Program Planning:

Community Nutrition
Assessment
Practical HND-714
 Community Nutrition
Assessment
• The nutritional assessment is done to obtain information
about the prevalence and geographic distribution of
nutritional disorders within a community or a specified
population group
• It can also be used to identify high-risk groups and to
assess the role of different epidemiological factors in
nutritional deficiency
• Assessment of the nutritional status aids assessing the
prevalence of nutritional disorders, planning corrective
measures, and evaluating the effectiveness of the
implemented strategies simultaneously
 Aims and objectives
• Nutritional assessment has a significant role in
– Policy-making and nutritional recommendations,
– Deciding fund allocations desired in the surveyed
area to program managers
– Evaluating the effectiveness of implemented
corrective measures
– Realizing the scarcity of resources, especially in
developing nations
• The goal is not to examine the entire population in the
community but limit the survey to a representative group
so that the results can be generalized to the entire
community
 Successful Community
Assessment Includes:
• Understanding current conditions of
families, individuals, institutions & policies
• Evaluating local capacities for supporting
change
• Building community support for
implementing changes
 METHODS FOR NUTRITIONAL
ASSESSMENT
The assessment of the nutritional status involves two
methods:
• Direct (- deals with individuals and measures the
objective criteria)
• indirect (- uses community health indices reflecting
nutritional influences)
These methods include
– Anthropometric,
– Biochemical,
– Clinical,
– Dietary,
– Emotional and Functional measurements to cover all
the phases of the disease
Quality of life Assessment (QoL)
• QoL is based upon the perception of well
being in different domains:
• Physical (Mobility, muscle strength)
• Symptoms (Pain, weight, loss of appetite,
nausea, constipation and diarrhea)
• Psychological ( Anxiety, emotions,
Depression)
• Social (Isolation, eating behavior)
 National Diet and Nutrition Survey
Rolling Programme (NDNS RP)
• Designed to assess the dietary habits and
nutritional status of adults and children in
the UK
• The survey is unique as it provides the
only source of high quality data on dietary
intakes and nutritional status in
representative sample of the population
 Survey contents
• All survey components are carried out in the
participant’s home.
• The survey is carried out in two stages,
comprising:
– An interview visit
– Follow up by a nurse visit generally conducted around
8 – 12 weeks later
• Each cross sectional survey focused on a
different age group, e.g. preschool children (1.5
to 4.5 years) or adults aged 50 years and over
• A minimum of 500 adults and 500 children are
recruited
 Interview data
The NDNS interview collects data on
• Demographic and socio-economic characteristics
• Dietary habits, food and nutrient intake and population trends in food
consumption
• Physical activity
• Oral health
• General health and lifestyle, including smoking and alcohol
consumption
• A spot urine sample for iodine status assessment
• Food intake data is collected using an estimated recent foods
available
• Participants are offered opportunity to receive feedback about their
diet after completion of the nurse visit.
 The nurse visit includes

• Anthropometric measurements
• Blood pressure measurement
• Blood sample collection for laboratory
analysis for nutritional, routine metabolic
and cardio-vascular status assessment
 Specific Responsibilities
Responsibilities to the NDNS RP are as follows:
• Dietary assessment
• Fieldwork support and training and logistics support
• Blood and urine specimen logistics and analysis
• Management of the NDNS Biorepository
• Doubly-labelled-water logistics and analysis
• Data management
• Statistical analysis and reporting
 Results of the NDNS RP
• The results of the NDNS RP are used:
• To assess the adequacy of food and nutrient intake and
nutritional status in different population groups.
• Used by government to develop policy and monitor
progress on diet and nutrition objectives, such as work to
move the public towards a healthier diet or tackling
obesity
• Food consumption data is also used by the Food
Standards Agency (FSA) to assess exposure to
chemicals in food, this informs risk assessments and the
setting of regulatory limits for contaminants
 Case studies
• A community-based nutrition education
programme for people with learning
disabilities
• Note: “people with a (learning) disability
• should be provided with healthy eating
support and advice appropriate to their
needs”
• Select group and conduct survey
 “Malnutrition Universal
Screening Tool” (MUST)
• ‘MUST’ is a five-step screening tool to identify
adults, who are malnourished, at risk of
malnutrition (undernutrition), or obese. It also
includes management guidelines which can be
used
• To develop a care plan
• It is for use in hospitals, community and other
care settings and can be used by all care
workers
 The 5 ‘MUST’ Steps
Step 1
• Measure height and weight to get a BMI score using chart provided.
Step 2
• Note percentage unplanned weight loss
Step 3
• Establish acute disease effect and score
Step 4
• Add scores from steps 1, 2 and 3 together to obtain overall risk of
malnutrition
Step 5
• Use management guidelines and/or local policy to develop care plan
Why Do Assessment?
 Models and Protocols for
Community Assessment
• Planned Approaches to Community Health
(PATCH) – CDC
• Assessment Protocol for Excellence in
Public Health (APEXPH) – NACHO (National
Association of County Health Officials)

