Encouraging healthy eating in teens is not easy. Yet, healthy eating is important for young patients with lupus. A recent HSS study shows promising results for a hospital-based education program specially designed for a culturally diverse group of teens with lupus and their families to learn about healthy nutrition together.
Charla de Lupus is an award-winning program at HSS that provides bilingual peer support and education, at no cost, to people with lupus and their families. Based on results of a previously reported needs assessment, a 5-session, bilingual nutrition curriculum was developed by the HSS Public and Patient Education Department for a pilot test group of Charla de Lupus teens and their families. The lessons were adapted from the hospital’s existing culturally sensitive nutrition program, SNEAKER©, to meet the needs of predominantly Hispanic teens with lupus and their families.
The curriculum focused on learning about the nutritional benefits of whole grains/fiber, calcium/vitamin D, fruits/vegetables, protein foods, and snacks/fast foods. Several key topics were included throughout all 5 sessions, including portion control, food labels, sodium and culturally appropriate recipe examples.
“Lupus Links” were provided by a Registered Dietitian to address bone and cardiac health, hypertension, renal disease, and obesity. The program’s goal was to provide practical strategies to initiate and sustain healthy nutrition practices for the teens with lupus, and their families.
To validate the program’s impact on knowledge and behavior, a bilingual (English/Spanish) 68-item test was administered at the first session, before any teaching started. Then at the fifth session, after the final lesson, a 78-item post-test was given. True/false, multiple choice, Likert-type, and open ended questions were included. Program satisfaction was also assessed. Three months later, a follow-up survey was conducted.
Results indicated a statistically significant increase in cooking with canola oil (41% to 76%) in the families’ practices.Weekly frequency of reported consumption of fish, poultry and hot cereals increased, as did consumption of whole or rye bread. Positive behavioral changes occurred in most households along every nutritional item.
The most knowledge gained (11%) related to whole grains/fiber. Although mean knowledge scores increased from pre to post-test – 64% to 70% – this was not statistically significant. However, behavior was impacted. 94% of the participants reported that the program led them to include more nutritious foods in their diet.
Overall, teens and their parents didn’t always agree on how often they cooked or ate healthy at pre-test, but more congruent behavioral responses were reported from most households at post test.
The program received high ratings from the participants and was extremely well received. 94% of participants rated overall content as excellent. 88% gave an excellent rating to the program’s organization, clarity, and level of presentation. 93% rated the instructor’s knowledge of the subject and ability to keep the group engaged as excellent.
This initial program included 19 participants – 8 teens, 11 parents – in a total of 7 households. Pre/post tests were completed by 100% of participants. 80% of participants were female with ages ranging from 12 to 50. Over 70% of the group were Hispanic. 66% of the household incomes ranged from $10,000-29,999 per year.
Seven participants completed the 3-month follow up survey (3 teens, 4 parents). All reported eating healthier. Though there were slight reductions in several knowledge items since the last class, the use of canola oil for cooking decreased to 66.7% at follow-up, still higher than baseline.
A consideration for future planning is building in follow-up communications, possibly using texting/social media, to reinforce knowledge learned in the classes and engage participants in sustaining healthy nutritional choices.
This study was presented at the 2012 Annual Meeting of the American College of Rheumatology in Washington, D.C.
Morgan Stanley Children's Hospital,
New York-Presbyterian Columbia University
Lisa F. Imundo, MD