Food Safety Knowledge, Attitudes, and Behaviors of Native American Families with Young Children: A Mixed Methods Study

Children are at increased risk for foodborne illness due to underdeveloped immune system. Limited research has been reported on food safety knowledge of Native American families with children 10 years of age and younger. This study was conducted to determine the food safety knowledge, attitudes, and behaviors of the main food preparer in these families by collecting quantitative and qualitative data simultaneously in a mixed method approach. A food safety knowledge survey created using FightBAC!™ concepts was administered prior to focus groups discussions held in Native American communities using a script based upon the Health Belief Model. Quantitative data were analyzed using SPSS. Qualitative data were coded by three reviewers independently and then compared jointly for themes. Over three fourths of participants (n = 102) were female with an average age of 38.3 years. Over one half of participants were unemployed (54 %), lived on reservations (54 %), and 86 % had a high school degree or higher level of education. The following four themes emerged from the eight focus groups (n=66): food can make one sick, I am not in control when others handle food, I know how to safely prepare foods for my family, and I do not have time or best equipment (for food safety). Mixed method analysis revealed that participants were aware of the severity and susceptibility for foodborne illness but were confident in preparing foods safely for their family. A food safety education program for Native American food preparers with young children is needed to prevent foodborne illness (FBI) in this population and promote safe food handling practice

Food Safety Knowledge, Attitudes, and Behaviors of Native American Families with Young Children: A Mixed Methods Study

Children are at increased risk for foodborne illness due to underdeveloped immune system. Limited research has been reported on food safety knowledge of Native American families with children 10 years of age and younger. This study was conducted to determine the food safety knowledge, attitudes, and behaviors of the main food preparer in these families by collecting quantitative and qualitative data simultaneously in a mixed method approach. A food safety knowledge survey created using FightBAC!™ concepts was administered prior to focus groups discussions held in Native American communities using a script based upon the Health Belief Model. Quantitative data were analyzed using SPSS. Qualitative data were coded by three reviewers independently and then compared jointly for themes. Over three fourths of participants (n = 102) were female with an average age of 38.3 years. Over one half of participants were unemployed (54 %), lived on reservations (54 %), and 86 % had a high school degree or higher level of education. The following four themes emerged from the eight focus groups (n=66): food can make one sick, I am not in control when others handle food, I know how to safely prepare foods for my family, and I do not have time or best equipment (for food safety). Mixed method analysis revealed that participants were aware of the severity and susceptibility for foodborne illness but were confident in preparing foods safely for their family. A food safety education program for Native American food preparers with young children is needed to prevent foodborne illness (FBI) in this population and promote safe food handling practice

Content Validation of a Standardized Language Diagnosis by Certified Specialists in Gerontological Nutrition

Validation of the nutrition standardized language assures the language is accurate for use in practice, policy, and research, but few validation studies have been reported. The purpose of this descriptive study was to validate content of all components of the nutrition diagnostic term involuntary weight loss using experts providing care for older adults in health care settings. A Nutrition Diagnosis Validation Instrument was developed that contained the definition, etiologies, and signs and symptoms of the diagnosis plus items added from literature review. Questions on clarity and completeness of the language were included. The Nutrition Diagnosis Validation Instrument used a Likert-type scale for deriving a Diagnostic Content Validity (DCV) score for all items in the definition, etiology, and signs and symptoms components to define major, minor, and nonrelevant characteristics and a mean total DCV score for the term. In 2008, all Board Certified Specialists in Gerontological Nutrition (CSGs) were recruited by mail. CSGs (n = 110, 73% response) reported 15 ± 10 (mean ± standard deviation) practice years in gerontological nutrition. The total DCV component scores were 0.80 ± 0.17 (definition), 0.63 ± 0.08 (etiology), and 0.69 ± 0.12 (signs and symptoms). The mean total DCV score of the diagnostic term was 0.69 ± 0.11. Cognitive decline, poor oral health, and impaired skin integrity were identified as missing language. In conclusion, the majority of the definition, etiologies, and signs and symptoms of the term were contentvalidated, including seven items derived from literature review. The validated items, including recommendations for added language, need to be retested using the same process

Content Validation of a Standardized Language Diagnosis by Certified Specialists in Gerontological Nutrition

