Professional Documents
Culture Documents
Overview
The Mesa County Health Department provides Community Health Services
including WIC (Women, Infants, and Children). Mesa County WIC is a special
supplemental nutrition program for women, infants and children located in the towns
Fruita and Grand Junction of Colorado. WIC provides nutrition education, free nutritious
foods, referrals, and breastfeeding promotion. The eligibility requirement is that the
combined gross family income cannot exceed 185% of the federal poverty income
guideline for nutritional risk. Those already enrolled in Medicaid, Food Stamps or TANF
(temporary assistance for needy families) automatically qualify for WIC. The majority of
participants receiving WIC in Mesa County are Caucasian (the racial makeup of the
county is 89.4% white1), so it is important to keep their cultural practices in mind when
providing services.
One educational session about eating vegetables was provided to parents and
children ages 2-5 years old in the How Does Your Salad Grow class. The outcomes of
the class was 100% of participants could state the recommended amount of fruits and
vegetables a 2-5 year old should consume each day, and 50% of participants (applies
to parents only) could learn at least one tip to incorporate more produce into their
childs diet. Limitations included getting people to come to the class and attention span
of the children throughout the class. All written materials developed for the successful
implementation of this education class are available in the Appendix section.
Nutrition Assessment
Food/Nutrition-Related History (1)
and surgery to treat symptoms, rather than focusing on preventative care.3 Some people
do also seek alternative or complimentary medicine for more intensive diseases.
Knowledge/Beliefs and Attitudes (4)
Beliefs and attitudes (4.2)
The predominant religious group that the Caucasian race belongs to is Lutheran.
They also tend to belong to the Baptist, Methodist, Episcopal, Presbyterian, Jewish, and
Catholic church.4 The majority of this race identify with religious faith and have a belief
in God. For Roman Catholics, meat is not consumed on Fridays during Lent (40 days
before Easter). Jewish dietary laws are complex and follow kosher guidelines, such as
pork and shellfish being prohibited. The laws define how birds and mammals must be
slaughtered, prepared, and when they may be consumed.2
Factors affecting access to food and food nutrition-related supplies (6)
Food/nutrition program participation (6.1)
According to Health Department data & statistics, 15.6% of adults 18+ years of
age reported that their general health was fair to poor in 2010, with a mean number of
3.9 days in the last 30 days that their physical health was not good.1 In 2009, 23.7% of
children ages 2-14 years old were overweight or obese. In 2012, it was reported that
14% of Mesa County residents had limited access to healthy foods (low-income people
who do not live close to a grocery store). In 2011, 21.4% of adults ages 18-24 years
were uninsured. In 2010 statistics show 18% of children less than 18 years fell below
the federal poverty level, and in 2011 44.1% of students were eligible for free and
reduced school lunch.
Nutrition Diagnosis
PES Statement
Food- and nutrition-related knowledge deficit related to lack of prior nutrition-related
education as evidenced by verbal group reports indicating needs for fruit and vegetable
intake education.
Limited access to food related to lack of financial resources to purchase a sufficient
quantity or variety of culturally appropriate healthful food as evidenced by lack of
resources and need for WIC program for free nutritious foods and education to improve
health status of participants.
Nutrition Intervention
Nutrition Education-content related to nutrition relationship to health/disease as
evidenced by food- and nutrition-related knowledge deficit.
To address the nutrition diagnoses an education intervention toward eating five
fruits and vegetables a day as they relate to health/disease prevention, one of the major
dietary flaws of the clients served, was planned and provided.
Nutrition Education (E-1.5) Recommended modifications
Nutrition Education (E1.4) Nutrition relationship to health/disease
Nutrition Monitoring & Evaluation
span of three months. The Education Intervention Program Objective: Increase parents
and childrens (ages 2+ yrs) understanding of fruit and vegetable servings per day for
age in one class education session.
Lesson Plan
How Does Your Salad Grow educational class will be presented to parents and
children 2+ years of age that are WIC participants. The goal of the class is to provide
information and literature to increase knowledge of a healthful diet. This class is to be
30 minutes in duration and be held monthly at the WIC office. The class focuses on the
following: each child participating can name and identify the color of one vegetable,
each parent can report understanding of appropriate vegetable servings/intake per day
specific to their childs age, and each family goes home with a handout, gift, and check
to implement what theyve learned. (See Lesson Plan Template in the Appendix
section).
Marketing
This education opportunity will be advertised verbally over the phone when
appointments are scheduled for check pickups. This provides the opportunity to join a
free class when they would have already been coming into the office anyways. This
addresses the 4 Ps of marketing: price (free), product (fun and informational class with
take home gifts), promotion (receptionist calls to schedule), and place (conveniently
located at WIC office where you have to come anyways to pick up your checks). In the
future, it may also be advertised via social media on the Health Departments Face book
page.
