April 2014 Question #2
Numerous barriers to making changes were mentioned in this study including unsafe environments for physical activity, lack of time or knowledge in regards to preparing healthier foods, and higher costs of healthy foods. What strategies would you use to help patients overcome these barriers?
posted by Unknown @ 10:54 AM
28 comments
28 Comments:
I would tell the parents to make good use of their time outside of the home. I would encourage them to take advantage of their breaks or lunch hour at work to go for a 10 or 15 minute walk. I would encourage them to look into different community centers or organizations that support families like theirs to be a valuable resource for them. I would emphasize planning for these families as well. Finding recipes, making detailed shopping lists, and planning out their physical activity and maybe once a week trying to go to a park as a family.
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I would provide the families with quick and easy recipes they could prepare. I would also gladly go on a grocery store tour with them to show them how to shop smart to reduce their overall costs. As far as exercise I would challenge them to become creative. Some ideas would be to create a relay race inside, have a dance contest, or go to a local park to play games and be active.
I would suggest after school sports, finding safer places to walk such as community parks or hikes, or even doing exercise programs in the home together. Getting up early and preparing breakfast and lunches can become an easy routine. Making large quantities of meals and portioning them out also saves time for later. Buying healthier foods in bulk and in season are ways to avoid higher costs. Starting a garden if there is available space could also be an option.
These barriers can definitely make sticking to a healthy lifestyle difficult. I would encourage these families to take advantage of resources available to them and look for ways to be creative when thinking about being healthy. While the neighborhood itself may be unsafe, most cities have community centers where children and adults together can participate in physical activity. As for the cost of healthy foods, a good strategy might be to shop for foods in season, go to local farmers markets, and use coupons for produce and other grocery foods. It may take some extra effort and be difficult at first, but improving their health will be worth it.
I also like Erin's idea of providing families with quick and easy recipes to prepare. I think the biggest obstacle that families face when trying to prepare healthy meals is that they don't know where to start when planning their grocery shopping. Giving these families samples of what healthy meals look like may help them to feel more confident about what good foods to buy and cook with are.
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I would focus on teaching the child and parent Problem Solving skills. I would first ask the child to identify one specific barrier that they are interested in working on. I'd then ask them to brainstorm some creative ways to overcome that barrier as a team with me and their parents. Together we could write the ideas on a sticky notes and select an idea that everyone likes. The child may then select the solution he or she is interested in implementing. All parties sign a contract to remind them of the goal and then plan follow-up.
I also really like the suggestions that Hayley shared. Getting the child and parents involved with the local Parks and Rec group is a great way to increase physical activity in a safe and fun environment.
For physical activity, I would suggest purchasing a workout video that come be done in their own living room. Also, something as easy as walking around their home during TV commercial breaks could make a difference.
Everyone seems to own a smartphone now a days so watching a cooking demonstration online (or even looking up recipes) could be a good teaching tool. Grocery store tours would be a great asset too. Emphasizing crock pot meals or ahead of time prep for freezer meals would be something positive to talk about.
If they think that all healthy food is expensive, I would show them prices of canned and frozen fruits and vegetables. Providing them with a list of when fruits/vegetables are in season would help them find good prices also.
Jessica brought up a great point about taking advantage of work breaks/lunches. So many people use that time to surf the internet, however they should be getting up and moving. Explain to them the boost of energy they can get just by going on a short walk. Haley mentioned getting up early to prepare a healthy breakfast and lunch which is a great idea. Preparing lunch the night before would be an even better suggestion!
As far as unsafe environments are concerned, I would suggest looking up a community resource such as a YMCA or community center in their area that the kids can just go walk the track or play basketball or get moving in some way. I also agree with what has been said by a few others about purchasing healthier options in bulk and in season to cut costs, as well as using resources such as coupons. I think not being able to eat healthy on a budget is a common misconception that people have but there are definitely ways around this. Even buying canned or frozen vegetables over fresh is a better option than some of the processed foods, and Erin mentioned taking them on a grocery store tour to show them how to do this, which I think is a great idea.
Many unsafe areas have community resources such as a Boys & Girls club, YMCA, or a recreation center where kids can go after school to be active, so I would encourage & help them to find out what their local resources are. The kids could even get involved in sports clubs after school. If these aren't options, I would work with them to find things they could do inside their home or apartment complex. If they have stairs, they could come up with some kind of game or contest involving that. If they have video games, something like Wii Fit would be a better option.
As for knowledge of healthy foods, I would give them guidelines to use when they shop, such as sticking to the perimeter of the store, looking for less than 10 ingredients in the things they buy, & sticking to less processed foods. Places like Walmart & aldi's have affordable options for fresh foods. I would also see if they are tech savvy or use things like apps where they could get ideas for recipes if they haven't cooked a lot before.
