- What is food security? Food insecurity?
o Security: access by all people at all times to enough food for an active,
o Insecurity: limited or uncertain ability to acquire or consume an adequate
quality or sufficient quantity of food in socially acceptable ways
- What are the five components of food security?
o Quantity: access to sufficient quantity of food?
o Quality: is food nutritionally adequate?
o Suitability: culturally acceptable and the capacity for storage and
o Psychological: do the type and quantity of food alleviate anxiety, lack of
choice, and feelings of deprivation?
o Social: are the methods of acquiring food socially acceptable?
- What factors may be associated with household food insecurity? What could
be the outcomes? (Reference Table 10-1)
- What are some types of issues are asked about through survey questions
measuring food insecurity? (Reference Table 10-2)
o Fear and anxiety related to insufficiency of food budget to meet basic
o Experiencing food shortages without having money to purchase more.
o Perceived quality and quantity of food eaten by household members.
o Atypical food usage (substituting fewer or cheaper foods).
o Episodes of reduced food intake, hunger, or weight loss by household
- Based on the survey, what are the four categories related to food
- Who are the food-insecure in the United States? Why might each group be
food-insecure (factors specific to them)?
o Poor and working poor, young and older adults, ethnic minorities, innercity and rural dwellers, certain southern and western states, many farmers,
- What are some causes of food insecurity in the United States?
o Unemployment, poverty, low wages, high housing and health care costs
- Explain the paradox of food insecurity and obesity in the United States.
o Occurs due to the need to maximize caloric intake, the trade-off between
food quantity and quality, and overeating when food is available.
- Names/descriptions/eligibility information for nutrition assistance programs
(reference Table 10-4) (If you are given a brief scenario and asked to identify
nutrition assistance programs for which the individual would meet the
eligibility guidelines, could you list those programs?)
o VIEW TABLE 10-4
- What are some ways that individuals can help reduce food insecurity in
o Participate in soup kitchens, church charities, surplus food giveaways,
food banks, food pantries, or prepared and perishable food programs.
- The Transtheoretical Model (Stages of Change)
o What are the three assumptions?
Behavior change involves a series of diff steps or stages
There are common stages and processes of change across a
variety of health behaviors
Tailoring an intervention to the stage of change in which people
are at the moment is effective than not considering the stage
people are in
o What are the stages? Including a brief explanation of each stage.
Precontemplation- individual unaware of or not interested in
making a change
Contemplation- individual is thinking about making a change
within the near future
Preparation- individual actively decides to change and plans a
change very soon
Action- individual is trying to make the desired change; has
worked at it for less than 6 months
Maintenance- individual sustains change for 6 months or longer
- Motivational Interviewing
o What is it?
Builds upon client-centered counseling
o What are the four principles? Including a brief explanation of each
Resist urge to confront client about need to change
Understand- proceed in nonjudgmental way
Listen- express empathy
Empower- support self-efficacy
- Health Belief Model
o What is its purpose?
Theory that there are 3 components for adopting a new health
o What are the three components? Including a brief explanation of each
The perception of a threat to health
Expectation of certain outcomes related to a behavior-benefits
Self-efficacy- the belief that one can make a behavior change to
- Theory of Planned Behavior
o What is its purpose?
Individual’s intention to change behavior is determined by both
personal attitudes towards the new behavior and perception of
social pressure to change the behavior
o What are the constructs?
Perceived behavioral control
- Social Cognitive Theory
o What is its purpose?
Focuses on target behaviors rather than knowledge and attitudes
o What are the key concepts? Including a brief explanation of each
Environment, behavioral capabilities, expectations, self-efficacy,
- Cognitive-Behavioral Theory
o What is its purpose?
Best applied when people are actively ready to make a change
o What is its assumption?
Behavior is learned and directly related to internal and external
o What are behavioral strategies associated with this theory?
Highly process oriented, goal directed, and facilitate through a
variety of problem-solving tools
- The Diffusion of Innovation Model
o What is its purpose?
People cannot or will not change their behavior, and many do not
adopt to innovations easily
o What are the four stages?
o Who are the different groups of individuals? What do they represent?
