Developing and Pilot Testing a Population-focused Nutrition Screen Incorporating Social Determinants of Health

An Example from Rural Appalachia, United States

Abstract

Introduction: Given that nutrition status is directly related to a variety of health outcomes, nutrition screening is a prime focus of public health nutrition practice. 

Objectives: The purposes of this pilot study were to develop and pilot test a Rural Adult Nutrition Screen (RANS) that includes criteria addressing social determinants of health and to explore possible applications of the screen development methodology in other settings.

Methods: Mixed-methods research including interviews and survey dissemination was conducted among a rural southern Appalachian population in the United States.  Themes identified in the research were used to construct a preliminary rural adult nutrition screen (RANS-1).  The RANS-1 was pilot-tested among a sample of community-dwelling rural residents (n = 83), and was revised based on participant, administrator, and nutrition practitioner comments.  The revised screen, the RANS, was pilot-tested among a sample of attendees of a free community medical clinic (n = 37).   Nutrition risk as determined by the RANS was compared with the Nutrition Triage Score of the Patient-Generated Subjective Global Assessment (PG-SGA), the United States Department of Agriculture 6-item Household Food Security Survey Module (USDA-6), and nutrition assessment performed by a Registered Dietitian Nutritionist who was also credentialed as a Physician Assistant (RDN, PA).  Non-parametric statistical tests were used to compare the results of the PG-SGA NTS and the USDA-6 with the RANS regarding “at risk” and “low risk” status.

Results: In this small pilot study, no statistically significant differences were found among either comparative instrument and the RANS in determination of “at risk” and “low risk” status.  The RDN, PA’s agreement with the RANS was 100%. 

Conclusion:  This pilot study provides some evidence that the RANS may be used to screen rural, community-dwelling adults for nutrition needs in light of social determinants of health common in rural settings.  Further research and formal validation of the RANS are needed in order to establish this tool as a valid nutrition screen for use in the rural community setting.  Procedures used to develop the RANS may be applicable to the development of population-specific nutrition screens in other rural and urban global populations.