General Questions about NutriSTEP®

  • What does NutriSTEP® stand for?
  • NutriSTEP® stands for Nutrition Screening Tool for Every Preschooler. The original NutriSTEP® is a valid and reliable nutrition risk screening questionnaire for preschoolers, aged 3 to 5 years. The questionnaire is designed to be completed by the child's parent or primary caregiver to assess nutrition risk in his/her child. The original NutriSTEP® was developed in both English and French and has also been translated into six other languages that are commonly-spoken in Canada: simplified and traditional Chinese, Punjabi, Spanish, Tamil, and Vietnamese.

    In 2012, Toddler NutriSTEP® was released. The toddler version of NutriSTEP® is for children 18 - 35 months of age. Toddler NutriSTEP® was developed in English and French.

  • What is the NutriSTEP® program?
  • The NutriSTEP® program includes:

    • The orignal NutriSTEP® questionnaire for preschoolers (3 - 5 years on age)
    • The Toddler NutriSTEP® questionnaire for toddlers (18 - 35 months of age)
    • The NutriSTEP® Implementation Toolkit
    • Preschool Nutrition Primers for Registered Dietitians
    • Parent education resources
    • Research activities
    • Success stories
    • NutriSTEP® Online Community

  • Who is the NutriSTEP® program intended for?
  • The program is designed for community professionals working with parents of young children ages 18 months to 5 years of age. The NutriSTEP® ImplementationToolkit provides background information and details about conducting nutrition screening for young children in various community settings.

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Questions related to the NutriSTEP® license on Flintbox

  • What is Flintbox?
  • Flintbox is an online portal for university technologies. University Technology Transfer offices across Canada all use Flintbox to disseminate information about their technologies and to make certain items available for immediate download.

  • Why are the NutriSTEP® questionnaires available on only Flintbox?
  • The distribution rights for the NutriSTEP® questionnaire have been granted to the University of Guelph through the Catalyst Centre. By using Flintbox, the University can make the NutriSTEP® questionnaires available at the click of a button and at the same time ensure that the integrity of the questionnaires are protected through a license agreement.

  • Is it necessary to complete a licensing agreement?
  • Yes. It is necessary that all copyrighted materials are licensed for use. The NutriSTEP® questionnaires are the products of substantial research and validation. In order to protect the integrity of the questionnaires and monitor their use, a formal licensing system has been established. This ensures that the questionnaires are used appropriately and clarifies everyone's rights and liabilities. It also facilitates follow-up with users for possible improvements.

  • What are the steps in accessing the NutriSTEP® questionnaires through Flintbox?
  • To access the questionnaires, follow the steps outlined on the Acquire a License page. Scroll down to the section providing the steps to access the the NutriSTEP® questionnaire through Flintbox

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Questions about the NutriSTEP® Questionnaires

  • 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).

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Questions related to NutriSTEP® program implementation and support

  • How do I set up the NutriSTEP® program in my community?
  • For more information about setting up the program read the About NutriSTEP® section and the NutriSTEP® Implementation Toolkit and resources sections before downloading the NutriSTEP® Implementation Toolkit.

    The NutriSTEP® Implementation Toolkit was developed by Registered Dietitians (RDs), who have been the only implementation coordinators to date. There are a few models available describing best practices in nutrition screening using RDs as the basis. The current NutriSTEP® Implementation Toolkit content may not meet the needs of non-RDs.

    The NutriSTEP® Implementation Toolkit describes some potential screening models and interested sites will need to individualize a program that is feasible and meets their own nutrition screening and/or surveillance goals and objectives.

    Implementing a new program is extremely time consuming and complex. The purpose of the NutriSTEP® Implementation Toolkit is to emphasize the complexity of the screening process and if undertaken, be prepared for a busy start-up that needs significant dedicated time.

  • Who can answer my nutrition questions for the NutriSTEP® program?
  • Contact your local public health department or community health centre. They may also redirect you to the most appropriate agency in your community or province. For example, in Ontario, Registered Dietitians at EatRight Ontario (877-510-5102) can also respond to nutrition questions about NutriSTEP®. Research support is available from the University of Guelph (rjanis@uoguelph.ca).

  • Is there someone who has used the NutriSTEP® program whom I could contact?
  • Yes. The NutriSTEP® Online Community involves individuals who have used the NutriSTEP® program in various communities and provinces. You can contact members of this group by posting questions to this group.

  • What staffing requirements are needed to coordinate a NutriSTEP® program in my community?
  • It is estimated that a minimum 0.5 FTE Site Coordinator is needed. The planning, training and implementation phase will be very labour intensive for the Coordinator. Once the program is running, the program coordination should be manageable at 0.5 FTE.

  • What is the expected timeline for implementation? (i.e., from the time screening sites receive their NutriSTEP® Implementation Toolkit to the time they do their first screening? Days, weeks, months?)
  • It will likely take about six months to plan with dedicated staff time which can be part-time to full-time hours depending on how much planning is needed for community consultations, referral mapping, ethics (if required), individualizing the forms, promotion, etc.

    Without RD coordination and support, the screening process will be more difficult to implement particularly the community referral map and community consultations.

  • What are the steps a potential screening site needs to get a NutriSTEP® program off the ground?
  • Many early years programs have experience in screening using other health screens and/or early child screening indexes. NutriSTEP® is an additional screen to their screening program.

    The Site Coordinator needs to know his/her community or find someone who does. Public health departments are experienced in community development and consultation and key partners in any nutrition screening program. There also needs to be RD involvement in most planning and implementation steps.

  • What does it cost to run a NutriSTEP® program in my community?
  • An exact cost is difficult to estimate. Screening works best if it becomes part of a job description for a current staff member(s) for program coordination and support. There will also be material costs which will vary depending on where you live (in Ontario, printed versions of the questionnaire and educational materials are available free of charge).

  • Can anyone be a screen administrator? (e.g., the receptionist at the doctor's office)
  • The NutriSTEP® Implementation Toolkit discusses the role and training of screen administrators. If adequately trained, competent and comfortable, a variety of staff and volunteers can administer the NutriSTEP® questionnaire.

  • Does an organization need to collect screening information and if so how, who and where would it be kept? Could it be stored in a patient's electronic file in a family practice?
  • Data collection is a recommended activity in the process evaluation of a new program and/or an outcome evaluation of any existing program. Data collection and storage would be individualized for the agency according to its policies and procedures.

    The NutriSTEP® Implementation Toolkit also covers these issues and includes sample data collection and evaluation forms.

    The NutriSTEP® Online Community will also have information on what other sites have developed and used related to tracking and evaluation.

  • Training practitioners - who needs to be trained and how?
  • There may be training needs for a variety of people including the screen administrators and those individuals who are receiving nutrition-related referrals (e.g.. public health nurses, community dietitians, family physicians, etc.) The NutriSTEP® Implementation Toolkit covers this topic and includes training materials that can be adapted and individualized.

    The NutriSTEP® Implementation Toolkit Updates will also include new and/or updated training materials as they are developed. The NutriSTEP® Online Community will also have information on what other sites have developed and used related to training and continuing education needs.

  • Is there a protocol for following up with different risk levels?
  • The NutriSTEP® Implementation Toolkit provides information on the referral process and the recommended steps to be taken. This includes community consultations to determine the current and relevant services, their current and potential roles and their capacity to accept referrals. The NutriSTEP® ImplementationToolkit includes sample referral maps.

    The protocol will be dependent on your community and the protocols in place for other similar child health screening activities.

    The NutriSTEP® Online Community will have information on what other sites have developed and used related to referrals and following up with parents.

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