Chapter 3
Assessing the Target
Population’s Nutritional Status
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Learning Objectives
• Describe the types of data that
might be collected about the target
population specified in the
community needs assessment.
• Describe a minimum of eight
methods for obtaining data about
the target population.
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Learning Objectives
• Discuss the issues of validity and
reliability as they apply to data
collection.
• Discuss cultural issues that are
considered when choosing a
method for obtaining data about
the target population.
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Introduction
• The purpose of the community needs
assessment is to obtain answers to
basic questions such as:
– What is the nutritional problem of the target
population?
– Which factors contribute to the nutritional
problem?
– How can their health and nutritional status
be improved?
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Introduction
• When key questions are
unanswered, the community
nutritionist must identify those
data elements that are still needed
and choose methods for obtaining
them.
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A Plan for Collecting Data
• Decisions about which data to
collect about the target population
are made carefully following a plan
laid out before the first data
element is ever collected.
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A Plan for Collecting Data
• The following planning activities should
be completed before data collection
begins:
– Step 1: Review the purpose, goals, and
objectives of the needs assessment.
– Step 2: Develop a set of questions related
to the target population’s nutritional
problem, how it developed, and/or the
factors that influence it.
– Step 3: Choose a method for obtaining
answers to these questions.
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A Plan for Collecting Data
• At this point in the assessment
process, the community
nutritionist has already obtained
information about the community
and about the broad background
issues that influence its nutritional
and health status.
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A Plan for Collecting Data
• The nutritionist must now decide
the following:
– Which questions about the target
population are most important.
– Which methods can be used to obtain
answers to those questions.
– Whether the answers are measurable.
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Types of Data to Collect
about the Target Population
• Questions should be asked about
lifestyle choices, dietary patterns,
working conditions, and social networks
that affect the health and nutritional
status of the target population.
• Types of data:
– Individual lifestyle factors
– Living, working and social conditions
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Individual Lifestyle Factors
• Lifestyle
– Physical activity level
– Choice of leisure time activities
– Ability to handle stress
– Smoking status
– Use of alcohol or drugs
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Individual Lifestyle Factors
• Diet
– Diet is a key individual factor to be
analyzed because nutritional status is
affected directly by nutrient intake
and utilization and indirectly by the
food supply and a host of other
factors.
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Individual Lifestyle Factors
• The food supply determines which foods
are available to the target population
and this is a product of:
–
–
–
–
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Geographical area
Climate
Soil conditions
Labor
Capital available for building the agricultural
base
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Individual Lifestyle Factors
• Food intake is influenced by many
factors, including the following:
– Biological, psychosocial, cultural, and
lifestyle factors.
– Personal food preferences, cognitions,
and attitudes.
– Health beliefs and practices.
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Individual Lifestyle Factors
• Nutrient utilization is affected by:
– Activity levels.
– Smoking status.
– Dietary supplement use.
– Drug-nutrient interactions.
– Physiological status.
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Living, Working, and Social
Conditions
• Education, occupations, and
income all have powerful effects on
health.
• Individuals who have few or no job
skills or who are poor and
uneducated tend to have more
health problems than those with
job training and education.
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Living, Working, and Social
Conditions
• Low socioeconomic status is linked
with:
– High prevalence rates of chronic
conditions.
– High stress levels.
– Reduced access to medical care for
the diagnosis and treatment of
diseases.
– Poor outcomes following treatment.
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Living, Working, and Social
Conditions
• Poverty, even more than family
structure, has the strongest association
with health among children.
• Primary social groups also influence
health and nutritional status.
• The family exerts the most influence on
health and nutritional status.
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Case Study 1: Women and
Coronary Heart Disease
• The community nutritionist reviews the
assessment’s objectives and determines
a list of questions about this
population’s knowledge, attitudes, and
practices related to Cardiovascular
Heart Disease (CHD).
• Demographic data, such as age,
education level, and income are
collected as a matter of course.
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Case Study 1: Women and
Coronary Heart Disease
• Answers to questions are obtained from
individuals who represent the target
population, which is called the sample.
• Next, the nutritionist would consider the
types of data that might be collected to
answer the questions and chooses a
method for obtaining them.