Resources
The education class will require a space large enough to hold the number of
attendees, which for now can be one of the WIC educator offices. The staff required for
the class will consist of the WIC educator whose office is being used along with the RD
hosting the class. If the group grows to a larger number in subsequent warmer months,
the class can be held outside of the Health Department building on a large area of
grass. All materials required for the handouts and coloring activity (printer, ink, paper,
stapler, pens, crayons, copy machine) as well as the book and gift will be provided by
the WIC facility. Since these items are already part of the WIC budget, there will be no
expenses to budget for above and beyond normal operation.
Nutrition Monitoring and Evaluation
The method of obtaining measurement for the objectives are a pre-test and posttest for parents, with verbal affirmation from children. Tests were collected and results
were analyzed for evaluation of learning achievement. The results indicated 100% of
participants could report the recommended amount of fruits and vegetables a 2-5 year
old should consume each day, and 50% of participants (applies to parents only) could
learn at least one tip to incorporate more produce into their childs diet. 100% of parents
found the class helpful and enjoyable. Factors hindering results were the lack of detail
provided by participants on the test answers. The pre- and post-test can be located in
the Appendix section.
Other positive or negative outcomes: there were originally two classes
scheduled, but only one was accomplished despite several efforts. The receptionist was
in charge of trying to get people to come to the class during her scheduling calls. The
WIC staff and dietetic intern also went through lists of people who still needed these
months checks and fit the criteria for the class to come up with more people to reach
out to. The cancellations are out of our control, however, the hope is that the class will
consist of up to 10 children in the future.
Future plans for nutrition care, monitoring, and follow-up: at the next appointment
the class participant comes in for, ask the parent how many fruits and vegetables their
child is eating each day and what size the servings are. See if they retained and applied
information from the education class into daily life. Monitoring shows success of the
intervention toward the diagnoses I established by confirming that in the 3 months
following the class the participants improved upon their fruit and vegetable intake due to
what they learned in the class. The results may have contributed to the success of the
targeted HP 2020 goal by potentially reducing the proportion of children aged 2 to 5
years who are considered obese through an increase in healthy diets consisting of more
fruits and vegetables in place of less healthful food choices.
Appendix A: Lesson Plan
The title of the lesson is: How Does Your Salad Grow?
The target audience: WIC participants with children ages 2 years and older.
Duration: 30 minutes.
Introduction (5 minutes),
Body of the Lesson: 20 minutes total: reading the book with participation 10 minutes, activity and action plan - 10 minutes
Conclusion: (5 minutes).
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Goal: Increase daily intake of fruits and vegetables to 5 per day in WIC
participants ages 2 years- 5 years old over the time span of three months.
Specific Objectives
Procedure
(Use SMART
criteria)
Learning
Activity
Evaluation
Method
Introduction
Have everyone sit criss-cross
applesauce in a circle on the rug
and share his or her name and age.
Verbal
group
discussion
Participant
verbal
feedback
Pre-test
Body of Lesson
1. Participant (child)
will be able to
identify the color and
name of one
vegetable in the
book, and state how
many fruits and
vegetables they
Activity
Read Book
Verbal Q&A
R realistic
expectations of
learning servings
T timely
achievement of
objectives
2. Participant
(parent) will
understand the
appropriate
vegetable serving
size specific to their
childs age and
recommended intake
of fruits and
vegetables.
S specific to parent
M measureable
results on post-test
A attainable
information during
class time
Discussion
1. Discuss with parents tips to
increase vegetable consumption,
appropriate serving sizes for their
childrens age, and how many
servings the kids should eat each
day while kids do the coloring
activity and their checks are issued.
Recipe,
Tips &
Portions
Handout
Post-test
R realistic
expectations of
learning servings
T timely
achievement of
objectives
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Conclusion
Materials List
1. Colored plastic vegetables
2. Book, How Does Your Salad Grow?
3. Crayons and paper with picture of salad bowl
4. Recipes, tips, and portions handouts
5. Pre-tests and post-tests with pens
6. Plate and toothbrush take-home gifts
Appendix B: Handout
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Ingredients
1 package (8 ounces) refrigerated crescent rolls
1 package (8 ounces) 1/3 fat cream cheese, softened
1 tablespoon mayonnaise
1 garlic clove, minced
1 teaspoon dried dill weed
Salt and ground black pepper to taste
2 cups assorted fresh vegetables such as broccoli, cauliflower, cucumber, green or red
bell pepper, tomato, green onions, mushrooms, carrot, zucchini or yellow summer
squash.
(No oven? Try whole wheat tortillas, bagels, English muffins, or pita bread!)
