FEATURED PUBLICATION​

Beyond BMI: A feasibility study implementing NutriSTEP in primary care practices using electronic
medical records

Lesley Andrade, Kathy Moran, Susan J. Snelling, Darshaka Malaviarachchi, Joanne Beyers,
Kelsie Near, Janis Randall Simpson


Read the paper

Primary care providers have a role to play in supporting the development of healthy eating habits, particularly in a child’s early years. This study examined the feasibility of implementing the NutriSTEP® screen—a 17-item nutrition risk screening tool validated for use with both toddler and preschooler populations—integrated with an electronic medical record (EMR) in primary care practices in Ontario, Canada, to inform primary care decision-making and public health surveillance. Five primary care practices implemented the NutriSTEP screen as a standardized form into their EMRs. To understand practitioners’ experiences with delivery and assess factors associated with successful implementation, we conducted semi-structured qualitative interviews with primary care providers who were most knowledgeable about NutriSTEP implementation at their site. We assessed the quality of the extracted patient EMR data by determining the number of fully completed NutriSTEP screens and documented growth measurements of children. Primary care practices implemented the NutriSTEP screen as part of a variety of routine clinical contacts; specific data collection processes varied by site. Valid NutriSTEP screen data were captured in the EMRs of 80% of primary care practices. Approximately 90% of records had valid NutriSTEP screen completions and 70% of records had both valid NutriSTEP screen completions and valid growth measurements. Integration of NutriSTEP as a standardized EMR form is feasible in primary care practices, although implementation varied in our study. The application of EMR-integrated NutriSTEP screening as part of a comprehensive childhood healthy weights surveillance system warrants further exploration.

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Tweets by Lesley andrade

Lesley Andrade
​BSc MHSc PhD(c) RD

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Research interests: healthy eating and nutrition policy, chronic disease prevention, dietary assessment, non-nutritive sweeteners, healthy weights promotions and eating disorder/disordered eating prevention, population and public health, health equity, public health systems

Education:
PhD Candidate, Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo (2017- )

MHSc, Public Health Science, Community Nutrition stream, University of Toronto (2003-2005)  

BSc, Honours Nutrition & Nutraceutical Sciences, University of Guelph (1998-2002)

Select publications:
Peer-reviewed:

• Andrade L, Moran K, Snelling S, Malaviarachchi D, Beyers J, Near K, and Randall Simpson J. Beyond BMI: A feasibility study implementing NutriSTEP in primary care practices using electronic medical records (EMR). Health Promotion and Chronic Disease Prevention. 2020; 40(1):1-10.
• Maynard M, Andrade L, Packull-McCormick S, Perlman C, Leos-Toro C, Kirkpatrick SI. Food insecurity and mental health among females in high-income countries. International Journal of Environmental Research and Public Health. 2018, 15:1424..
  

Reports and other publications:

• Kirkpatrick SI, Andrade L. State of the evidence on non-nutritive sweeteners. Submitted to Health Canada, 2018.
• Beyond BMI Research Team. Beyond BMI: Building an EMR-based childhood healthy weights surveillance system to include nutritional risk and protective factors through the collection and EMR-integration of NutriSTEP®. Submitted to Public Health Ontario. 2017.
• Andrade L, Yantzi N, Urajnik D, Graham C; Craig C; Despatie L, Barber K. Healthy Kids Community Challenge City of Greater Sudbury: Community needs assessment. Submitted to City of Greater Sudbury Healthy Kids Community Challenge Planning and Advisory Committee, 2016.
• Snelling S, Andrade L, Beyers J, Malaviarachchi D, Biro S. Fera L. Beyond BMI: Risk and protective factors for child healthy weights assessed using NutriSTEP® in primary care. Submitted to Public Health Ontario, 2015.

Select presentations:

• Andrade L, Lee KM, Stapleton J, Kirkpatrick SI. Is increasing use of low-calorie sweeteners a cause for concern? A rapid review of systematic reviews. Canadian Nutrition Society Annual Meeting, 2019.
  
• Andrade L, Raffoul A, Hammond D, Kirkpatrick SI. Indicators of disordered eating are common among urban Canadian young adults. Dietitians of Canada Annual Conference, 2019.
• Andrade L, Raffoul A, Acton R, Lee K, Burns K, Godin K, Hanning R. Tackling weight-based stigma in the classroom: Developing capacity for weight-sensitive instruction among university students and instructors. Canadian Obesity Summit, 2019.
• Andrade L, Kirkpatrick SI. Examining the impact of food insecurity on eating disorder pathologies. Canadian Institutes of Health Research Student Health Research Forum. 2018.
• Andrade L, McDonough T. Beyond BMI: NutriSTEP® for the prevention, and care and management of childhood obesity. Canadian Obesity Summit, 2017.
• Andrade L, McDonough T, Randall Simpson J. Beyond BMI: The collection and integration of risk and protective factor information in electronic medical records (EMRs) for childhood healthy weights surveillance in Ontario. Nutrition Resource Centre Forum and Nutrition Exchange, 2016.
• Andrade L, Moran K. Beyond BMI: Investigating the feasibility of using electronic medical records and NutriSTEP® for childhood healthy weights surveillance. Grand Rounds, Public Health Ontario. 2015.
• Andrade L. NutriSTEP® implementation at the Sudbury & District Health Unit: A tool to start the conversation. Mental Health and Healthy Weights for Children and Youth Knowledge Exchange Forum, 2015.
  
• Andrade L. Social determinants of healthy eating and obesity: a northern health unit’s perspective. Eat Less, Eat Better… is it really that simple? Rethinking our message about healthy eating and obesity. Ontario Public Health Association Nutrition Resource Centre, 2015.

Recognitions:

• 2018-2021: Ontario Graduate Scholarship, Government of Ontario
• 2018-2021: President's Graduate Scholarship, University of Waterloo​ ​
• 2018-2019: Graduate Student Experience Award, University of Waterloo
• 2018: Canadian Institutes of Health Research Travel Award
  

Select professional activities and networks:

• Chair, Community and Public Health Nutrition Network, Dietitians of Canada (2018 - Present)
• Member in Good Standing, College of Dietitians of Ontario (2005 – Present)
• Member and Evaluation Representative, City of Greater Sudbury Healthy Kids Community Challenge Planning and Advisory Committee (2015 – 2017)
• Foundational Standards Specialist, Public Health Sudbury & Districts (2015-2017)
• Interim Manager, Health Promotion Division, Public Health Sudbury & Districts (2013-2014)
• Public Health Nutritionist, Public Health Sudbury & Districts (2005-2015)
• Coordinator, Northern Healthy Eating Project (NHEP) (2007 – 2012)