Community Education Intervention Project:

Whole Grains Education and Cooking Demonstration

Featuring: Tropical Chicken and Brown Rice
May 11th, 2014
Brittany McCarel
ARAMARK Dietetic Internship 2013-2014










1



Overview
The outpatient clinic at which I am working provides basic primary care to area
residents who are of low socioeconomic status. The clinics population is largely
Hispanic, which affects how the population views both life and healthcare as a whole.
With a large group of patients being diabetic as well, it was thought that the session
should be especially helpful for diabetic patients, but also helpful for non-diabetic
patients as well. An education session focused on whole grains, utilizing handouts and
a cooking demonstration featuring Tropical Chicken and Brown Rice, was developed
to benefit the clinic population. The featured meal was designed as something healthy,
easy, fun, and affordable.
Eight patients attended the 60 minute education session. First, a five question
pre-test (based on the lesson plan goal and objectives) was utilized to assess how
much accurate information the patients already knew about whole grains. After the
session, a post-test was utilized to assess improved comprehension about whole
grains. When asked the definition and benefits of whole grains, a comprehensive
improvement was observed between the pre- and post-tests. Knowledge of whole grain
sources, relative plate portions of food groups, and ability of oneself or a family member
to be able to make a meal with whole grain also improved. Education sessions like this
one, incorporating both handout information and demonstration, could be used to further
community-based awareness of healthy nutrition.



2



Nutrition Assessment
The clinic exists to provide healthcare to low-income individuals and families
without health insurance (Socioeconomic Factors CH-3.1.1)
1(pp 16)
. For treatment, a five
dollar donation is requested at the time of each visit, but this donation is optional
because many are unable to afford it. In general, those eligible to be served by the clinic
must also live in the northern part of Lake County, Indiana (Geographic Location CH-
3.1.5)
1(pp 16)
. According to the data provided by the clinic, roughly 72% of those utilizing
the clinic are female (Gender CH-1.1.2)
1(pp 16)
. The data also shows that one of the most
prominent ethnicities that the clinic serves is the Hispanic population (Race/Ethnicity
CH-1.1.3)
1(pp 16)
. The CDC details that the religious affiliation of Hispanics/Latinos in
the U.S. is 68% Catholic
2(pp 11)
(Religion CH-3.1.7)
1(pp 16)
. The clinic is affiliated with the
Catholic church, as well.
Throughout Coming Home to Salsa: Latino Roots of American Food, several
foods such as rice, beans, maize, salsa, beans, squash, chili con carne, tamales, and
tortillas are all provided as examples by the National Park Service as being traditionally
Latino or Hispanic food choices
3
. The CDC adds that food is very important within this
cultural subset
2
. Certain practices associated with the Hispanic cultures view of food
include ingesting hot and cold food types, possessing a good appetite in relation to
good health, honoring childrens food likes and dislikes, and matriarchs not feeding
family members certain harmful foods which they believe make family members sick
2
.
In relation to general health, the CDC warns that while Hispanics have a
generally longer lifespan than average, high instance of chronic disease development
within the Hispanic population is strongly concerning
2
. Heart disease and diabetes
3



mellitus are each numbered as one of the top 10 leading causes of death for Hispanics
by the CDC
2
. The CDC also reveals that Hispanics have the highest uninsured rates
(32%) of any racial or ethnic group within the United States, while only 15% the overall
U.S. population is uninsured
2(pp 9)
. The Hispanic culture is largely patriarchal
2
; the CDC
reveals that although the matriarch often determines when a family member needs
medical care, the male head still gives permission to seek treatment
2(pp 8)
(Role in
Family CH-1.1.7)
1(pp 16)
. Traditional Hispanic healing methods are often relied upon
instead of modern healthcare methods due to the high cost of modern healthcare,
especially when a family is uninsured
2
.
Services provided by the clinic include (but are not necessarily limited to) nurse
practitioner and doctor visits, provision of low cost medications, and (sometimes)
nutrition education (Medical treatment/therapy CH-2.2.1)
1(pp 16)
. However, the availability
of a nutrition professional to volunteer at the clinic is often very sparing at best, which
makes it crucial to provide as much quality and quantity of nutritional education to the
clinics patients when a nutrition profession is able to come.