Lynetta, I really like the idea of letting the child choose one barrier at a time to work on. This is a valuable tool Chicago Children's uses in their cystic fibrosis unit and from what we saw at the peds conference it looks like it is very effective. I think it is a huge deal for kids to have choice, because they are so used to everyone telling them what to do all the time.
I would encourage the family to do physical activity together in their backyard or a local park. They can play games together such as wiffleball or kickball. If those places are unsafe I would encourage them to look into local organizations where they may be able to go together to do these activities. If their after school/work routine is to come home and watch TV, I would provide them with activities they can do to encourage more physical activity. I would also ask for input from them on activities they feel they can do together. They may be more willing to try the activity if it is their idea rather than mine. The best way to improve the knowledge of preparing healthy foods is through education and food demonstrations. Showing them how easy it can be to make healthy foods/meals for their family may encourage them to make changes. Providing them with several recipes as well as resources where they can find more may also be helpful for them.
I think Erin has a great idea about doing a grocery store tour. Going to the store and actually showing them how to shop for healthy foods on a budget may be a helpful step towards eating healthier.
To help overcome the physical activity barrier, I would suggest what many others already have...to find a program like a Boys and Girls Club, YMCA or an open gym at the local school. Additionally, families could do things like stick to exercising during the daylight in public places, such as on weekends. If it really is that unsafe of a neighborhood, the parents would be more inclined to go out and perform the activities with their children (hopefully). This could be a blessing in disguise, as this gets the entire family moving and also allows for quality time together.
As for foods, meal planning and finding simple, easy to make recipes (like casseroles, chili recipes etc.) that can be eaten as leftovers would be key. Cooking when their is time in the week such as on a Sunday would be of great benefit for the rest of the week, as the family has food pre-made and ready to go. Investing in tupperware (which can be cheap if purchased correctly) would be a great choice for storage of food and also to make the food more portable.
While the notion that healthier food is more expensive is common, it's not necessarily true. I would talk about ways to incorporate healthy foods that are also affordable including whole grain products (rice, breads), low-fat dairy, and fruits and vegetables (canned and/or frozen can save money). I would love to take a client and his/her family to the grocery store with a calculator and a notepad to see how far we can "stretch" their current budget with healthier food choices. I think many clients would be shocked to see how affordable it can be if done correctly.
I agree with everyone who talked about potentially setting up grocery store tours, that's a fantastic idea. Hy-Vee, which is a big grocery chain based in Iowa, is coming here to Bloomington-Normal in 2015. They offer grocery store tours led by an R.D. and they are quite informative and popular.
If families don't even know how to navigate the grocery store, that makes all other recommendations and advice all the more difficult to adhere to...kind of like if families don't know how to read labels, it just makes everything else so much tougher to implement. So, basic skills like grocery store tours are definitely a solid idea and would be beneficial for anybody who'd like to learn more about how to shop effectively!
I think that it can be very hard for families to get enough physical activity together and that there's a huge notion of healthy eating being more expensive. I think that's just part of the education we have to provide these families. As far as food costs go, there are healthy cheaper options, however, what is hard is changing the families habits and taste in food. It took them years to develop what they're used to and are willing to eat, so you can't just go in and switch out their pizza and burgers to tofu and carrots. I think there's a lot to behavior modification and readiness before any of the great ideas we have can even sink in. This article was about families with hispanic background, so that also adds a culture aspect we have to respect and understand.
I like Haley's ideas of joining after school sports, but my concern would be that those sports cost money. If we're talking about low-income families, this could be a problem. Susan brought up a good point about community centers. These could be useful as long as families have a way of getting there. I worked with the Boys and Girls Club in Bloomington,IN and they made it a point to keep the children active and educate them about fruits and vegetables. It holds a dear place in my heart and it's great to see these families getting the help they need.
Regarding unsafe environments for physical activity, like others, I also immediately thought of YMCAs or other organizations that allow families to be physically active together in a safe environment. Regarding lack of knowledge for preparing healthier foods, this is where R.D.s come in! Educating families about healthy foods, and even doing cooking demonstrations would be great ways to increase families’ knowledge of how to prepare healthier foods. To address lack of time for preparing healthier foods, I would suggest making crockpot meals or doing food prep on the weekend when people often have more free time. Getting the entire family involved with food preparation not only will make it go more quickly, but children will be more likely to eat healthier foods if they get involved with the preparation and cooking process. Regarding higher cost of healthy foods, I would suggest the family look for sales, buy what is in season, and buy in bulk. Also, choosing less expensive proteins like beans instead of expensive meats is a great way to increase nutrition and save money at the same time. I would suggest a family do a “Meatless Monday” meal every week.
