n = 8) based in Australia and the United Kingdom to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care. Framework analysis identified five key themes: (1) knowledge and skills in nutrition to support medical nutrition care, (2) the delivery of nutrition education, (3) multidisciplinary and interdisciplinary care, (4) systemic barriers and facilitators to care and (5) the need for a paradigm shift. Participants acknowledged nutrition as an important component of medical care but recognised they are currently ill-equipped to support such care, identifying limitations to the systems supporting integrated care. Participants identified that nutrition sits within both a health promotion and medical/treatment model, but they currently work only within the latter. Participants highlighted a lack of knowledge and training regarding nutrition, without which change is not possible. Efforts to improve the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition - a paradigm shift from the medical model.

Evaluation of the PhunkyFoods intervention on food literacy and cooking skills of children aged 7–9 years: a cluster randomised controlled trial in Yorkshire Primary Schools UK

BackgroundChildhood obesity rates more than double during primary school in England. Acquiring competent cooking skills is a key part of children’s education that can lead to improved knowledge of a healthy lifestyle and dietary behaviours. Evaluation of the impact of ‘PhunkyFoods’, a school-based food and nutrition education programme, will assess food literacy, cooking skills and dietary behaviour in primary-school children.MethodsA cluster randomised controlled trial will be undertaken in 28 primary schools in North Yorkshire, UK, including a total population of children aged 7–9 years (n = 420). The trial has two arms: (a) the intervention group receiving PhunkyFoods programme (n = 210) and (b) the wait-list control group receiving the usual school curriculum (n = 210). The intervention ‘PhunkyFoods’ will be delivered by Purely Nutrition Ltd. The participating school staff are supported with training, policy development and access to resources to improve the delivery of nutrition education. Children participate through whole school assemblies, classroom activities, and after-school clubs about food preparation, cooking healthy meals and healthy living. Schools, parents and children have access to healthy meal recipes through the PhunkyFoods website. The primary outcomes are differences in food literacy and cooking skills scores between control and intervention arms after 12 months of the intervention and adjusted for baseline values. The secondary outcome is differences in fruit and vegetable intake between the arms after 12 months (adjusted for baseline). Treatment effects will be examined using mixed ANOVA and regression analysis. Primary analyses will adjust for baseline food literacy and cooking skills scores and secondary analysis will adjust for pre-specified baseline school and child level covariates.DiscussionThe PhunkyFoods programme is a flexible menu of options for schools to choose from, making this a highly complex intervention. Following Medical Research Council guidance, research perspectives will focus on effectiveness and theory-based approaches: to what extent the intervention produces the intended outcomes in real-world settings and what works in which circumstances.Trial registrationISRCTN ISRCTN68114155. Prospectively registered on 22 October 2021

A Qualitative Examination of California WIC Participants' and Local Agency Directors' Experiences during the Coronavirus Disease 2019 Pandemic.

BackgroundThe US Department of Agriculture granted waivers to allow flexibility in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) operations during the coronavirus disease 2019 (COVID-19) pandemic; however, research examining the associations between waiver introduction and changes in perceptions, practices, and challenges of WIC participants’ and agency directors’ experiences is limited.ObjectiveThe objective of this study was to assess California WIC participants’ and agency directors’ perceptions and practices of remote WIC services during the COVID-19 pandemic. A secondary aim was to understand other COVID-19 challenges related to maintaining access to healthy foods by WIC participants.DesignA qualitative study that included semistructured interviews was conducted between June 2020 and March 2021.Participants and settingOne hundred eighty-two WIC participants with a child aged 0 to 5 years from three regions of California (Southern, Central, and Northern) and 22 local WIC agency directors across the state were interviewed.Main outcome measuresWIC participants’ and agency directors’ perceptions, practices, and other challenges during COVID-19.Statistical analyses performedInterviews were recorded, transcribed, and analyzed using a grounded theory approach.ResultsParticipants shared that they valued the information received from WIC and were very satisfied with remote WIC services. Participants reported that enrolling in WIC remotely was easier than coming in person. All waivers and changes to WIC operations, namely the physical presence, remote benefit issuance, and separation of duties waivers, and remote work and remote delivery of nutrition education, were largely viewed by WIC agency directors as options that should be continued postpandemic. Further, a majority (63%) of households reported experiencing food insecurity, and half of respondents received food from a food bank or pantry during the pandemic.ConclusionsFindings suggest WIC will attract and retain the most families by offering a hybrid model of services, incorporating both onsite services and remote options to work more efficiently and effectively.