4



Nutrition Diagnosis
Less than optimal intake of types of carbohydrate (whole grains) (NI-5.8.3)
related to food- and nutrition-related knowledge deficit as evidenced by hyperglycemia,
limited knowledge of carbohydrate consumption of foods and of carbohydrate
metabolism, and perceived limited availability of appropriate foods caused by economic
concerns
1(pp 213-214)
.
Nutrition Intervention
Clinic officials state that according to data, out of the roughly 700 patients that
the clinic currently serves, roughly 200 patients have diabetes mellitus. However, since
all patients at the clinic do not have diabetes, it was decided that a topic be chosen that
was important for all patients, but especially so for those presenting with diabetes.
To address the identified nutrition diagnosis, an education intervention was
planned and provided. The intervention focused on increasing knowledge about the
definition, health benefits, and incorporation of whole grains in the diet, for general
health as well as for diabetes.
1. Nutrition Education-content, relationship to health and disease (E.1.4)
1(pp298)

2. Composition of meals/snacks (ND-1.2)
1(pp297)

3. Nutrition Education application, skill development (E-2.2)
1(pp298)

Healthy People 2020 and Emerging Trend

Healthy People 2020 is a United States-based program that sets health-based
initiatives for the Americans
4
. In 10-year increments, the quantitative results of these
initiatives are measured for success, and a reflective set of updated initiatives are then
developed
4
.
5



One goal of Healthy People 2020 (NWS) is as follows: Promote health and
reduce chronic disease risk through the consumption of healthful diets and achievement
and maintenance of healthy body weights.
5
One associated objective (NWS-16) is as
follows: Increase the contribution of whole grains to the diets of the population aged 2
years and older.
5

The objective was written in SMART criteria (meaning it was specific,
measurable, achievable, realistic, and timed). First, the objective is specific by stating
what types of grains (whole) need to be increased in what age group (2 years and
older). It is measurable because we can measure increased whole grain consumption
quantitatively. Increasing whole grain consumption in those 2 years and old is definitely
achievable and realistic, with a stated time goal of this being accomplished by the year
2020. Nutrition education being central to promoting health, as well as preventing and
managing chronic disease, is an emerging trend in dietetics that this objective
addresses.
Lesson Plan Summary
The intervention event was a whole grains education and cooking demonstration,
featuring Tropical Chicken and Brown Rice. This recipe is an original recipe by the
presenter. The target audience for the event was all interested clinic clients, especially
those with diabetes. The total event duration was 60 minutes, and the overarching goal
was that participants would increase their knowledge about the definition and health
benefits of whole grains, for general health as well as for diabetes, and understand
ways to incorporate whole grains into their own diet. The success of whether the lesson
goal and objectives were met was measured with a pre- and post-test.
6



Marketing
Product
Our product, a whole grain education session which included a cooking
demonstration of Tropical Chicken and Brown Rice, provided a nice combination of
familiarity and innovation with a healthy focus. This session provided a great way to
educate clinic clients because it was applicable for those with or without diabetes, was
culturally sensitive but not exclusive to Hispanics, and was taught with both visual and
auditory materials.
Price
The presenter made presentation attendance free to clients. This decision was
made because clients come to the clinic because they do not have a lot of income, and
also to encourage clinic client attendance.
Place
The session was held in the front lobby of the clinic. The clinic lobby had roughly
enough seating for 10-12 clients. This venue was chosen to hold the session because it
is a location with which all clients are familiar, and hosting the event there was free of
charge. The clinic also had a microwave and small refrigerator/freezer in the employee
lounge, both of which were used. (The microwave was used to cook the frozen
steamable vegetables, and the refrigerator/freezer was used to store food during the
work day before the session started.
Promotion
The event was promoted using an Advertisement Flyer created by the presenter
(available in the Appendix section). The flyer was made to be very colorful, as to entice
7