I like Lynetta’s suggestion of writing down potential barriers and thinking of ways to overcome them. If families prepare for problems before-hand, then they can avoid them from happening. For example, if a family’s barrier is lack of time to make healthy meals, perhaps creating a weekly meal plan and doing prep work before-hand could be one way to avoid the problem.
For high cost of healthy foods, I would do a grocery store tour with the family. It would be individualized based on what they usually buy and what they would be willing to change. Suggestions would be frozen fruits and vegetables. They are inexpensive, can be bought in bulk, and take little time to prepare. If they lack the time and knowledge, I would provide recipes that are quick and simple to make, that even the children could help with. When it comes to physical activity, I would first inquire how much screen time happens on a daily basis and challenge the family to try a few hours less each week. Even playing games in the house, or doing arts and crafts burns more calories than sitting in front of a TV or computer.
Clearly, Lynetta's idea is great, it has been proven to work! I would use it to have to family identify barriers to physical activity and we could all come up with suggestions on how to overcome these barriers.
If they think they are lacking time or knowledge for preparing healthier foods, we have to start by trying to show them that it doesn’t take as much time as they think. Provide recipes that make a lot of food in a little amount of time. Show them cost comparisons on healthy recipes so they know it doesn’t have to be a financial burden to eat healthy. If they lack cooking skills, then give them some simple recipes to start with or even some links to youtube videos that could help them gain a few kitchen skills. There are a lot of free resources that will help parents feel more comfortable in the kitchen.
I think it would be important to only focus on one or two barriers at a time. For instance, I would make my first goal to overcome the barrier of lack of time. I could arrange a cooking class emphasizing quick family meals.
Anna J said:
There is a lot of physical activity that can me done in a small space, inside and without a lot of equipment. Simply jumping around, playing Simon says or dancing to music could be a fun inside physical activity where a lot of space would not be needed. Providing ideas for parents of simple inside activity ideas could be helpful. I think providing recipes and teaching cooking techniques to parents would be important and could be taught one to one or in a group setting. Healthy food can be a little more expensive, but there are less expensive healthy options that could be emphasized such as frozen vegetables, beans, lentils, whole grain pastas, or oatmeal and the importance of spending money on healthy food as money is available could be emphasized as well. Planning ahead, looking for bargains and buying food on sale could help save money. Meeting the family where they are at and cheering on even small positive changes could be helpful to encourage additional healthy changes.
Anna J. said:
I think Erin's comment to focus on low cost items in a grocery store tour is great. A lot of times I think about focusing just on the healthy options in a grocery store tour, so also focusing on ways to decrease cost would be a really good fit for parents who do not have a lot of money to spend on food.
I would educate the families about how o shop on a budget and how to make cheap, quick, and healthy family meals. One method is by batch cooking on Sunday or prepping crock pot meals and freezing until needed. As for physical activity, getting the kids involved in after school programs, sports, and joining the YMCA as a family are some good choices. Really just emphasizing moving is key. Doing chores and any activity that doesn't involve the kids sitting on the couch will be beneficial.
I agree with Carly that making lunches the night before is an easy way to prepare a healthy meal for the next day. There are also recipes like overnight oatmeal that you put together the night before and will be ready to eat for breakfast.
When it comes to physical activity, it's important to find something that works for the parents and the kids enjoy doing. There are lots of options, both indoor and out, that can be done at home or elsewhere. Talking it through with the parents can help them determine which barriers are surmountable and help identify the type of exercise that is right for them and their kids.
I think many people who struggle with preparing healthy foods don't understand how to get from what they currently eat and know they like to what they are told is healthy for them to eat. I think we need to teach them how to find recipes that fit their budget, cooking skills and taste preferences, as well as being good for their family's health.
Safety for physical activity is definitely a high priority and I think it is important to meet clients where they are and really help them overcome their specific barriers and brainstorm with them for what they feel would be attainable goals. Time, cost, and availability is also a difficult challenge. Again, figuring out what clients barriers are and brainstorming what individual options are for their situation. Increasing awareness for specific services they may benefit from such as food programs and other services. Encouraging parents to use their time with their kids to be active instead of watching TV or other screen time after dinner is also an idea to increase physical activity. I think there is always time in the day that people have available for physical activity (that they just don't utilize) so maybe talking through the day with them to determine where they have time that the client may not realize could be a perfect time for them to get active.
I also like the idea of using lunch hours for walks and providing recipes to families.
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