vol. 3 • no.
ICAN: Infant, Child, & Adolescent Nutrition
Parent Perceptions of NutriSTEP and Nutrition Risk Screening in a Sample of Ontario Preschool Children
Lee A. Rysdale, MEd, RD, Eliana C. Witchell, MAN, Heather H. Keller, PhD, RD, Janis A. Randall Simpson, PhD, RD, Mary C. Turfryer, MHSc, RD, Kim A. McGibbon, MScCH, RD, and Joanne E. Beyers, MA, RD
Abstract: Nutrition screening with NutriSTEP (Nutrition Screening Tool for Every Preschooler) requires parents to complete a 17-item, self-administered questionnaire and follow through with appropriate recommendations. Parents’ perceptions of screening and referral procedures can be used to evaluate the process of an ethical child nutrition screening program. Targeted implementation of NutriSTEP took place in 3 diverse Ontario communities using an assisted or self-referral model. Of the 364 respondents, 264 parents consented to a follow-up telephone interview, with 164 (62%) interviews conducted in English or French. The interview focused on parents’ reasons for participating, their perspectives of screening and referral processes, and any perceived barriers to, concerns about, and benefits of screening. Most parents reported that screening confirmed their perception of risk; reminded them about healthy preschool diets and areas to improve; increased their nutrition awareness, motivation, and confidence; and informed them about additional information sources. Some barriers to seeking referrals or further education included not being concerned, no time
for referrals or dietary changes, and not knowing where to go for more information. Overall, nutrition risk screening using NutriSTEP was well accepted, yet referral uptake was modest. Efforts are needed to encourage parents of children at risk to follow through with recommendations. Keywords: preschooler; other topic not listed; nutrition care process
school performance.4-9 Nutrition screening can identify individuals who may not be consuming nutritionally adequate diets and who may be at risk of malnutrition.10-15 NutriSTEP (Nutrition Screening Tool for Every Preschooler) is a valid and reliable, parent-completed questionnaire that can identify nutrition risk in preschool-aged (3-5 years) children in community settings.2 NutriSTEP development and testing
“Some parents chose to make positive behavior changes as they appreciated the potential harm, whereas others rationalized why they had not made any changes to their children’s behaviors or else chose to dismiss the potentiality of harm.”
Introduction Recent research has shown that young Canadian children may not be consuming nutritionally adequate diets,1-3 which can lead to consequences such as failure to thrive, dental caries, iron deficiency anemia, and obesity, as well as poor involved more than 1500 preschoolers and their parents from across Canada over 10 years (1997-2007). Face and content validity were carried out in the first 2 project phases, whereas criterion validity and retest reliability were completed in phase III.2 NutriSTEP is now part of a comprehensive provincially
DOI: 10.1177/1941406411414292. From the Nutrition Resource Centre, Ontario Public Health Association, Toronto (LAR); Department of Family Relations and Applied Nutrition, University of Guelph, Guelph (EW, HHK, JARS); York Region Community and Health Services, Newmarket (MCT); Thunder Bay District Health Unit, Thunder Bay (KAM); Sudbury & District Health Unit, Sudbury (JEB), Ontario, Canada. Address correspondence to Lee Rysdale, Nutrition Resource Centre, Ontario Public Health Association, 700 Lawrence Avenue West, Suite 310, Toronto, ON M6A 3B4, Canada; e-mail: email@example.com. For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. Copyright © 2011 The Author(s)
which included an information and consent form. and follows up with at-risk individuals to ensure that any needs are met. Targeted implementation and process evaluation of NutriSTEP took place in 3 diverse communities using either a self-referral (Region of York. few screening programs evaluate these steps to ensure that an ethical process is followed or to determine the barriers and facilitators to the implementation of nutrition screening. ineligibility of children who were too old (11%). The implementation of an ethical screening process requires a valid and reliable screening tool. seeking out additional information on the Internet or talking to friends/family). if required. and individualized with implementation site–specific information (eg. Ethics approval was obtained from the University of Guelph Research Ethics Board and the Sudbury & District Health Unit. Demographics. and crosstabs using SPSS (version 16. Demographic data (parents/ caregivers and children) for the interviewed sample (n = 164) varied from the total sample (n = 364) only in that mothers in the interviewed sample were more likely to be Anglophone. and 7% high risk.ICAN: Infant.
