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April 2016

Dear (Editor):
A lack of nutrition education may be a contributing cause to the onset of obesity
and other chronic diseases. Research has shown that worksite wellness programs that
include nutrition education have led to an improvement in employee health. An
improvement in employee health can potentially decrease the risk of chronic disease
and obesity-related healthcare costs for an institution. When nutrition education is
provided for healthcare workers, it is also hoped that learned information will be
incorporated into patient care, not just the lives of employees.
This study will help promote and establish the value of nutrition education
provided by Registered Dietitians. The results of this study show that, overall, hospital
employees are interested in receiving more nutrition education in the future.
This study was conducted in fulfillment of requirements of the Aramark Distance
Learning Dietetic Internship. The study was conducted under the supervision of
Registered Dietitians at the three different hospitals where the study was implemented:
1) Maple Grove Hospital in Maple Grove, Minnesota, 2) University of Maryland Medical
Center Midtown Campus in Baltimore, Maryland, and 3) Inspira Medical Center in
Woodbury, New Jersey. The information provided from this study will guide Registered
Dietitians when designing effective employee nutrition-related education sessions in the
future. Thank you for your consideration of this manuscript.
Sincerely,
Kristen Molnar, BS, Nutrition and Dietetics, Corresponding Author
Dietetic Intern
Aramark Healthcare Distance Learning Dietetic Internship
509 N. Broadway
Woodbury, NJ 08096
molnar-kristen@aramark.com
Eman Kemp, BS, Nutrition, Corresponding Author
Dietetic Intern
Aramark Healthcare Distance Learning Dietetic Internship
9875 Hospital Drive
Maple Grove, MN 55369
kemp-eman@aramark.com
Ashley Roberts, BS, Dietetics, Corresponding Author
Dietetic Intern
Aramark Healthcare Distance Learning Dietetic Internship
827 Linden Ave
Baltimore, MD 21201
roberts-ashley@aramark.com
Research Practice and Innovation

Worksite wellness, nutrition education, cooking demonstrations, hospital staff,


acceptability
Word Count: 2986

Hospital staff acceptability of cooking demonstrations and nutrition education

Kristen Molnar
Dietetic Intern
Aramark Healthcare Distance Learning Dietetic Internship
509 N. Broadway
Woodbury, NJ 08096
molnar-kristen@aramark.com
Eman Kemp
Dietetic Intern
Aramark Healthcare Distance Learning Dietetic Internship
9875 Hospital Drive
Maple Grove, MN 55369
kemp-eman@aramark.com
Ashley Roberts
Dietetic Intern
Aramark Healthcare Distance Learning Dietetic Internship
827 Linden Ave
Baltimore, MD 21201
roberts-ashley@aramark.com
Hospital staff acceptability of cooking demonstrations and nutrition education
ABSTRACT

Americas obesity rates are on the rise and an absence of nutrition education
may be a contributing cause. Studies suggest that by providing cooking demonstrations
and promoting worksite wellness, employees are likely to make healthier choices. A
research study was conducted to evaluate the acceptability of cooking demonstrations
and nutrition education among hospital staff. This study was implemented by three
dietetic interns at different hospital sites: University of Maryland Medical Center Midtown
Campus in Baltimore, Maryland, Inspira Medical Center in Woodbury, New Jersey, and
Maple Grove Hospital in Maple Grove, Minnesota. A recipe was highlighted during a
two-hour demonstration, and hospital employees were encouraged to participate in a
nutrition lesson followed by a survey. Results showed that 77% of participants (n = 70)
learned new nutrition information, indicating high acceptability of the overall lesson.
There was poor acceptability (<50% of participants) regarding making healthy changes
moving forward; however, 52.9% said they were likely to make the recipe at home.
Results showed that 61.4% of the participants had received nutrition education in the
past, but were interested in learning more through cooking demonstrations and lessons.
Limitations and suggestions for future studies are discussed.

