Final_AHRQ PRBN pwr pt 2008

Barriers and Facilitators to Delivering Diet and Nutrition Messages into Primary Health Care Visits at Community Health Centers with Latino Patient Populations : 

Barriers and Facilitators to Delivering Diet and Nutrition Messages into Primary Health Care Visits at Community Health Centers with Latino Patient Populations Laura M. Myerchin, MA AHRQ PBRN Research Conference 2008 Reducing Health Care Disparities in Southern California Through Participatory Research Partnerships With the Health Care Community

Overview : 

Overview Americans in Motion - Healthy Interventions (AIM-HI) Brings together the AAFP NRN, SECRN and LA Net in a national study of practice level intervention to improve “fitness” (physical activity, diet and nutrition and emotional well-being) in adult patients. LA Net LA Net is a non profit PBRN located in Los Angeles, CA Five Community Health Centers (CHCs) members of LA Net are participating in AIM-HI.

Participating Clinics : 

Participating Clinics Located in low-income, primarily urban areas of Southern California. Patient population is primarily Latino and Spanish speaking and adult patients are generally recent immigrants or first generation. These clinics are specifically interested in examining the unique needs and challenges that come with making diet and nutrition counseling concurrent to their patients’ cultural background.

Slide 4: 

Objective: To identify staff perceptions of barriers and facilitators to delivering culturally sensitive diet and nutrition messages during routine health care visits with Latino patients. Design: Key informant and focus group interviews were conducted with clinicians and staff from the five participating CHCs. Data were analyzed for content and theme. Participants: Four physicians and six staff members from the five CHCs participated in key informant interviews; eight physicians and staff members participated in focus group interviews. The physicians and staff were of multiple cultural backgrounds and had all worked at their various sits for at least one year.

Staff Identified Variables: : 

Staff Identified Variables: These variables should be thought of as a constant level on influence: Individual - the patient Family - the immediate or extended family of the patient Community/Environment - the greater social network of the patient and/or the environment where the patient lives These variables should be thought of on a sliding scale from low to high intensity: Tradition/Custom - traditions and customs reflective of the patient’s cultural background or interpretation of “American culture” SES/Availability - the socioeconomic status of the patient and the availability of resources to them Health Education - the patient’s knowledge of healthy living, healthy cooking, diet and exercise

Slide 6: 

Individual Family Community/Environment Tradition/Custom SES / Availability Health Education Barriers Described by Staff

Staff suggested the following facilitators to diet and nutrition counseling that are staff based: : 

Staff suggested the following facilitators to diet and nutrition counseling that are staff based: Doing an environmental scan for local resources 99¢ Stores, Farmer’s Markets, WIC Stores, Community Gardens And including public transportation methods to these resources Creating a bilingual Vegetable of the Week Board in the clinic waiting room including: Color pictures of the fruit or vegetable Recipes and an overview of how to prepare the vegetable How to tell if the fruit or vegetable is ripe A brief overview of why it is good for you

Staff suggested the following facilitators to diet and nutrition counseling that are staff based (cont): : 

Staff suggested the following facilitators to diet and nutrition counseling that are staff based (cont): Utilizing AIM-HI tools, such as the food journal, and teaching patients mindful eating techniques Counseling children about healthy eating Staff members who were children of immigrants recounted that they were the ones to teach their parents about nutrition after learning about in school

Staff suggested the following facilitators to diet and nutrition counseling that are patient based: : 

Staff suggested the following facilitators to diet and nutrition counseling that are patient based: Cooking without lard and with less cheese Drinking more water and less soda or juice Growing a home garden or joining a community garden Getting the whole family involved in healthier eating Gradually integrating new types of food to their family Cooking traditional foods in a healthier way

Two Key Reoccurring Topics : 

Two Key Reoccurring Topics The Tortilla Issue Eating Everything on Your Plate

The Tortilla Issue : 

The Tortilla Issue “Tortillas aren’t thought of as food, they are an instrument to get food to your mouth so you eat 11 or 13 per meal but they don’t count.” - a family practice physician at a participating clinic Staff estimates of how many tortillas patients ate per day ranged from 5 to 15. A patient went from eating 14 tortillas a day to 4 a week and lost 20 pounds by the time of her 2 month follow up appointment. Staff suggest encouraging patients to work on being aware of the number of tortillas they eat and attempt to lower it over a month.

Cleaning Your Plate : 

Cleaning Your Plate “Leaving food on your plate is taboo and rude.” “[Patients] have a need to fill the ‘warehouse,’ if they don’t they are not nourishing themselves.” “You feed those you love . . . that’s how you show love on a regular basis.” “For men, you want to make your wife or mother feel good by telling them how good it was or give me more.”

It is considered culturally taboo to not eat everything on your plate; you need to continue eating until stuffed. : 

It is considered culturally taboo to not eat everything on your plate; you need to continue eating until stuffed. As part of a group, food-based dynamic. To show love or appreciation for the person who prepared the food. To take care of yourself. Particularly a taboo when eating at a friend or family member’s home. Staff indicated that this is the most ingrained and significant barrier to diet and nutrition counseling.

It was suggested that patients: : 

It was suggested that patients: Plan their daily meals knowing they would eat one large meal Ask for the recipe instead of more servings Ask to help prepare the food before hand to be involved in the meal process Ask for some to take home to eat the next day

Slide 15: 

In conclusion . . . “There are some traditional foods and associated behaviors that can’t be separated from the culture, so you have to work within those boundaries but there are other food issues and behaviors that need to be separated . . . but it is hard to do due to money, time, etc.” - a family practice physician at a participating clinic

Thanks to : 

Thanks to The Children’s Clinic, Long Beach The Vasek Polack Children’s Clinic Family Health Center, Long Beach Family Health Care Centers of Greater Los Angeles, Bell Gardens and Hawaiian Gardens Comprehensive Community Health Centers, Highland Park LA Net staff AAFP NRN staff Dr. Michelle May Dr. Heather Paladine Zori Rodriguez, MA

Slide 17: 

Laura M. Myerchin, MA Network Coordinator LA Net, a Project of Community Partners Laura_Myerchin@hotmail.com Tel: 213-346-3245 Fax: 213-808-1009 1000 N. Alameda Ste 240 Los Angeles, CA 90012 www.lanetpbrn.net