- Where can a parent get a copy of the NutriSTEP® questionnaires? Are the NutriSTEP® questionnaires available in print form?
The NutriSTEP® questionnaires are copyright protected and can be obtained by from Flintbox Technologies, available through Acquire a license. There is a charge for the licenses that allows a purchaser to download a PDF version of the questionnaires. The purchaser can then print copies according to the licensing agreement.
A limited supply of print copies of the original NustriSTEP® questionnaire for preschoolers, in 8 languages, are available only in Ontario and through Ontario public health units who can order from Service Ontario. Print copies of the Toddler NutriSTEP® questionnaire are not available.
- Are the NutriSTEP® questionnaires for screening only? Could they be used as surveillance tools?
The NutriSTEP® questionnaires can be used for surveillance and/or screening purposes.
As surveillance tools, they can easily be incorporated into existing population level surveys for surveillance purposes without reporting a nutrition risk score to the parent (which is done when conducting screening). These data can then be used for local and provincial surveillance efforts, to plan programs and identify the implications for further research and practice.
When the NutriSTEP® questionnaires are used in the context of screening, approximately 10-20% of the population of toddlers and preschoolers will potentially be identified as needing some form of primary prevention. This proportion is comparable to other Ontario provincial screening initiatives in Dental Health and Healthy Babies, Healthy Children.
The original NutriSTEP® questionnaire for preschoolers is listed as a valid and reliable tool to be used in the Child Health Program, Requirement # 11 of the Ontario Public Health Standards. The Standards were released in November 2008 with health unit implementation in 2009. The NutriSTEP® questionnaires can easily dovetail into existing provincial programs and reach at risk preschoolers and their families in locations such as Best Start hubs, parent education programs, school readiness programs, and primary health care settings such as Family Health Teams (FHTs).
- Are there supplemental educational resources to accompany the NutriSTEP® questionnaires?
How to Build a Healthy Preschooler is a 4-page educational booklet that was developed and evaluated by parents to support the original NutriSTEP® questionnaire for preschoolers and the screening process. It is available in English, French, simplified and traditional Chinese, Punjabi and Vietnamese. In Ontario, print versions are available through Service Ontario.
How to Build a Healthy Toddler is a 4-page parent education booklet that has been developed to support the Toddler NutriSTEP® questionnaire and the screening process. It is only available electronically and only in English and French.
- How long does it take for parents to complete the NutriSTEP® questionnaires?
It takes no more than five minutes. It may take a minute to score the questionnaire and a few extra minutes to advise and refer parents depending on the issues identified in the questionnaire and the parent's response to their child's score.
- How often should toddlers and preschoolers be screened? Should children be screened every year?
Toddlers or preschoolers can be screened annually to look for changes. We encourage parents to screen children each year to identify and address children's risk behaviours.
- Are there any barriers to parents completing the NutriSTEP® questionnaires on their own?
There shouldn't be. Completing the NutriSTEP® questionnaires is similar to completing other child health screens. Parents may find it easier to complete it at home when they are able to concentrate without any distractions.
- If a child in an “early years” program appears poorly nourished, is it appropriate for a screen administrator to suggest to the parent/caregiver to have him/her complete the NutriSTEP® questionnaires?
Yes, if the parent is receptive. It would be the same practice as any other suspected health or developmental concern.
- How do parents usually feel after completing the NutriSTEP® questionnaires? How does a screen administrator cope with a parent who is upset?
Generally, most parents are relieved or reassured with the results while others may feel motivated to improve areas of concern. A screen administrator needs the skills and training to understand and deal with parental concerns as well as be comfortable with identifying what resources may be useful to the parent.
- What do the screening administrators do with the NutriSTEP® questionnaires once they are complete? Do parents keep teh questionnaire(s)? Do they file or shred the questionnaire(s)?
The practice will be determined by the screening agencies and their privacy policies as well as their purpose for screening. Some agencies may be gathering nutrition data for surveillance, program planning and evaluation and/or as a screening and referral service to parents.
- What are the confidentiality concerns? Does the nutrition screening need to be conducted in a private room? Or, can it be done in a public place (e.g., doctor's waiting room)?
This nutrition screening is the same as any other screen conducted in a setting. It should be individualized to the agency and its usual screening practices.
- Should nutrition screenings be conducted in a group setting or one at a time? Does it matter?
Nutrition screening can be individualized to the setting and purpose of the screen administration.
- If there are confidentiality concerns, what are the implications of this with the parent?
Each setting/agency has its own confidentiality policies and procedures and need to follow them.
- Are there any issues with literacy? How are these dealt with?
The NutriSTEP® questionnaires have been developed and validated at a grade 6/7 literacy level. English as a second language (ESL) parents may require assistance from a screen administrator to answer the questions and add up the score.
- Are there any tips or suggestions for using the NutriSTEP® questionnaires in a non-English speaking population?
There has been some experience with the use of volunteer interpreters (Chinese, Urdu, Punjabi and Tamil). Overall, it was positive but some problems included: some interpreters who didn't speak English very well; some who didn't listen to instructions and at times pressured parents to participate; some who expand/explain/provide more information beyond the screening tool questions and responses; and, some didn't translate fully. You may not have these issues if you use an interpreter service.
Some tips to consider with this population are:
- Provide the translators with an understanding of your key messages and your goals.
- Have some educational materials translated in those languages.
- Have any steps been taken to translate the NutriSTEP® questionnaires?
The original NutriSTEP® questionnaire for preschoolers is available in eight languages-English, French, traditional and simplified Chinese, Punjabi, Vietnamese, Spanish and Tamil. A license to use the translated versions can be obtained from Flintbox (www.flintbox.com).
The Toddler NutriSTEP® questionnaire is available in English and French only. A license to use the translated versions can be obtained from Flintbox (www.flintbox.com).