Program Plan

 

 

Program Setting:

 

            This program is aimed at children who have chronic diseases or illnesses to gain knowledge and skills about healthy eating to help them feel empowered over their own bodies.  The lessons and activities will allow them to learn about promoting health in their adverse conditions, without specifically highlighting their specific disease or illness.  Moreover, the lessons will be on general healthy eating that can apply to everybody’s lives. 

In a hospital setting most of the healthcare professionals will talk with the parents if they feel the child is too young to understand, and even neglect to interact with the child.  Therefore, having a program where the child is the priority population is different than most programs implemented in healthcare settings.  This program will put the health information in terms appropriate for children.  I will use a superhero to guide the children in fighting “evil,” which represents bad feelings that arise from eating unhealthy foods, ailments, or unhealthy foods, themselves.  The program will entail different lessons on energy, different vitamins and minerals, and what they do for the body.  Then there will be a corresponding activity, which will reinforce the information taught in the story.  All the lessons will offer engaging activities to allow the children to learn about nutrition in a fun, relaxing environment.

This program will mainly be focused on interacting with the child, but include parents and guardians at all meetings.  It is important for the child to feel supported in learning new information about health and nutrition, and have somebody to turn to when they are outside of the hospital setting in the real-world having to make decisions about what to eat.  Children often look to their parents’ as role models, so engaging the parents in this program could benefit the adult by learning healthy behaviors, too.  Parents will also be involved in certain parts of the program, when the healthcare professional is not with the child, which is described later.

This program is created to implement at the Pediatric unit in the Clinical Center of the National Institutes of Health.  Every child in the pediatric unit comes from various backgrounds, but the majority of them has two parents in the household and is Caucasian.  I will target the younger population within the unit.  All of the children have a chronic illness or disease, such as Chronic Granulomatous Disorder (CGD), Sever Combined Immune System (XSCID), and Ataxia Telangiectasia (ATM), and are on test-treatment protocols.  Furthermore, the children are always being examined and rarely have the opportunity to engage in fun activities while still learning about health.  Most of the children feel confined in their room, yet there is a playground area both inside, and outside of the research hospital.  The hospital rooms are brightly colored, with creative kids drawings throughout the unit, including on the walls, ceilings, and windows.  The NIH tries to make children feel as comfortable as they can be, and will go to many lengths in order to strive for a comfortable setting.  In the pediatric unit there is a room designed for activities, such as teaching or crafts, which I will request to use on the days I will implement the program.

 

 

 

 

Program Plan:

Rationale

A rationale for “Courageous Cassidy to the Rescue!”: A program to educate and empower children with chronic diseases and illnesses via nutrition.

 

Background:

Childhood obesity: Childhood obesity has become an increasingly bigger problem that our nation faces.  In fact, it has more than doubled in children and quadrupled in adolescents in the past 30 years.  The percent of children who are obese between the ages of 2 and 19 years old is 17%, which is about 12.7 million children and adolescents.  If the age range is decreased, the percentage is still high; adolescents aged 6 to 11 years old, have increased by 11% from 1980 to 2012.  Furthermore, in 2012, over one third of children in the United States were overweight or obese (2014).

Childhood obesity can lead to biological complications such as: high cholesterol, hypertension, asthma, type 2 diabetes, metabolic syndrome, sleep disorders, nonalcoholic fatty liver disease.  It can also lead to social and emotional problems, such as low self-esteem, bullying, depression, and behavior and learning problems.  The biggest contribution factor for child obesity is lifestyle behaviors, specifically diet (Mayo Clinic Staff, 2015).  Eating foods that are high in fat, sugar, salt, and calories are adding to this epidemic.  However, increasing education about healthy eating has been shown to significantly reduce childhood obesity, even in a short period of time observed with primary school interventions (Manios et al., 1999).  And when nutrition education is paired with skills to change lifestyle behaviors, that is the key to long-term healthy behaviors (Brownell & Kaye, 1982).