. SPSS Inc. Process evaluation was conducted at the community. there was no financial incentive for completion of the study. Most children were born in Canada (97%). 80% of fathers). and Nutrition Risk
of Guelph. The purpose of this article is to describe parents’ perceptions as well as their perceived benefits and barriers to the screening and referral processes in these 3 implementation settings. and financially stable (71% had household earnings above $60 000 Canadian dollars). spoke English as a first language (90%).14.and closed-ended questions included the following: reasons for participating in screening. Interviews lasted between 15 and 20 minutes and were conducted from January to October 2008. Open-ended questions were qualitatively analyzed using thematic analysis following the methodology from Braun and Clarke.17 Results
Participation. incorrect contact information (8%).010. Health Unit name.15 However. sustainable funding. including further assessment.nutristep. and 164 interviews (62% of 264) were completed. a screening location. Consenting parents were contacted between 6 and 10 weeks after screening to allow sufficient recall of the screening process as well as time for any follow-up with referrals. postscreening activities (eg. 79% of fathers) and were born in Canada (90% of mothers. provides at-risk individuals with appropriate treatment options. and communication issues because of inability to speak either English or French (the official Canadian languages. program/school name). an action plan for screening and referrals. & Adolescent Nutrition
recognized program in Ontario (see www. IL.
Quantitative data from the NutriSTEP and demographic questionnaires were analyzed through frequencies.052) = −3. means.16 “Ethical nutrition screening”10 targets a specific population with an appropriate screening tool.nutritionrc. ON).0. Interviewed respondents (n = 164) were mainly female (92%). Open. t(336. and related nutrition education materials.2 There were no differences in level of risk for children whose parents participated in the interview as compared with the total sample. usefulness of nutrition resources.
The Parental Experience of Screening
A total of 364 completed questionnaire packages were returned to the University
There are 2 main themes that described parent perceptions of screening: seeing the whole picture and obstacles to the screening and referral processes.001. Two trained research assistants conducted the interviews in English (n = 151) or French (n = 13). Chicago. the prevalence of overall nutrition risk in the total sample (n = 364) was 81% low risk. and parent levels. community-wide collaboration and buy-in. Researchers attempted to call parents up to 10 times at various times throughout the day and early evening before calls were abandoned. see Table 1. and were considered “healthy” (93% had no reported medical conditions) (data not shown). 5%).ca and www. which was comparable with other recent evaluations conducted in Ontario using similar screening models18 as well as with the NutriSTEP validation sample. pretested.ca for more information).10. their children’s nutrition risk. highly educated (76% graduated from university or college). P = . see Table 1. Most parents/caregivers spoke English (82% of mothers. unable to reach within 10 weeks postscreen as a result of vacations/rescheduled calls (5%) or timing issues related to research protocol (21%).
A telephone interview guide was developed. Methods
Research applications were also approved by the York Region Community and Health Services Department and the York Region District School Board. and a plan to follow up with at-risk individuals. A total of 264 parents (73%) consented to be contacted by telephone. 12% moderate risk. 2008) to compare respondents who were interviewed by telephone with the entire sample. Parents completed the NutriSTEP questionnaire and consent (including consent to participate in a follow-up telephone interview) and demographic forms. married/commonlaw (94%). the referral process. Based on the NutriSTEP questionnaire risk scores. ON) or an assisted-referral process (Sudbury and Thunder Bay. demographic form. Child. NutriSTEP questionnaire. screening venue. site. and their overall experiences with the screening process. parents’ perceptions of the NutriSTEP questionnaire. which were returned to the University of Guelph. group comparisons were made with significant differences identified at P < .
Parents in the screening communities were provided with a screening package. resources and referral capacity.213. Reasons for nonresponse included the following: unable to reach within 10 call attempts (50%).