• A survey instrument is used to obtain
answers to several of the questions and
a 24-hour recall method is used as a
separate tool.
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Methods of Obtaining Data
about the Target Population
• A variety of methods exist for collecting
data related to the target population:
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–
–
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Survey
Screening
Focus groups
Interviews with key informants
Direct assessment of nutritional status
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Methods of Obtaining Data
about the Target Population
• Survey
– A survey is a systematic study of a
cross-section of individuals who
represent the target population.
– It is a relatively inexpensive method
of collecting information from a large
group of people.
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Methods of Obtaining Data –
Surveys
• Surveys can be used to collect
qualitative or quantitative data in
formal structured interviews and they
can be used by phone, mail, or online.
• They can be used with individuals and
groups and they can be either selfadministered or administered by a
trained interviewer.
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Methods of Obtaining Data –
Surveys
• Survey design and analysis is a
discipline in itself.
• The first step is to determine the
purpose of the survey.
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Methods of Obtaining Data –
Surveys
• Most nutrition surveys are carried
out to:
– Assess the food consumption of
households or individuals.
– Evaluate eating patterns.
– Estimate the adequacy of the food
supply.
– Assess the nutritional quality of the
food supply.
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Methods of Obtaining Data –
Surveys
• Nutrition surveys are carried out
to:
– Measure the nutrient intake of a
certain population group.
– Study the relationship of diet and
nutritional status to health.
– Determine the effectiveness of an
education program.
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Methods of Obtaining Data –
Surveys
• Decisions must be made about
who will design the survey, who
will conduct it, and how it will be
carried out.
• Surveys must be designed and
carried out carefully to provide
valid and reliable information.
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Methods of Obtaining Data –
Surveys
• Health Risk Appraisal
– The health risk appraisal (HRA) is a
type of survey instrument used to
characterize a population’s general
health status.
– It is used in different settings as a
health education or screening tool.
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Methods of Obtaining Data –
Surveys
• The HRA consists of three parts:
– A questionnaire.
– Certain calculations that predict risk of
disease.
– An educational message or report to the
participant.
• HRAs are used to alert people about
their risky health behaviors and how
such behaviors might be modified
through a lifestyle modification
program.
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Methods of Obtaining Data –
Screening
• Screening
– Screening is an important preventive
health activity designed to reverse,
retard, or halt the progress of a
disease by detecting it as soon as
possible.
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Methods of Obtaining Data –
Screening
• Screening can be conducted in clinical
and community settings and examples
include:
– Blood pressure checks
– Blood cholesterol checks
– Height and weight
• Screening programs are not meant to
substitute for a health care visit but
they do have educational value and
serve to identify high-risk persons.
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Methods of Obtaining Data –
Focus Groups
• Focus Groups
– Focus groups are informal groups of
about 5 to 12 people who are asked
to share their concerns, experiences,
beliefs, opinions, or problems.
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Methods of Obtaining Data –
Focus Groups
• Focus groups can be used to:
– Obtain advice and insights about new
products and services.
– Research data and information about
key variables used in quantitative
studies.
– Obtain opinions about products or
creative concepts such as advertising
campaigns or program logos.
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Methods of Obtaining Data –
Focus Groups
• Focus groups are led by a trained
moderator and listening is the most
important skill used during focus
groups.
• Information from a focus group is used
to provide direction for the needs
assessment or change a marketing
strategy, product, or existing program.
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Key Focus Group Questions
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Methods of Obtaining Data –
Focus Groups
• Focus groups provide qualitative
information that helps nutritionists
understand:
– How the nutritional problem
developed
– Whether the target population
perceives a problem
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Methods of Obtaining Data –
Interviews
• Interviews with Key Informants
– Interviews with key informants, or
people in the know about the
community, can also provide
information about the target
population.
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Methods of Obtaining Data –
Interviews
• Informant interviews can be used to:
– Complete a cultural assessment of the
target population.
– Provide insights about whether the target
population perceives a nutritional problem
and which actions for addressing the
problem are culturally appropriate.
• Key informants may have worked with
the target population in the community
or conducted research on the
population.