 

Nutrition Education:  Practically all public schools have a nutrition education program, and over 50% of all school districts or states have requirements for students to receive nutrition education.   Yet the amount of nutrition education needed to make a difference is about 50 hours, and schools programs had a mean total of 13 hours of nutrition education per year (2015).  Some students with chronic diseases are constantly missing school, if not home schooled where they are receiving zero hours of nutrition education due to their being no requirement for home-school teaching.  Therefore, when in the hospital, nutrition education should be taught to such children.  Although they are suffering from an illness, they should still be learning about nutrition for symptom management and to provide their body with the best nutrients in their adverse condition.

 

Children with Chronic illnesses: Healthy eating is especially important in children who have illnesses that are not due to lifestyle factors.   Because such children already have health barriers they need to over-come in daily life, healthy eating habits are crucial to allow their body to grow and develop to the best of its ability (2015).  There is no policy that children should be taught nutrition education while hospitalized for an extended period of time.  In fact, children often feel afraid when entering a hospital setting due to a lack of knowledge of what is happening with their body (Salmela et al., 2009).  Children with chronic diseases are at high risk of developing depression (Bennet, 1994), perhaps due to the perception that they lack control over their ailing bodies.  Therefore, having nutrition education programs would allow the child to feel as though they are learning about their body, and how to make themselves feel better.  Allowing the child to feel as though they are in some control of their body, by empowering themselves via knowledge about nutrition can help improve their mental health, as well. 

 

Program Description: A nutrition education program will not only take the child’s mind off of their illness, but he/she will be getting educated while in the hospital setting in a fun way. Kids will be kids and want to engage in fun activities; such activities will alleviate “white coat syndrome” children often develop, making them fear doctors and other healthcare professionals (Sine, 2008).  Therefore having the children interact with healthcare professionals in a fun manner will decrease their chances of developing, or lessen their symptoms, of white coat syndrome.  A nutrition program in hospitals will also promote healthy eating outside of the hospital.  Dietitians are available to the patients in the hospital, however when outside of the hospital, kids need to be equipped with the knowledge and skills necessary to make healthy decisions about their diet.  This program will equip children and their caregivers with the skills needed to choose nutritious foods.

“Courageous Cassidy to the Rescue!” nutrition education program will teach children about nutrition in a fun, engaging manner.  Each lesson will consist of a story about a superhero, Courageous Cassidy, fighting “evil,” which represents characters symbolizing feelings or general illnesses that can make a person feel tired or weak.  The first week’s story will be about vitamin C and how that vitamin can ward off the common cold and flu.  The second story will be about vitamin B keeping one energized, the third story about being strong with calcium, and the last story talks about how garlic and other foods can help circulate blood around the body.  After the story, there will be an activity to reinforce the information that was taught, and to empower the children to feel as though they can be their own superheroes by battling their way to make healthy decisions when eating.  The kids participating in the program will perform a taste test after the story about vitamin C with foods like kiwi and papaya.  Then the children will color and cut out foods that contain vitamin C and paste them onto a MyPlate template.  For the vitamin B activity, the kids will perform a craft using potatoes, since potatoes are high in vitamin B.  Specifically they will make potato “monsters” using half a potato as a sponge applicator with paint for the potato body.  If children are older they will complete a word-search that contains foods high in vitamin B.  There will be another craft for the calcium lesson where the children will make a cow mask or doorknob.  Then for the last module on foods that help with circulation, children will use their senses to smell garlic and ginger, taste dark chocolate, feel and taste avocado, and complete a maze to help find such fuels for the body, if age appropriate.  All activities can be modified depending on the age of the participant(s).

To further help reinforce the behavior the child will receive a sticker chart with stickers that the parent/caregiver will have control over when at home.  Once a child gets three stickers, the child will receive a prize.  The prize will consist of a stuffed animal that is a fruit or vegetable, a chance to play their favorite game, a coloring page, a pencil with fruits on it, an eraser in the shape of crops, or time to read their favorite book.  Performing the sticker chart will help gauge if the children are understanding and practicing healthy behaviors while completing “Courageous Cassidy to the Rescue.”  However, there will be pre and post surveys given to the child, as well as the healthcare professional, to also evaluate the program’s success.

