RESUMEN
OBJECTIVE: Using 24-hour dietary recalls, compare Healthy Eating Index (HEI)-2005 scores of Expanded Food and Nutrition Education Program participants before and after 8-12 weekly lessons. DESIGN: Analysis of preexisting 24-hour dietary recalls information collected from October, 2012 through September, 2014. PARTICIPANTS: Participants with complete pre-post dietary data (nâ¯=â¯122,961); subset of those with complete demographic data (nâ¯=â¯97,522). MAIN OUTCOME MEASURES: Change in HEI-2005 scores (total and components). STATISTICAL ANALYSIS: Linear regression model fit separately for total HEI and 12 components. The response variable was changed in the HEI-2005 score; predictor variables included age, education, sex, and race/ethnicity. RESULTS: The mean total HEI scores were 51.1 (SD, 13.7) at entry and 56.5 (SD, 13.7) at exit, with a change of 5.4 (SD, 16.2). Nine of 12 component scores increased. Changes were greater as age increased, with increasing education, and in women. Hispanics had the greatest improvement (mean ± SE) in total HEI score (8.3 ± 0.1). CONCLUSIONS AND IMPLICATIONS: Although diet quality remained poor, participation in the Expanded Food and Nutrition Education Program resulted in improvement in dietary quality. The degree of improvements varied among demographic groups, but all groups improved.
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Dieta Saludable , Dieta , Adulto , Estudios Transversales , Femenino , Alimentos , Humanos , PobrezaRESUMEN
OBJECTIVE: Develop and establish the reliability and validity of dietary behavior evaluation questions for the Expanded Food and Nutrition Education Program (EFNEP). DESIGN: A mixed-methods study using cognitive interviews, expert panels, test/retest reliability, and pretests/posttests. SETTING: 14 states across the US. PARTICIPANTS: A convenience sample of low-income EFNEP or EFNEP-eligible participants for cognitive interviews (nâ¯=â¯111), reliability testing (nâ¯=â¯181), and sensitivity to change testing (nâ¯=â¯382). MAIN OUTCOMES MEASURES: Indicators of face and content validity, temporal reliability, and sensitivity to change. ANALYSIS: Questions interpreted as intended in cognitive interviews, intraclass correlation coefficient and Spearman rank-order correlation for reliability testing; paired t tests or Wilcoxon signed-rank tests for sensitivity to change; and exploratory factor analyses to identify possible scales. RESULTS: Cognitive interviews resulted in 3 rounds of question revisions; reliability value ranges were 0.48-0.77 for intraclass correlation coefficient and 0.43-0.77 for Spearman rank-order correlation. For sensitivity to change, 9 items had evidence of change (P < 0.05) between pretests and posttests, whereas 5 items had evidence for change after removing those with little room to change. Two scales were identified: diet quality and non-cheese dairy. CONCLUSIONS AND IMPLICATIONS: The EFNEP's new dietary behavior evaluation questions demonstrated face and content validity, moderate to strong reliability, and sensitivity to detect self-reported behavior changes among low-income, diverse populations (culturally, racially/ethnically, and level of education) across 14 states. Nutrition education programs targeting similar behaviors with English speaking clients could consider this dietary behavior questionnaire.
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Dieta , Conducta Alimentaria , Educación en Salud/métodos , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Femenino , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud/métodos , Evaluación de Programas y Proyectos de Salud/normas , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
OBJECTIVE: Design, implement, and evaluate the effectiveness of a video-based online training addressing prenatal nutrition for paraprofessional peer educators. METHODS: Quasi-experimental pre-posttest study with 2 groups of paraprofessionals working for the Expanded Food and Nutrition Education Program in 17 states and US territories: intervention (nâ¯=â¯67) and delayed intervention comparison group (nâ¯=â¯64). An online training was systematically developed using Smith and Ragan's instructional design model, the Cognitive Theory of Multimedia Learning, principles of adult learning, and selected constructs of the Social Cognitive Theory. Changes in knowledge, identification of inappropriate teaching practices, and self-efficacy, were assessed. Within- and between-group comparisons were done using ANCOVA. RESULTS: The intervention group scored significantly higher (P < .05) in all evaluations compared with preassessments and the comparison group. After delayed intervention, the comparison group scored significantly higher (P < .05) than in preassessments. Paraprofessionals reacted positively to future online trainings and were interested in them. CONCLUSIONS AND IMPLICATIONS: A video-based online training is an effective method to complement in-person trainings to prepare paraprofessionals to teach nutrition lessons.