Hospital staff acceptability of cooking demonstrations and nutrition education


INTRODUCTION

Today, 78.6 million U.S. adults and 12.7 million children and adolescents are
obese. Medical costs for obese individuals are $1,429 higher, on average, than those of
a healthy weight.1,2 Obesity is one example of a serious public health epidemic that can
be prevented with proper nutrition. Unfortunately, a lack of nutrition knowledge, coupled
with other factors, is causing obesity and other preventative diseases to follow an
upward trend. Nutrition education and worksite wellness programs are part of a recent
trend in dietetics that aim to prevent nutrition-related diseases and decrease healthcare
costs.3 Recent research studies have investigated the effects of nutrition education
programs. Results of such studies have suggested that healthy cooking demonstrations,
along with basic nutrition knowledge, can greatly improve an individuals health. 4
Additionally, nutrition education offered through worksite wellness programs can
help reduce the cost of obesity-related health care for employers. Research studies
have shown that educating employees on healthy cooking, basic nutrition, and benefits
of exercising can lead to weight loss and a decrease in disease risk, as well as a
decrease in obesity-related costs for the employer.5,6
A study that assesses the acceptability of a cooking demonstration and nutrition
education lesson among hospital staff will provide valuable information on how to
effectively educate hospital staff on nutrition. It is also hoped that from learning how to
improve personal nutrition, hospital staff will be more likely to take nutrition into
consideration during patient care. This can help to highlight the importance of nutrition
in a healthcare setting for not only employees, but for patients as well.
Worksite Wellness Programs

In addition to employee health benefits, health promotion programs in the


workplace can be beneficial to employers. Poor health can be expensive for employers
through costly health insurance and decreased productivity. Employers spend an
estimated 75 million dollars annually on obesity-related health care. By gradually
implementing health-based incentives and programs, companies are starting to reap the
rewards of healthy employees.6
In a systematic review of sixteen studies on worksite interventions on employee
diets, eight studies implemented employee education programs, two involved changes
to the worksite environment, and six used a combination of education and environment.
The programs included nutrition counseling, shopping tours, diet plans, dietary
feedback, and health promotion emails. Only three studies included effects on body
weight, two of which reported weight loss with dietary changes. The review concluded
that worksite health promotion programs can moderately improve dietary intake. 7
Another study assessed 774 employees enrolled in a 10 week program involving
nutrition and physical activity in a Boston hospital. Program completion and changes in
weight, blood pressure, and cholesterol were compared amongst normal, overweight,
and obese participants. Results showed that obese participants lost 3% body weight,
but overweight participants weight loss at the end of one year did not differ. Mean
cholesterol and blood pressure were lower at the end of the program and one year. This
study concluded that worksite wellness programs can successfully initiate
cardiovascular risk reduction, but more intensive interventions are needed to make
significant improvements.5

Additionally, another study evaluated the use of Internet support tools during a 9
month maintenance intervention among employees. The 9 month maintenance
intervention was set up with employees following a 10 week exercise and nutrition
program. Employees were divided into teams for weight maintenance or control. Both
groups lost weight and maintained 65% of weight loss for a year. Overall, this program
showed moderate weight loss and improvements in diet and exercise after one year
among employees.8
In 2007, a study involving 419 employees assessed the effectiveness of Webbased versus print health programs over a three month period. Pre and post surveys
regarding attitude toward a healthful diet, eating practices, motivation to improve diet,
dietary stage of change, and others were administered. The study revealed that
retention rates for Web-based and print groups were both high, 85% and 87%
respectively. Subjects using the Web-based programs performed slightly better on
attitudes toward a healthful diet and dietary stage of change. Overall, the Web-based
program was more effective than print materials for improvement in diet and nutrition,
but not in reducing stress or increasing physical activity.9
Community Nutrition Education Programs
Nutrition education in the community is not limited to one population group;
previous studies have shown that lessons can increase overall basic nutrition
knowledge among various populations. A study that assessed the impact of nutrition
education among young female students suggested that nutrition lessons can increase
knowledge of the negative health effects of junk food and decrease the consumption of
such foods. Control and experimental groups were both given pre- and post- tests to