health connection (free telephone service where parents could call a dietitian) was available Individual parents Parents were given the questionnaire package to complete on their own and seek their own referrals.3%) 58 (44%) 6 (30%)
35 (21. school Francophone and Anglophone population. information provided on how to phone health connection dietitian Eat Right Be Active booklet. offreserve First Nation Public health unit (site coordinator) Facilitators gave parents recommendations on how to improve as well as to see the child’s doctor York Region Kindergarten registration (school)
Multiethnic community. Child.3%) 26 (20%) 8 (40%)
4 (33. EatRight Ontario magnet 300 153 (42%) 118 (45%)
Eat Right Be Active booklet. information to call the health connection 1400 131 (36%) 88 (33%)
Packages returned to researchers by Method of referral for high risk families
Eat Right Be Active booklet. How to Build a Healthy Preschooler booklet. 3 • no. 4
ICAN: Infant. Site Information for the NutriSTEP Implementation Sites Used in the NutriSTEP Implementation Study Thunder Bay Location of screening implementation Reasons for choosing site Junior Kindergarten screening fairs (n = 10). EatRight Ontario magnet 200 80 (22%) 58 (22%)
Number of packages sent to each site Number of packages returned (n = 364) Number of packages with parental consent to contact (n = 264) Number of interviews conducted (n = 164) Number of interviews with low risk (n = 132) Number of interviews with moderate risk (n = 20) Number of interviews with high risk (n = 12)
. How to Build a Healthy Preschooler booklet. public health unit Francophone and Anglophone population. & Adolescent Nutrition
Table 1. off-reserve First Nation preschool screening fairs Public health unit (site coordinator) Facilitators faxed a copy of questionnaire to child’s doctor to encourage parents to seek referral Sudbury Best start hubs (n = 10).vol.3%)
1 (8.4%) 48 (36%) 6 (30%)
Obstacles to the screening and referral processes. an affirmation reflected by their children’s scores and acknowledgement for their hard work. · Becoming aware: Parents stated that they were made aware of the recommended number of food group servings and appropriate portion sizes as well as potentially harmful practices such as forcing children to finish a meal or eating in front of the television. Seeing the whole picture is described as parents’ increased awareness about their children’s health. Some parents were unwilling to address the notion that their children were actually at risk and did not follow through on referrals because of the time this would have taken as well as the belief that the educational materials provided were sufficient. Completing the questionnaire acted as confirmation that the child was either doing well nutritionally or that there were problems. only one of these parents was told that her child was underweight. learn what to feed their children. and answer questions. Table 2 provides select quotes to support these subthemes. 19% of the 164 interviewed). In addition. 5 subthemes were provided by parents through a number of quotes. and need screening to help reduce childhood obesity. One parent of a high-risk child was told that her child was fine by a doctor. good eating habits. parents
suggested other options such as taking the NutriSTEP questionnaire home. and having competing priorities that influenced followthrough with screening recommendations (Is knowing enough?). & Adolescent Nutrition
Seeing the whole picture.ICAN: Infant. and community resources as well as their responses to the results considering their personal context and interactions with others. lack of concern for the child’s nutritional status (risk). For parents whose children were not at nutrition risk. and Nutrition Risk
Despite the inclusion of diverse communities and implementation models. Demographics.
. understand. In addition to parent lack of prioritization of nutrition. having child care available so they could concentrate on completing the questionnaire. Parents also used the questionnaire as a means of verifying their internal comparisons of themselves with other parents and their children. or were picky eaters. Two of the sites involved completion of the screening tool in group settings with children present. there was positive confirmation even though there might be areas for improvement. Obstacles such as time and priority of nutrition risk also influenced the uptake of referrals and use of community resources. The questionnaire highlighted the problems or acted as a reminder for parents to continue to address the problem(s). Parents with children who were
at high nutrition risk were generally not surprised as their children’s scores were consistent with their thoughts and current feeding experiences with their children. · “Being on the right track”: Parents described screening as a way to check on their children’s nutrition status. Parents whose children were at nutrition risk received the affirmation that a problem was present and needed to be addressed. To overcome this potential obstacle to completion. · Reacting to the score: Parents with children at either low or high nutrition risk were generally not surprised at their children’s scores. Parents for whom English was a second language found the questionnaire difficult to complete on their own and required extra time to translate. furthermore. worries over who would see the screening results (How will the results affect me?). Other parents stated that their children’s scores were not reflective of their children’s healthy eating habits and thus denied the risk score results. Both parents of moderate. including environments that were not parent centered (Parent-centered environments). had small appetites. yet received and accepted a dietitian referral and reported receiving relevant information and helpful suggestions. They also reported learning about the importance of overall nutrition from the NutriSTEP questions. · Making comparisons: Some parents felt that other parents (rather than themselves) need to receive the resources. The total number of parents—regardless of child’s risk level—seeking any referrals was modest (n = 31. Only 6 parents of moderate-/ high-risk children (19%) reported following through with further assessments by a physician or dietitian. Those parents who did consult other professionals were concerned that their children were small for their age. Table 2 provides an illustration of this theme along with select quotes to support subthemes. These parents reported that they would have preferred to complete the questionnaire with a health professional because they were not able to completely understand nutrition risk items or available nutrition programs/referrals. Parents with children who scored at low risk reported positive emotions. · What the doctor says: Consistent health messages between NutriSTEP and other health professional advice was important to parents in seeing the relevance of nutrition screening and the need for any behavior change. and having a quiet environment to think about the questions. Parents with moderate risk children were generally surprised and expressed concern and frustration. parents became aware of programs and services that they could contact to get more nutrition information. If there were inconsistent or conflicting screening results with a health professional’s opinion. they felt supported with the additional nutrition education resources they received. Parents described changing their behaviors as a result of the screening. having no time to seek out referrals or make changes to the diet. including health professionals. Discussion
Participation. This theme is described as those barriers that parents faced during screening and referral. the health professional’s comments were generally more valued by the parent.and high-risk children were disappointed that their children were not doing better and felt responsible but also talked about how they wanted to improve their children’s diet. Child. Within this theme. physicians who were seen typically reassured parents that their children were fine.
