LOGIC MODEL Worksheet (Table format)



NUTR 461, Assignment 1

Program Planning Worksheet, Focus on Elderly (Meals on Wheels)

Fall 2013

Background: You are a community nutritionist at the Department of Social Services serving the fictitious city of Jeffers. A community assessment of the elderly population has recently been conducted by your organization to direct nutrition-related programming for the fiscal year. It is your job to develop an intervention to address findings of the needs assessment. For the purposes of this assignment, you can focus on one or two of the findings to address in your programming.

1. Review results from community needs assessment.

The city of Jeffers has a population of 434,000. This is 71% of the total metropolitan area population (that is, Jeffers plus four adjoining municipalities). The number of older adults > 75 years living in the city of Jeffers is 60,760 (14%), an increase of 12% since 2000. More than half (56%) of these older adults are living independently, typically in their own homes or apartments, and of those, 11% qualify for home-delivered meals. Over 80% of MOW participants in Jeffers have some form of chronic disease that can be improved by nutrition intervention (e.g. diabetes, hyperlipidemia, and hypertension). A recent cost-benefit analysis found that the cost of a one-day hospital day was equal to one year worth of home-delivered meals.

The overall nutrition status of the 3,742 Meals-on-Wheels (MOW) participants is fairly good, but several key nutritional findings emerged:

• Compared to non-MOW participants, food insecurity was lessened and nutrient density increased for MOW participants.

• Approximately 7% of the Jeffers senior community are food insecure, with >65% of MOW participants at high nutritional risk.

• Women, African Americans, low income, and limited education individuals were less likely to meet RDA requirements for key nutrients, such as vitamin B12, calcium, vitamin D, magnesium, and vitamin E.

• Approximately 1 out of 5 meals provided by MOW go uneaten by participants.

• On average, 38% of MOW participants do not consume breakfast.

• Approximately 88% of MOW participants had little to no knowledge of their nutritional needs.

• It is estimated that at least 9% of MOW participants qualify for nursing home care but are unaware.

• Approximately 90% of MOW participants enjoyed the social aspect of the service.

• Over 45% of participants agree that MOW has helped improved their health.

Fewer than one in five (18%) use community-based services such as personal care services, homemaker services (assistance with meal preparation), and adult day care.

The number of independent older adults living in Jeffers who participate in federal assistance programs are shown here:

PROGRAM Number (%) of Participants

SNAP 10,888 (32%)

Social Security 29,942 (88%)

Medicare/Medicaid 24,158 (71%)

Supplemental Security Income 4,083 (12%)

Delivery of health care and nutritional services has traditionally occurred through the state Department of Social Services.

Sources:

Boyle, M. A. & Holben, D. H. (2010). Community nutrition in action (6th ed.). Belmont, CA: Thomson/Wadsworth.

Bryant, M. (2011). The value and outcomes of Michigan’s home delivered meals for the elderly program. Southfield, MI.

Buchanan, S., Murray, B., Williams, N., Ennis, L. & Eckhardt, E. (2009). Best Practices, Meals on Wheels: A Needs Assessment, Final Report. Montreal, Quebec.

Frongillo, E. & Wolfe, W.S. (2010). Impact of Participation in Home-Delivered Meals on nutrient intake, dietary patterns, and food insecurity of older persons in New York State. Journal of Nutrition for the Elderly, 29(3), 293-310.

Sharkey, J.R., Branch, L.G., Zohoori, N., Giuliani, C., Busby-Whitehead, J. & Haines, P.S. (2002). Inadequate nutrient intakes among homebound elderly and their correlation with individual characteristics and health-related factors. The American Journal of Clinical Nutrition, 76(6), 1434-45.

Timonen, V. & O’Dwyer, C. (2010). “It is nice to see someone coming in”: exploring the social objectives of Meals-on-Wheels. Canadian Journal on Aging, 29(3), 399-410.

2. Part A. Set goals and impact and outcome objectives for the intervention. Indicate if each objective is an impact or outcome objective. Focus on the target audience. Consider changes in health outcomes, but also address the knowledge and lifestyle changes necessary to accomplish the changes in health outcomes. (8 points)

GOALS:

1) To increase the knowledge of the importance of breakfast

2) Increase the knowledge of the nutritional needs of the participants

3) Decrease the number of participants that are at high nutritional risk

OBJECTIVES:

1) To increase the number of participants consuming breakfast to 75% by the end of the year by providing them with breakfast for the next day along with lunch and a hot dinner (outcome)

2) To decrease the percent of participants that are not aware of their nutritional needs from 88% to 25% by the end of the year by meeting with a RD at least once to access proper needs.(impact)

3) Less than 25% of participants will not be at nutritional risk in the next year by providing them with proper nutritional choices and education to meet their needs. (Outcome)

Part B. Tie your program’s goal(s) and objectives with national goals/objectives. Indicate Healthy People 2020 objectives and/or Dietary Guidelines for Americans to which your program will contribute. (2 points)

A goal of Healthy People 2020 is to attain high quality, long lives free of preventable disease, disability, injury and premature death. My goals and objectives tie right into that goal because we are going to increase their quality of life by decreasing their nutritional risk along with giving them proper education. The goals that I have set forth fall under this national goal.