Innovators- adopt innovation readily, perceive themselves as
popular, are financially privileged
Early adopters- opinion leaders, well respected by peers
Early majority- cautious
Late majority- skeptical, adopt innovation only through peer
Laggards- last to adopt idea
- What is a community needs assessment?
o Process of evaluating health and nutrition status of a community
- What is target population?
o The pop. That is the focus of an assessment, study, or intervention
- What is the purpose of studying the target population?
o The purpose of studying the target population is to identify any potential
needs of the target population.
- What types of data should be collected about the target population?
o Food preferences and attitudes, health beliefs and knowledge, lifestyle
factors, nutrition status, social and cultural factors, priorities and
- What could trigger a community needs assessment?
o Need for new data due to outdated or missing data about health and
nutritional status of community
o Mandate from state or federal agency
o Research findings
o Raised awareness in community
o Availability of funds
- What are the steps in conducting a community needs assessment?
o Set parameters of the assessment
o Develop a data collection plan
o Collect data
o Analyze and interpret the data
o Share the findings
o Set priorities
o Choose a plan of action
- What is involved in each of the steps? (E.g., when defining the nutritional
problem, what should be included in the statement? What are community
characteristics to consider when collecting data? What are four steps
involved in making the community diagnosis? How should priorities be set
for the community? Etc.)
o Parameters: set the direction for the assessment, define community,
determine the purpose of the needs assessment, set goals and objectives
for the needs assessment
o Develop: observe the community and listen to its members prior to
developing a program, specify the types of data needed
Community data, community environment and background
conditions, target pop.
o Collect: methods include survey, health risk appraisal, screening, focus
groups, interviews with key informants, direct assessments of nutrition
o Analyze and interpret: data is collated, coded, entered into computer,
checked for error, analyzed using accepted statistical methods, compared
against reference data, then used to diagnose the community, executive
summary is prepared
o Share findings: results are useful to other agencies and organizations,
prevents duplication of effort, enables more than one agency to address
problem, be sure key stakeholders are informed before release of
o Set priorities: involves who is to get what at whose expense, you want the
best health outcome, limited resources require decisions based on
- What are factors that influence decisions about food choices and physical
activity? What are methods to obtain data about the target population? (E.g.
survey, health risk appraisal, screening, focus groups, interviews with key
o Factors that influence decisions about food choices and physical activity:
nutrition status, food preferences and attitudes, health beliefs and
knowledge, lifestyle factors, sociocultural factors, and priorities and
o Methods to obtain data about target population: survey, health risk
appraisal, screening, focus groups, and interviews with key informants.
- What are some questions that should be asked when designing a survey?
o Is the survey valid and reliable, are norms available, is the survey suitable
for the target pop. are the survey questions easy to read and understand, is
the format of the questionnaire clear, are the responses clear
- What diet assessment tools could be used? What are some examples of
strengths/weaknesses of the diet assessment tools?
o 24 hr. recall: easy to administer in person or by phone and lends itself to
large pop studies/ validity or accuracy
o Diet record: over a period of multiple days or years/ actual food intake
recording changes the actual food chosen for recording (e.g., choosing
meals that are easy to record)
o Food frequency: self-administered, requires only 15 to 20 mins to
complete, and is analyzed at a reasonable cost/ accurate reporting of intake
depends on memory
- What are some issues that could arise in the data collection? (E.g. number of
staff, cost, time; scientific issues such as validity and reliability; factors that
could impact validity and reliability; cultural issues)
o Practical: number of staff available, cost, amount of time needed
o Scientific: validity and reliability
o Cultural: religion, etiquette and social customs
- What factors could trigger program planning?
o Results of the community needs assessment.
o Mandate from an organization’s national office or from a federal agency.
o Research findings.
o Community leader or coalition.
o Availability of funding for new programs.
o Government policy.