P091 Assessing Level of Interest in In-person and Virtual Nutrition Education Among SNAP-Ed Eligible Utahns

<h3>Background</h3> In response to SARS-CoV-2, Utah's Supplemental Nutrition Assistance Program-Education (SNAP-Ed) pivoted from in-person to virtual nutrition education classes. Virtual nutrition programs have been found to be effective among certain demographics. Additionally, virtual classes may be a preferred mode of SNAP-Ed nutrition education delivery. <h3>Objective</h3> The objective of this needs assessment was to compare the level of interest in in-person and virtual nutrition classes, as well as several online platforms among SNAP-Ed eligible Utahns. <h3>Study Design, Settings, Participants</h3> An electronic survey was sent to eligible Utahns through a listserv of current SNAP recipients, a SNAP-Ed e-newsletter, and links posted on SNAP-Ed social media platforms. Survey respondents were asked to report demographics, preferred frequency and duration of classes, and electronic device use and access barriers. Respondents also ranked six preferred modes of delivery including in-person, Facebook Live, YouTube, Zoom, Canvas, and other. <h3>Measurable Outcomes/Analysis</h3> Descriptive statistics were collected and analyzed. Responses to questions about class duration and frequency, virtual platforms, and electronic device use were compared among age groups, ethnicities, gender, and rurality. Respondents ranked six modes of delivery on a scale of 1-6 (1 = most preferred; 6 = least preferred) and mean scores were calculated. <h3>Results</h3> Two-hundred sixty-nine individuals completed the survey. In-person classes were ranked as the most popular mode of delivery (mean = 2.57) followed by Facebook Live (2.77), YouTube (2.84), Zoom (2.97), Canvas (3.89), other (5.73). In-person classes were ranked highest among most subgroups, however virtual classes were most popular among respondents aged 18-24 & older than 35. Respondents most selected weekly (49%), 45-minute classes (33%) as the preferred frequency and duration. Seventy percent reported no barriers to internet access. <h3>Conclusions</h3> The results of this assessment suggest that virtual education may be a valuable tool to reach certain subgroups of SNAP-Ed eligible Utahns. However, given the expressed preference of in-person classes, virtual education should be used as a supplemental approach to traditional group classes. <h3>Funding</h3> Supplemental Nutrition Assistance Program - Education

Nutrition Services and Resources for Families in the First 1000 Days: A Needs Assessment in the State of California

ObjectivesTo identify the current status of and gaps within nutrition services and resources provided to California families during the first 1000 days of life (from conception to age 2 years). MethodsA semi-structured online survey was developed by a task-force group at the University of California, Irvine, and Dairy Council of California. The survey addressed five pillars of nutrition service provision in the first 1000 days: accessibility of services, delivery of nutrition education, content of nutrition messages, breastfeeding support, and professional development on nutrition. The survey was disseminated across California to health professionals and providers from agencies that provide services to pregnant women and families with infants and young children up to 2 years of age. Results148 survey responses were obtained with representation across the state and organization types (37% healthcare, 23% childcare/preschools, 20% Government agencies, and 20% community organizations). Almost 60% of respondents estimated that at least 75% of the clients they serve are Medi-Cal eligible. Although most organizations provide referrals to the Women Infants and Children program, only 46% of clinical and 69% of community-based respondents reported referring clients to the CalFresh benefits program. Several needs were identified to better support optimal health, growth and development including improved access to nutritious food and educational resources for low-income families, improved cultural appropriateness in the delivery and content of nutrition education, messaging around key micronutrients for fetal and early child development, enhanced social support and guidance regarding breastfeeding, and further professional development opportunities on early life nutrition. Notably, technology as a means of outreach and communicating nutritional messages to families during the first 1000 days was reportedly underutilized. ConclusionsThe accessibility, content, and delivery of nutritious food, nutrition-related resources, and breastfeeding support for families in the first 1000 days can be improved. A comprehensive and coordinated approach to improve social support, nutrition security and education is needed to support health outcomes during the first 1000 days of life. Funding SourcesNIH National Center for Advancing Translational Sciences.