· “I’ve stopped dictating how much food my child should eat and I’ve learned not to be so stressed out about my child’s eating”(TB 111). & Adolescent Nutrition
Table 2. · “I was not surprised. as a parent. · “I have already discussed this with my doctor. etc. you don’t always know if you are doing [the] right things”(SB 081). This put it in front of me.b · “My daughter has been anemic since she was born. Now she eats regularly and has a third meal. If the doctor had said that there were problems. It’s useful to see . . · “I am very glad that someone is paying attention [to children’s nutrition]. It feels good knowing I’m doing a ‘good mommy job’”(TSB 1450). fruit. Reacting to the score · “He’s very easy [to feed]. . . Being on the right track? · “[I completed the questionnaire] to see if we were on the right track. · “I felt good. · “[The screening program was useful] mainly because of the ‘if something did happen’ question. and I don’t want [the nutrition screening] to stop.b · “I was surprised that [the score] was as good as it was! I was slightly concerned. now that we’re not pushing him to eat” (TB 111). at the fifth percentile. I see the whole picture”(TB 023). You get into [a] routine and don’t count the number of servings any more . 3 • no. Quotations to Support Thematic Analysisa Theme 1: Seeing the whole picture “I felt comforted. I would fix it right away and ask for a referral to a registered dietitian. I have no concerns for him. where to improve”(Y 0723). Becoming aware · “It allowed me to focus on and look at all aspects of my kids’ meals: the number of vegetables.b · “I’m sad that she didn’t get the best score”(Y 1275).b (continued)
. She’s picky. . . · “I felt a sense of accomplishment” (Y 0695). and drew it to my face” (TB 128). but personally I didn’t need it. you need to sit back and think about it. but when I sit down and think about it.b Making comparisons · “Maybe it would be more useful for others because they are maybe not aware of how badly they feed their children. 4
ICAN: Infant. It was good motivation to get me to feed her better”(Y 0134).” (TB 247) What the doctor says goes · “The questionnaire was a waste of time because I go to my doctor to get feedback and to see how my child is doing” (Y 0049).b · “I did not realize that I wasn’t giving my daughter all the right stuff.b · “I was ashamed and embarrassed that she scored so [high]. I knew it was an issue already. . [We have] really struggled. I will monitor the issues” (TB 244). She’d only eat fruits and vegetables. but he eats everything else” (TSB 1530).vol. · “My child’s doctor was concerned because my daughter was thin. I now know where to go [for more information]: Eat Right Ontario” (TB 209). and eats every two hours” (Y 0134). even. But I’m aware” (SB 118). I was pleased that my child got a good score. I’m not surprised. My child is healthy. I need to make more of an effort. We saw a dietitian in the hospital but we couldn’t get her to eat. and we’ve seen an improvement. as opposed to solid food. but sometimes my child doesn’t like to eat” (Y 1275). I’m always worried that my child is not eating well. [Our son] doesn’t eat vegetables . The whole family eats well” (TB 121). and everything is fine. so I wanted to see how badly she was doing” (TSB 1480). She’s hungry now. · “I am aware that my daughter doesn’t eat well. but both of us [mom and dad] are thin. The pediatrician said to let him eat when he wants. The doctor said she was drinking too much milk. I was concerned for her health. Child.