interest in a fun demonstration for the prospective attendee. Flyers were placed over
one week in advance in several areas of the clinics front lobby, and one flyer was hung
in the office that the presenter had been using to conduct individual nutrition education
appointments. In addition to the flyers, the clinics secretary called clients to ask if they
would like to attend the session. It was asked that clients inform the clinic if they were
attending two days before the event, so that sufficient time was available for purchasing
supplies for the final number of attendees.
Promotion was not conducted outside of the clinic because the session was
purposely marketed toward clinic clients only. Financial and spacial resources would not
have been sufficient to accommodate additional non-client attendees.
Resources
The budget for the event was very limited. The clinic does not have a great deal
of extraneous funds, so all costs were incurred by the presented and the clinics lead
nurse practitioner. Food-based materials totaled to roughly $25.00 (about $13.00 of
those costs were incurred by the chicken breasts.) Cooking resources (rice cooker,
griddle, spatula, etc.) were either brought in or already at the clinic (instead of needing
to be bought specifically for the session), so the usage of cooking resources was
completely free. Serving materials (disposable plates, silverware, and napkins) were
already at the clinic in the employee lounge, so these resources were free. Educational
materials were free to utilize, as well. Therefore, the overall cost of the session was
roughly $25.00.
The overall cost was feasible for an education session of this nature because it
was not too great of an expense for the presenter and lead nurse practitioner to take on.
8



However, similar future demonstrations with food samples would need to be kept to a
small attendance pool at this clinic (or a similar one) to remain cost effective, unless the
clinic had extra finances to support it or if attendees were charged a fee.
Below is the list of resources that were needed for the education session:

Food-Based Materials:
1. Chicken (2 large packs)
2. Frozen vegetables (3 boxes)
3. Brown rice (2 small bags)
4. Pam spray (1 can)
5. Pineapple (1 medium bowl)
6. Reduced fat shredded cheddar cheese (1 small bag)

Cooking Materials:
1. Rice Cooker
2. Griddle
3. Microwave
4. Refrigerator
5. Freezer
6. Spatula

Serving Materials:
1. Paper Plates
2. Plastic Silverware
3. Paper Napkins

Educational Materials (full handouts available in the Appendix section):
1. Welcome to Whole Grains Handout
6

2. 10 Tips Choose My Plate Handout
7

3. Tropical Chicken and Brown Rice: Recipe Handout (an original recipe)
4. Eating Better on a Budget Handout
8

5. Cooking & Eating Whole Grains Handout
9

6. Pre- and Post-Tests

Nutrition Monitoring and Evaluation
Overall, the results of the education session were very successful, and could
potentially assist in meeting the Healthy People 2020 goal of promot(ing) health and
reduce chronic disease risk through the consumption of healthful diets and achievement
9



and maintenance of healthy body weights.
5
Education sessions similar to this one
could also help with the associated Healthy People 2020 objective of increas(ing) the
contribution of whole grains to the diets of the population aged 2 years and older.
5

Below is the overarching session goal with its associated objectives, with the
quantitative results reflected by pre- and post-test knowledge.
Goal:
Participants will increase their knowledge about the definition and health benefits of
whole grains, as well as understand ways to incorporate whole grains into their own
diet.
Associated Objectives:
1. By the end of the session through the use of a post-test, clients will be able to identify
whole grain sources and their relationship to health and disease management.
2. By the end of the session through the use of a post-test, clients will be able to identify
how to generally compose their plates with whole grains and other food sources.
3. By the end of the session through the use cooking demonstration observation, clients
will know an example of how to cook a healthy, well balanced meal using whole grains.
Only one of the eight participants knew what a whole grain was at the time of the
pre-test; all participants knew what a whole grain was at the time of the post-test.
Quantitatively, there was an 87.5% difference in attendant comprehension between pre-
and post-test results (12.5% to 100%).
Only two of eight attendees could name three benefits of whole grains at the time
of the pre-test. All participants knew what three benefits of whole grains were at the time
10