O18 Hispanic Caregivers’ Communication Preferences for Content, Delivery and Sources of Nutrition Education: Qualitative Findings

<h3>Background</h3> Nutrition education interventions to improve child healthy eating behaviors often rely on caregivers to support these behaviors at home, yet it is difficult to engage caregivers in interventions. <h3>Objective</h3> To explore communication preferences of low-income Hispanic female caregivers of preschoolers on preferred content and delivery of nutrition education to augment a child-focused classroom-based nutrition literacy program. <h3>Study Design, Setting, Participants</h3> Qualitative interviews (n = 25) in Spanish with Hispanic female caregivers of 3- to 5-year-old children in Washington, D.C., area. Audio-recorded phone/Zoom interviews transcribed verbatim in Spanish and translated into English. Transcripts coded using NVivo v12. Two coders independently developed codebook (ICR = 89%), reconciled discrepancies with PI, and identified themes and subthemes within them between codes. <h3>Measurable Outcome/Analysis</h3> Caregivers' mean age was 35.5 ± 6.3, 72% had high school education or less, 64% were receiving the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits. Caregivers resided in the US 13.6±4.4 years, and 88% spoke Spanish only or Spanish better than English. <h3>Results</h3> Four themes were identified: Preferred Content of Nutrition Information (subthemes: Wanting to Know What Foods are Healthy for the Child, Desire to Learn Feeding Strategies for Vegetables), Delivery Methods (subthemes: Digital Messages: Videos, Texts, and Social Media; Printed Information; In-Person Nutrition Classes; Recipes), Educators as Sources of Nutrition Information, and Cultural Customs and Family Feeding. Caregivers indicated a desire to receive nutrition education via printed methods, in-person classes, and text messages. This group also asked for detail about how foods nourish preschoolers, as well as strategies and recipes to make healthy foods - especially vegetables - appeal to children. <h3>Conclusion</h3> Themes that emerged show nutrition content preferences are focused on vegetable feeding strategies as well as providing clarity about what foods are healthy for preschoolers. Delivery methods themes reveal that a multi-pronged approach is key to meeting this population where they are - electronically, in person, and in print.

Study Protocol for a Comprehensive Virtual Professional Development Model to Improve Self-efficacy to Teach Food Literacy in Undergraduate Students

ObjectivesTo determine the effectiveness of a comprehensive professional development model (CPDM) adapted for virtual instruction in its ability to improve self-efficacy related to food literacy and development of remote food literacy education. MethodsUndergraduate students (n = 12) from two universities participate in a yearlong CPDM. In the first semester, undergraduates attend weekly meetings focused on online learning platforms; building community of practice; reviewing learning models, theories, and pedagogy; and building skills to support social and emotional learning. Undergraduates participate in reflective practice throughout the CPDM to advance their teaching skills. In the second semester, undergraduates develop online modules supporting remote instruction for the learner-centered curriculum Teens CAN: Comprehensive Food Literacy in Cooking, Agriculture, and Nutrition. Undergraduates develop virtual lesson procedures and content to be pilot tested with the community of practice. ResultsUpon project conclusion, undergraduates will complete a retrospective questionnaire measuring self-efficacy to teach nutrition. They will also participate in an in-depth interview that mirrors the reflective practice, where they reflect on what they gained and wished to change for future CPDM projects. ConclusionsIn response to the COVID-19 pandemic, utilizing strategies from in-person CPDMs in virtual professional development may provide an efficient, effective, and equitable methodology to connect with undergraduate students and improve their self-efficacy to teach while providing training and skills. This virtual methodology may serve two purposes; decreasing attrition in participation by removing barriers such as travel and scheduling, but also enhancing the delivery of nutrition education through utilization of modern technology. Limitations of remote instruction are numerous, but providing opportunities for undergraduates to develop skills in online education has the potential to broaden the reach of health-focused programming delivered by agencies with limited staff during and after the COVID-19 pandemic. Funding SourcesUSDA NIFA SPECA; USDA NIFA NNF.

