(2004, p. S147) These nursing interventions can like this work stress the implementation of a program that exposes adolescents to healthier alternatives and builds the efficacy for obtaining them through successfully seeking family behavior changes and building awareness about healthier options and food costing that make such options obtainable. What interventions have been successful and what interventions have NOT been successful?

It is clear that general nutrition education, in the schools or in the community has not been an effective intervention tool for children in general, especially given what some would consider the deplorable condition of the public school nutrition programs in most states. It is also clear that family focused interventions are rare, but where they have been tried they have proven most successful for the MA population. (Heiss, 2008, p. 475) Seeking to change the cultural understanding of obesity at the maternal and family level is likely one of the most important aspects of nursing intervention for MA adolescents

Ward offered a powerful set of options, coming from the perspective of the school nurse researcher:

By gaining a greater understanding of parental cultural beliefs and values, parenting styles, and acculturation in the Mexican-American community, the school nurse will be able to develop culturally relevant interventions for nutrition education in the school setting….Tyler (2004) explored the interest of overweight Hispanic children in making lifestyle changes to promote a healthy weight and found the children were interested in family-based interventions, such as & #8230;learning about healthy eating together as a family. School nurses should include family participation in many different school-based nutrition education programs. (2008, p. 412)

The development of an intervention plan with both short-term and long-term goals, surrounding family focused interventions is clearly the best and most logical evidentiary standard. (Tyler, 2004)

Planning

Plan Title: "Obesity Among Mexican-American Adolescents: Family Centered Nursing Intervention"

Short-Term Goal

A developed and implemented plan for an obesity prevention family intervention-based program for MA adolescents seeded in one middle school and continued in at least one community center or church. Program components include three strategies, first to introduce middle school classrooms to healthy eating through a demonstration and instructional session. Second strategy is to hold a four-week class involving families in buying, eating and cooking with better healthier options. The third aspect of the work plan will be to evaluate the outcome of the family intervention strategy.

Measurable Objectives

1. The conduction of a mini-introduction to culturally sensitive healthy eating and cooking in middle school classrooms in a single school with a high number of MA students, Cognitive

2. Enrolment of ten families with adolescents in a healthy low cost culturally sensitive healthy eating class, 8 weekly sessions. Consisting of recipes and education about alternative foods. Affective 3. Follow up questionnaire three weeks after close of class, discussing the nature of change in eating and cooking in the home, conduct by phone interview. Affective Objectives Summary

These three objectives involve the family in a change that is health related and specific to culture. The mini-introduction classes may get the individual adolescents thinking about how they cook and eat at home while the classes specifically involve the families and address the ability of the family to stretch its food dollar while still staying healthy and true to their culture. The objectives are specific, measurable, reasonable/feasible and clearly fit within the context of a community setting, they are also clearly understood and practical for the clients. The application of food buying techniques and healthier replacement options that are sensitive to culture, healthy, full of fruits and vegetables and fast and easy to make is essential to involving the family in a change action that will aide them in making better decisions in their own homes, for meals as well as bulk stored healthy snacks.

Budget

Table 1 Budget

Development+ Class Time

10 hours

Evaluation Questionnaire Phone Time

5 Hours

60

Classroom Intro Food Supplies Budget (Bulk Healthy Snacks) donated in kind from school lunch program

30 students per class x 10 classes

Primary prevention strategy to assess current eating habits, strategy will focus on a single bulk healthy snack (something in their individual scope) and introduce the opportunity of the student to the family healthy buying and eating class. This will begin by reaching the students at school and seeking out those with the highest need and desire for change. Secondary prevention will be an introduction to culturally sensitive healthy eating and cooking in middle school classrooms in a single school with a high number of MA students.
Goal 2. Primary Prevention strategy of enrolment of ten families with adolescents in a healthy low cost culturally sensitive buying and eating class, 4 weekly sessions to promote primary change in buying, cooking and eating more healthy foods. Secondary prevention strategy screening current modes of buying and eating and supporting primary change prevention strategy includes the information class emphasis on obtaining and using high numbers of fresh fruits and vegetables and lesser amounts of high carb/high fat foods and cooking meals in short time periods, all on a budget. This will be an applicable way to introduce the family to better ways of eating in a hurry and on a budget with recipes and examples.

Goal 3. The primary prevention of the goal will be to discussing the nature of change in cooking in the home, conducted by phone interview will assess the change outcome of the class intervention. Secondary prevention strategy is to assess efficacy of class using a follow up questionnaire three weeks after close of class, while it is still fresh.

Evaluation

Objective One

Primary intervention strategy will be measured by the completion of the class in one entire school, numbers of class exposures being 30x10 classes. Secondary intervention strategy will be the ability of individual students to demonstrate during the intro interest in change and family focused better choices.

Objective Two

Primary intervention strategy will be evaluation of appropriate responses and real potential implementation of behavior change, i.e. stated willingness to seek out and obtain better food choice options. Secondary prevention strategy will be measured by the ability of the student (families) to seek out better options with information on local sources, farmers markets, community gardens, low income food share programs.

Objective Three

Primary prevention strategy will be to review potential long-term success of the class, i.e. how often the recipes are used and if changes in other recipes have been made to better fit the high fruit and vegetable content and lower carbohydrate and fat options and ultimately if the resources offered are being used. Secondary prevention strategy will be to measure the outcome of the class on home cooking.

References

Heiss, G.L. (2008) Chapter 18: Health Promotion and Risk Reduction in the Community. In Maurer, F.A. & Smith C.M. eds. (2008) Community/Public Health Nursing Practice: Health for Families and Populations Philadelphia, PA. Saunders.

Flegal, K.M. Ogden, C.L. & Carroll, M.D. (July 2004) Prevalence and Trends in Overweight in Mexican-American Adults and Children. Nutrition Reviews 62 (7) S144-S148.

Fortmeier-Saucier, L. Savrin, C. Heinzer, M. & Hudak, C. (Third-Quarter 2008) BMI and Lipid Levels in Mexican-American Children Diagnosed with Type 2 Diabetes World Views on Evidenced-Based Nursing. 142-147.

Kumanyika, S. & Grier. S. (2006) "Targeting Interventions for Ethnic Minority and Low-Income Populations." The Future of Children 16 (1) 187.

Maurer, F.A. & Smith C.M. eds. (2008) Community/Public Health Nursing Practice: Health for Families and Populations Philadelphia, PA. Saunders.

Tyler, D.O. (Oct. 2004) Overweight and Perceived Health in Mexican-American Children: A Pilot Study in a Central Texas Community. Journal of School Nursing 20 (5) 285-292.

US Department of Health and Human Services Healthy People 2010 (2001) Retrieved June 1, 2010 from: http://www.healthypeople.gov/

Ward, C.A. (2008) Parental Perceptions of Childhood Overweight in the Mexican-American Population: An Integrative Review. Journal of School Nursing 24 407-416.