Internship Activities, Methods & Outcomes

The work and general tasks for the JoyFull Eats project consisted of capturing enhanced data by conducting extensive research on addressing hunger within RMHH families. Understanding the base population was key to begin research on diet needs for RMHH families. Preliminary research initiated by searching topics such as factors that contribute to hunger, social determinants of health-related to hunger, foods that support immunity, and side effects of chemotherapy and foods to eat/avoid. A common factor that continually surfaced when researching factors that contribute to hunger was how the combination of stress and poor nutrition made it more challenging for individuals to manage food insecurity as well a connection between compounding factors and hunger such as chronic disease, low socioeconomic status, and/or unemployment (Hunger and Health, n.d.). These factors play a major role in an individual’s inability to reduce hunger all while trying to focus on eating a balanced diet. In keeping these factors in mind, further research was conducted to find out how the JoyFULL Eats menu plan could play a vital role in reducing some of the burden in families who may be experiencing hunger, thus shifting research efforts on developing a self-administered questionnaire to gauge the level of food insecurity and food preferences among RMHH families.

RMHH Food Choice Questionnaire

The development and pilot testing of a self-administered questionnaire to gather information on sociodemographic characteristics, barriers to food (includes cultural and ethnic barriers), preferences in food from a cultural perspective, and families’ hospital food insecurity level was created for the purpose to assess specific nutritional needs in families. Significant efforts by hospitals and health systems to reduce food insecurity have led to improvement in population health, encouraging hospitals and clinics to continue addressing determinants of health in their communities (AHA Trustee Services, n.d.). As such, many hospitals have integrated the Children’s HealthWatch Hunger Vital Sign, a two-question screening tool based on the USDA’s household food security scale (AHA Trustee Services, n.d.). The following are the two screening questions used:

• “Within the past 12 months, we worried whether our food would run out before we got money to buy more.” Was that often true, sometimes true or never true for your household?

• “Within the past 12 months, the food we bought just didn’t last, and we didn’t have money to get more.” Was that often true, sometimes true or never true for your household?

A closer look at a widely used multidimensional tool used in food research was assessed and slightly modified to be used for the purpose of learning more about food preferences among RMHH families. The Food Choice Questionnaire (FCQ) was developed by Steptoe et al. (1995) as a tool to measure motives that underly the selection of food in individuals. According to Steptoe et al. (1995), there are nine factors that contribute to a person’s dietary choice: Health, Mood, Convenience, Sensory Appeal, Natural Content, Price, Weight Control, Familiarity, and Ethical Concern. The FCQ was used as a framework for the self-administered questionnaire, however, it was slightly modified as some of the nine factors in the original FCQ do not pertain to RMHH families (i.e., Convenience, Price, and Ethical Concern).

Incorporating the two-question screening tool with the FCQ, allowed for the RMHH Food Choice Questionnaire to be developed and used for pilot testing among RMHH families (Appendix I). The pilot testing was conducted on May 20^th and questionnaires were collected on May 22^nd to allow families enough time to complete. Questionnaires were delivered to families who had been staying at RMHH for at least one week (a total of 38 families). The questionnaires were delivered to their room and were instructed to drop off completed questionnaires at the front desk lobby by the deadline. The total number of questionnaires collected by the end of the deadline was 33. Although data entry and reviewal were not permitted due to lack of time, one recommendation to streamline questionnaires for future families is to use the RMHH app as a tool to send questionnaires and collect data in a much more efficient and time-saving process.

21-Item JoyFULL Menu Plan

In addition to the development of the RMHH Food Choice Questionnaire, a project plan proposal (Appendix II) along with an easy-to-follow project plan for the implementation of the 21-item JoyFULL Menu Options was also created (Appendix III). The project plan included information on implementation and potential donor participation along with a full 21 item menu. Based on the exploration of researching nutritional information for various dietary needs and the health basis behind eating nutritious foods, the 21-item menu options were developed. Once the menu was selected, designed, and RMHH-branded, easy to read menu documents were created for Volunteer Groups, or donors to use (Appendix IV). The 21-item menu option was designed to allow Volunteer Groups and donors the opportunity to choose from a wide range of menu items to purchase from a grocery store (direct links from the HEB website were attached to each ingredient) along with easy-to-follow cooking instructions. Ensuring that all dietary restrictions and limitations (including cultural and ethnic gaps) were observed and met for all guests was also a focus of this project. By creating the 21-item Menu Options, families would have access to healthier food options, a variety of meal options during their stay, and a greater focus on their well-being.

The outcomes of the JoyFULL Eats project included (1) the development of the RMHH Food Choice Questionnaire and (2) the development of a project plan proposal for the implementation of a 21-item menu option. The intent behind this project was to provide meals for RMHH families, who may be experiencing food insecurity all while educating families, donors, and volunteer groups on healthy eating habits. Keeping in mind menu options for families of various cultural and ethnic backgrounds allowed RMHH to lessen the burden of families trying to find out what to eat while they care for their hospitalized child as well as introduce foods to individuals who wouldn’t necessarily try new foods. Likewise, this project has helped RMHH built stronger relationships with community partners by bringing awareness to the issue of hunger faced by RMHH families thus initiating current stakeholders to want to give more and be part of ending food insecurity in this population. A meeting was conducted with two current stakeholders, The Junior League of Houston and The Houston Junior Women’s Club, in which the JoyFULL 21-item Menu Option was discussed. Conversations surrounding the need to addressed food insecurity among RMHH families were discussed as well as how the JoyFULL 21-item Menu Option will benefit families was mentioned. In the end, both groups were extremely excited about the project and wanted to support it in any way. Similarly, the JoyFULL Eats Menu project has helped established new relationships with local restaurants such as Denny’s and Boston Market to cater meals during these times when volunteer groups and donors are unable to come in and serve families due to COVID-19 restrictions. These new relationships were initiated by placing phone calls to these establishments and informing them of the RMHH mission and detailing the reasons why RMHH serves families. Through several communications, new partnerships were cultivated and resulting in a long-lasting partnership to benefit future RMHH families.