Assessment of an integrated knowledge translation intervention to improve nutrition intakes among patients undergoing elective bowel surgery: a mixed-method process evaluation

BackgroundA large evidence-practice gap exists regarding provision of nutrition to patients following surgery. The aim of this study was to evaluate the processes supporting the implementation of an intervention designed to improve the timing and adequacy of nutrition following bowel surgery.MethodsA mixed-method pilot study, using an integrated knowledge translation (iKT) approach, was undertaken at a tertiary teaching hospital in Australia. A tailored, multifaceted intervention including ten strategies targeted at staff or patients were co-developed with knowledge users at the hospital and implemented in practice. Process evaluation outcomes included reach, intervention delivery and staffs’ responses to the intervention. Quantitative data, including patient demographics and surgical characteristics, intervention reach, and intervention delivery were collected via chart review and direct observation. Qualitative data (responses to the intervention) were sequentially collected from staff during one-on-one, semi-structured interviews. Quantitative data were summarized using median (IQR), mean (SD) or frequency(%), while qualitative data were analysed using content analysis.ResultsThe intervention reached 34 patients. Eighty-four percent of nursing staff received an awareness and education session, while 0% of medical staff received a formal orientation or awareness and education session, despite the original intention to deliver these sessions. Several strategies targeted at patients had high fidelity, including delivery of nutrition education (92%); and prescription of oral nutrition supplements (100%) and free fluids immediately post-surgery (79%). Prescription of a high energy high protein diet on postoperative day one (0%) and oral nutrition supplements on postoperative day zero (62%); and delivery of preoperative nutrition handout (74%) and meal ordering education (50%) were not as well implemented. Interview data indicated that staff regard nutrition-related messages as important, however, their acceptance, awareness and perceptions of the intervention were mixed.ConclusionsApproximately half the patient-related strategies were implemented well, which is likely attributed to the medical and nursing staff involved in intervention design championing these strategies. However, some strategies had low delivery, which was likely due to the varied awareness and acceptance of the intervention among staff on the ward. These findings suggest the importance of having buy-in from all staff when using an iKT approach to design and implement interventions.

Indonesian antenatal nutrition education: A qualitative study of healthcare professional views.

Background:Early lifestyle intervention, including antenatal nutrition education, is required to reduce the triple burden of malnutrition. Understanding healthcare professionals’ views and experiences is essential for improving future nutrition education programmes for Indonesian pregnant women. This study aimed to investigate the views of Indonesian antenatal healthcare professionals regarding nutrition education for pregnant women and the improvements required to provide more effective antenatal nutrition education.Methods:A descriptive qualitative study involved semi-structured interviews was conducted with 24 healthcare professionals, including nutritionists (n = 10), midwives (n = 9) and obstetricians (n = 5) in Malang, Indonesia, between December 2018 and January 2019. Data were analysed using thematic analysis.Results:The study identified four main themes. First, healthcare professionals were aware of the importance of providing antenatal nutrition education, which included supporting its targeted delivery. Second, there were differing views on who should provide nutrition education. Most midwives and obstetricians viewed nutritionists as the prime nutrition education provider. Nutritionists were confident in their capability to provide nutrition education. However, some nutritionists reported that only a few women visited primary health centres and received nutrition counselling via this pathway. Third, healthcare professionals revealed some barriers in providing education for women. These barriers included a limited number of nutritionists, lack of consistent guidelines, lack of healthcare professionals’ nutrition knowledge and lack of time during antenatal care services. Fourth, participants expressed the need to strengthen some system elements, including reinforcing collaboration, developing guidelines, and enhancing capacity building to improve future antenatal nutrition education.Conclusions:Healthcare professionals play a central role in the provision of antenatal nutrition education. This study highlighted the importance of educational models that incorporate various antenatal nutrition education delivery strategies. These methods include maximizing referral systems and optimizing education through multiple delivery methods, from digital modes to traditional face-to-face nutrition education in pregnancy classes and community-based health services.