Validation of the nutrition standardized language assures the language is accurate for use in practice, policy, and research, but few validation studies have been reported. The purpose of this descriptive study was to validate content of all components of the nutrition diagnostic term involuntary weight loss using experts providing care for older adults in health care settings. A Nutrition Diagnosis Validation Instrument was developed that contained the definition, etiologies, and signs and symptoms of the diagnosis plus items added from literature review. Questions on clarity and completeness of the language were included. The Nutrition Diagnosis Validation Instrument used a Likert-type scale for deriving a Diagnostic Content Validity (DCV) score for all items in the definition, etiology, and signs and symptoms components to define major, minor, and nonrelevant characteristics and a mean total DCV score for the term. In 2008, all Board Certified Specialists in Gerontological Nutrition (CSGs) were recruited by mail. CSGs (n = 110, 73% response) reported 15 ± 10 (mean ± standard deviation) practice years in gerontological nutrition. The total DCV component scores were 0.80 ± 0.17 (definition), 0.63 ± 0.08 (etiology), and 0.69 ± 0.12 (signs and symptoms). The mean total DCV score of the diagnostic term was 0.69 ± 0.11. Cognitive decline, poor oral health, and impaired skin integrity were identified as missing language. In conclusion, the majority of the definition, etiologies, and signs and symptoms of the term were contentvalidated, including seven items derived from literature review. The validated items, including recommendations for added language, need to be retested using the same process

Obtaining and Using Copyrighted Research Journal Content—Convenience vs Ethics

Members of American Dietetic Association (ADA) or those credentialed by the Commission on Dietetic Registration agree to abide by the ADA/Commission on Dietetic Registration Code of Ethics for the dietetics profession (1). A fundamental principle within the Code is to conduct dietetics practice with honor, integrity, and fairness and to comply with all laws and regulations applicable or related to the profession. Dietetics practitioners read and apply the results of research published in professional journals and other publications to guide their evidence-based practice. Authors of research articles can, in some cases, make their work more accessible to practitioners by amendment of the copyright transfer agreements required by the publisher. And practitioners working in the United States must understand and abide by the US copyright laws that govern the fair use of these resources. In this digital age, inappropriate access to and distribution of copyrighted research content can occur. This article briefly describes the key requirements of current US copyright law, generalized to situations that a dietetics practitioner might encounter, through scenarios that illustrate implications for practitioners and suggests options for the retrieval and use of copyrighted research information while abiding by the Code of Ethics. The discovery, access, and use of freely available literature (“open access”) with proper attribution of authorship is also discussed

Content Validation of Nutrition Diagnostic Term Involuntary Weight Loss by Board Certified Specialists in Gerontological Nutrition

The purpose of this study was to validate content of the Nutrition Diagnostic Term NC- 3.2 Involuntary Weight Loss using expert raters. This descriptive survey invited all Board Certified Specialists in Gerontological Nutrition (CSG) to participate by mail. An instrument was developed that included the definition, etiologies, and signs and symptoms of the diagnosis with items added from literature review. CSG rated how common or characteristic each item is to the diagnosis using a 5 point Likert scale. A weighted response for each item was used to calculate a Diagnostic Content Validity (DCV) score. DCV scores of 0.80 and above were classified as major characteristics, 0.50 to 0.799 were minor characteristics, and those scoring below 0.50 were unrepresentative of the diagnosis. A mean total DCV score was calculated using the major and minor characteristics. Dietitians were asked to comment on clarity and completeness of the language. Seventy three percent of CSG (n=110) had participated, 43% percent had an MS degree or higher level of education. Reported years of practice in gerontological nutrition were 15±10 years (mean ± SD). The DCV score was 0.80 for the definition, 0.63 for the etiologies, and 0.69 for signs and symptoms. Total DCV score for the diagnostic term was 0.69. Thirty six percent and 40% of the CSG recommended adding language to etiologies and signs and symptoms respectively. Results indicate the majority of items were valid to the diagnostic term but responses for adding items need further investigation in clinical testing, the next phase of validation. Advisor: Nancy M. Lewi

Validation of Nutrition Standardized Language—Next Steps

To provide a model for quality care and outcomes management, the Nutrition Care Process (NCP) and standardized language were introduced in 2003 by the American Dietetic Association (ADA). The standardized language, published in the International Dietetics & Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the Nutrition Care Process, is designed to facilitate communication, improve care, and close the gap in health care quality. When registered dietitians (RDs) are oriented to a nutrition care process, improvement in their documentation of nutrition care occurs. Since the introduction of the NCP and standardized language, RDs and dietetic technicians, registered (DTRs), have begun to adopt the process and language into their practice. This article explains why validation of the standardized language is needed to make the language accurate and meaningful for practice and describes how validation is conducted using RDs