 

 

 

Logic Model:

 

 

 

 

 

 

 

 

 

 

 

 

 

           

 

 

           

 

            The inputs for this program include the resources that are needed to plan, implement, and evaluate the program.  In order to create and design the educational story, technical assistance will be needed by PhotoShop.  A printing source will also be needed, such as the library printer for various activities for the children and the stories.  The educational room at the NIH will have to be reserved in order to bring the child out of his/her hospital room, and feel as though they are getting a break from the hospital setting in a non-medical environment. 

            The outputs for this program will be the educational information incorporated into the story.  The story will provide the child with information on how to choose healthy food options when they encounter different scenarios, for example if a person needs energy determining what foods he/she should consume, as well as the skills to accomplish such tasks.  This will then include a fun activity at the end of the story to reinforce the information presented to them via the story.  This program will also allow the child to build a relationship with a health professional at the hospital, without speaking to him/her about their health adversities.  The relationship that will result will allow the child to have a voice when a dietitian or nutritionist comes to talk to him/her about their food intake.  A parent(s) or caregiver will be encourage to sit in on the lesson so the child feels supported when learning new information about healthy eating.  It would also be beneficial for them to understand what the child is learning and behaviors to reward via the sticker chart.

      The short-term outcomes will include change in awareness and knowledge of the program to the National Institutes of Health Pediatric Unit, the Nutrition Unit in the Clinical Center, the participants’ families, and the participants.  In addition to knowing about the program, the child participating in the program will change his/her attitudes towards healthy eating once learning from the story how nutritious foods can fuel the body.  Once the children’s attitudes are changed, they will acquire the skills to apply the information learned to his/her every-day lives, even outside of the hospital.  During this program, children will be socializing with a healthcare professional in a non-medical way.  Having the child perform fun activities with a dietitian will allow them to build a bond with him/her so they will feel comfortable asking about their diet, what foods they should eat, or simply talking with them about their consumption.  The increased communication will help to increase the child’s confidence with interacting with others, and being proactive about eating healthy.  The child’s social environment will also increase by having support from a parent(s) or caregiver that will also be present in the lesson.

A mid-term outcome will be increased awareness of food consumption, increased participation in healthy food selection, and family support with possibly role-modeling trying new foods or eating healthy foods.  One of the long-term outcomes of the program will have the child feel empowered over his/her body through healthy eating, even though they have an uncontrollable chronic disease or illness.  Children will transcend the information they acquire during the lesson to their lives, both inside and outside of the hospital.  The child should have an easy job trying to implement eating healthier by having family participation in the child’s new healthy food habits.

 

Theory-Based Framework for the Program:

 

            The program will specifically aim to change the attitudes and behaviors of the child, and will therefore follow an Intrapersonal Level Theory.  The specific theory the program is based on is called the Social Cognitive Theory (SCT) (Bandura, 1998).  This theory roots in the belief that reinforcement and observation can shape behavior.  Vicarious reinforcement is one aspect of this theory, which is when an individual observes somebody else performing a behavior, and getting reinforced for behaving in an appropriate matter.  Self-reinforcement is also a component of the SCT, which is when a person keeps records of his/her own behavior, and is rewarded when performing such behavior.  If one is to perform such behavior he/she first needs to be notified such behavior exists, and acquire the skills on how to perform such behavior.  And once taught that behavior, the individual needs to feel as though they are able to perform such act, known as self-efficacy.  Self-efficacy is a belief in oneself that he/she is competent enough to perform a desired behavior.  Having self-efficacy can build to efficacy expectations, which means that the person feels as though he/she can perform a behavior under any circumstance.  In order for this to occur, the individual needs to believe he/she is capable of performing the behavior, and that the behavior will benefit his/her well-being (McKenzie et al., 2013). 

This theory uses reciprocal determinants in explaining what influences one’s life; the person, the environment, and the behavior all influence each other and shape the person.  These relationships are dynamic and are impactful to one’s behavior change.  In conjunction with recognizing how the person’s environment can shape one’s acts, a person’s locus of control is crucial when trying to make a behavior modification.  When a person feels in control of his/her internal locus of control, that individual feels in control of their actions (McKenzie et al., 2013). 

