Community Intervention Project

The Food Group and Neighborhood House

February 21, 2016
Eman Kemp
Aramark Dietetic Internship

Overview
The Food Group is a non-profit food bank located in New Hope, Minnesota that
works to provide healthy food to people in need. They serve over 100 food shelves
across the metro area, each with their own demographics. Through donors and local
sourcing, The Food Group distributes healthy foods to their programs and partner
agencies either free or at a reduced cost. From there, families in need and facing
hunger can visit their local food shelf and obtain healthy and nutritious foods.
Though the demographics vary from food shelf to food shelf, they all struggle
with similar chronic diseases, a major problem being obesity To help inform clients, an
obesity toolkit was created for food shelves this specific display being advertised at
Neighborhood House in St. Paul, Minnesota. Through this display, clients were
educated on weight management, portion sizes, and what making healthy choices
provides for the body. The outcome of the display was that, through evaluation, 100% of
the participants were able to identify three of the six food groups to include throughout
the day and 86% of the participants were able to identify 2 health benefits from the food
groups. Limitations include that participants were able to view the display while taking
the evaluation. Included in the Appendix is a lesson plan, advertisement for the class,
picture of the educational display, handouts offered to the participants, and the
evaluation form.

Nutrition Assessment

Client History (CH)

Personal Data (1.1), Patient/Client/Family Medical/Health History (2), Social History
(3.1)
Neighborhood House is one of the many agency partners of The Food Group.
Neighborhood House is a multi-service agency that works to serve the low-income
community as well as new refugees through basic needs, health and wellness, and
continuing education. They help over 15,000 individuals each year find comfort,
consistency, and reliance in their everyday lives. The majority of the client population
includes Somali and Karen immigrants that have come to America within the last five
years as well as families of 5 or larger making less than $30,000/year. Oftentimes,
these clients dont speak English, have a limited understanding of basic life skills such
as grocery shopping, and come from underserved and impoverished areas. As long as
you live in the 55107 zip code, you may shop at the Neighborhood House market once
a month for you or family there are no restrictions or limitations though most families
tend to be low-income.
Along with a balance of nutritious foods from the market, Neighborhood House
assesses each family that comes through based on their needs and provides brief
counseling sessions. Some families come in with a host of chronic diseases and several
children to feed. Neighborhood House will produce a customized meal plan for each
family that is culturally specific and recommended to meet their needs and treat chronic

conditions, such as obesity. These are only a suggestion for families; they are not
required to follow the plan.
The Neighborhood Houses clients are very diverse. 58% of the clients are Asian,
(mostly Karen), 12% are African American, 17% are Hispanic, 7% are White, 3% are
Multiracial, and 1% are American Indian. 50% of the clients identified themselves as
female, 49% as male, and 1% as other. 37% of the clients are between the ages 23 and
54 years of age. Though 87% of Neighborhood House clients are below 100% of the
poverty level, anyone is able to shop at the Neighborhood House market and 1% of
individuals in the area that are above the 200% poverty level do. Because most of the
clients live below the poverty line, transportation to and from a grocery store can be
difficult. Oftentimes instead, these individuals have to rely on the unhealthy foods at the
nearby convenience shop and are not getting a balanced plate full of lean protein, low
fat dairy, whole grains, and fresh fruit and vegetables. Theyre feeding their families
calorically dense, highly processed foods full of salt, fat, and sugar. Some clients are
embarrassed of this and do not fully disclose all of the foods they eat during their
counseling sessions, so building an honest and trustful relationship with each client is
important to obtain all of the correct information from them.8

Food/Nutrition-Related History (FH)

Food and Beverage Intake (1.2), Food intake (1.2.2)
Food plays a central role in the Karen culture. Meals are traditionally eaten at 10
am and 4 pm. Bowls of rice, vegetables, fish, pork, soup, or curries are shared. Each
meal is small and considered medicinal for the body and soul. At weddings and

festivals, families tend to indulge and consume glutinous sticky rice as a delicacy
compared to traditional white rice. Karen people prefer to eat food that they have caught
and killed themselves, so hunting and gathering is popular in this culture. When food
production in the area is prosperous, the spirits of the land are considered happy. If
there is a famine or epidemic in the area, a ritual will be performed as to not further
anger the spirits and restore the land.1, 2, 5
Neighborhood House works to accommodate different cultures with foods they
are accustomed to eating. Though recommendations are made for them and their
health through personalized counseling sessions, clients are free to take any of the
foods in the market. There are designations around the market that specify how many of
each item a client can take based on family size. A volunteer walks around with each
client to help them choose healthy items and make sure theyre getting enough food for
the month. The food at Neighborhood House market is intended to be supplemental for
families, but because so many live below the poverty line, the food they receive at the
market is a large source of their nutrition each month.