of the post-test, resulting in a 75% difference in attendant comprehension (25% to
100%).
None of the eight attendees knew what five sources of whole grains were at the
time of pre-test (four answered no, and four answered maybe/somewhat). Five out of
eight attendees knew what five sources of whole grains were at the time of post-test
(none circled no, and three circled maybe/somewhat). The change in percentage of
those answering yes at pre-test time to yes at post-test time was 62.5% (0% to
62.5%).
Only three out of eight felt they knew how much of each food group, including
whole grains, should be on a plate at pre-test time (three answered maybe/somewhat,
and two answered no). Six out of eight answered that they knew food group portion
sizes by plate, including whole grain, at the time of post-test (two answered
maybe/somewhat, while none answered no). The change in percentage of those
answering yes at pre-test time to yes at post-test time doubled (37.5% to 75%).
Only two attendees felt they or a family member could make a meal with whole
grain included at pre-test time (four answered no, and two answered
maybe/somewhat). At the time of post-test, seven of eight attendees felt they or a
family member could make a meal with whole grain included (none answered no, and
one answered maybe/somewhat). The change in percentage of those answering yes
at pre-test time to yes at post-test time increased by 62.5% (25% to 87.5%).
A factor facilitating session progress was that the attendees were excited to learn
how to nutritionally manage their health, overall. Without interested attendees who
listened to the information being provided, a successful session would not have
11



happened. A factor hindering session progress was the limited funds available to host
the education session; however, the funds that were able to be gathered were utilized
very well. One example of excellent financial resource management is that the fruit
picked to go with the meal, pineapple, was in season and able to be obtained at great
quality on sale. Comparable bowl sizes of non-seasonal fruit cost roughly $8.00-$10.00;
the bowl of pineapple cost roughly $2.50.
Due to the limited nutrition counselor lengths-of-stay at the clinic, extensive
monitoring and evaluation post-session is not very feasible. However, if a nutrition
counselor were regularly stationed at the clinic, this session could have been the start of
a series of sessions based on eating for diabetes or even general healthy nutrition.
However, clinics that do have regular nutrition counselor coverage could use a series of
sessions like this one to improve their patients nutritional health management, as well
as to help our nation meet the goals and objectives of Healthy People 2020.










12



Appendix A: Lesson Plan
Venue:
Clinic Lobby
Lesson Plan:
Whole Grains Education and Cooking Demonstration, featuring original recipe of
Tropical Chicken and Brown Rice
Target Audience:
All interested clinic clients, especially (but not exclusively) those with diabetes
Duration:
60 minutes: 5 minute pretest, 10 minute initial verbal education (definition, basic
benefits, portion sizing), 30 minute cooking demonstration, 10 minute recipe sample
provision combined with post-test completion, 5 minutes for questions/sharing.
Goal:
Participants will increase their knowledge about the definition and health benefits of
whole grains, as well as understand ways to incorporate whole grains into their own
diet.
Specific Objectives:
1. By the end of the session through the use of a post-test, clients will be able to
identify whole grain sources and their relationship to health and disease
management.
S: Specific to clients attending the educational session.
M: Results measurable through participants responses on pre/post-test.
13



A: Objective to be attained within educational session time-frame. R:
Improvement in the identification of whole grains sources and their
relationship to health and disease management is realistic.
T: Achieving the objective by the end of the class session is timely.
2. By the end of the session through the use of a post-test, clients will be able to
identify how to generally compose their plates with whole grains and other food
sources.
S: Specific to the clients attending the educational session.
M: Results measured through participants responses on pre/post-test.
A: Objective to be attained within educational session time-frame.
R: Improvement in the identification of generally composing their plates
with whole grains and other food sources is realistic.
T: Achieving the objective by the end of the class session is timely.
3. By the end of the session through the use cooking demonstration observation,
clients will know an example of how to cook a health, well balanced meal using
whole grains.
S: Specific to the clients attending the educational session.
M: Results measured through participants observation of cooking
demonstration, as well as receiving the corresponding recipe.
A: Objective to be attained within educational session time-frame.
R: It is realistic that clients will be able to observe the cooking
demonstration and understand the corresponding recipe.
T: Achieving the objective by the end of the class session is timely.
14



Specific Objectives
(Use SMART criteria)
Procedure
(State how each specific objective
will be met)
Learning
Activity
Evaluation
Method

Introduction

Presenter introduces self and topic
of demonstration
Assess prior knowledge about
topic with 5 question pre-test in
true or false format
(Estimated Time Frame: 5
minutes)
Listening to
speaker

Pre-test

Body of Lesson

1. By the end of the
session through
the use of a post-
test, clients will be
able to identify
whole grain
sources and their
relationship to
health and
disease
management.
Summarize the definition and
basic benefits of whole grains
(Estimated Time Frame: 5
minutes)
Listening to
speaker

