Utilization Of Nutrition Services Research Articles

Barriers and facilitators of nutrition service utilization among adolescent girls in Southern Ethiopia

Health and nutrition service for adolescents, will serve as a future investment for breaking the cycle of intergenerational poor health. Thus, understanding barriers and facilitators for nutrition service utilization is critical to timely address malnutrition problem in this age group. This study was conducted in Wolaita and Hadiya zones, Ethiopia. A qualitative study was conducted from April 30/2019 to May 30/2019. Purposively selected health extension workers, school leaders, gender focal persons, health center experts, and youth center leaders from each village were involved in this study as key informants. In addition to this, a total of 6 FGDs were conducted. Eight adolescent girls were included in each focus group discussion. The process of analysis was conducted with open coding, identifying concepts, categories and properties/subcategories. The study was approved by Addis Ababa University (AAU), College of Natural Sciences Research Ethics Review Committee. Official letter of cooperation was written to Wolaita and Hadiya zones, and districts of health offices. The nature of the study was fully explained to the study participants. Informed verbal and written consent was obtained from each participant. The collected data has been kept confidential. Barriers for nutrition service utilization among adolescent girls were lack of awareness for study participants and their families, shortage of iron-folate and deworming tablets, lack of trained experts who were responsible for the nutrition service implementation, low economic status of the family, lack of coordination among different sectors for nutrition service, low educational status of the adolescent girls’ family. Facilitators for nutrition service utilization among adolescent girls in the study area were supplementation of iron-folate and deworming tablets was without payment. In addition, the utilization of social and community networks motivates the utilization of nutrition services among adolescent girls. Recommendation: Awareness creation training should be given for adolescent girls and their families, and male adolescent before the implementation of nutrition service provision.

Peran Dukungan Suami dan Faktor Lainnya terhadap Pemanfaatan Pelayanan Gizi oleh Ibu Hamil dengan Risiko Kurang Energi Kronis (KEK)

This study aims to determine the factors that cause the behavior of using nutrition services by pregnant women with the risk of KEK at the Nutrition Clinic of the Kasemen Health Center, Serang City. This research method uses cross-sectional research. The results showed that 66.2% of pregnant women at risk of KESK did not take advantage of nutrition services at the nutrition clinic. The behavior of the utilization of nutrition services in pregnant women with the risk of SEZ was most dominantly influenced by support (OR=6.31; 95% CI: 2.633-15.138). In addition, this behavior is influenced by other factors, namely needs (OR = 5.22; 95% CI: 1.608-16.926) and family income (OR = 2.48; 95% CI: 1.061-5.814). In conclusion, pregnant women at risk of CED who do not receive support from their husbands are at risk of 6.31 times more at risk of not using nutrition services than pregnant women with the risk of CED who receive their husband's support.
 
 Keywords: Pregnant Women, Nutrition Services, Risk of Chronic Energy Deficiency (KEK)

Workforce needs and estimated costs/savings for nutrition care in chronic kidney disease-stage 3 through maintenance dialysis.

The role of nutrition in chronic kidney disease (CKD) is well known. However, controversies, misconceptions, and gaps in the literature exist regarding the workforce required to provide nutrition care in CKD. This paper reviews the existing literature on this topic, focusing primarily on the United States. Topics covered in this review include the qualifications and services of the registered dietitian nutritionist (RDN), to which specific patients nutrition care should be provided in CKD and on dialysis, barriers to the utilization of nutrition services, the quantity of nutrition care needed to improve patient outcomes, and the risks of provider burnout. Controversies include whether more staffing is associated with better care and the best measures of staffing. The topics are supported with estimations for the economic impact and practicality of workforce decisions.

Power dynamics as a determinant of access and utilization of nutrition services by pregnant and lactating adolescent girls in Trans-Mara East Sub-County, Narok County, Kenya

BackgroundDuring pregnancy or lactating, adequate nutrition for adolescents becomes critical to reduce risks for both child and maternal-related morbidity and mortality. Power dynamics play a massive role in health outcomes. The main objective of this study was to examine the power dynamics in the families and communities and their impact on the pregnant and lactating adolescent girls’ access and utilization of nutrition services in Trans-Mara East Sub-County, Narok County.MethodsA cross-sectional approach that employed mixed methods with both quantitative and qualitative research was adopted. Probability proportionate to size sampling techniques using cluster and simple random methods were used to practically access pregnant or lactating adolescents. Data was collected using questionnaires, in-depth interview and Focus Group Discussion. Quantitative data was analyzed descriptively using frequencies and inferentially using odds ratio and Z-test. Framework analysis was employed to analyze qualitative data. P ≤ 0.05 was considered statistically significant.ResultsIn the power dynamics analyses, the intrinsic capability (Intrinsic capabilities are those adolescent driven initiatives that facilitate their access to nutrition services) was more likely to decrease awareness by half (OR = 0.52, 95% CI = 0.4–0.7, P < 0.01) whereas extrinsic dependency was likely to increase utilization by 1.2 times (OR = 1.2, 95% CI = 1.0–1.5, P = 0.055). From the stakeholder power matrix, the health personnel had observable visible power to influence access and utilization of nutrition services. Additional results revealed that adolescents who draw their support from significant others were more likely to utilize nutrition services as compared to those who attempted to make their own efforts to seek these services. Furthermore, health personnel have the most influential powers in ensuring adolescents access services and thus the most important actors in the stakeholder matrix. Other actors requiring focus included parents, political figures and governments while stakeholder engagement have higher potential of increasing access and utilization of services through dialogue.ConclusionsCommunity access to nutritional services can be increased through use of multiple avenues to reach adolescents, including school-based, health system-based, community-based approaches and even marriage registries. A heightened engagement in the identified stakeholder network is necessary when planning community conversations, to ensure a multi-stakeholder approaches in meeting the nutrition needs of adolescents.

