Effectiveness of nutrition aides in a migrant population

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Abstract
Although there was suggestive evidence that the aides’ influence helped families improve their nutritional status, the effectiveness of the aides in this study was not shown to be statistically significant. The limited number of families assigned to each aide as well as the extensive professional training and support should have maximized the effectiveness of the aides. The following may be factors that contributed to the apparent ineffectiveness of the nutrition aides: 1) Aides worked with families for a reltively short length of time (less than 1 year, after subtracting the time during migration when aides were not in contact with families). 2) Although aides generally had extensive contact with families during the year (2 to 4 visits/month), the time may have been too short to: a) bring about improved nutrition practices using aides as the primary source of contact with families; or b) observe improvements in biochemical and physical status resulting from changes that might have been made in dietary patterns. 3) Changes made by families, although brought about by the aides’ intervention, may have been too small to result in measurable improvements in biochemical and physical status. 4) The extremely low socioeconomic condition of the target population may have offset attempts to improve the eating patterns of the population, because immediate needs overshadow possible long-range benefits of improved nutrition. 5) This socioeconomic group may be resistant to adoption of new ideas and may be the last segment of the population to change. 6) Although standard measures of nutritional status were used, and the results were similar to other surveys of the same population (1, 3), it is possible that these measures were inappropriate for this study. The influence of the aides on increased self-image or future expectations of the target population, as has been noted previously (9, 10), may be more accurate indicators of the effectiveness of aides. Many families reported “feeling better,” apparently as a result of the aides’ assistance; however, this positive response did not show up in physical or biochemical determinations. Major limitations in the present study were the relatively short length of time to bring about and measure nutritional improvement (1 year), and the small size of the study population. If future studies with longer time periods and larger study populations are still unable to objectively show improvement in families taught in their homes by nutrition aides, other approaches to nutrition education should be considered. Aides might be more effective in other settings, such as schools, hospitals, or grocery stores. Mass media could be used more extensively for nutrition education. Professionals, who may prove to be more effective than aides in improving nutritional status of individuals could present intensive training programs similar to that given to the aides in this project. The effectiveness of this latter approach is suggested in that the aides’ children although few in number showed almost uniform improvement in blood biochemical levels and nutrient intake. A cost-benefit analysis of each of these alternatives might indicate which one would be the best approach to nutrition education for poorly nourished population groups. Meanwhile, aide programs should consider innovative changes in training, activities, and supervision of aides, to allow aides to accomplish their goal of improving the nutritional status of their assigned families as well as of their own families.