The SCT theory is appropriate for this program for many reasons.  First, the theory says that reinforcement of a behavior will solidify the actions with a person.  Therefore, the story in conjunction with the activities will reinforce the nutrition information to the child, as well as using vicarious reinforcement with the superhero acting towards the observational learning process.  The children will see the superhero acting a certain way in order to feel better and “fighting evil,” and the children will observe the superhero’s healthy actions.  Throughout the program when a child does eat a nutritious food, he/she will write down the food that he/she consumed (or have the parent/caregiver if the child is too young), and will be rewarded for such actions.  As part of the program, a child will receive a sticker for demonstrating a healthy behavior, such as choosing to eat a nutritious food.  To further reward the child for the healthy behaviors performed, after so many stickers, he/she will receive a special prize.  The caregiver will be in charge of giving the child a sticker when he/she chooses to eat a nutritious food, and the caregiver will report to the healthcare professional when the child has reached his/her quota for a prize.  After receiving many stickers throughout the program, the child will start to gain self-efficacy, and confidence in eating nutritious foods by proving to themselves they can do so.  Then when enough confidence in the child build, he/she will be applying the knowledge and skills taught to them to any environment or situation they are in and exhibit efficacy expectations.  The SCT helps provide a framework to empower the children in having control over their bodies via nutrition.

 

Goals:

            The goals of the program are as follows: improve child’s awareness of healthy food items, increase child’s knowledge of what different foods do for the body, provide the child with skills to accomplish eating healthier foods, promote healthy eating in all environments, reduce negative psychological thoughts about child’s control of his/her body, increase child’s confidence in a medical setting, and improve the child’s social environment. 

 

Goal 1: Improve the child’s awareness of healthy food items:  The story will provide the children about eating healthy while making them aware of what foods are considered to be “healthy.”

 

Goal 2: Increase the child’s knowledge of what different foods do for the body: The child participating in the program will be educated on a variety of healthy foods that provide the body with different things, such as energy, vitamins, minerals, etc. 

 

Goal 3: Provide the child with skills to accomplish eating healthier foods: The story will facilitate the learning of such information as well as provide the child with how to go about choosing nutritious foods.  Furthermore, the activities that the program delivers will help solidify the knowledge and skills learned. 

 

Goal 4: Promote healthy eating in all environments: To reinforce that the behavior should happen in various environment, the caregiver will be instructed to give the child a sticker after performing a healthy behavior, such as eating a piece of fruit or trying a different vegetable.  Having a person watch over them outside of the hospital setting will encourage them to perform such behaviors in order to receive a sticker.

 

Goal 5 and 6: Improve the child’s social environment and increase child’s confidence in a medical setting: By having the child socialize with another human being besides their doctor or family members will allow the child to improve his/her social and mental health, which is important when being in a medical setting.  This will also allow the child to not fear health professionals especially when in a hospital setting.  Children with chronic diseases often become anxious when seeing a white coat, but having increased positive reactions with health care professionals can lessen that anxiety.

 

Goal 7: Reduce negative psychological thoughts about child’s control of his/her body: People with chronic illnesses often feel as though they do not have control of their body, or sometimes have negative thoughts about oneself since they have many health problems.  However, this program will provide people with the confidence they need to feel empowered with their own body, and to feel as though they can help themselves from becoming obese or having other health issues due to a poor diet.  Childhood obesity is a worldwide epidemic, and is of special concern for children who already have an illness.  The body is working hard enough to combat the illness or disease, and the body needs the proper fuel in order to perform optimally.

 

Objectives:

 

Process Objectives: Before implementation, feedback will be received after presenting the program to the nutrition department at the NIH Clinical Center.  Being able to use a space in the NIH will be a process objective, as well as the actual presentation of the program.  The book that will be read to the child will exhibit adequate resources for the implementation of the program, as well as the activities and handouts that will be given to the child.  Some other process objectives will be the attendance of the child participants, as well as a parent or caregiver.  This will be tracked by the number of sessions that are held with the participants.  Throughout the program, the implementer will track the different lessons that were performed and how well the information resonated with the child.  Then after completing the program, the data collection of how the program impacts the child’s life will be evaluated.