Preparation
Preheat oven to 350F. Unroll crescent dough; separate into eight triangles. On a sheet
pan, arrange triangles in a circle with points in the center and wide ends toward the
outside. Using lightly floured roller, roll dough to a 12-inch circle, pressing seams
together to seal. Bake 12-15 minutes or until light golden brown. Remove from oven;
cool completely.
In a big bowl, combine cream cheese, mayonnaise, garlic and dill weed. Season with salt
and black pepper; mix well. Spread cream cheese mixture evenly over crust.
To prepare vegetables, coarsely chop broccoli or cauliflower. Dice or slice cucumber, bell
pepper, green onions, tomato, mushrooms, yellow squash or zucchini. Grate carrots.
Preparation
Preheat oven to 400 degrees.
Spray a cookie sheet with non-stick cooking spray.
Prepare the sweet potatoes. You can leave the skin on if you choose. Make slices
about 1/8" thick. Place in a large bowl with the oil and any seasonings. Toss to coat.
Spread the slices in a single layer on the cookie sheet.
Bake for about 15 minutes until they are golden brown. Turn halfway through the
baking time.
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Carefully spread the baked chips on a paper towel to drain any excess oil.
(Baked sweet potato chips can be stored up to a week in an airtight container)
3. Ants on a Log
Ingredients
Celery sticks
Peanut butter
Raisins (or dried cranberries for fire ants)
Preparation
Fill the center of the celery stick with peanut butter.
Place a few raisins on top to be your ants.
Eat and enjoy!
4. Carrot Fries
Ingredients
1 lb carrots
1 tbsp cornstarch (or 2 tbsp all purpose flour)
1 tbsp canola oil
1 tsp dried tarragon (or rosemary)
Black pepper + salt
Preparation
Preheat oven to 400 degrees.
Cut carrots into fries, about 1 cm thick, and mix with cornstarch and a little black
pepper.
Toss with canola oil, spread in a single layer on a baking tray lined with parchment.
Bake for 40-45 mins, turning halfway.
Mix a little salt with tarragon and toss through the cooked fries.
5. Kale Chips
Ingredients
2 large bunches of kale, rinsed, dried, and torn into 1-2 inch pieces
2-3 tbsp olive oil (or canola oil)
2 tsp coarse salt
Preparation
Preheat oven to 350 degrees.
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Toss kale pieces with oil and salt, spread in a single layer on a baking sheet.
Bake for 10-12 mins (or until crisp) and serve.
Tips!
Tip #1: Time
Grab and go foods: fresh apples, ripe plums, pears, grapes, carrots, and celery. Have
these foods washed and ready for eating on your refrigerator shelf.
Dried fruit like raisins, apricots, cranberries and others: Add to salads, mix with nuts, or
add to cottage cheese or yogurt.
Vegetable and fruit juice remember cup = adult serving.
Stock up on frozen vegetables- they are easy to do in the microwave and great
additions to canned soup or casseroles.
Canned fruit in the fridge ready to add to cereal or as the start of a fruit salad
Roasting is a quick, easy way to bring out the best flavors of much vegetable such as
carrots, eggplant, red peppers, squash, onions, sweet potatoes, and mushrooms.
Use fruit chutneys or fruit such as pineapple, apple or papaya to complement meat
dishes.
Blend it. Use any combination of fresh, frozen or canned fruit to make a smoothie.
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4. If you could choose when the class was held, what day(s) and time(s) would be
the most convenient for you?
Post -Class Questions
1.
2.
3.
4.
How many servings of fruits and vegetables should a 2-5 year old eat each day?
How old is your child, and what would a serving size be for him/her?
What is one tip you learned to get your child to eat more fruits or vegetables?
Did you find this class helpful? Enjoyable?
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References
1. Mesa County website. http://www.mesacounty.us. Published 2004. Accessed
January 28, 2016.
2. Boyle MA, Holben DH. Gaining Cultural Competence in Community Nutrition. In:
Boyle MA, Holben DH. Community Nutrition in Action: an entrepreneurial approach.
6thed. Belmont, CA: Wadsworth; 2013:555-588.
3. Macmillan Dictionary website.
http://www.macmillandictionary.com/us/dictionary/american/western-medicine.
Published 2009. Updated 2016. Accessed January 31, 2016.
4. Pew Research Center website. http://www.pewresearch.org/fact-tank/2015/07/27/themost-and-least-racially-diverse-u-s-religious-groups/. Published 2016. Accessed
January 30, 2016.
5. Office of Disease Prevention and Health Promotion website. Retrieved February 20,
2016, from http://www.eatright.org.
6. Alexander F. How Does Your Salad Grow? Scholastic; 2004.
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