Module 4 Patientcentered Behavior Interventions Learning Objectives Describe effective strategies for facilitating behavior change in patients Discuss the impact of parentalcaretaker life course on disease management and overall health of the pediatric CF patient ID: 591513
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Slide1
Nutrition and Cystic Fibrosis
Module 4:
Patient-centered
Behavior
InterventionsSlide2
Learning Objectives
Describe effective strategies for facilitating behavior change in patients.
Discuss the impact of parental/care-taker life course on disease management and overall health of the pediatric CF patient.
Describe appropriate culturally competent approaches to patient care.Slide3
Importance of Adherence to Nutrition Recommendations
Strong link between weight-for-length/BMI and lung function
Early intervention likely to provide best long-term outcomes for growth and survival
Historically among CF pediatric population non-adherence to nutrition recommendations is high
Dietary adherence closely related to
Child mealtime behaviorParent-child mealtime interactionsKnowledge level of nutrition and CF
www.cff.orgSlide4
Strategies to Promote Behavior Change
Differential attention – parents/caregivers praise appropriate behavior, ignore inappropriate behavior
Child Behavior
Typical Parent Response
Behavioral
Change
Taking
bites
Not Noticing
Compliment
child on eatingExcess talkingInstructing child to eatFeeding childIgnore child until they take a bite, then answer questions or engage in conversationComplaints such as not liking food or negotiatingCoaxing, promptingMaking meal itemsIgnore complaints and compliment child for eating foodsLeaving the tableCoax or instruct child to returnSet rules about staying at the table during mealsGuide back to table with little discussionComplaints of being fullCoaxing, promoting, feedingNegotiate amount of food child will eatSet appropriate food intake expectations and meal length, and set rewards
Adapted from
Borowitz
et al.
Using
Nutrition to Stay Healthy with
CF
presentation
. Slide5
Strategies to Promote Behavior Change
Contingency management
– parents/caregivers establishing expectations along with positive and negative consequences
Rewards – provide immediately after positive behavior
Withhold reward for negative behaviorContracting – Written agreement between parents/caregivers and child outlining goals and consequencesSMART goals – provide more accountability and measurabilitySpecific
MeasurableAttainableRealisticTimelySlide6
Getting to the Goal
Anticipated Results
Broad Goals
Specific Goals
Weight gain
↑
kcal and fat intake
Add 1
Tbs
of butter to your oatmeal every morning
Decreased malabsorption
Take enzymes as prescribed
Take enzymes before each meal or snack on 5 out of 7 days
Improve vitamin D status
Take vitamin D supplement as prescribed
Take vitamin D supplement each morning before your bowl of oatmealSlide7
Goal Setting Practice
Rewrite the following goals to be more
specific:
Remember to take your acid pill
Increase your
activity over the next monthGain 2 pounds by the next clinic visitSlide8
Strategies to Promote Behavior Change
See text Table 17.2 Behavioral strategies and application in CF nutrition.
Consider…
Culture aspects of nutrition education and counseling
Life course of both child and
parents/caregiversIt can be difficult and may take a significant amount of time for parents/caregivers to reverse problem behaviorsParents/caregivers may need support themselves to help facilitate behavior change
RDN provides education and assistance to parents/caregivers and child with these behavior change strategiesMay need referral to feeding programWork with other professionals on health care team, especially social workerCheck in at each clinic visit and reinforce conceptsSlide9
Considerations When W
orking
with
P
atients
and Families
Aspects of food behavior and food environmentWhat the RDN needs to know
Example
Availability
What types of food are available
both in the environment and economically?Note foods available from local food sources and their relative priceAcceptabilityWhat items are accepted as food and under what conditions?Differentiate those foods preferred from those available but not preferredSelectionWhich foods are most commonly chosen for consumption, and who makes the food selection decisions?Differentiate those foods chosen consistently that make up a substantial part of overall intakeProcurementHow and where are foods obtained by household?Note foods obtained from grocery stores, home gardens, vending machines, restaurants, etc.PreparationHow is food prepared before eating?Cooking and preparation methods for major foods consumed.
Adapted from Table, Terry RD.Slide10
References
Nutrition in Cystic Fibrosis
, Yen and
Radmer Leonard – Chapter 17
Cystic
Fibrosis Foundation – www.cff.org Borowitz et al.
- Using Nutrition to Stay Healthy with CF presentationTerry RD. Needed: A new appreciation of culture and food behavior. J Am Diet Assoc. 1994;94(5):501-503.