Handout
Verbal
Q&A


Post-test
2. By the end of the
session through
the use of a post-
test, clients will be
able to identify
how to generally
compose their
plates with whole
grains and other
food sources.
Describe in general what portions
of protein, grains/starches, and
non-starchy vegetables to
compose a plate for optimal
nutritional value
(Estimated Time Frame: 5
minutes)

Listening to
speaker

Handout
Verbal
Q&A


Post-test
3. By the end of the
session through
the cooking
demonstration
observation,
clients will know
an example of
how to cook a well
balanced meal
using whole
grains.
Demonstrate to attendees how to
cook a balanced healthy meal
using affordable whole grain:
Tropical Chicken and Brown Rice
(Estimated Time Frame: 30
minutes)

Listening to
speaker

Handout
Verbal
Q&A


Post-test
15



Materials List (divided by material category):

Food and Beverage
1. Chicken
2. Frozen vegetables
3. Brown rice
4. Pam spray
5. Pineapple
6. Reduced fat shredded cheddar cheese
7. Bottled Water

Cooking Materials:
1. Rice Cooker
2. Griddle
3. Microwave
4. Refrigerator
5. Freezer
6. Spatula

Serving Materials:
1. Paper Plates
2. Plastic Silverware
3. Paper Napkins

Educational Materials (Title List):
1. Welcome to Whole Grains Handout
2. Choose My Plate: Ten Tips to a Better Plate Handout
3. Recipe: Tropical Chicken and Brown Rice Handout (Original Recipe by the
Presenter)
4. Eating Better on a Budget Handout
5. Cooking & Eating Whole Grains Handout
6. Pre- and Post-Test


Conclusion


Provide samples of prepared
recipe to attendees, as well as a
post-test (identical to pre-test) to
complete during sampling to
assess if post-demonstration
knowledge
Wrap Up with Questions and
Answers, and the provision of
complementary take home
materials
(Estimated Time Frame: 15
minutes)
Sampling
prepared
recipe

Handouts
Verbal
Q&A



Post-test
16



Appendix B: Educational Handout Materials
1. Welcome to Whole Grains Handout (Front and Back)
6




17



2. Choose My Plate: Ten Tips to a Great Plate Handout
7




18



3. Recipe: Tropical Chicken and Rice Handout (Original Recipe by the Presenter)
Recipe: Tropical Chicken and Brown Rice
By: Brittany McCarel
Serves: 4

Ingredients:
16 ounces/1 pound Raw, Skinless, Boneless Chicken Breast (thawed)
1 7-oz. Bag Frozen vegetables (Green Giant Antioxidant Blend: Olive Oil Seasoning)
2 cups Bag brown rice (Dry, uncooked makes 4 cups total cooked)
1 spray Non-stick Spray (to prevent sticking to pan)
4 cups Pineapple
1 cup Reduced-fat shredded cheddar cheese
1 tablespoon Soft margarine (for rice - optional)
1 dash Mrs. Dash Lemon Pepper, lime juice, lemon juice (optional)

Cooking Materials:
Rice Cooker
Griddle
Microwave

Estimated Calories and Carbohydrate Servings:
Estimated Calories: 585 calories
Estimated Carbohydrate Servings: about 4 servings

Instructions:
Rice
1. Place 2 cups of dry rice in rice cooker. Add roughly 3 - 3 cups of water. Add 1
tablespoon of soft margarine if desired. Close lid to rice cooker and press button to start.
Cooking of rice may take up to roughly 45 minutes -1 hour to complete.
Chicken
2. Season chicken as desired (optional).
3. Turn griddle on to medium heat. Allow to heat up for roughly 10 minutes. (The low heat
setting may not cook the chicken completely, while the high heat setting may char the
chicken or cause it to cook too dry.)
4. Spray griddle with non-stick spray while it heats up.
5. Place chicken on griddle. Flip chicken as soon as downside of meat appears cooked.
Remove chicken from griddle when other side appears cooked. (Before eating, cut into
chicken to make sure that it is white all of the way through, with no pinkness or rawness
even in the middle. If chicken is found to not be thoroughly cooked, place back on
griddle until it is fully cooked through.)
Vegetables
6. To steam vegetables in microwave, follow instructions on package as directed.
Putting it All Together:
7. When rice, chicken, and vegetables are finished cooking, place of prepared rice,
chicken, and vegetables on each plate.
8. To each plate, add 1 cup pineapple, cup reduced-fat shredded cheese, and seasoning
as desired (optional).
9. Enjoy your tropical creation!!!
19



