My name is Cassandra Daniels. I'm a fourth year medical student at Pacific Northwest University of Health Sciences, and this is our presentation on culturally competent nutrition education for pediatrics health promotion, assessing efficacy and implications. So first some context. We are located in Yakima, Washington. And to give a little bit of background on what it's like there, families in Yakima experience various intersections of financial language and access barriers to medical care and appropriate health resources. Some fast statistics and the poverty rate in Yakima is about 5.3% higher than Washington state average and 3.4% above national average. We have a total of 19.1% of the population living below the poverty line. 50.2% of the population identifies as Hispanic with 27.8% relying on seasonal agricultural work. And 34% of our pediatric population in Yakima are classified as obese compared to the national average rate of 23%. So how we kind of gotten started on this project was in 2022, PNWU collaborated with the Yakima school district, recognizing this trend of increasing rates of pediatric obesity and created a free pediatric sports physical clinic for students in the community that wanted to pursue afterschool sports and remain active that way, but lacked access to medical professionals who could fill out their pediatric sports physical paperwork. So we created this free sports physical clinic and during its inaugural year of doing sports physicals, countless families would ask about their child's BMI, ask about a lot of nutrition recommendation, calorie intake, snacks, meals and drinks that they should and should not be feeding their child and asking for recommendations on portion sizing. And these are all things that would typically be tackled in like a well child check type of visit. But again, we have a lot of barriers with access, lack of access to care and poverty kind of impacting that. So when preparing for our second year of sports physical clinic visits, we created this quality improvement project aimed at addressing these concerns. And our goal is to help provide nutrition education counseling through an avenue of harm reduction by increasing community access to nutrition resources and hopefully improving pediatric and community health by improving access to nutrition education. So our objectives are first to describe a novel approach to increasing nutrition literacy in Hispanic families through increasing access to culturally competent nutrition resources. And secondly, to describe efficacy of improvement in nutrition knowledge following interventions delivered. So for our methods, our participants were recruited from the Yakima School District free sports physical clinics and participants were able to opt in or opt out of nutrition counseling that was supplemental to the free sports physicals, but it did not, whether or not they opted in or out did not impact their ability to receive their free sports physical. Parents for an intervention, parents were given a nutrition handout and were counseled on nutrition by first-year medical students. Parents completed a pre and post survey to gauge learning and comprehension of the handout. And then the handout was available in English and in Spanish. It was created by head nutrition consultants and migrant health promotion salute. It was created to be geared towards Hispanic cultural foods and health practices. The nutrition handouts had culturally relevant and relatable photos and descriptions of foods and foods to avoid, foods to add, examples of good protein, carbs, fruits, and vegetables. And again, showing with photos and descriptions that people would be able to recognize in their own traditional cultural foods. And then the survey that we used was the shortened generalized nutrition knowledge questionnaire revised version. The survey questions focused again on portion sizes, servings of fruits and vegetables, adequate sources of proteins, and then those that are more and less recommended. And here we have the front side of the nutrition handout and a excerpt of the survey that we were using. In terms of results, we had a total of 34 questions on the survey, only three yielded statistically significant differences between a pre and post survey. We use an unpaired t-test to assess the change between the pre and post test questions that were answered more correctly on the post-test versus the pre-test and then measuring the statistically significant difference with the p-value. So, we only had three of those questions that were statistically significant. We had 52 participants who completed the pre-test survey and only 46 of participants completed the post-test survey. All of our other p-values range from 0.0559 to 1. So, in terms of kind of contextualizing these results, overall the nutrition counseling and handout were not proven effective at improving nutrition knowledge for our target population and participants. Some limitations of our quality improvement project that we've been able to identify are not all participants completed the post-test survey due to technology issues with iPad malfunctioning and limited availability of research team members. And then also, most notably, we got some feedback from our community partners and clinic volunteers that identified that the survey that we were using to assess nutrition knowledge and change in knowledge after our intervention was difficult for our target population to understand. So, in terms of looking towards the next steps, we'll definitely need more future cycles of this quality improvement project. And to help make those more successful, we plan to work with parents and stakeholders to identify or create a more culturally relevant and relatable survey that will be more easily understood by our target population. And then determine, kind of analyze our counseling periods and what information we're giving during counseling and even the handouts and determine if all of that is sufficient at improving nutrition knowledge. And also increase the number of medical students available to deliver nutrition counseling to hopefully not lose any more people for the post-test follow-up. So, yeah, that is kind of the overview of our quality improvement project. Thank you for listening and let me know if you have any questions.

nutrition education

Hispanic families

Yakima Washington

pediatric obesity

medical student involvement