Socio-demographic and facility-based determinants of perceived quality of nutrition Services of Pregnant and Lactating Adolescent Girls in Trans-Mara east Sub-County, Narok County, Kenya

BackgroundIt has been established that use and utilization of nutrition services among adolescents are highly linked to availability, access, cost and quality of care. The main objective of this study was to assess the socio-demographic and facility-based factors as proxies to access to perceived quality of nutrition-specific and nutrition-sensitive services among adolescents in Trans-Mara East Sub-County, Narok County.MethodsThe study adopted a cross-sectional approach that employed mixed methods on 291 households. Probability proportionate to size sampling techniques using cluster and simple random methods were used to practically access adolescents who are pregnant or lactating. Data were collected using questionnaires, in-depth interview and Focus Group Discussion. Quantitative data was analyzed descriptively using frequencies and inferentially using odds ratio and Z-test. Framework analysis was employed to analyze qualitative data.ResultsA nutritionist was more likely to increase overall utilization (considered as a proxy index to access quality nutrition-sensitive and -specific services) by 3.18 times (OR = 3.18, 95% CI = 1.50–6.60, P = 0.002) and nurses 2.7 times (OR = 2.70, 95% CI = 1.40–5.30, P = 0.005). Generally, 80.7 and 69.4% attached positive value to environmental and basic personal hygiene, respectively, as being areas of nutrition-sensitive service delivery with a significant number higher than expected frequency of 50% (P < 0.05). An assessment of facility networks isolated only public health center as the key determinant of overall utilization. Public health centers among other health facilities were more likely to increase utilization (OR = 4.52, 95% CI = 1.50–13.50, P = 0.007). Assessment of distance to facility identified both distances as key determinants of overall utilization as those resident < 1 km from the facilities were 2.4 times more likely to utilize the facilities (OR = 2.42, 95% CI = 1.20–4.80, P = 0.012) while those resident 1-5 km were 5.3 times more likely to utilize the services (OR = 5.34, 95% CI = 1.90–15.10, P = 0.002) relative to longer distances. Finally, on methods of conveying messages, those who received messages through Information Education and Communication (IEC) materials were 7.8 times (OR = 7.85, 95% CI = 1.50–40.50, P = 0.014) and through face-to-face were 3.9 times more likely to utilize the services (OR = 3.91, 95% CI = 1.30–11.90, P = 0.016).ConclusionCritical facility-based determinants of utilization of nutrition services include personnel (mainly nutritionist and nurse), distance and IEC materials.

Nutritional service needs of pregnant and lactating adolescent girls in Trans-Mara East Sub-County, Narok County: focus on access and utilization of nutritional advice and services

BackgroundAn understanding of the association between adolescent nutrition, adolescent pregnancy and their quest for healthcare services may elucidate a basis for intervention and formulation of programs that enhance post-partum and increase the lifespan of the newborn, improve the quality of life and bridge morbidity, mortality and healthcare-associated cost. However, the nutritional needs of pregnant and lactating adolescent girls aged below 10 years resident in Trans Mara East Sub-County, Kenya remained unestablished. The objective of this study was to assess the nutritional needs of pregnant and lactating adolescent girls (under 19) when accessing and utilizing nutritional advice and services in Trans-Mara East Sub-County, Narok County.MethodsThe study adopted a cross-sectional approach that employed mixed methods with both quantitative and qualitative research approaches. Cochran formula was applied to arrive at a minimum of 291 households. Probability proportionate to size sampling techniques using cluster and simple random methods were used to practically access adolescents who are pregnant or lactating. Data was collected using questionnaires, in-depth interview and Focus Group Discussion. Quantitative data was analyzed descriptively using frequencies and inferentially using odds ratio and z-test. Framework analysis was employed to analyze qualitative data. p ≤ 0.05 was considered statistically significant.ResultsThe study revealed that access of pieces of nutritional-related advice represented by 67.8% was significantly higher than expected frequency of 50%. Nutrition supplementation, food fortification or blending and complementary feeding were significantly below the expectant frequency (p < 0.01) of 50%. Nutrition service areas such as provision and collection of vitamin A and IFAS were significantly lower than expected frequency (p < 0.01).ConclusionsThe most widely utilized were nutrition services that falls within the preventive-focused services followed by curative-focused services. Nutritionist and nurse more likely to increase overall utilization of nutrition services.