4. Eating Better on a Budget Handout
8



20



5. Cooking & Eating Whole Grains Handout (Front and Back)
9


21





22



Appendix C: Pre-Test and Post-Test
Whole Grains Education and Cooking Demonstration
Tropical Chicken and Brown Rice
Pre-Test and Post-Test

Directions: Before the presentation, circle the answer that fits best under the Pre-Test column. Keep
your sheet during the presentation. When prompted to complete the post-test at the end of the
presentation, please circle the answer that fits best under the
Post-Test column. The purpose of the pre-test and post-test is to evaluate if this demonstration has
been helpful in teaching you. Please give this sheet to Brittany McCarel before leaving.

1. The definition of a whole grain is:

Pre-Test: ________________________________________________________
Post-Test: ________________________________________________________

2. Three benefits of whole grains include:

Pre-Test: ________________________________________________________
Post-Test: ________________________________________________________

3. I know 5 or more sources of whole grains.
Pre-Test Post-Test
Yes Yes
No No
Maybe/Somewhat Maybe/Somewhat
4. On a plate, I know in general how much of each food group there should be.
Pre-Test Post-Test
Yes Yes
No No
Maybe/Somewhat Maybe/Somewhat
5. I feel that I (or a family member, such as my wife, mother, husband, etc.) could cook a well-balanced
meal with whole grains at home.
Pre-Test Post-Test
Yes Yes
No No
Maybe/Somewhat Maybe/Somewhat
23



Appendix D: Advertisement Flyer

Please join us for a fun-filled cooking
demonstration, focused on whole
grains as a part of healthy nutrition!

Meal:
Tropical Chicken
and Brown Rice

Location:
The McAuley Clinic in Hammond, Indiana

Date:
Wednesday, April 30
th
, 2014

Time:
5:30 pm

Lead Presenter:
Brittany McCarel

Please call the McAuley Clinic to RSVP by
Monday, April 28
th
, 2014.
Look forward to seeing you there!


24



References:
1. Academy of Nutrition and Dietetics. Pocket Guide for International Dietetics &
Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the
Nutrition Care Process. Chicago, IL; 2013.
2. Building Our Understanding: Culture Insights Communicating with Hispanic/Latinos.
Center of Disease Control (CDC). 2011; 1-17. Available at:
http://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/his
panic_latinos_insight.pdf. Accessed on April 11
th
, 2014.
3. Pilcher, J. Coming Home to Salsa: Latino Roots of American Food. National Park
Service (NPS). 184-197. Accessed on April 11
th
, 2014. Available at:
http://www.nps.gov/latino/latinothemestudy/pdfs/Food_web_final.pdf
4. About Healthy People. Healthy People 2020. 2014.
http://www.healthypeople.gov/2020/about/default.aspx. Accessed on April 23
rd
,
2014.
5. Nutrition and Weight Status. Healthy People 2020. 2013.
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=29.
Accessed April 11
th
, 2014.
6. Welcome to Whole Grains: Healthy, Convenient, Delicious. The Whole Grains
Council. 2011. http://wholegrainscouncil.org/files/WholeGrains101brochure.pdf.
Accessed on April 23
rd
, 2014.


25



7. Choose My Plate: 10 Tips to a Great Plate. Choose My Plate.
http://www.choosemyplate.gov/food-
groups/downloads/TenTips/DGTipsheet1ChooseMyPlate.pdf. Accessed on April
23
rd
, 2014.
8. Eating on a Budget: 10 Tips to Help Stretch Your Food Dollars. Choose My Plate.
http://www.choosemyplate.gov/foodgroups/downloads/TenTips/DGTipsheet16Eating
BetterOnABudget.pdf. Accessed on April 23
rd
, 2014.
9. Cooking and Eating Whole Grains. The Whole Grains Council. 2013.
http://wholegrainscouncil.org/files/CookingWholeGrains.pdf. Accessed on April 23
rd
,
2014.