SUMMARY REPORT OF CONTRACT TO
PROVIDE NUTRITION EDUCATION
CONSULTANTS
For
The Nutrition Services Program Integrity Workgroup
in the Southwest Region
April-October 2000
Prepared by:
Cheryl Achterberg, Ph.D.
Dean, Schreyer Honors College
Professor, Department of Nutrition
The Pennsylvania State University
Mary Lou Kiel, Ph.D., R.D. Jeannie McKenzie, Dr.P.H., R.D.
Research Associates
Department of Nutrition
The Pennsylvania State University
Carla Miller, Ph.D., R.D.
Assistant Professor
Department of Nutrition and Foodservice Systems
University of North Carolina at Greensboro
2
TABLE OF CONTENTS
(*asterisk and page # indicates section is included on the web site)
Page #
Introduction
I.
*Background and Purpose of Project
3
Organization of This Manual - Preparation and Use
What do Nutrition Educators Do
1. Session 1: Theory Base for Nutrition Education - May, 2000
* Session Agenda and Objective
4
Content Overview:
Section 1A Theory Base for Nutrition Education
Section 1B Communication/Social Marketing
Session 1 Handouts with Index
2. Session 2: Best Practices in Nutrition Education - July, 2000
* Session Agenda and Objectives
6
Content Overview:
Section 2A Learning Theory
Section 2B What is Meaningful Nutrition Education?
Section 2C Cultural Sensitivity
Section 2D Working with Adults and Low Literacy Audiences
Section 2E Working with Children and Adolescents
Section 2F Presentations
Section 2G Visual Aids
Section 2H Color Psychology
Session 2 Handouts with Index
3. Session 3: Evaluation of Nutrition Education - August, 2000
*Session Agenda and Objectives
8
Content Overview:
Section 3A Evaluation
Session 3 Handouts with Index
4. Evaluation and Planning Resources
*Reference List on Evaluation
10
*
Nutrition Education Materials Resource List 12
5. Summary
*Final Report
14
*Matrix of Good Practices for Nutrition Education in a WIC Setting
(Separate document)
3
Introduction
Background and Purpose of Project
In April, 2000, The Nutrition Services Initiative Workgroup contracted with The
Pennsylvania State University to provide experts in nutrition education as consultants in
an effort to help improve the effectiveness of nutrition education in the State Agency
WIC Programs for the Southwest Region.
The intent of sharing this information is to provide a springboard for other regions that
would like to undertake a similar process. Each region would need to go through the
steps of identifying the issues to be addressed, and selecting the most effective method(s)
to work on their needs. The Southwest Region began with a workgroup of state and
territorial nutrition directors who had a vision to increase the effectiveness of WIC
nutrition education. They chose to address their plan via seminars for the workgroup
members, with the result that what they learned could be passed down to the grassroots
educator level. One of the ways they determined to make this happen was through a
regional teleconference entitled "Nutrition Education: On the Road to Excellence," to be
held April 26 & 27, 2001.
A Nutrition Education Ideas Resource Manual was developed as one of the deliverables
for use in WIC nutrition education activities within the Southwest Region. The content
of the manual reflected the three separate 10 hour intensive seminars on effective
nutrition education as well as input from the workgroup at the final seminar. The initial
seminar presented information about theory-based nutrition education. The second
seminar presented best practices in nutrition education and the final seminar addressed
evaluation of nutrition education.
Included on the following pages are excerpts from the manual. These examples can
assist other regions in making a plan to assess and address their needs. To provide the
whole manual would be inappropriate; it was designed as a support document for the
people who attended the workgroup seminars. It would be like giving a student the notes
without attending class! Additionally, each region will want to select topics tailored to
their audience.
To provide an overview of the process and content, we have included the manual's Table
of Contents, the Agendas and Objectives for each of the three seminars, the Final Report
of the Project, a matrix of good practices in nutrition education, and several
reference/resource lists. We hope that this material will help other regions as we all
strive toward the vision of improving the effectiveness of WIC nutrition education.
4
Education Plan for the Nutrition Services Program
Workgroup Initiative of the
State and Territorial Agency WIC Programs
In the Southwest Region
Session I -Theory Base for Nutrition Education*
May 1 and 2,
Santa Fe, New Mexico
Presenter:
Dr. Cheryl Achterberg
Dean, Schreyers Honor College
The Pennsylvania State University
Day 1
I
Overview of the Session
- What is nutrition education?
II
Philosophical Perspectives
- Why do we do nutrition education?