ICAN: Infant. com/index. and continued efforts are under way to integrate NutriSTEP. I try to cook in advance” (TSB 1460).html) to identify “high-risk” schools. · “I found the questions difficult because English is my second language” (Y 0689). want is to have Family Services reviewing it. but not enough to go and see a dietitian. now available in 8 languages at www. The doctor said [my child] is doing OK. In Ontario. as well as universal screening using the Rourke Baby Record in primary health care settings (http://www. using a universal screening approach. TSB. How will the results affect me? · “Where is [the questionnaire] going and who is seeing [the results]? The last thing you. and my child is in the picky stage” (TB 189). · “I felt nothing. I would have preferred to take it home to do it during a quiet time” (SB 030). screening could be facilitated
with the use of translators18 as well as the translated versions of the NutriSTEP questionnaire and educational resources. flintbox. . Screening was successful in raising awareness and confirmation for parents on the nutritional health of their children. · “I am concerned that the questionnaire will be lost in the shuffle of the different screens. & Adolescent Nutrition
Table 2. I will continue to offer [my child] new foods” (TB 244). etc). · “It was difficult . where it will be going . now that I’m working” (Y 0936). Sudbury) as well as a unique number assigned to the specific individual. I filled [the questionnaire] out to think about something else” (Y 0233). obesity. Non-mandatory equals not important” (TB 043). I am aware of the issues.b · Mom didn’t talk to anyone because: “I’m busy.
there was participant self-selection. Meanwhile preschool nutrition screening using a more targeted approach within a “high-risk” setting may see a greater percentage of high-risk children (22%) as was seen in an Ontario school pilot of 11 schools with high numbers of newcomer families (English was the second language for 90% of the parents). other targeted screening initiatives include Healthy Smiles Ontario—a low-income dental program (http://www.b · “[The questionnaire] gives me ideas where to improve with [my child]. SB.
a Each quotation will be followed by a letter or letters representing the participant site (Y. from both the facilitator’s and parental view. Will it be part of my child’s school file? It would be good for parents to know up front and be fully aware of who will see the questionnaire. SBF. parents with lower income and lower levels of education and parents for whom English is a second language). Thunder Bay.com. which limited involvement from various groups of parents.
The Parental Experience of Screening
Seeing the whole picture. But. it took me a long time to it fill out because I was watching my infant and toddler” (SB 098). So. In addition to raising awareness and confirming previously held beliefs. I know where to fix the problems: fruits and vegetables.ca/). It was shown that the prevalence of nutrition risk was similar to other reported findings.b · “It’s just been a busy time since [the screening fair]” (TB 115). it’s hard. Child. Thunder Bay. parents also responded to screening by reacting. (continued)
Theme 2: Obstacles to the screening and referral processes Parent-centered environments · “It was hard because there were so many kids running around. I’m trying.gov. · “I was not concerned.
. My mother is dying. York. . TB. Regardless of the approach. it would seem
prudent to include NutriSTEP along with these early childhood screening initiatives. I know I’m not focused on my son because of his brother. Is knowing enough? · “I was concerned. · “I know what I do sometimes is wrong but when you are pressed for time.18 For newcomer families. including those considered harder to reach (eg. rourkebabyrecord. as a parent. school performance.health. When I’m off. [the Hub is] a busy place.offordcentre. dental caries. and how it will be used” (TB 128). and my kids were all over the place. In light of the consequences of not addressing nutrition concerns early (eg. Sudbury.ca/ en/public/programs/dental/)—and the Early Development Instrument—a school readiness tool (http://www. .on. . an ethical child nutrition screening program needs to have sufficient capacity to screen and refer as well as provide follow-up to children and their families. b Child was found to be at moderate or high nutrition risk. but I don’t have as much time because my youngest child is autistic.” (Y 1239)b · “It costs money to make [dietary] changes” (Y 0742).