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Educación en Salud/organización & administración , Personal de Salud/educación , Fenómenos Fisiologicos Nutricionales Maternos/fisiología , Ciencias de la Nutrición , Atención Prenatal/organización & administración , Adolescente , Adulto , Femenino , Humanos , Internet , Persona de Mediana Edad , Ciencias de la Nutrición/educación , Ciencias de la Nutrición/organización & administración , Embarazo , Grabación en Video , Adulto JovenRESUMEN
OBJECTIVE: To determine how the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QoL) of its low-income adult participants. METHODS: A cross-sectional exploratory study using focus groups (nâ¯=â¯15) in 8 states with EFNEP participants (nâ¯=â¯111) 2-4 months after graduation. Focus groups were conducted with non-Hispanic white (4 groups), black (4), English-speaking Hispanic (4), and Spanish-speaking Hispanic (3) respondents. A priori template analysis based on constructs from the University of Toronto's Quality of Life Profile for Adults and constant comparative procedures were used to generate results. RESULTS: Participants reported following healthier dietary and physical activity behaviors and having increased motivation to improve themselves and greater satisfaction with life. All groups noted being a more positive influence on their families and a having willingness to learn and try new things. CONCLUSIONS AND IMPLICATIONS: The EFNEP enhances the QoL of its participants, which suggests that the program's benefits go beyond participants' documented nutrition and health-related behavior changes. In the future, EFNEP might examine whether improved QoL is also a predictor of sustained behavior change and a means for differentiating program impacts owing to variations in dose (number of contacts) or delivery methods (face-to-face vs online).
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Negro o Afroamericano/psicología , Conocimientos, Actitudes y Práctica en Salud , Hispánicos o Latinos/psicología , Ciencias de la Nutrición/educación , Calidad de Vida , Población Blanca/psicología , Adulto , Estudios Transversales , Femenino , Grupos Focales , Humanos , Masculino , Estados Unidos , Adulto JovenRESUMEN
OBJECTIVE: Research methods are described for developing a food and physical activity behaviors questionnaire for the Expanded Food and Nutrition Education Program (EFNEP), a US Department of Agriculture nutrition education program serving low-income families. DESIGN: Mixed-methods observational study. The questionnaire will include 5 domains: (1) diet quality, (2) physical activity, (3) food safety, (4) food security, and (5) food resource management. A 5-stage process will be used to assess the questionnaire's test-retest reliability and content, face, and construct validity. SETTING: Research teams across the US will coordinate questionnaire development and testing nationally. PARTICIPANTS: Convenience samples of low-income EFNEP, or EFNEP-eligible, adult participants across the US. INTERVENTIONS: A 5-stage process: (1) prioritize domain concepts to evaluate (2) question generation and content analysis panel, (3) question pretesting using cognitive interviews, (4) test-retest reliability assessment, and (5) construct validity testing. MAIN OUTCOME MEASURE: A nationally tested valid and reliable food and physical activity behaviors questionnaire for low-income adults to evaluate EFNEP's effectiveness. ANALYSIS: Cognitive interviews will be summarized to identify themes and dominant trends. Paired t tests (P ≤ .05) and Spearman and intra-class correlation coefficients (r > .5) will be conducted to assess reliability. Construct validity will be assessed using Wilcoxon t test (P ≤ .05), Spearman correlations, and Bland-Altman plots.
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Ejercicio Físico , Educación en Salud , Encuestas Epidemiológicas/normas , Encuestas Nutricionales/normas , Encuestas y Cuestionarios/normas , Conducta Alimentaria , Conductas Relacionadas con la Salud , Humanos , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: Identify practices for the collection of the 24-hour dietary recall (24HR) as used by the Expanded Food and Nutrition Education Program (EFNEP) to assess the fidelity with which dietary data are collected. METHODS: An electronic survey sent nationally to all 75 EFNEP coordinators to assess methodology for collection, staff training, and coding of 24HR. RESULTS: A total of 67 surveys were returned, 53 of which were usable: 57% of programs used multiple collection periods (previous day vs previous 24 hours), 36% did not use a consistent number of passes in recall collection; only 17% exclusively used the validated 5-pass method; 88% trained paraprofessionals for ≤8 hours on recall collection and >6 different training programs were used; and 86% of programs used multiple coders. CONCLUSIONS AND IMPLICATIONS: The wide variation in reported collection, training, and coding practices raises concerns about the validity of the recall data and the appropriateness of combining data from multiple programs. To improve consistency, EFNEP could establish standardized methods for training, data collection, and data entry for the 24HR. These results may encourage the national program office to establish programmatic change that will support the fidelity of collection methods across all programs.