- Finding purpose and justifying process
III
The Challenge of Changing Dietary Behavior
- Open discussion
IV
Nature of Theory
V
Brofenbrenner's Ecosystem Theory
Day 2
VI
How do People Learn? -Part I Theoretical Perspectives
- History of theory in nutrition education (Knowledge, Attitude,
Behavior)
- Prochaska's stages of change (assignment: write questions to assess
change)
- Learner readiness
- PSU model
- Social Marketing
- Systems approach
VII
Wrap-up/Discussion of Sessions II and III
*Recommended reference: Health Behavior and Health Education Theory Research and Practice, 2nd
edition, K. Glanz, F. Lewix, and B. Remer, editors. Jossey-Bass Publishers, SanFrancisco, 1997.
5
OBJECTIVES00HEORY BASE FOR NUTRITION EDUCATION
The objectives for this session are: To help you develop your own thinking skills about
nutrition education, and to introduce you to the major theories in nutrition education. The
focus of this dialogue is on the actual practice of nutrition education, but it is practice that
is informed by the latest research and by concepts and methods from other related
disciplines including (but not limited to) anthropology, psychology, sociology, human
development, marketing/business, and of course, education.
Special notice:
A tolerance for ambiguity and for reasoned argument will be an asset today. Participants
will be expected to present their own views, to ask questions and debate perspectives
throughout the session. To introduce you to what I mean by ambiguity, let us examine
three concepts: green, justice, and pretty. Most of the concepts that we will need to deal
with from an educational or learning perspective will not be as precise as the definition
for green, nor will they be as subjective as the definition of "pretty." Rather they will be
somewhere in between such as with the concept of "justice" - which most should agree
has some core of meaning that all can identify with, but it is difficult to put exact
boundaries on the idea under debate. That is why a major portion of our discussion will
be to push each other to explore, expand, and define the meaning of key concepts in our
field as much as possible.
Consider now the concepts vitamin C, health and delicious. Each are concepts that the
nutrition educators in WIC deal with on a daily basis, but how you deal with them will
depend upon how you define these concepts and also on the philosophy that you attach to
them consciously or unconsciously. Philosophies are very rarely attached to ideas that
are as concise as "green" or "vitamin C" but books are written on the meaning of ideas
like "health", "justice", and even "delicious". What is important about these concepts is
that they have the power to move, motivate, or change the scheme of things that concepts
like "green" or "vitamin C" do not have.
6
Session II-
Best Practices in Nutrition Education*
July 10 and 11, 2000
Dallas, Texas
Presenters:
Dr. Mary Lou Kiel
Instructor in Nutrition, Department of Distance Education
Dr. Jeannie McKenzie
Research Associate, Department of Nutrition
The Pennsylvania State University
Day 1
I
How do People Communicate?
- Social learning theory (locus of control/self-efficacy)
- Facilitated group discussion
- Cultural sensitivity
- Open discussion
II
How do People Learn? -Part II
- Meaningful learning
- Adult learning
Day 2
III
General Education Principles00indings from the Education Research Literature
Tips for working with:
- Adult learners
- Tips to organize content/curricula
- Tips to present materials
- Tips for graphic design
- Tips for leading discussion
IV
Special Audiences00ips for working with these audiences in a WIC setting
- Preschool children
- Adolescents
- Low-literacy adults
- Multicultural/ethnic audiences
Hispanic, Native American, African American, other
V
Wrap-up/Discussion of Teleconference
*Recommended reference: How People Learn Brain, Mind, Experience, and School. J. Bransford, A.
Brown, and R. Cocking, editiors. National Academy Press, Washington, D.C., 1999.
7
GOALS:
We hope you will "take home:"
00Some BRAND NEW information;
00Some techniques you knew a little about, and now you know more;
00Some techniques you have used, and now you have shared others' experiences in
using them;
00Some techniques you have used frequently, but now you have more support and
reinforcement for using them;
00Some techniques you could have given the presentation on, but it is beneficial to hear
other's viewpoints!
LEARNING OBJECTIVES:
00For each participant to learn about at least one technique for delivering nutrition
education effectively;
00For each participant to learn more about at least one technique that they wil TAKE
HOME and INCORPORATE into daily practice.
8
Session III-
Evaluation of Nutrition Education*
August 14 and 15, 2000
Dallas, Texas
Presenters:
Dr. Carla Miller
Assistant Professor
Department of Nutrition and Foodservice Systems
University of North Carolina at Greensboro
Dr. Jeannie McKenzie
Research Associate
Department of Nutrition
The Pennsylvania State University
Day 1
I
What is Evaluation?
- Who is it for?
II
Process Evaluation versus Outcome Evaluation
- One or the other or both?
III
Qualitative versus Quantitative Research and Evaluation
- Which, when, why?