Implementation of Remote Interventions in Older Adults: Lessons Learned During COVID-19 Isolation

Recommendations for older adults to socially isolate during the COVID-19 pandemic will have lasting impacts on body weight and physical activity. Due to the pandemic, two in-person RCT weight-loss interventions in obese older adults with prediabetes, Veterans Achieving Weight Loss and Optimizing Resilience-Using Protein (VALOR-UP, n=12) and the Egg-Supplemented Pre-Diabetes Intervention Trial (EGGSPDITE, n=7), were converted to remote formats and weekly nutrition (EGGSPDITE and VALOR-UP) and exercise (VALOR-UP only) classes were delivered using synchronous videoconference technology (Webex); classes were accessed via tablet/desktop/laptop or smart phone. Steps taken to transition participants to remote formats included technology training, implementation of staff tech-support, and delivery of nutrition education, tablets, scales, and exercise bands. The time to successfully transition participants was 1 week for early adopters (n=10) and up to 4 weeks for those with significant technology barriers (n=9); their difficulties included internet access, camera and microphone access and use, and electronic submission of weight and food records. Even with these challenges, in the first 3 months of remote delivery, participant dropout rate was low (10.5%, n=2), attendance was high (87.6% nutrition class (n=19); 76.4% exercise class (VALOR-UP, n=12)), and weight loss was successful (>2.5% loss (n=13); >5% loss (n=8)), showing that lifestyle interventions can be successfully adapted for remote delivery. Remote interventions also have potential for use in non-pandemic times to reach underserved populations who often have high drop-out rates due to caretaker roles, transportation limitations, and work schedules. These barriers were significantly reduced using a virtual intervention platform.

A qualitative investigation of school age children, their parents and school staff on their participation in the Digital Education to LImit Salt in the Home (DELISH) program.

This study explored the views of participants who completed a 5-week, online, interactive, family-based, salt reduction education program (Digital Education to LImit Salt in the Home). A secondary aim was to explore the views of school staff on the delivery of food and nutrition education in schools. Children aged 7-10 years, their parents and principals/teachers from participating schools located in Victoria, Australia, completed a semi-structured evaluation interview. Audio-recordings of interviews were transcribed verbatim and analysed using NVivo. Twenty-eight interviews (13 children; 11 parents; 4 school staff) were included. Thematic analysis revealed that the program was well received by all groups. Children reported that the interactivity of the education sessions helped them to learn. Parents thought the program was interesting and important, and reported learning skills to reduce salt in the family diet. School staff supported the delivery of nutrition education in schools but indicated difficulties in sourcing well-packed nutrition resources aligned with the curriculum. It appears that there is support from parents and teachers in the delivery of innovative, engaging, nutrition education in schools, however such programs need to be of high quality, aligned with the school curriculum and readily available for incorporation within the school's teaching program.

P146 California Youth Participatory Action Research Projects Illustrates the Need for Nutrition Staff Professional Development