Knowledge/Beliefs and Attitudes (4)

Beliefs and Attitudes (4.2)
There are two subgroups of the Karen: Pwo Karen and Sgaw Karen. Though
there are different sects of Karen, many Karen people identify as Buddhist, Christian, or
Animist. Each religion in itself believes very has very different view about life and moral
beliefs, but all believe in looking to a higher power than themselves for guidance
through life. Though faith might differ, there are several cultural practices that remain

the same between the Karen people. Food is thought to play a large role with overall
wellbeing and healing. In the Karen culture, there are concepts of hot and cold foods. If
someone is sick, its believed to be better for the body to eat foods that will make the
body hot, such as turmeric. At the same time, there are food taboos that should never
be consumed. For example, papaya is believed to trigger malaria and should not be
eaten under any circumstances. A person with hepatitis should avoid yellow foods as
they are thought to aggravate the body.2, 4, 6, 7

Behavior (5)
Adherence (5.1)
A common health problem amongst the Karen people is gastric ulcers, thought to
arise from a diet rich in hot chili peppers. Many are ashamed or embarrassed to seek
medical attention for such problems, so they dont. This has been found especially true
with female patients. Being direct is considered culturally rude and several American
physicians communicate with patients this way. In Burma where the Karen live, doctors
have a high social status and are separated from the common folk, so patients arent
comfortable asking questions. Many Karen people believe in Western medicine
practices and the health care system, but are skeptical to see a physician when arriving
in America because of these beliefs and many health conditions go unaddressed.4, 5

Factors Affecting Access to Food and Food Nutrition-Related Supplies (6)

Food/nutrition program participation (6.1)

Because Neighborhood House serves all people in the 55107 zip code, including
those above the poverty line, some clients may or may not qualify for other
supplemental food programs. Most clients however are utilizing additional programs
such as Supplemental Nutrition Assistance Program (SNAP), Women, Infants, Children
(WIC), The Emergency Food Assistance Program (TEFAP), or other local food shelves
and churches/temples for additional food for their families.

Nutrition Diagnosis
PES Statement
Food- and nutrition-related knowledge deficit (NB-1.1) related to lack of prior nutritionrelated education about managing chronic diseases with nutrition as evidenced by no
prior education provided on how to apply food- and nutrition-related information to
existing health conditions.

Nutrition Intervention
Nutrition Education (E)
Purpose of the nutrition education (E-1.1), Nutrition relationship to health/disease (E1.4), Recommended modifications (E-1.5)
To help the clients of Neighborhood House better understand how to care for
their obesity through nutrition, an interactive educational intervention was provided.

Healthy People 2020

Healthy People 2020 is a comprehensive list of goals and objectives set forth for
Americans to achieve over a 10-year period. These guidelines encourage individuals to
lead a healthier and more active lifestyle through disease awareness and prevention,
healthy eating guidelines, participation in community-based programs, and making their
health a priority.
One goal includes increasing the availability and effectiveness of educational and
community-based programs. Community-based programs are designed to promote
disease prevention and injury, overall health improvement, and quality of life. Settings of
these programs can include schools, worksites, health care facilities, and communities,
which include topics ranging from chronic illness to tobacco use. Objectives of the
educational and community-based programs that relate to the intervention created for
Neighborhood House include increasing the number of community-based organizations
(including local health departments, Tribal health services, nongovernmental
organizations, and State agencies) that provide population-based primary prevention
services chronic disease and nutrition (ECBP-10.7 and ECBP-10.8). Through this
intervention, these objectives will be fulfilled by providing education to the public on
obesity and evaluating the effectiveness of the program for future use.3
These objectives utilize SMART (specific, measureable, attainable, realistic, and
timely) goal-setting criteria. The educational and community-based programs objectives
for chronic diseases and nutrition are predicting a 10% improvement in organization
participation by 2020, up from 82.6% participation in 2008, making this a clear and
realistic goal.