assess knowledge gained. The experimental group received nutrition education; when
compared to the control group who did not receive lessons, the experimental group
showed a significant increase in knowledge of the nutritional implications of junk food
consumption in the post test. Before the intervention program, the average knowledge
score among the two experimental groups were 28.94 15.10 and 18.70 12.51, but
raised to 93.52 8.93 immediately and 90.27 8.79 two months after the intervention,
highlighting the positive effect of nutrition education on basic nutrition knowledge. 10
Another study was conducted to assess the effects of a 12-week gardening,
nutrition, and cooking intervention program among low income youth. Classes were
taught once a week in 90 minute sessions; 45 minutes were devoted to nutrition and
healthy cooking lessons and 45 minutes spent teaching gardening techniques.
Anthropometric measurements were taken of students in the experimental and control
group, and pre- and post- tests were distributed. Compared to the control group, the
experimental group showed health improvements, including significantly greater
decreases in BMI and reductions in waist circumference. Seven participants in the
experimental group originally were identified as having the metabolic syndrome, but
only one participant was identified as having the metabolic syndrome after program
completion. Comparatively, the control group increased the number of students who had
the metabolic syndrome during the time period of the intervention program. Overall,
results showed a significant impact of nutrition and cooking intervention programs on
the health of youth.4
Nutrition Links provides nutrition education lessons for low-income families
across Pennsylvania. Results from a 2013-2014 fiscal year report showed that 99.8% of

adult participants made a dietary improvement, 78% expressed an improvement in food


resource management, and 85% showed an improvement in nutrition practices after
program completion. These statistics suggest that the nutrition education and cooking
lessons provided greatly increased nutrition knowledge among participants. 11
Relation to Dietetics
It is important to acknowledge the effectiveness of nutrition education and
cooking demonstrations among all population groups. This allows dietitians to assess
effective techniques when developing a nutrition education plan for a new population
group.
The purpose of this study is to evaluate the acceptability of cooking
demonstrations and nutrition education amongst hospital staff. The study will seek to
expand the interest level of personal health, as well as the feasibility of replicating a
basic recipe at home. It is expected that hospital staff will be receptive to the lesson and
cooking demonstration and will be willing to make positive, healthy changes. In turn, it is
hoped that hospital staff will then be more likely to consider nutrition while working with
patients in the healthcare setting.

METHODOLOGY
Study Design
A cross-sectional research design will be used to determine the acceptability of
cooking demonstrations and education by hospital staff. This study design allows
researchers to collect data from a population at one specific point in time; for this study,
a cooking demonstration, combined with nutrition education, will be offered for a two
hour period on one day of the week to hospital staff. Surveys will be distributed to all

participants. Survey data will be collected and results will be analyzed. The survey used
for this study can be found in Appendix 1.
The study will take place at three different hospitals: 1) Maple Grove Hospital in
Maple Grove, Minnesota, 2) University of Maryland Medical Center Midtown Campus in
Baltimore, Maryland, and 3) Inspira Medical Center Woodbury in Woodbury, New
Jersey. During the demonstration at each site, the dietetic intern will show how to
prepare a healthy Winter Four Bean Salad while reviewing nutritional facts and cooking
tips. See Appendix 2 for full lesson plan.
Each hospital site will offer different incentives for participants to attend the
demonstration and complete the survey. At Maple Grove Hospital, participants that
return the surveys will be entered into a drawing to win a reuseable grocery bag and
measuring cups. At the University of Maryland Medical Center Midtown Campus, survey
respondents can play Guess the Beans. Players with the two closest guesses of how
many beans are in the glass jar will win a prize of either five free meal tickets or a
reusable shopping bag containing National Nutrition Month gift items. At Inspira Medical
Center, each participant who returns a survey will be entered to win a gift basket
prepared by the hospitals F.I.T. committee. The demonstrations at each site will all be
combined with the promotion of National Nutrition Month at the hospital. Dietetic interns
will prepare the recipe samples and registered dietitians at each site will provide
assistance. The demonstrations will be marketed through the hospital websites, tabletop
advertisements and hospital-wide emails.
At all sites, each participant will be given a survey to complete and a copy of the
recipe (see Appendix 1 for the survey and Appendix 4 for the recipe). The purpose of