<h3>Background</h3> Youth Participatory Action Research (YPAR) is an innovative approach to engage youth (ages 12-18) in projects that address issues in their community. When implemented as part of a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program, YPAR aims to empower youth to achieve policy, systems, and environmental (PSE) changes related to community health and nutrition. SNAP-Ed programming has traditionally focused on direct nutrition education, which may require substantially different professional skills than needed to implement YPAR projects. <h3>Objective</h3> This qualitative research project aimed to assess the impact of professional development and learning to support the shift from traditional nutrition education delivery to an approach that engages youth in creating PSE changes. <h3>Study Design, Setting, Participants</h3> Pre- and post-project interviews were conducted with 6 SNAP-Ed staff members who implemented or attempted to implement YPAR projects in 4 California counties during the 2018-2019 school year. Questions assessed the impact of current technical assistance, professional learning opportunities and needs, and suggestions for improving future support. <h3>Analysis</h3> Members of the research team each individually analyzed a subset of the interview responses and reported emerging themes. The team consolidated reports and identified key findings for 3 outcome measures related to 1) Staff capacities for YPAR work aimed at PSE changes; 2) key topics; and 3) key processes/structures for additional professional learning support. <h3>Results</h3> The following themes emerged related to the outcome measures: 1) the importance of comprehensive knowledge and skills related to youth engagement and positive relationship skills to build support for YPAR: 2) the need for information on the history of YPAR; training around PSE change work, evaluation and reporting; and curricula for younger youth; and 3) the need for regular support from supervisors. <h3>Conclusions</h3> Staff articulated the capacities they gained, key learning topics and support received, and additional professional development support needed to conduct a YPAR project. Key themes were identified that can help inform practitioners interested in conducting YPAR projects, especially under the SNAP-Ed framework. <h3>Funding</h3> Supplemental Nutrition Assistance Program - Education.

Effect of social networks on household dietary diversity: Evidence from smallholder farmers in Kisii and Nyamira counties, Kenya

Nutrition knowledge is an important driver of household dietary diversity that can be improved through access to nutrition information. However, in many rural areas, the formal flow of nutrition information is limited, although social networks could play an important role as an informal source of such information. This paper evaluates the effect of nutrition information networks on household dietary diversity in Nyamira and Kisii counties in Kenya. The paper employs a Poisson regression model on a sample of 462 farmers selected using a multi-stage sampling technique. The results show that the average household dietary diversity of an individual’s network (a proxy for social networks) had a positive and significant effect on the dietary diversity of the individual, implying that social networks have a positive effect on household dietary diversity. Moreover, the average education of an individual’s network, along with household size, wealth status and farm size, had positive significant effects on household dietary diversity. These results imply that farmers’ social networks could be used as a complementary tool for the effective delivery of nutrition education targeting the enhancement of nutritional quality.

Identification of a Framework for Best Practices in Nutrition Education for Low-Income Audiences

To promote effective low-income nutrition education programs, an expert panel of nutrition education and public health researchers built consensus around 28 best practices grouped into 5 domains (Program Design, Program Delivery, Educator Characteristics, Educator Training, and Evaluation) targeting direct delivery of nutrition education. These best practices can be used to assess program strengths, promote fidelity in delivery and evaluation, and design research to strengthen programs’ evidence base. A survey of Supplemental Nutrition Assistance Program–Education nutrition education leaders helped identify staff development needs and interest relative to specific best practices. Best practices can be used to identify staff development needs among frontline educators, supervisors, and program leaders in Supplemental Nutrition Assistance Program–Education, Expanded Food and Nutrition Education Program, and other programs targeting low-income audiences.

Pairing Feeding Content With a Nutrition Education Curriculum: A Comparison of Online and In-Class Delivery

ObjectiveTo develop a childhood obesity prevention program, Food, Feeding and Your Family (FFYF), which encourages eating self-regulation in young children. This article describes the research methods for FFYF. Activities that will be used to guide the development of the program are illustrated in a logic model. DesignA randomized control trial will be conducted with participant groups randomized into 1 of 3 conditions: (1) in-class delivery of feeding content and nutrition education, (2) online delivery of feeding content and in-class delivery of nutrition education, and (3) nutrition education only. Assessments will be collected at baseline, program completion, and 6 and 12 months after completion of the program. SettingStudy will be conducted through the Expanded Food and Nutrition Education Program in Colorado and Washington State. ParticipantsParents with 2- to 8-year-old children will be recruited from affiliated community agencies, 540 participants across both states. InterventionsFFYF derives content from an empirically validated parental feeding program, Strategies for Effective Eating Development, and will be administered with Eating Smart • Being Active, an evidence-based, nutrition education curriculum. Main Outcome MeasuresParents will report on feeding practices, child eating behaviors, feeding styles, and acculturation. AnalysisBecause of the nested nature of the data, multilevel analyses will be used: time points, within parents, and within groups.