The feasibility of a nutrition screening tool to improve food habits of Pacific pre-schoolers : a co-designed study : a thesis presented for the partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany Campus, Auckland, New Zealand
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2024
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Massey University
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Abstract
Aim: To collaborate with stakeholders (Pacific Heartbeat and parents/care givers of Pacific pre-schoolers) in a co-designed feasibility study to assess the acceptability and use of the NutriSTEP nutrition screening tool to improve Pacific pre-schooler eating habits. The aim was to assess the appropriateness of the NutriSTEP questionnaire items with end-users’, to discuss potential adaptations, scoring methods and recommendations for use of the NutriSTEP tool in the community. Methods/Design: The co-design method involved extensive discussions with the Pacific Heartbeat stakeholder team to plan the engagement with end-user groups (Pacific communities). Five focus groups were undertaken across communities in Auckland (N=38 participants, mean age 38±10.9 years, 36 females, 2 male) who were parents/carers of Pacific children between the ages of 2-5 years old. Participants completed and provided feedback on the NutriSTEP tool in focus group discussions. Key findings were collated and presented in a final focus group with representatives from the previous round of focus group participants. Discussions enabled the approval of recommended changes for use of the NutriSTEP tool prior to community implementation. Results: Half of the participants were born in New Zealand with the remaining half born in various Pacific countries, nine participants had a tertiary education while 15 participants preferred not to comment, and over half (58%) of the participants used a first language other than English. Focus group discussions revealed six main themes: 1) The NutriSTEP tool is exposing and eye opening and raised awareness of daily habits, highlighting areas for improvement. 2) The opportunity for parents/carers to self-score the tool to clearly identify nutrition risk level outcomes was preferred. 3) Several proposed wording changes were needed to improve the clarity of questionnaire items. 4) Food group items were ambiguous and needed inclusion of cultural foods in item examples (e.g. taro and cassava in vegetable group). 5) Items related to food habits created a sense of embarrassment and judgement and highlighted the importance of community screening in a supportive group environment. 6) Physical activity, weight and growth items needed reframing to encompass a cultural perspective. Conclusions: The NutriSTEP tool was acceptable for the most part by the end-user groups. Amendments were needed for specified items to improve cultural acceptability and understanding. Groups sessions for completion of the tool was recommended for successful implementation in the Pacific community. The tool increased parent/carers awareness of nutrition related habits, and highlighted areas for improvement. The development of culturally appropriate resources to enable improved eating habits for Pacific pre-schoolers at all levels of health literacy was identified. Post tool completion resources will include material suggested in this co-designed study to increase knowledge around nutrition related topics.