the survey is to collect data about staff acceptability of nutrition education and cooking
demonstrations, and the likelihood of using learned information. At the end of the study,
all survey results will be combined and analyzed.
Participants
A sample of 70 participants will be analyzed during this study. Inclusion criteria is
that the participants need to be hospital staff at Maple Grove Hospital, University of
Maryland Medical Center Midtown Campus, or Inspira Medical Center Woodbury. Only
participants who check on the survey that they agree to participation in the study will be
included. Patients, visitors, and non-hospital employees will all be excluded from the
study. Subjects will be recruited through a hospital-wide email, Intranet advertisement,
and tabletop advertisements.
Statistical Analysis
Excel will be used to inferentially evaluate survey results by calculating means
and percentages of collected data.
Resources
To complete the study, several resources are necessary. First, a table will be
needed to provide an area for the demonstration. Additionally, a kitchen will be needed;
the food prep area and refrigerators in each hospital will be available for use. Surveys
and advertisements will be developed prior to the study. During the study, recipe cards
to distribute to participants, pencils for survey completion, bowls, and sample cups with
spoons will be used. A total of three hours will be needed to conduct the study; one hour
for set-up and cleanup and two hours for the demonstration. It is expected that
participants will be able to complete the survey in under five minutes. Microsoft Excel

and Word will be used to analyze all of the collected data. Dietetic interns will be
responsible for any costs involved.
RESULTS
Survey data was analyzed after the demonstrations at each site were complete.
A total of 72 surveys were collected. Two did not meet inclusion criteria as survey
respondents were not hospital staff, so a total of 70 surveys were used. See Appendix 5
for collected demographic information.
Total percentages of each survey response were calculated. A large majority of
the survey questions gathered demographic information. Numbers 8, 9, 11, 12, and 14
were aimed at determining the acceptability of the demonstration and education. Refer
to Appendix 1 for survey questions. A baseline percentage of 50% was chosen to
determine the degree of acceptability. If the results for these questions were less than
50%, the acceptability was deemed low; if the results were greater than 50%, the
acceptability was determined as high.
Question #8 aimed at collecting information about how often participants
considered nutrition during meals before the demonstration; #9 collected information
about the likeliness of participants applying learned nutrition information after the
demonstration. Results of #8 were compared to those of #9 from each individual. If
>50% of respondents put a higher ranking in #9 than in #8, this would indicate high
acceptability of the demonstration, as it suggests that the demonstration effectively
caused the participant to consider implementing learned nutrition information into
everyday life. If participants put the same ranking for both questions, it was determined
they would not make any change. This question indicated poor acceptability, as <50% of

participants placed a higher ranking on #9. A graph of this data is displayed in Appendix
6.
Numbers 11 and 13 both indicated high acceptability of the demonstration among
hospital staff, as 77% of respondents reported that they learned something new about
nutrition and 90% of people stated they were interested in more cooking demonstrations
and nutrition education (both >50%, indicating high acceptability).
Survey question 12 was open-ended and allowed participants to write in what
they learned from viewing the demonstration. Forty-three participants, or 61.4%, were
able to recall something new they learned. A breakdown of all responses can be found
in Appendix 7.
Question 14 allowed participants to choose actions that they planned to take
after attending the demonstration. Totals of each action selected were calculated, with
results suggesting overall poor acceptability. Only one action indicated high
acceptability, with 52.9% of participants reporting they will make the Four Bean Salad at
home. A pie chart in Appendix 8 depicts full question results.
DISCUSSION
This study aimed to determine the acceptability of cooking demonstrations and
nutrition education among hospital staff. While results did not indicate an overall high
acceptability, data did show that 77% of participants learned new nutrition information.
Research review suggests that education programs or demonstrations that increase
nutrition and food knowledge among participants help lead to positive lifestyle changes
among these participants.11

Study limitations were acknowledged by research members. First, this study was
implemented across three different hospitals. Each site had different incentives, utilized
different resources, and presented the demonstration to populations with differing
demographics. This lack of strict standardization may have caused unreliable data.
Additionally, the demonstration was offered on one day over a two-hour time
period. It was observed that many staff members rushed the presenter, as they were
quickly passing by the table on a lunch break. The lesson plan script was shortened to
accommodate the participant with limited time. This resulted in some participants not
receiving the exact information as those who had a long time to spend at the
demonstration, which may have skewed the results. If the demon
stration was held in a classroom setting where all participants stayed the entirety
of the class and heard the same exact lesson plan, results would have been more
reliable.
A final limitation of this study was related to survey design. Questions 1-13 were
listed on the front of the paper and question 14 on the back. Many participants did not
notice the last question on the back of the paper. Results of question 14 were
imperative in determining the actual acceptability among participants; since not all
participants filled out the last question, data is unreliable and does not indicate the true
acceptability.
Despite limitations, results did show that participants learned new nutrition
information and were interested in receiving additional cooking demonstrations and
nutrition education sessions. These specific results are relevant in the field of dietetics

