Digital nutrition intervention in Older Americans Act programs impacts knowledge and desire to participate in virtual...

The Older Americans Act of the United States is a federal law providing funding for meals and nutrition education, primarily for adults aged ≥ 60 years, to help them live independently. Nutrition education has traditionally been delivered in-person, but an evolving population has prompted a need to utilize digital programming to expand reach. The Georgians Receiving Insightful Telenutrition Services (GRITS) study was a 20-month program to provide group education and individual medical nutrition therapy (MNT) to adults using phone and online video conferencing. The objective of this study was to develop a virtual program for group and individual settings and to evaluate its effect on nutrition knowledge, confidence, and health behaviors, as well as overall feasibility and acceptability of delivering education in a virtual format.

Implementation and evaluation occurred from 2020-2023 within senior centers across four regions in the state of Georgia, USA. Group education and individual MNT sessions were led by a Registered Dietitian Nutritionist (RDN). Group education was delivered as standardized 30-min lessons over Zoom for 12-20 months, with length of time varying by site. Individual MNT was completed primarily over the phone and Zoom, with session duration of approximately 30-60 minutes for initial sessions and 15-30 minutes for follow-up sessions. Outcome measures were collected in both groups at baseline and post-intervention using short- and long-term qualitative surveys to assess program effects and acceptability of the program. Senior center staff also completed post-intervention qualitative surveys and focus groups to evaluate feasibility of program implementation. The program structure and evaluation were guided by RE-AIM framework for creating sustainable, generalizable interventions. Mixed-effects regression models were used to examine effects of the program.

In group education, a total of 22 centers completed at least 12 group sessions serving 5,012 duplicated clients. Participants who completed knowledge surveys showed a modest 1.6% improvement in knowledge scores at post-session compared to pre-session (95% CI: 0.4, 2.9; p = 0.012, FDR-adjusted p = 0.012). Across all confidence, motivation, and lifestyle behaviors measured, no meaningful differences from pre to post were observed. For acceptability, 87% of group education respondents (n = 142/163) reported to be satisfied with the nutrition sessions overall, and 79% of group education respondents (n = 128/163) indicated interest in continuing education in a virtual format with online video conferencing. In individual MNT, a total of 318 virtual MNT sessions were completed with 142 unduplicated clients. Among participants with matched pre- and post-surveys (n = 29), quality of life, general health, and confidence in problem-solving remained stable over time, with no detectable changes after MNT. At post-survey, 87% (95% CI: 0.76, 0.94; n = 49/55) of post-survey respondents reported at least one behavior change after participating in MNT sessions, with the most common changes being adjusting intake of foods, adjusting portion sizes, and incorporating more physical activity into their routines. Among participants who responded, 91% (95% CI: 0.80, 0.96; n = 49/54) reported that they found benefit in talking with the dietitian. In terms of feasibility, senior center staff reported positive feedback regarding the virtual format and its ability to expand client access to registered dietitians. Drivers of engagement for participants were novel education topics, lessons that were 30 min in length, and gift cards offered to maintain engagement. Challenges of program implementation included limited capacity of senior center staff in facilitating survey administration, difficulty tracking unduplicated participant numbers, and having participants not complete pre- and post-surveys.

Results from this study suggest virtual nutrition education in group and individual settings was acceptable, feasible, and showed preliminary effects on knowledge and behavior among a subset of Older Americans Act clients. Future directions include long-term evaluation of virtual methods to deliver nutrition education to better serve community-dwelling older adults in ways that are sustainable, efficient, and effective for long-term health.