3. Design the intervention. Choose an intervention strategy. Describe the target audience, the level(s) of intervention, and the program format. Please include at least one strategy that focuses on either the community or systems level. Remember, you should focus on one or two areas of need identified in the needs assessment. Tie the program format to the goals and objectives. (20 points)

Program name: Meals on ALL Wheels

Target audience: Elders receiving meals on a regular basis and are at high nutritional risk

List program activities in the chart below to indicate the level(s) of intervention.

| |Individuals |Communities |Systems |

|Build awareness |Flyers at senior communities, |Running commercials on the nightly |Offer nutritional information on |

| |nutritional risk health screens |news, along with newspaper adds |all hot meals that are served |

| |with all participants | | |

|Change lifestyles |One on one nutritional counseling |Open nutritional forum at senior |Formation of a volunteer peer group|

| |with participants |centers |for these participants |

|Create a supportive environment |Give the participants a hotline |Offer an open meeting for |Legislation, express free meals for|

| |where they can ask questions |participants and families of |participants that are eligible |

| |regarding nutrition |participants held at a local | |

| | |facility. | |

Provide a description of each of the program activities listed above. Your description might include what program providers will do, who they will partner with, where activities will be held, etc.

When it comes to building awareness for individuals, posting flyers at senior centers and long with giving nutritional health risk screens to all the participants. As the nutritional assessment stated greater than 65 percent are at high nutritional risk. A health screen will lower this number by assessing the nutritional needs of each individual. Changing lifestyles as it concerns individuals we would offer nutritional counseling with each participant when they sign up. This will establish specific diets tailored to each individual. Creating a supportive environment by establishing a hotline during business hours for participants to call in if they have any questions regarding nutrition. This would have to be ran by people who have above average knowledge of nutrition.

Building awareness in the community could involve running commercials during the nightly news a long with newspaper adds. The elder population usually watches the nightly news so it would be good exposure if MOW could run an add during that. Same concept goes with the newspaper adds, this could build awareness of the services that MOW offers. MOW’s could offer nutritional forums held a senior centers. At these forums, it could be just about general nutrition and the people could come in with questions for the RD running the program. To create a supportive environment in the community, our program could offer open meetings held for participants and families of participants at a local facility. With the increase of age come different nutritional requirements, some people might not be aware of this. So these open meetings for the participants and the families could give great insight to the programs goals of optimum nutrition.

When it comes to building awareness for systems, a simple thing like putting nutritional facts on the sack lunches and dinners could be a huge change. I think that it would be very educational for the participants to see the ingredients that they are putting in their body. To help facilitate lifestyle changes, volunteers with the MOW program could be involved in peer groups for the participants. What this would entail is being there if the participant has a question about something or they do not require a meal for the say than they can contact their volunteer peer. Creating a supportive environment could involve expressing free meals for all participants. This could be established by holding month fundraisers in the community so that they are able to prepare the meals for the participants at a low to free rate.

4. Describe how your program will be evaluated. (10 points) Include a description of your formative assessment (this is what you do to test your proposed intervention prior to carrying it out. Also include process objectives. This will include a list of tasks you will complete to carry out the program (process evaluation tests if the program was carried out as intended, not if it is effective). You have already developed impact and outcome objectives for your program.

|Description of formative assessment |Process evaluation |

| | |

| | |

|For the formative assessment, we would send out a survey of potential |In the process evaluation issues such as how fluid the operation is |

|and current participants about nutrition needs and food security. Some|along with an emphasis on activities |

|of the elder might need assistant filling out this survey so we could |Administer a nutritional knowledge test to each participant that is |

|set a meeting at a senior center and assist them if need be. Questions|able to take it and the beginning of each program |

|such as |6 months into the MOW plan administer the same test and check for |

|Do you know where you next meal is coming from? |improvements in test scores. |

|Are you home bound? |Check if giving each participants 3 meals per day would be something |

|Do you have a medical condition? |that the participants would be interested in |

|Do you know your nutritional needs? |Make sure that participants are aware of focus groups built on the |

|Do you have a support system, such as family members or friends? |nutritional knowledge |

|All of these questions could help evaluate the program before it is |Provide a nutritional assessment for each participant at the beginning |

|implemented in the community |of the program and every 6 months after to see improvements in there |

| |status. |

| | |

| | |

| | |

|Impact evaluation |Outcome evaluation |

| | |

|(Should be listed as objectives for your program in #2.) |(Should be listed as objectives for your program in #2.) |

Program: Meal on ALL Wheels Logic Model

Situation: To increase nutritional knowledge of participants a long with decreasing the nutritional risk of the participants

|Inputs | |Outputs | |Outcomes -- Impact |

| | |Activities |Participation | |Short |Medium |Long |

|Assumptions | |External Factors |

|That participants will buy into the programs philosophy | |Families |

|That there will be enough resources to facilitate these changes | |Financial situations |

| | |Existing health conditions |

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