23. This current finding suggests that for screening programs with the NutriSTEP questionnaire. regardless of their children’s risk category.eatrightontario. These responses are consistent with the process of cognitive recognition. We found that parents desired information through means such as nutrition resources and Web sites rather than accessing professional services. Based on this finding.ca). the present study found that if other health professionals stated that the child was fine nutritionally.27 This finding also confirms that awareness of a problem is not sufficient to change behavior. easy to complete. there should be follow-up for all high-risk families.13 Some parents chose to make positive behavior changes as they appreciated the potential harm. This suggests that there is an opportunity to increase parent awareness and knowledge through screening. Similar findings were reported by Keller et al. Furthermore. appeared
to have been educated by the nutrition resources provided. they reported that they could independently make sufficient changes and correct the nutrition risk behavior. basic. This study also identified that parents look to this professional group for confirmation of screening results. such as a free provincial dietitian service. literacy level. such as How to Build a Healthy Preschooler.vol.24 The NutriSTEP findings suggest that collaboration with medical practitioners in the screening process as well as physician education on preschooler nutrition risk is essential for successful nutrition screening programs. this requires time and resources. Knowing the target population and its needs would enhance the uptake of an ethical screening program. and considering what they were told by other professionals. particularly with children at moderate risk. Specifically. it is recommended that the NutriSTEP questionnaire always be accompanied with supporting nutrition resources. Despite the inclusion of diverse communities and implementation models.18 Efforts have been taken to educate family physicians on child nutrition through Continuing Medical Education workshops in which NutriSTEP has been included along with supportive educational resources and sources of credible nutrition information for their patients.25 that was developed and evaluated26 to accompany the questionnaire. However. diverse nutrition screening programs are acceptable to parents. and cognitive ability. they found it to be straightforward. EatRight Ontario (www. “the questions were straightforward. some parents appeared to be unwilling to address the notion that their children were actually at risk either because they disagreed with results or did not prioritize the problem and had insufficient time to follow through. obstacles were identified that could provide guidance for future screening programs. at doctors’ appointments. educating them on behavior and eating goals. whereas others rationalized why they had not made any changes to their children’s behaviors or else chose to dismiss the potentiality of harm. about their child’s health. Through follow-up after screening and recommendations of referrals. 4
ICAN: Infant. “the questionnaire creates awareness and is a good reminder for the parents”(participant #Y 0919). Lee et al22 also identified that a screened population may not psychologically be ready to be helped. the self-selection of participants in this study did limit the generalizability of the results. parents dismissed the risk determined by the NutriSTEP. At follow-up. and thought that it asked appropriate questions about their children: for example. Although research has shown that parents generally underestimate their children’s risk for overweight/obesity. Ontario family physicians and
pediatricians have noted that NutriSTEP is a useful tool for initiation of nutrition conversations with parents because it helps identify potential areas of concern and also informs them of the child’s nutritional risk. nutrition counseling took up very little. Child. A number of parents. 3 • no. programs need to provide a flexible environment in which all parents can complete the questionnaire independently or with assistance.24 Moreover. Medical practitioners have reported that they feel that it is part of their job to counsel patients on nutrition and assess nutrition status. This could have been to the result of a number of factors. Our results also indicate that overall.23. including those considered harder to
. Parents appreciated the questions that sensitized them to think about what they were feeding their children while. valid” (participant #Y 0919). & Adolescent Nutrition
comparing. depending on parents’ language fluency. they did not feel trained enough to discuss nutrition-related issues with patients. however. if desired. at the same time. seniors were given a second opportunity to discuss their risk status and then accept referrals. and program funding has to be done properly. and screening requires further steps to support behavior change. if any. Furthermore. Early identification could encourage parents to make positive changes with their children and improve their children’s nutritional status and risk level. however. indicating that nutrition risk was not seen as a priority in their lives at the time of the screening. parents whose children fell into the moderate-risk category were generally surprised by their children’s scores. Parents liked the NutriSTEP questionnaire. Obstacles to the screening and referral processes.27 who found that some nutritionally at-risk seniors needed time to psychologically accept that there were nutrition risk behaviors they needed to change.19-21 the results of this study found that parents of children at low or high nutrition risk could predict how well their children would do on the NutriSTEP questionnaire because they were not surprised at the results. Lee et al22 predicted that the gatekeepers who decide which individuals are at nutrition risk may disagree with one another. and specifically doctors.10 Uptake of referrals was nominal because only 1 in 5 followed through with this recommendation. whereby thought and perception about self and/or others as well as a decisionmaking process is based on probability or weighing the possibilities or potentialities. and further research with various groups of parents of preschoolers. However. parents also rationalized reasons for not having made any changes to their children’s diets.