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Methods of Obtaining Data –
Direct Assessment
• Direct Assessment of Nutritional
Status: An Overview of Methods
– There are several methods for
conducting a direct assessment of
nutritional status.
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Methods of Obtaining Data –
Direct Assessment
• Dietary assessment methods are used
to determine an individual’s or
population’s usual dietary intake and to
identify potential dietary inadequacies.
• The primary methods of measuring food
consumption of individuals include:
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Diet History Method
Twenty-four-Hour Recall Method
Diet Record Method
Food Frequency Method
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Methods of Obtaining Data –
Direct Assessment
• Additional methods of assessing
nutritional status include:
– Other Diet Assessment Methods
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Methods of Obtaining Data –
Direct Assessment
• Additional methods (continued):
– Laboratory methods can be used to
identify individuals at risk of a
nutrient deficiency and to detect
subclinical deficiencies.
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Methods of Obtaining Data –
Direct Assessment
• Additional methods (continued):
– Measurements of the body’s physical
dimensions and composition, called
anthropometric methods, are used
to detect degrees of malnutrition and
chronic imbalances in energy and
protein status.
• The most common growth indices include
measures of stature (height and length),
weight, and circumference of the head.
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Methods of Obtaining Data –
Direct Assessment
• Additional methods (continued):
– Clinical methods consist of a
medical history and physical
examination to detect physical signs
and symptoms associated with
malnutrition.
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Methods of Obtaining Data –
Direct Assessment
• Clinical methods
– The history includes a description of
factors such as living situation, existing
clinical conditions, smoking status,
medications, and usual level of physical
activity.
– In the physical exam the clinician
evaluates the major organ systems and
examines the hair, face, eyes, lips, tongue,
teeth and gums, and nails for signs of
malnutrition.
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Issues in Data Collection
• Practical Issues
– The number of staff available to collect and
analyze the data.
– The cost of administering the test.
– The amount of time needed to identify and
interview or sample members of the target
population.
– The assessment method chosen should be
simple to administer, take only a few
minutes to complete, be inexpensive, and
be safe.
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Issues in Data Collection
• Scientific Issues
– Sensitivity versus specificity
– Validity and reliability
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Issues in Data Collection –
Scientific
• Sensitivity - the proportion of subjects
with the disease or condition who have
a positive test for the disease or
condition.
– A sensitive test rarely misses people with
the disease or condition.
– It is often used in screening situations in
which the purpose of the test is to detect a
disease or condition in people who appear
to be asymptomatic.
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Issues in Data Collection –
Scientific
• Specificity - the proportion of subjects
without the disease or condition who
have a negative test.
– Specific tests are used to confirm a
diagnosis.
– The oral glucose tolerance test is a highly
specific test for diagnosing diabetes
mellitus.
• Ideally, the assessment method should
be both highly sensitive and highly
specific.
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Issues in Data Collection –
Scientific
• Validity - the ability of the instrument
to measure what it is intended to
measure.
– Another word for validity is accuracy.
– An instrument’s validity can be affected by
many factors including the characteristics of
the respondent, the questionnaire design,
the adequacy of reference data, and the
accuracy of data input and management.
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Issues in Data Collection –
Scientific
• Reliability - the ability of an
assessment instrument to produce the
same estimate of dietary intake, for
example, on two separate occasions.
– Other terms for reliability are precision,
repeatability, and reproducibility.
– It is different from validity and it is possible
for an instrument to give reproducible
results that are incorrect.
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Issues in Data Collection –
Cultural
• Cultural Issues
– A cultural assessment of the target
population is needed before data
collection begins.
– A cultural assessment is undertaken
to identify appropriate and
inappropriate behaviors within the
target population’s culture.
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Issues in Data Collection –
Cultural
• The manner in which people greet
each other, the types of questions
that are appropriate to ask, body
language, and customs differ
among cultures.
• Survey questions must also be
culturally appropriate.
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Case Study 2: Nutritional Status
of Independent Elderly Persons
• Before collecting data about the target
population, the nutritionist reviews the
purpose, goals, and objectives of the
assessment and then develops a set of
questions aimed at measuring the
nutritional status of this target group.