IV
Validity and Reliability of Evaluation Measures
- Key considerations
Day 2
V
How to Evaluate a Curriculum
VI
Construction of Multiple Choice Tests and Questionnaires
- What you need to know
VII
Interviews for Evaluation/Research Purposes
VIII Concept Maps
- Examples (why women retain water during pregnancy)
IX
Wrap-up/Discussion
*Reference list on evaluation follows
9
Evaluation of Nutrition Education00bjectives
Following this presentation, you will be able to:
00Define the term evaluation.
00Identify and explain differences between the four types of evaluation.
00Compare qualitative versus quantitative evaluation, and useful models that integrate
both methods.
00Discuss measurement issues, including credibility, validity, and reliability.
00Construct basic multiple choice assessment instruments.
00Discuss the use of interviews for research and evaluation.
00Use concept maps to help organize material and see which concepts are linked.
10
REFERENCE LIST ON EVALUATION
Cook, T.D., and D.T. Campbell. 1979. Quasi-Experimentation: Design and Analysis
Issues for Field Settings. Boston: Houghton Mifflin Company.
Conover, W.J. Practical Nonparametric Statistics. 1971. New York: John Wiley & Sons.
Cody, R.P. and J.K. Smith. Applied Statistics and the SAS Programming Language.
1991. Englewood Cliffs, NJ: Prentice Hall.
Dillman, D.A. Mail and Telephone Surveys: The Total Design Method . 1978. New York:
John Wiley & Sons.
Gall, M.D., Borg, W.R., and J.P. Gall. 1996. Educational Research: An
Introduction.
Longman Publishers USA.
Glaser, B.G., and A.L. Strauss. The Discovery of Grounded Theory: Strategies for
Qualitative Research. 1967. New York: Aldine de Gruyter.
Keppel, G. Design and Analysis: A Researcher's Handbook. 1982. Engelwood Cliffs, NJ:
Prentice Hall.
Marshall, C., and G.B. Rossman. Designing Qualitative Research. 1989. London: Sage
Publications.
Miles, M.B., and A.M. Huberman. Qualitative Data Analysis: A Sourcebook for New
Methods. 1984. London: Sage Publications.
Morgan D.L. (ed.). Suceessful Focus Groups: Advancing the State of the Art. 1993.
London: Sage Publications.
Patton, M.Q. Qualitative Evaluation Methods. 1984. London: Sage Publications.
Rovine, M.J., and A. von Eye. Applied Computational Statistics in Longitudinal
Research. 1991. Boston: Academic Press, Inc.
Sommer, R., and B.B. Sommer. A Practical Guide to Behavioral Research . 1986. New
York: Oxford University Press.
Slavin, R.E. Research Methods in Education: A Practical Guide. 1984. Engelwood
Cliffs, NJ: Prentice Hall.
Snedecor, G. W., and W.G. Cochran. Statistical Methods. 1980. Ames, IA: The Iowa
State University Press.
11
Strauss, A., and Corbin, J. 1990. Basics of Qualitative Research: Grounded Theory
Procedures and Techniques. 1990. London: Sage Publications.
Yoddumnern-Attig, B. , Attig, G.A., Boonchalaksi, W., Richter, K., and A.
Soonthorndhada. (eds.). 1993. Qualitative Methods for Population and Health Research.
Mahidol University at Salaya, Thailand: Institute for Population and Social Research.
Zar, J.H. Biostatistical Analysis. 1974. . Engelwood Cliffs, NJ: Prentice Hall.
12
NUTRITION EDUCATION MATERIALS RESOURCE LIST
American Academy of Pediatrics
P.O. Box 927
141 Northwest Point Blvd.
Elk Grove Village, IL 60009-0927
American Cancer Society
Cancer Information Center
1701 Rickenbacker Dr., Suite 5B
Sun City Center, FL 33573-5361
800-ACS-2345
American Dental Association
211 E. Chicago Ave.
Chicago, OL 60611-2678
312-440-2500
American Heart Association
Box BHG, National Center
7320 Greenville Ave.
Dallas, TX 75231
800-527-6941
Dannon Institute
120 White Plains Rd.
Tarrytown, NY 10591
914-332-1092
Community Nutritionary
Food and Nutrition Information Center
National Agricultural Library, Rm. 304
10301 Baltimore Blvd.
Beltsville, MD 20705
301-344-3719
March of Dimes
1275 Mamaroneck Ave.
White Plains, NY 10605
914-428-7100
National Cancer Institute
Office of Cancer Communications
Building 31, Room 10824
Bethesda, MD 20892
800-4-CANCER
13
National Dairy Council
O'Hare International Center
10255 West Higgins Rd. Suite 900
Rosemond, IL 60018
312-696-1020
(Dairy Council Digest)