as they indicate that hospital staff may be becoming more aware of the importance of
nutrition related to health.
CONCLUSION
Nutrition education and cooking demonstrations among hospital staff provide an
opportunity to learn ways to make healthy, positive lifestyle changes. This study sought
to understand the interest level of hospital staff and the feasibility of replicating a basic,
healthy recipe at home. While the majority of survey results indicated poor acceptability,
it should be highlighted that hospital staff indicated they were willing to receive further
nutrition education or cooking demonstrations and that they would replicate the recipe at
home. This provides hope that hospital staff will implement healthy lifestyle changes as
a direct result of nutrition demonstrations. If nutrition education becomes more readily
available to hospital staff, acceptability rates may increase. Future studies investigating
the acceptability of cooking demonstrations and nutrition education among hospital staff
should hold specific classes and focus on standardization across research sites to
ensure reliable results. Additionally, future studies should follow through with hospital
staff participants to determine if changes are actually implemented and if these changes
also impact patient care.

REFERENCES
1.

Adult Obesity Facts. Centers for Disease Control and Prevention Web site.

http://www.cdc.gov/obesity/data/adult.html. Updated September 21, 2015. Accessed


December 4, 2015.
2.

Childhood Obesity Facts. Centers for Disease Control and Prevention Web site.

http://www.cdc.gov/obesity/data/childhood.html. Updated June 19, 2015. Accessed


December 4, 2015.
3.

Anderko L, Roffenbender JS, Goetzel RZ, et al. Promoting prevention through the

Affordable Care Act: workplace wellness. Prev Chronic Dis. 2012;9:120092. doi:
http://dx.doi.org/10.5888/pcd9.120092.
4.

Gatto NM, Martinez LC, Spruijt-Metz D, David JN. LA sprouts randomized

controlled nutrition and gardening program reduces obesity and metabolic risk in latino
youth. Obesity (Silver Spring). 2015;23(6):1244-1252. doi:10.1002/oby.21077.

5.

Thorndike A, Healey E, Sonnenberg L, Regan S. Participation and cardiovascular

risk reduction in a voluntary worksite nutrition and physical activity program. Prev Med.
2011;52(2):164-166. doi:10.1016/j.ypmed.2010.11.023.
6.

Gates D, Brehm B, Hutton S, Singler M, Poeppelman A. Changing the work

environment to promote wellness: a focus group study. Workplace Health & Safety.
2006;54(12):515-520. doi:10.1177/216507990605401202.
7.

Ni Mhurchu C, Aston LM, Jebb SA. Effects of worksite health promotion

interventions on employee diets: a systematic review. BMC Public Health. 2010;10:62.


doi:10.1186/1471-2458-10-62.
8.

Thorndike A, Sonnenberg L, Healey E, Myint-U K, Kvedar J, Regan S. Prevention

of weight gain following a worksite nutrition and exercise program. Am J Prev Med.
2012;43(1):27-33. doi:10.1016/j.amepre.2012.02.029.
9.

Cook RF, Billings DW, Hersch RK, Back AS, Hendrickson A. A field test of a web-

based workplace health promotion program to improve dietary practices, reduce stress,
and increase physical activity: randomized controlled trial. Journal of Medical Internet
Research. 2007;9(2):e17. doi:10.2196/jmir.9.2.e17.
10. Vardanjani AE, Reisi M, Javadzade H, Pour ZG, Tavassoli E. The effect of nutrition
education on knowledge, attitude, and performance about junk food consumption
among students of female primary schools. J Educ Health Promot. 2015;4(53). doi:
10.4103/2277-9531.162349.
11. 2013 Program Impact: Nutrition Links Annual Report for the 2013-2014 Fiscal Year.
Penn State Cooperative Extension Website. http://extension.psu.edu/health/nutrition-

links/about/annual-reports/2013/program-impact-2013. Published 2013. Accessed


November 1, 2015.

APPENDIX
1. Acceptability Survey

2. Lesson Plan
Introduction: Introduce yourself as an intern. Explain project/survey
Ask audience about their barriers to healthy eating time, work schedule,
kids, lack of cooking knowledge, no desire to cook, lack of recipes, etc.