Lesson Plan
An educational display will be presented to clients of Neighborhood House before
they shop for food in the market. When clients arrive, they first go through a brief
counseling session with a worker and then wait to be called and escorted to shop for
groceries in the market. While clients are in the waiting room, a short workshop and
lesson will be hosted about obesity and weight management, portion sizes, and what
vitamins and minerals are found in our foods. See Lesson Plan in Appendix A.

Marketing
Neighborhood House clients are notified of new classes and educational
sessions via phone, email, or mail. Because it takes some time for approval through the
marketing department to send events through email or mail, flyers were hung outside
other classes that were going on at Neighborhood House and in other high traffic areas
around the community, such as convenience stores, gas stations, and corner streets.
See flyer in Appendix B. With more time and in the future, marketing a chronic disease
education class by phone, email, or mail would be preferred to reach more
Neighborhood House market shoppers. On the flyer included details about the 4 Ps of
marketing: product, place, price, and promotion. The product, or service in this case,
was an educational class for the community about obesity and weight management.
The place was in a classroom right next to the Neighborhood House market. The price
was free to any and all community members. The promotion of the event was
communicated on brightly colored flyers posted around the community and around
Neighborhood House.

Resources
Making the educational display will require a large foldable demonstration board
($100) with food cutouts, MyPlate information, MyPlate plate, and vitamin and minerals
information (~5 cents/page for printing). See picture of display in Appendix C.
Additionally, two plastic literature displays ($35) will be needed for the handouts. See all
handouts in Appendix D. All of these items were produced with The Food Groups
resources. Neighborhood House will provide pens/pencils, display table, and chairs. An
evaluation was created for participants to fill out at the end of the session to assess
learned knowledge.

Nutrition Monitoring and Evaluation

In order to ensure that the display is effective and communicating the right
information to clients, an evaluation was created to assess what clients learned after
listening to the educational class. The evaluation covers five simple questions to be
answered by the client. Evaluation can be found in Appendix E.
The Obesity & Weight Management class had a fair turnout with 14 people
attending. To address any language barriers in the group, an interpreter was present
provided by Neighborhood House. The group was very engaged in the discussion and
had great questions about managing weight and portion sizes. After receiving the
evaluations back and interpreting the results, 100% of the participants were able to
identify three of the six food groups to include throughout the day and 86% of the
participants were able to identify 2 health benefits from the food groups. The evaluation
may not be an accurate representation of the participants knowledge of obesity and

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weight management as the display board remained open and available for the class to
look at during the evaluation. Besides the written evaluation, several participants
verbally expressed that they learned something new during the class and were
surprised what a serving is actually considered.
To host another chronic disease class on obesity at Neighborhood House, it
would be helpful to have a larger class size by marketing the class a couple weeks in
advance so clients can make plans to attend. It would also be helpful to have food
models to pass around so participants can see the actually portion size rather than food
cutout pieces. More culturally specific foods might help some clients relate better to the
display and visualize themselves eating the foods as the correct portion size.

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Appendix A
Lesson Plan for Obesity & Weight Management Class

Target Audience: Neighborhood House clients and community members

Duration: 35 minutes total: 20 minute educational class, 10 minutes for

questions/comments, 5 minutes for evaluation

Goal: Participants will increase their knowledge about obesity, how to mange their
weight through MyPlate, and the benefits of eating foods from each food group.

Specific Objectives:
1) By the end of the end of class through a written evaluation, participants will be able to
identify three of the six food groups to include throughout their daily meals.
Specific: Class participants
Measurable: By evaluation
Attainable: Will cover thoroughly throughout educational class and discussion
Realistic: Knowing three of the six food groups is realistic as many already know
a couple.
Timely: By the end of class

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2) By the end of class through a written evaluation, participants will be able to identify
two health benefits from food groups.
Specific: Class participants
Measurable: By evaluation
Attainable: Will cover thoroughly throughout educational class and discussion
Realistic: Knowing two health benefits is realistic, as many already know some to
start
Timely: By the end of class

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Specific

Procedure

Learning

Evaluation

Objectives

(State how each specific

Activity

Method

(Use

objective will be met)

SMART
criteria)

Introduction
Introduce self, purpose of the

Verbal

educational class, and what

introduction

Verbal feedback

material will be covered today.