- What are the steps in program planning?
o Review results of community needs assessment
o Define program goals and objectives
o Develop a program plan
o Develop a management system
o Identify funding sources
o Implement the program
o Evaluate program elements and effectiveness
- What are goals and objectives?
o Outcome objectives
o Process objectives
o Structure objectives
- When designing an intervention, what are the three levels of intervention?
o Level 1: building awareness
o Level 2: changing lifestyles
o Level 3: creating supportive environment for change
- What activities are related to designing a nutrition education component of a
o Assess needs, set goals and objectives, specify the format, develop a
lesson plan, specify nutrition messages, choose program identifiers,
develop a marketing plan, specify partnerships, conduct evaluation
- What is a main source of funding for community nutrition programs?
o Extramural funding, grants, government funding
- What are the components of the logic model that provides a framework for
planning, implementing, and evaluating programs?
o Situation, inputs, activities, outputs, outcomes, and influential factors
(assumptions and external factors).
- Why is program evaluation important?
o Helps managers make decisions about operations of program
o Determines progress toward goals and objectives and whether goals are
o Helps ensure that program resources are being used properly
- How can program components and program effectiveness be evaluated?
o To influence executive or politician with authority to distribute resources
or shape policy
o To alert managers and policy makers to the need for expanding or refining
- What are the six types of evaluations?
o Formative- testing and assessing program elements before implementing
o Process- examining program activities and how program is delivered
o Impact- determining whether and to what extent a program accomplished
o Outcome- measuring whether program changed overall health status or
o Structure- evaluating personnel and environmental factors related to
o Fiscal/efficiency- how outcomes compare with costs
- What is marketing? Social marketing?
o Process by which individuals and groups get what they need and want by
creating and exchanging products and values with others
- What are the steps in developing a marketing plan?
o Determine needs and wants of target population
o Specify benefits of product or service
o Conduct a situational analysis
o Develop marketing strategy
o Develop budget and timeline
- What are the 4 P’s of marketing?
o Product, Place, Price, Promotion
- What are the four types of behavior change?
o Cognitive, action, behavior, value
- What is SWOT? What is its purpose?
o Strengths, weaknesses, opportunities, threats
o Detailed assessment of the environment, including an evaluation of the
consumer, competition, and other factors that may affect the program or
- What are the four functions of management?
o Planning, organizing, leading, controlling
- What does planning involve?
o How best to achieve goals & objectives
o Setting goals and objectives
o Deciding what to do and when, where, and how to do it
- What does organizing involve?
o Process by which carefully formulated plans are carried out
o Human & non-human resources
- What is an organizational chart? Why is it important?
o Est. lines of communication and procedures
- What is involved with human resource management within an organization?
o Staffing and evaluating job performance
o Staffing includes activities designed to recruit individuals to help meet the
organization’s goals and objectives
- What does leading involve?
o Influencing others to achieve the organization’s goals and objectives
- What are ways to communicate with employees?
o Verbal, nonverbal, and written
- What does controlling involve?
o Regulation of organizational activities
o Determining which activities need control
Exam 2 Review
- What are the terms culture, cultural values, diversity, cross-cultural, and
o Culture: knowledge, beliefs, customs, laws, morals, art, and any other
habits and skills acquired by humans as members of society.
o Cultural values: principles or standards that members of a cultural group
share in common.
Any belief or quality that is important, desirable, or prized.
o Diversity: differences among groups of people; physical,
abilities/disabilities, language differences, sexual orientation, gender
identity, socioeconomic status, and age.
o Cross-cultural: denotes interaction between or among individuals who
represent distinctly different cultures.
o Ethnocentric: people who consider beliefs, values, customs, and
viewpoints of their own group superior to those of every other group.
- What factors are causes with health disparities?
o Health disparities (definition): also called health inequalities, disparities
based on gender, age, race or ethnicity, education, income, religion,
disability, geographic location, sexual orientation, or other characteristics
historically linked to discrimination or exclusion.
Can exist in regard to access to health care, delivery of quality,
competent health care services, and health outcomes.
Causes: socioeconomic status, culture, access to and utilization
of quality health care services,
discrimination/racism/stereotyping, environment and insurance
issues. (REVIEW EACH ON PAGE 604)
- Be aware of majority American culture values and beliefs vs. other cultures.