• Moving to the Future: Developing

Community Based Nutrition Services –
ASTPHND (Association of State and Territorial Public Health
Nutrition Directors)
Strategic Planning for Initiatives to
Address Local Health Efforts
• Organize a community planning group
• Define community boundaries
• Gather information
– Statistical profile
– Qualitative data
– Community Resources & Environments
– Policies

Agency for Health Care Policy and Research

 Strategic Planning, cont.
• Analyze Information
– Common issues
– High risk individuals
– Unmet needs
– Prioritize
• Develop and implement plan
• Monitor and evaluate plan
 Community Nutrition Planning
Group: Responsibilities
• Collect data and information
• Identify needs and gaps
• Set priorities
• Develop a plan
• Help to implement interventions
• Assist in evaluation
– Of assessment, planning, and intervention process
– Of impact of intervention
 Community Nutrition Planning
Group: Potential Members
• Community leaders & advocates
• Consumers
• Health and nutrition service providers
• Health organizations
• Schools
• Political office holders or their staff
• Fitness, Parks and medical professionals
• Representatives from greater community health
planning groups
• Food systems representatives
 Identify Community Assets
• Physical structure, place, business
• Concerned citizens
• History of successful efforts
• Organizations
• Individual and group skills
• Communications systems
• Relationships
 Identify Perceived Needs
• WHY?
– To understand public opinion
– To become aware of needs the planning
group doesn’t know about
– To gather support & expand group expertise
– To make decisions about priorities
– To plan programs in ways that will be
acceptable to stakeholders
 How do we assess perceived
needs?
• Listening sessions
• Public forums
• Key informant interviews
• Needs assessment survey or survey of
concerns
 Demographic Profile
• Economic status: income, employment, %
below poverty
• Education levels
• Age and gender
• Race & ethnicity
• Social factors: homelessness, immigration
status, family composition, TANF
utilization
 Community Health Status
• Causes of Mortality
• Hospital discharge data
• Disease prevalence data
• Food bourne illness reports
• Years of potential life lost
• Infant mortality
 Community Nutritional Status
• Pregnancy related:
– weight gain in pregnancy
– Pre-pregnancy weight
– Anemia
• Disease prevalence: HIV/AIDS, cardiovascular
disease, diabetes
• Activity levels (BRFSS)
• Food intake: fat, fruits & vegetables (BRFSS)
• Dental health
• Food/dieting related behaviors (YRBS)
• Food Security (BRFSS)
 Community Nutrition Resources
• Food assistance programs (WIC, SNAP,
summer feeding programs for school
children, etc.)
• Educational programs
• Media
• Professional and non-profit organizations
• Nutrition counseling
 Community Food Resources
• Grocery stores with high quality produce
• Food service with health promoting food
options
• Farmers’ Markets
• Vegetable gardens
• Community Supported Agriculture
• Supports for growing local foods
 Community Resources & Service
Utilization
• What resources are available?
• To what extent are people using them?
• Sources of Information:
– Citizens
– Service providers
• Tools
– Existing data
– Interviews
– Surveys
 Criteria for defining/prioritizing
community problems
• Frequency
• Duration
• Scope or range
• Severity
• Perceptions
• Root causes (“but why?”) & ability to impact root
causes (effectiveness of interventions)
• Barriers to resolutions
• Political and financial support
Group Work: Develop Problem List
• Brainstorm nutrition related issues &
problems that arise from these data
• Choose 5 issues that are of interest to all
stakeholders
• Prioritize these issues using criteria in
these slides
• Establish the one issue or problem that all
stakeholders will be comfortable working
on for the next two weeks