Cooking Demo
Talking Point
Knife Skills
Basic food prep begins with knife skills.
-Explain safety (tucking fingers back, how
to hold a knife, cutting board, taking it
slow)
-Different cuts: dice, mince, rough chop

Demonstration
Demonstrate mincing garlic, chopping
parsley (all ingredients for end recipe)

Cheap Cheats
Taking shortcuts in the kitchen can cut
down on prep time, save you money, and Open canned beans for recipe and rinse
allow you to eat more fruits and
Boil the water for the edamame and cook.
vegetables.
-Canned Beans: add fiber and nutrients
without having to soak the beans and wait Mix together in a large bowl.
for them to cook. Look for low-sodium
options, or rinse the beans under water
before incorporating into a recipe. Add
canned beans to your salad, soup, or rice.
-Frozen vegetables: perfect for when your
favorites are out of season. Cauliflower
and broccoli can be steamed easily
without the hassle of prep.
Batching Cooking
If you are going to make beans or grains, Clean up area and get ready to make
dressing.
make a large batch and use them
throughout the week. Grains can be
frozen after cooking; just cool, and spread
flat on a baking sheet.
Dress it Up
Sauces, dressings and spreads can add
flavor in a healthy way when they are
homemade. Remember to keep it simple.
Think acid (vinegar, lemon, lime) +
healthy fat (olive oil, avocado) +
herbs/spices

Mix together ingredients for recipe


dressing: honey, vinegar, minced garlic,
parsley, thyme, salt, pepper
Pour onto beans

-allow the salad to soak up the dressing in


the refrigerator before serving.
Finishing Touches

Toast pumpkin seeds

Incorporate different textures to add


variety. Add crunch to a salad with nuts,

Serve samples and pass out surveys and recipes.


Conclusion/Closing
Estimated lesson time: 10 minutes
3. Table Tent Advertisement

4. Recipe
This was the recipe utilized for the cooking demonstration; the image below is a recipe
card that was given to all participants. Recipe was taken from www.wholefoods.com

5. Demographics Table
Demographics
Gender

90 %
Female

10%
Male

Ethnicity

68.5%
White

26%
Black

3%
Asian

1.4%
Hispanic

1.4%
Other

Age

10%
18-29 years

19%
30-39
years

21%
40-49 years

37%
50-59 years

13%
60+ years

6. Likelihood to Make Healthy Changes - Data from Survey Questions 8 and 9

7. Open-Ended Response Table


Question 12 Results: Raw Data
Category
(Total
Responses)
Beans/Lentils
(12)

Open-Ended Response

Nutritional value of beans (2)


Beans are good for you (1)
Benefits of beans (1)
About types of beans (1)
High fiber content in beans (1)

About using lentils (1)


Nutritional value of beans (1)
Soak dry beans before cooking to help prevent them from breaking
apart (1)
New combinations for beans (2)
How to incorporate lentils into a salad (1)
Recipe
(9)

New recipe (4)


A recipe for bean salad (3)
How to make bean salad (1)
That bean salad could taste so good (1)

Sodium/Flavor
(7)

How to reduce sodium in canned beans & use of natural spices for
flavor (1)
The importance of substituting salt (1)
Beans dont need a lot of seasoning to taste good (1)
Combination of several beans with healthy toppings can be very tasty
without tons of salt (1)
How to prepare canned foods to decrease salt content (1)
Combining flavors (1)
Use of herbs in cooking (1)

Healthy/Meal
Prep
(5)

How to prepare healthy meals (1)


Healthy Tips (1)
How to eat healthy (2)
A fun alternative option (1)

Meatless Protein

Meatless protein (1)


Alternate protein sources (2)
The benefits of healthy eating/lifestyle with meatless protein (1)

(4)
Ingredients
(4)

Look at the ingredient list (1)


Making things from ingredients that are fresh are better than
processed foods (1)
Dry beans may be better than canned beans. Always read the label
(1)
Paying attention to what you put into your body is extremely important
(1)

Miscellaneous
Nutrition (2)

How to lower blood pressure (1)


You can eat starch in moderation; fruit is starch (1)
Total= 43 Comments

8. Future Healthy Changes - Data from Survey Question 14

9. Photos From Event