Mastery over nature Harmony with nature
Action, task oriented Being
Time dominates, punctual Personal interaction
Human equality Hierarchy/rank/status/autho
Individualism/privacy Group welfare
Future orientation Past or present orientation
Mind, body, and soul
Mind, body, and soul
Disease is preventable Humans cannot control
Confidentiality Family decision making
- What are some common barriers to cross-cultural communication?
o Language (either completely different or misinterpretations of similar
languages due to geography), nonverbal cues (body language/signals), and
- Who is a translator vs. interpreter? What is their relevance in a professional
o Translator: a person who works in converting written words into another
o Interpreter: a person who works in converting spoken words into another
Professional interpreters and/or translators can help effectively
relay information when there is a language barrier with yourself
and a client.
- What are the 3 levels of interventions for client-centered nutrition education?
o Build Awareness-Enhancing Motivation (Why change):
Explore feelings, attitudes, and beliefs about behaviors-
Increase client awareness about behaviors through selfassessment activities such as a food checklist or physical
Explore pros and cons of behaviors to help participants
explore and resolve ambivalence about trying a new
Address social norms by discussing impact of peers and
media on behavior changes.
Provide opportunities for clients to think about perceived
benefits and barriers for behaviors.
Help clients overcome barriers and increase selfconfidence, or self-efficacy, to make a change.
o Change Lifestyles-Providing Info and Skills to Act (How to change):
Incorporate activities that may help clients gain skills1. Discuss relevant nutrition-related info.
- Build skills in food preparation and cooking.
- Practice critical thinking skills to help clients make healthy
- Provide opportunities for clients to practice setting realistic
- Encourage self-monitoring of food intake and physical
activity in order to increase clients’ sense of control over
eating and activity behavior.
o Create a Supportive Environment-Creating a Support System:
Discuss how to develop a positive change support system
(finding an exercise buddy).
Map out places in community to exercise or find inexpensive
fruits and veggies.
- What are example methods for applying educational principles to program
design? (Table 16-2)
o Consonance: in intervention to improve proper self-monitoring of blood
glucose, teaching benefits of monitoring without showing how to monitor
would be insufficient.
o Relevance: program should be tailored to clients’ knowledge, beliefs,
circumstances, and prior experience, determined by pretests, baseline
questionnaires, or interviews,
o Individualization: because clients learn indifferent ways and at different
rates, a program is more likely to be effective if education is tailored to the
o Feedback: feedback can be based on achieved learning objectives (such as
increased knowledge about a given subject) or outcomes (such as
increased adherence to a prescribed diet).
o Reinforcement: praise and congratulations are very effective in rewarding
o Facilitation: for example, a weekly food diary sheet facilitates a client’s
ability to record actual food intake.
- What are important concepts to consider when teaching children vs. adult
Keep your message short, clear, and simple.
Emphasize positive points; avoid negative or judgmental
Relate the message to child’s interests. Make learning fun!
Make practical, concrete suggestions.
Involve the child (ask questions, relate to his or her experiences
Show the child how to, not why.
Relate to their interests.
Consider the impact of peer pressure.
Consider client’s rebelliousness and attitudes toward authority.
Address his or her insecurities about physical changes.
Discuss mood changes and impulsiveness.
Tie teaching concepts to adolescent concerns, such as appearance
and athletic performance.
Acknowledge and relate to client’s needs and concerns.
Consider his or her prior experiences with and knowledge of
Personalize your interaction to client’s current health profile.
Provide an opportunity to practice using knowledge and skills.
- What is typically included in the written document of the nutrition education
o The needs of the target population, goals and objectives for intervention
activities, program format, lesson plans (including instructional materials
such as handouts and videos), nutrition messages to be imparted to target
population, marketing plans, any partnerships that will support program
development or delivery, and evaluation instruments are all included in a
nutrition education plan.
- What is the first step in developing a lesson plan?
o The first step in developing a lesson plan is to know the target audience,
the setting, and the content.
- Based on experience, how best do learners retain information?
o People retain information differently, but I have noticed involving the
learner in the lesson is the most effective way to get them to retain the