Research Methodology for Validation of Nutrition Diagnostic Standardized Language Using Fehring Models

Validation of the nutrition standardized language (SL) confirms the language is accurate for use in practice, research, and policy. Nutrition diagnostic terms are identified by concept analysis using literature review and experts to distinguish and differentiate one nutrition problem from a similar or related problem. The Fehring models, used in nursing diagnosis validation research, are adopted to validate the SL nutrition diagnostic terms using experts and weighted inter-rater reliability ratios. In the first phase of validation research, diagnostic terms are validated by experts using the Diagnostic Content Validity Model (DCV). A Nutrition Diagnosis Validation Instrument (NDVI) is developed that contains the definition, etiologies, and signs and symptoms (s/s) of the diagnosis plus items added from literature review. Questions regarding clarity and completeness of the term are included. The NDVI uses a Likert-type scale with assigned weights to derive a DCV score. Using the weighted mean score, each item is classified into major (≥ 0.80), minor (0.50 to 0.79), or non- relevant (below 0.49) characteristics. The Clinical Diagnostic Validation Model (CDV) is employed in the second phase to validate the term in the clinical setting observing patients with the nutrition problem using the NDVI, expert dietitians and a CDV score. Use of the DCV and CDV Models provides clear, comprehensive and observable lists of defining s/s needed for accurate and valid SL diagnostic terms and allows comparisons between studies

Content Validity of Nutrition Diagnostic Term Involuntary Weight Loss

Objective The purpose of this study was to validate content of the Nutrition Diagnostic Term NC- 3.2 Involuntary Weight Loss using expert raters. Design/Subjects This descriptive survey invited all Board Certified Specialists in Gerontological Nutrition (CSG) to participate by mail. An instrument was developed that included the definition, etiologies, and signs and symptoms (s/s) of the diagnosis with items added from literature review. CSG rated how common or characteristic each item is to the diagnosis using a 5 point Likert scale. A weighted response for each item was used to calculate a Diagnostic Content Validity (DCV) score. DCV scores of 0.80 and above were classified as major characteristics, 0.50 to 0.799 were minor characteristics, and those scoring below 0.50 were unrepresentative of the diagnosis. A mean total DCV score was calculated using the major and minor characteristics. Dietitians were asked to comment on clarity and completeness of the language. Results/Discussion Seventy three percent of CSG (n=110) had participated, 43% percent had an MS degree or higher level of education. Reported years of practice in gerontological nutrition were 15±10 years (mean ± SD). The DCV score was 0.80 for the definition, 0.63 for the etiologies, and 0.70 for s/s. Total DCV score for the diagnostic term was 0.69. Thirty six percent and 40% of the CSG recommended adding language to etiologies and s/s respectively. Results indicate the majority of items were valid to the diagnostic term but responses for adding items need further investigation

Constructive Developmental Theory: An Alternative Approach to Leadership

As early as 1954, the critical value of leadership in dietetics was described by Rourke, who wrote, “When the day comes that your executive abilities equal your scientific knowledge, your profession (dietetics) will be secure. Until that day, you will be faced with a constant and unwelcome challenge” (1). Career and leadership skills development have been identified as an area for further attention by American Dietetic Association (ADA) practitioners and student members (2). Creation of the ADA Leadership Institute in 2003 represented an awareness of the need to invest in developing dietetic leaders (3). Proficient leaders are critical in keeping our profession on the cutting edge by identifying areas of need for change and providing leadership for change. Proficient leaders can also serve as role models for members. Leadership has been identified as essential for success in the 21st century and according to Bennis, “our quality of life amidst the volatility, turbulence and ambiguity of our present day societal context, depends on the quality of our leaders” (4). Leadership research theory has been based on objective measures such as traits, attitudes and performance, intellect, personality, relationships, competencies, and values. Dietetic leadership studies are limited and describe these objective characteristics and leadership styles (5-9). In their review of traditional leadership theory, Gregoire and Arendt (10) suggested that more information is needed about how dietitians develop as leaders. The present article describes one theory of leadership development—constructive developmental theory. Registered dietitians at advanced leadership stages can be identified and factors enabling their development can be studied. This theory provides a subjective approach for studying dietetic leadership and gives insight for leadership development programs