           

Impact objectives: The stories will model specific behaviors that reflect eating nutritiously.  For example, the superhero may have to go buy oranges at a fruit stand in order to receive Vitamin C in order to fight the “Big Bad Flu.”  Furthermore, the story will have learning objections for each lesson, as well as skills, which provide behavioral objections.  Increasing the child’s awareness will lead to improving his/her knowledge and attitude toward developing the skills to eat nutritiously.  The superhero will consume various foods as a healthy behavior that allows her to fuel her body with proper nutrients.  Seeing the superhero perform such healthy behaviors will show a behavioral objective the child can mimic.  Adherence to the new adopted behavior will be tracked by the caregiver giving the child a sticker for his/her sticker chart in order to reward the child for good behaviors.  Furthermore, having the supportive interactions with the caregiver, as well as the implementer of the program will improve the child’s social, psychological, and service environment.  Engaging with other health care professionals in a fun way can help the child feel social while still being educated.

 

Ultimate objectives: To empower the children to feel as though they have some control over their bodies via nutrition, even though they have a chronic disease or illness.  Making the child aware of how to eat healthy, and increase his/her consciousness of how certain foods can do different things in the body will help teach the child how eating fruits and vegetables can fuel their body with nutrients.  This program will reduce the risk of children becoming obese and acquiring health issues due to a poor diet.  The objectives of this program reflect those of Healthy People 2020 due to reducing obesity in children and adolescents, increasing fruit and vegetable consumption in people aged 2 years and older, reduce consumption of calories from solid fats and added sugars, and to reduce the consumption of saturated fats in people 2 years and older.  This program will give children other options, and show them that healthy eating can be just as delicious as other non-nutritious foods (2015).

 

SMART Objectives for Goals:

1. Increase the child’s knowledge of at least one fruit or vegetable, and how that food can improve the body with every weekly lesson performed by the dietitian in the NIH teaching room.

2. Increase the child’s consumption of fruits/vegetables to at least 3 per week, during implementation of the program.

3. Increase the child’s self-efficacy and confidence by 5% after completing the 4 week program.

4. Increase the child’s voice when interacting with healthcare professionals by 20% after completing the 4-week program. 

5. Reduce the risk of obesity of the children participating in the program by 5% after completing the 4-week program.

           

Implementation Plan:

Stakeholders: The National Institutes of Health (NIH) will be a direct stakeholder of the program, as well as the Nutrition Department within the Clinical Center of the NIH.  The Nutrition department, will help implement the program and be recruited as they are introduced to the program.  The Dietitians will implement the program when they go to visit their patients in the pediatric unit.  These people will be recruited by meeting with them to describe the program, the rationale, and general idea of the program.  Once the material for the program are created, they will be shown to such people for suggestions of improve and feedback.  The program materials will not be used unless approved by the NIH.

 

Space: The educational room within the pediatric unit of the NIH will be reserved for the program to take place.  I will arrange to have the room on days when I will be volunteering my time at the NIH. 

 

Staff: Once the program takes off, the dietitians will help implement the program on days I am not there if they want to continue the program after I complete my program of study.  I will need to coordinate with the teachers and other professionals who use the room when I can reserve the room for the program to be implemented. 

 

Program materials: The supplies for the program will be brought to the facilities, including the book and various handouts and activities that will be distributed to the participants during implementation of the program.  The materials for the activities will be purchased via a grant from the NIH.

           

Time line: The program will start in February 2016 and be for 4 weeks.  Then post-analysis of the program will be analyzed from March to May 2016.  Conclusions about the program will be made, as well as improvements that can be made to the program.

 

 

 

Marketing Plan:

            The stories developed for this program are the products that will be marketed as the basis for the program.  Such stories will be composed of health information to teach the children about healthy eating, while keeping them engaged in a fun story about a superhero fighting evil.  Some benefits of this social marketing program will allow the child to become more confident in interacting with healthcare professionals, as well as increase their knowledge of health information in a fun, interactive way.  The stories will also empower the children to mimic the characteristics of the superhero in making healthy decisions throughout their lives.  A chart will be given to the children, as well as the stories and activities, in order to track the children’s progress and reinforce his or her healthy behaviors.  Fruit and vegetable stickers will be given to the parent or caregiver to help track the progress of such innovations.  When a child reaches a certain amount of stickers, he/she will receive a prize that will be determined by the healthcare professional depending on the child’s age.  All products will be made and distributed to the participants during the program.