• The nutritionist might consider a
standard measure of health or
nutritional status which is called a
nutrition status indicator.
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Case Study 2: Nutritional Status
of Independent Elderly Persons
• A nutrition status indicator is a
quantitative measure used as a
guide to screen, diagnose, and
evaluate interventions in
individuals.
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Case Study 2: Nutritional Status
of Independent Elderly Persons
• Nutrition status indicators are
often used to:
– Estimate the magnitude of a nutrition
problem.
– Its distribution within the population.
– Its cause.
– The effects of the programs and
policies designed to alleviate the
problem.
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Case Study 2: Nutritional Status
of Independent Elderly Persons
• Several indicators, such as these,
might be used in the nutritional
status of the elderly.
– A weight loss of 5 percent or more of
body weight in 1 month.
– Being underweight or overweight.
– Having a serum albumin below 3.5
grams per deciliter.
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The Project L.E.A.N. Nutrition
Campaign
• L.E.A.N. = Low-fat Eating for America
Now
• Campaign of Orange County Head
Start, Inc. target audience:
– Over 3,500 low-income 3- and 4-year-old
children and their families
– Enrolled at the 40 OCHS centers throughout
Orange County, CA
– 76% of were members of the Hispanic
community
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The Project L.E.A.N. Nutrition
Campaign
• Goals and Objectives
– Improve the quality of life
– Reduce the incidence of nutritionrelated chronic diseases
– Means: low-fat eating and regular
physical activity
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The Project L.E.A.N. Nutrition
Campaign
• Methodology
– Nutrition lesson plan and food activity were
developed
– Lesson emphasized low-fat food choices and
physical activity
• Examples of low-fat foods
• Food activities
– Obstacle course was developed to
encourage physical activity
– Nutrition specialists conducted workshops
for parents
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The Project L.E.A.N. Nutrition
Campaign
• Results
– Lesson/food activity was conducted in
at least 34 OCHS classrooms
– Reached over 700 children
– Nearly 2/3 of OCHS teachers reported
that children were able to name 2-4
low-fat and high-fat foods
– All students understood the
importance of physical activity
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The Project L.E.A.N. Nutrition
Campaign
• Results (continued)
– 207 OCHS parents and families
participated in workshops
– > 90% of the parents stated that
they gained new knowledge and
found the workshop they attended to
be worthwhile and easy to follow
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The Project L.E.A.N. Nutrition
Campaign
• Lessons Learned
– Students modeled their behavior to match
that of their teachers.
– Factors to consider when offering services
to the parents of a culturally diverse, lowincome preschool population:
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Limited income
Lack of transportation
Child care needs
Work schedule
Culture
Language
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Putting It All Together
• This phase of the community
needs assessment focuses on
obtaining data about the target
population.
• It is designed to find answers to
questions about how extensive the
nutritional problem is and how it
developed.
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Putting It All Together
• Once the data are analyzed the
nutritionist must choose reference data
against which the assessment’s
outcomes can be compared.
– Nutrient intake data are usually compared
with the Dietary Reference Intakes (DRIs).
– Other data might be compared with
standards derived by the U.S. National
Center for Health Statistics or the NHANES
survey.
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Putting It All Together
• Statements drawn from the data
collected about the target population
and from comparisons with reference
data are then organized and added to
the final report.
• The final report contains information
about the target population and about
the community in which it lives and
works.
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Lighten Up—Be Willing to Make
Mistakes and Risk Failure
• What would our world be like if the
following individuals had given up
on their goals?
– Florence Nightingale
– Thomas Alva Edison
– Fred Smith (founder of FedEx)
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Lighten Up—Be Willing to Make
Mistakes and Risk Failure
• The Secret of Success
– Do your homework.
– Write down your options and the
potential outcome of each.
– Learn from your mistakes or failures.
– Be committed to your goal.
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Lighten Up—Be Willing to Make
Mistakes and Risk Failure
• Words to Work By
– “A great master teacher once said, ‘In
order to learn how to draw you have
to make two thousand mistakes. Get
busy and start making them.’”
• R. Bateman, The Art of Robert Bateman
(Ontario: Penguin Books Canada, 1981),
p. 19.
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