2008. Braun B. Canada: University of Guelph. McCargar LJ. 2005. self-perceived proficiency and knowledge.
23. Nutrition screening tool for every preschooler™: validation and test-retest reliability of a parent-administered questionnaire assessing nutrition risk of preschoolers. This includes the option to complete the questionnaire at home. Accessed April 11. 2002:247-268. 2007. Nutr Today. Ball GDC. Nutrition. In: Gary Bennett.
18. 2011. Collaboration and integration of efforts can ensure the success of a sustainable screening program with long-term positive outcomes for children and families. 1995. Boniface D. Herring SJ. with on-site child care supervision. Sothern MS.
illusory? [Commentary]. Phillips MM.
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11. Randall Simpson JA. Beyers JE. 2004. Raczynski JM. In: Principles of Nutritional Assessment. 1997. Rysdale L. Stroud J. PA: W B Saunders. How to build a healthy preschooler. 2005:1-26.
27. Sheeshka J. Nutrition for preschoolers. Lee JS. Prevention of obesity in young children: a critical challenge for medical professionals. Keller HH.56:65-68. 2004.pdf.
20.41:164-170. Vetter ML. ON.
13. Validity of nutritional screening and assessment tools. Rush D. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. There are opportunities to increase primary health care professionals’ knowledge and awareness of the purpose of nutrition screening. Evaluation of a nutrition education component nested in the NutriSTEP project. J Am Diet Assoc.
1. flexible environment in which all parents can complete the questionnaire comfortably. et al. Screening programs need to provide a parentcentered. Krause’s Food.php.68:86-91.
22. Haresign H. Parental perceptions of overweight in 3-5y olds. Jones JM. Washington. Maternal perceptions of overweight preschool children. 2002. For parents. Nutrient Intakes of Preschoolers (3-5 years old): Risk Factors and Sociodemographic Characteristics Associated With Selected Nutrients [master’s thesis].24: 546-552. & Adolescent Nutrition
reach.16: 630-636.3: 77-101.
6. Powers SW. Gibson RS. age 4-5 years. Iron. 2007:589-594. Manore M. ON. Rysdale LA. Beate Krinke U. Brown JE. and Diet Therapy. Chamberlin LA. Whitaker RC. In: Yvonne Alexopoulos. Brockest B. Nutrition Resource Centre. 2003.135:882-885. Canada: Statistics Canada. the screening process serves a facilitation role by increasing their knowledge and awareness about preschool nutrition and by potentially changing their behaviors. Haresign H. Can J Diet Pract Res.
14. Baer MT. In: Elizabeth Howe. Can J Diet Pract Res. Rysdale LA. 2001. Escott-Stump S. in a quiet environment. Nutrition Screening Institute.
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2. Gordon ST.
17. 2006.106:1380-1386.27:287-298. 2008. Croker H. Qual Res Psychol. Clin Pediatr (Phila). Conclusions It has been shown that NutriSTEP not only screens for nutrition risk but also serves to increase nutrition awareness and knowledge and to change reported nutrition behavior in parents of preschoolers. Brockest B. ed. 2006. Edwards C.com/ nutristep/110110/index. It can be implemented in a variety of ways in community settings. Nutrition Resource Centre. Follow-up.
9. Process evaluation of bringing nutrition screening to seniors in Canada (BNSS). Shah NR. NY: Oxford University Press. Accessed April 11. Sugarman Isaacs J. 2000.
7. Nutrition Through the Life-Cycle. Pediatric nutrition assessment: identifying children at risk.
8. J Nutr. Kalet AL. Kushner RF. Building capacity for nutrition screening. Randall Simpson J. ON. 1996. J Am Coll Nutr.42:S86. Canada: Pearson Education Canada. would enhance our understanding of the screening and referral processes. Screening for receipt of WIC benefits during pregnancy: feasible or 15. New York. Philadelphia. Baughcum AE. J Hum Nutr Diet. 2008. Frongillo EA. 2010. Guelph. ed.ca/resources/pdfs/nutristep_build-healthypreschooler-eng-4pg. This study has shown that targeted implementation of nutrition risk screening in preschool-aged children is acceptable to parents. Garriguet D.
24. and/or with completion assistance for those who need it. Implementing NutriSTEP® in Ontario: success stories. Keeping Older Americans Healthy at Home: Guidelines for Nutrition Programs in Home Health Care. Clarke V. The methodology of nutritional screening and assessment tools.
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