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Recolección de Datos/métodos , Encuestas sobre Dietas/métodos , Dieta , Educación en Salud/métodos , Estudios Transversales , Humanos , Estado NutricionalRESUMEN
The purpose of this study was to identify nutrition-related content employed nationally by the Expanded Food and Nutrition Education Program (EFNEP) with adult participants. A content analysis was used to assess the type, frequency, and depth of nutrition content in adult curricula most used by EFNEP nationally compared with the 2010 Dietary Guidelines for Americans (2010 DGA). All EFNEP curricula reviewed employed the vast majority of the 2010 DGA nutrition recommendations, with differences in the frequency and depth of nutrition content. Further research is needed to determine which 2010 DGA recommendations are most important to teach and evaluate within a low-income population.
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Educación en Salud/métodos , Educación en Salud/normas , Política Nutricional , Educación en Salud/estadística & datos numéricos , Humanos , Pobreza , Estados UnidosRESUMEN
OBJECTIVE: To determine the effectiveness of the Expanded Food and Nutrition Education Program (EFNEP) curriculum Eating Smart-Being Active (ESBA). DESIGN AND SETTING: A quantitative, multi-state, nonequivalent comparison group pretest-posttest design was used to compare nutrition-related behavior changes in participants. ESBA was compared to previously used curricula for 3 different time periods in 5 states using the EFNEP evaluation tool. PARTICIPANTS: Adults enrolled in EFNEP who completed their entry and exit paperwork during any of the 3 time points. INTERVENTION: An 8-lesson adult curriculum based on the Dietary Guidelines for Americans and MyPlate. ANALYSIS: Analysis of variance and covariance (with pretests scores and demographic variables as covariates) were used to analyze data with significance at P ≤ .05. RESULTS: ESBA elicited a mean positive behavior change for food resource management (P < .01), food safety (P ≤ .001), nutrition (P < .001), and physical activity level in participating states (P ≤ .01). Compared with previous curricula, ESBA produced better mean outcomes in food resource management, nutrition, physical activity, and intakes of fruit and vegetables. CONCLUSION AND IMPLICATIONS: ESBA is effective at eliciting positive nutrition-related behavior change. The results of this multi-state, practice-based approach suggest that ESBA is effective in multiple settings and has external validity for use in EFNEP and other community nutrition programs.
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Dieta , Asistencia Alimentaria , Actividad Motora , Política Nutricional , Ciencias de la Nutrición/educación , Cooperación del Paciente , Educación del Paciente como Asunto , Adulto , Dieta/efectos adversos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Estados UnidosRESUMEN
OBJECTIVE: Determine whether the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QOL) of its participants and educators. DESIGN: Longitudinal, where QOL was measured 3 times for participants (pre, post, 3-month delayed post) and educators (before and 6 and 12 months after training). SETTING: Participants' and educators' QOL was measured in Colorado, Kansas, Missouri, and Nebraska. Georgia and Texas measured educators; Minnesota and Virginia measured participants. PARTICIPANTS: English speaking EFNEP participants and educators. MAIN OUTCOME MEASURES: The investigators used the QOL Profile to measure QOL in 3 domains: Being (who one is), Belonging (connection with social and physical environment), and Becoming (achieving personal goals). ANALYSIS: Chi-square and t tests compared group demographics; repeated-measures ANOVA detected changes over time; ANCOVA examined the influence of demographic variables. RESULTS: Both groups had QOL Profile scores above 1.5, which is considered acceptable. Participants improved from pre to post in the Being domains including Overall Being (least square means [standard error of the mean], 3.1 [0.2] to 4.1 [0.3]), and in Social Belonging (3.5 [0.3] to 3.8 [0.3]); most improvements were sustained at 3 months. Educators improved in the Belonging domains, and a number of scores continued to improve at 1 year after training, for example, Social Belonging (4.2 [0.5], 5.0 [0.5], and 5.8 [0.6]); and Community Belonging (3.5 [0.5], 3.8 [0.5], and 4.7 [0.5]) at the 3 time points, respectively. CONCLUSIONS AND IMPLICATIONS: EFNEP improved the QOL of participants, primarily in the Being domain, and of educators, primarily in the Belonging domain. The QOL profile has the potential to broaden the assessment of EFNEP impacts.