Investigating and Refining Roles: Health Educators' Preparation and Competency for Delivering Nutrition Education

This dissertation presents four studies designed to investigate and provide evidence based insight into the preparation of health educators in the science and practice of nutrition. A mixed methods approach was utilized for this research. First, a review of the current literature will be presented discussing (a) what other authors have written regarding nutrition education for allied health professionals, and (b) the availability of research advocating for nutrition education for health educators. Also included is the review of twenty-three (23) articles addressing how researchers conceptualize nutrition, and their rationale for nutrition's inclusion into the respective allied health discipline's curriculum. Secondly, an analysis of the health education curriculum of a professional health program is presented. With the use of an availability scale, the university's most recent catalogue as well as the curriculum of the health degree was analyzed. The health program was also assessed for the presence of nutrition credentialed faculty and the presence of nutrition requirements and electives. Thirdly, the development and administration of an instrument to test the nutrition, nutrition education and health education knowledge of a sample of health and nutrition students will be discussed. The self-administered instrument was developed by the author. The final sample (n=123) comprised a purposeful set of students all currently enrolled at Texas A & M University, College Station, TX. The student's final scores on the instrument were assessed based on major, classification and by whether they had pursued a nutrition course during their undergraduate tenure. Lastly, a qualitative examination of health educators with the Certified Health Education Specialist (CHES) credential will be presented. Employing a naturalistic approach, semi-structured interviews were conducted. The final sample comprised four (4) persons. Health educators provided narratives related to their prior experiences in nutrition and their perceived competency in delivering nutrition education. Prior to this study, scientific literature has been deafeningly silent on nutrition and the health educator, the ability of health educators to deliver nutrition education, as well as the advocacy of nutrition for the profession. Thus, this study represents the first step towards addressing the limitations associated with the role of nutrition educator and filling the theoretical gaps

Novel Technologies for Assessing Dietary Intake: Evaluating the Usability of a Mobile Telephone Food Record Among Adults and Adolescents

The development of a mobile telephone food record has the potential to ameliorate much of the burden associated with current methods of dietary assessment. When using the mobile telephone food record, respondents capture an image of their foods and beverages before and after eating. Methods of image analysis and volume estimation allow for automatic identification and volume estimation of foods. To obtain a suitable image, all foods and beverages and a fiducial marker must be included in the image

A realist review to explore how low-income pregnant women use food vouchers from the UK’s Healthy Start programme

Objectives: To explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, which women might experience these impacts and why. Design: A realist review. Eligibility criteria for selecting studies: Primary or empirical studies (of any design) were included if they contributed relevant evidence or insights about how low-income women use food vouchers from the Healthy Start (UK) or the Special Supplemental Nutrition Program for Women, Infants and Children (US) programmes. The assessment of ‘relevance’ was deliberately broad to ensure that reviewers remained open to new ideas from a variety of sources of evidence. Analysis: A combination of evidence synthesis and realist analysis techniques was used to modify, refine and substantiate programme theories, which were constructed as explanatory ‘context – mechanism – outcome’ (CMO) configurations. Results: 38 primary studies were included in this review: four studies on Healthy Start and 34 studies on WIC. Two main outcome strands were identified: dietary improvements (intended) and financial assistance (unintended). Three evidence-informed programme theories were proposed to explain how aspects of context (and mechanisms) may generate these outcomes: the ‘relative value’ of healthy eating (prioritisation of resources); retailer discretion (pressure to ‘bend the rules’); the influence of other family members (disempowerment). Conclusions: This realist review suggests that some low-income pregnant women may use Healthy Start vouchers to increase their consumption of fruits and vegetables and plain cow’s milk, whereas others may use them to reduce food expenditure and save money for other things