Inadequate Nutrition Services in Outpatient Cancer Centers (P05-036-19)

ObjectivesNutritional services are a critical component of cancer care, yet Registered Dietitian Nutritionist (RDN) staffing patterns in outpatient cancer centers are poorly documented. The objective of this study was to inform availability of nutrition services by examining RDN staffing and utilization in outpatient cancer centers nationwide. MethodsAn online questionnaire was developed and approved by the Oncology Nutrition Dietetic Practice Group (a practice group of the Academy of Nutrition and Dietetics) and The Ohio State University Institutional Review Board. The deidentified survey was intended for RDNs who practice at outpatient oncology centers and distributed via Academy email in fall 2017. To avoid duplication, each respondent was prompted to submit one survey per center. Annual analytic cases, representing unique new patients diagnosed and treated at each center, were collected. Data on RDN staffing patterns, reimbursement for services, and malnutrition screening practices were analyzed. ResultsOver one year, 310 surveys were submitted and 206 provided usable data. Of those, 82% of the centers reported at least one dedicated RDN on staff with an average of 1.7 RDN full-time equivalents. The mean annual analytic cases reported were 2043, representing a RDN-to-patient ratio of 1:1202. During this time, RDNs evaluated an average of 7.5 patients per day, yet 48% of centers did not bill for nutrition services. Over half (54%) of the participating facilities screened for malnutrition using a validated or adapted screening tool, such as the Malnutrition Screening Tool. ConclusionsThis is the first comprehensive, national study to inform nutrition care provider-to-patient ratio in cancer centers which have at least one dedicated RDN. Screening for malnutrition and billing for nutritional evaluations were not widely practiced in the participating facilities. Our findings indicate that the majority of cancer centers nationally are providing inadequate RDN coverage and have low utilization of nutrition services. Funding SourcesN/A.

Nutrition for Substance Use Disorder Recovery: The Gut-Brain Axis

With substance use disorder rates rising, there is an urgent need for new and effective treatment modalities. The utilization of nutrition services in addiction treatment has not been standardized, but there is a growing trend towards incorporating registered dietitian nutritionists into the treatment team. This comprehensive overview explores the impact of alcohol, cocaine, methamphetamine, and opioids on nutritional status. This presentation places particular emphasis on gut health, microbiome, and associated neural interactions. Homeostatic and hedonic mechanisms of eating behavior are discussed in the context of eating disorders and food addiction. Given the current crisis of addictive disorders, consideration should be given to prioritizing efforts to improve eating habits and overall health in recovery programs. Guidelines for nutrition interventions will be proposed, and a summary of where more information is needed will point towards future directions.

Initiatives Implemented to Improve the Utilization of Nutrition Services by HIV-Infected Patients Followed at a Regional HIV Centre

Initiatives Implemented to Improve the Utilization of Nutrition Services by HIV-Infected Patients Followed at a Regional HIV Centre

Utilization of Nutrition Services within the Managed Care Setting

LEARNING OUTCOME: To recognize the need for dietetic professionals to market systematic nutrition care in health maintenance organizations. The purpose of this study was to examine if and how nutrition services, such as initial screenings, individual counseling and group sessions, are utilized within the health maintenance organizations (HMOs) in the northeast region (ME, VT, NH, RI, MA, CT, NY, NJ) of the United States. A questionnaire was distributed to administrators and medical directors, thus purposefully focusing on administrative decision-makers. Of the 83 HMOs surveyed, a total of 27 questionnaires were returned and analyzed. The results indicated that 93% (n=25) of the respondents offered nutrition services. Of those offering nutrition services, 87% reported that dietitians/nutritionists provided the services; 90% of these HMOs required that nutrition staff have RD credentials. Of those offering nutrition services, 92% reported incorporating nutrition services into their basic coverage plan. Only 13% reported that nutrition screening was a standard procedure for all subscribers. Results from this study indicate that HMOs offer nutrition services to their subscribers, but most do not have a standard nutrition screening procedure. Thus, in general no systematic procedure is in place to identify subscribers who could be at nutritional risk. The findings provide insight into the utilization of nutrition services within the HMOs surveyed. Continued aggressive attempts by dietetic professionals are needed to educate physicians and administrators of HMOs to understand the benefits of timely nutrition screening/assessment and intervention and its potential in reducing health care costs.

Nutritional Service Use Among Rural Elders

The study purpose was to determine the impact of demographic, social, environmental, and health indicators on utilization of nutrition services among rural elders. Existing data from a regional Area Agency on Aging were used and the sample (N = 712) included men, African-Americans, and low income rural elders. Congregate meal was the most frequent nutrition service used. Age, race, marital status, income adequacy, payment source, transportation capability, health conditions, and function were predictors of service use. Implications for health care management, delivery, and policy are discussed.