            The program will be free to the participants who are involved at the NIH.  Cost of the program for the NIH is low since it does not entail any special equipment, mostly consisting of products that can be printed on paper and objects that can be purchased from local vendors.  The participants in the program will receive great cost benefits by not having to pay for the program, and then having the program reduce medical costs in the long term.  If children learn about healthy eating habits while young, that knowledge will transcend into adult-hood and reduce their risk of adverse health effects that come from consuming a poor diet, such as hypertension and high blood pressure.  Therefore, in the long run it will save medical costs.

            Having the program implemented at the NIH pediatric unit will make it accessible to the children admitted.  When a program is implemented in an environment that the priority population is housed, it eliminates the traveling barrier from getting to the program.  This will lead to greater attendance to the program, and the program will be implemented when it is convenient for the child.  For example, while admitted to the NIH the children will have many tests and scans that need to be taken at specific times throughout their day.  Therefore, the program will take place when the child has down-time in their day to not interfere with their necessary medical attention.

            Regarding the promotion of the program, it will come from informing the children and more importantly the children’s parent(s) or caregiver(s) about the program and receiving consent from them first.  Once consent is received, a program schedule can be created when looking at the child’s schedule of procedures and tests.  The child will have a lesson every week, but to help reinforce the information the child will be given handouts and activities that will reinforce the information learned.  Also, having the reinforcement system of getting a sticker after performing a learned healthy behavior will also keep the child engaged with the program since those stickers will lead to a prize.  There is no current program in hospitals like this one since most hospitals have a short retention time for patients.  Since the National Institutes of Health is a Research hospital, many of the patients are there for an extended period of time.  During their stay, there are no healthy-education programs there, which is why this program is essential to implement.

 

 

 

 

Sources:

(2014).  Childhood Obesity Facts.  Retrieved from CDC Web site:

http://www.cdc.gov/obesity/data/childhood.html

 

(2015).  Healthy People 2020.  Retrieved from http://www.healthypeople.gov/2020/topics-

            objectives/topic/nutrition-and-weight-status/objectives

 

(2015).  Nutrition and the Health of Young People.  Retrieved from CDC Web site:

http://www.cdc.gov/healthyschools/nutrition/facts.htm

 

Bandura, A.  (1998).  Health promotion from the perspective of social cognitive theory.

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http://www.tandfonline.com/doi/pdf/10.1080/08870449808407422

 

Bennett, D.  (1994).  Depression Among Children with Chronic Medical Problems: A Meta-

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http://jpepsy.oxfordjournals.org/content/19/2/149.short

 

Brownell, K., & Kaye, F.  (1982).  A school-based behavior modification, nutrition education

and physical activity program for obese children.  American Journal of Clinical

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http://ajcn.nutrition.org/content/35/2/277.full.pdf+html

 

Manios, Y., Moschandreas, J., Hatzis, C., & Kafatos, A.  (1999).  Evaluation of a Health and

            Nutrition Education Program in Primary School Children of Crete over a Three-Year

            Period.  Preventive Medicine, 28(2),  149-159.  Retrieved from:

            http://www.sciencedirect.com/science/article/pii/S0091743598903887

 

Mayo Clinical staff.  (2015).  Disease and Conditions: Childhood obesity.  Retrieved from

            Mayo Clinical Web site: http://www.mayoclinic.org/diseases-conditions/childhood-

            obesity/basics/complications/con-20027428

 

McKenzie, J., Neiger, B., & Thackeray, R.  (2013).  Planning, Implementing & Evaluating:

            Health promotion programs.  Glenview, IL: Pearson Education, Inc.

 

Salmela, M., Salantera, S., & Aronen, E.  (2009).  Child-reported hospital fears in 4 to 6-year-old

            children.  Pediatric Nurs., 35(5), 269-276, 303.  Retrieved from:

            http://www.ncbi.nlm.nih.gov/pubmed/19916342

 

Sine, R.  (2008).  Fear of doctors and tests can hinder preventative health care.  Retrieved

            from WebMD Web site: http://www.webmd.com/anxiety-panic/features/beyond-

            white-coat-syndrome