Body of Lesson
By the end

What does a balanced meal look

Visual display Verbal Q&A

of the class like?

through a
written

1. MyPlate
a. Grains, Fruits,

evaluation,

Veggies, Protein,

participants

Dairy

will be able

b. Oils and fats in

Verbal
education

Supplemental
handouts

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to identify
three of the

moderation
c. Portions of each

six food

food group

group to

d. Portion sizes

include in
their daily
meals.
By the end
of class
through a

What is in my food?
1. Vitamins and Minerals
a. Found in grains,

written

fruits, veggies,

evaluation,

protein, dairy, and

participants

oils

will be able

b. What these

to identify

vitamins and

two health

minerals provide

benefits

for the body

from food
groups.

Visual display Verbal Q&A

Verbal

Evaluation

education

Supplemental
handouts

c. Common foods in
stores or food
shelves of each of
the food groups

Conclusion

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Verbal
Summarize obesity and weight

Questions/concerns

conclusion

management class with

participants and main takeaway
points. Thank participants for
attending.

Materials List (attached page): i.e.: audio-visual equipment, food models, video, flip
chart, specific foods for food demo, pencils, paper, attendance sheet, evaluation,
handouts (specified), other visuals, etc.

1. Evaluation
2. MyPlate plate
3. Food cutouts
4. Learn About Obesity handout
5. Get a Handle on Portions handout
6. Portion Size Your Plate handout
7. How to Read a Food Label handout
8. MyPlate Made Easy handout

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Appendix B
Obesity & Weight Management Advertisement

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Appendix C
Obesity & Weight Management Demonstration Board

18

Appendix D
Obesity & Weight Management Handouts

19

20

21

22

23

24

25

26

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Appendix E
Obesity & Weight Management Evaluation
Please answer the following questions related to what you heard today.
1) Name two health benefits of any of the food groups.
-Promotes healing/immunity, good for eyes, good for gut health, improves
memory and brain function, more energy, repairs muscles, healthier teeth,
stronger bones, burns fat, improves heart health

2) List three of the food groups discussed during class.

-Grains, fruits, vegetables, protein, dairy, oils

3) Apple juice is considered part of the fruit food group.

True

or

False (Circle one)

4) What is the name of the USDAs balanced meal approach?

A: Healthy Plate
B: My Plate
C: The Food Pyramid

5) Eating oils and fats, like nuts or peanut butter, is not healthy.

True

or

False (Circle one)

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References
1. Buddhist beliefs - ReligionFacts. Buddhist beliefs - ReligionFacts. Available at:
http://www.religionfacts.com/buddhism/beliefs. Accessed February 16, 2016.
2. Chapman S. The Karen People: A Brief Introduction for Health Care Workers.
www.colorado.gov. Available at:
https://www.colorado.gov/pacific/sites/default/files/hpf_rh_refugee-burma.pdf. Accessed
February 16, 2016.
3. Educational and Community-Based Programs. Educational and Community-Based
Programs. Available at: http://www.healthypeople.gov/2020/topicsobjectives/topic/educational-and-community-based-programs/objectives. Accessed
February 17, 2016.
4. Karen Cultural Profile. EthnoMed. Available at:
https://ethnomed.org/culture/karen/karen-cultural-profile. Accessed February 16, 2016.
5. Overview Of Karen Culture. Available at:
http://www.cdc.gov/tb/publications/guidestoolkits/ethnographicguides/burma/chapters/ch
apter2.pdf. Accessed February 17, 2016.
6. The Karen People: Culture, Faith, And History. Karen Buddhist Dhamma Dhutta
Foundation Available at: http://www.karen.org.au/docs/karen_people_booklet.pdf.
Accessed February 17, 2016.
7. The Karen People. Karen people of Burma. Available at:
http://www.karen.org.au/karen_people.htm. Accessed February 16, 2016.
8. Wellstone Demographics. Wellstone Demographics.

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