National Heart Lung & Blood Institute
National High Blood Pressure Education
P.O. Box 30105
Bethesda, MD 20824-0105
301-951-3260
National Livestock and Meat Board
444 N. Michigan Ave.
Chicago, IL 60611
312-467-5520
(Nutrition News)
National Maternal & Child Health Clearinghouse
38th and R St. NW
Washington, DC 20057
202-625-8410
Society for Nutrition Education
2001 Killebrew Dr. Suite 340
Minneapolis, MN 55425-1882
415-444-7133
(Journal of Nutrition Education; monthly Gems section)
Tufts University, School of Nutrition
203 Harrison Ave.
Boston, MA 02111
(Tifts Diet and Nutrition Newsletter)
USDA Cooperative Extension Service
Home Economics
14th St., SW and Independence Ave.
Washington, DC 20250
202-720-2791
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Final Report
Prepared for: The Nutrition Services Program Integrity (NSPI)
Workgroup of the Southwest Region
Date: October 17, 2000
Introduction
On April 21, 2000 The Pennsylvania State University entered into a contract with the
Pueblo of Zuni WIC Program to provide experts in nutrition education as consultants to
the Nutrition Services Program Integrity (NSPI) workgroup. The NSPI workgroup
initiative was created to improve the effectiveness of nutrition education in the State
Agency WIC Programs in the southwest region. Since that date, the contractor has
worked directly with the NSPI workgroup members and its advisory board members to
provide these consultative services.
On Sunday April 16, 2000, prior to the contract date, Drs. Cheryl Achterberg, Mary Lou
Kiel, and Jeannie McKenzie traveled to Philadelphia to the NAWD convention in order
to meet with NSPI workgroup and advisory board members. The purpose of this
introductory meeting was to review the contract's timeline and list of deliverables.
Adjustments were made to the project's timeline, where needed, and the project officially
started five days later.
Faculty
The contract stipulated that three PhDs and additional support staff with a strong record
of nutrition education research, and first hand knowledge of the nutrition education in
WIC work on this project. Drs. Achterberg, Kiel and McKenzie formed the core for the
Penn State expert team. In addition, Dr. Carla Miller from the University of North
Carolina at Greensboro routinely collaborated on the project. These four experts directed
the project at Penn State and were assisted by Patricia Treanor, a graduate student in
Nutrition and Stacey Hugney, the Nutrition Center's staff assistant.
Time Frame
The timeline for deliverables that was established at the April 16, 2000 meeting was
adhered to and all deadlines were met by the contractor.
15
Accomplishments
The following list provides an overview of what the contractor provided to the NSPI
work group between April 18 and October 17, 2000:
1. April 18 - the review article describing self-efficacy and locus of
control was mailed to all workgroup and advisory members.
2. April 24 - the draft education plan for the three intensive nutrition
seminars was mailed to all workgroup and advisory members.
3. May 1 and 2 - Dr. Achterberg presented Theory Base for Nutrition
Education to the workgroup in Santa Fe for 11 hours and reviewed the
draft education plan.
4. May 15 - the final education plan and additional reprint on the use of
theory was mailed to all workgroup and advisory members.
5. May 18 - Drs. Kiel and McKenzie were part of the workgroup's
conference call about developing a survey instrument to prioritize topics
for the proposed teleconference.
6. May 23 - an additional chapter reference about obesity in low income
women was mailed to Darlene Irwin.
7. June 20 - a literature review of the impact of the Special Supplemental
Nutrition Program for Women, Infants and Children on nutrition-related
behavioral outcomes was mailed to all workgroup and advisory members.
8. July 10, 11 and 12 - Drs. Kiel and McKenzie presented Best Practices
in Nutrition Education to the workgroup in Dallas for 11 hours. For an
additional 2 hours they provided consultation for the workgroup's planned
teleconference in 2001.
9. August 4 - Drs. Achterberg and McKenzie were part of the
workgroup's conference call about the teleconference.
10.August 14 and 15 - Dr. Miller presented Evaluation of Nutrition
Education to the workgroup in Dallas for 10 hours. Dr. McKenzie
assisted with the session and ascertained the workgroup's expectations for
the remaining project deliverables.
11.August 29 - an addendum to the literature review summarizing
nutrition education research for preschool aged children in the general
population was mailed to all workgroup and advisory members.
16
12.September 6 - Drs. Kiel and McKenzie mailed written evaluations for
the curricula and nutrition education materials back to the workgroup
members who submitted them. All materials were returned to those
individuals.
13.September 12 - Dr. McKenzie was part of the workgroup's conference
call in which progress towards obtaining teleconference speakers was
discussed and concerns expressed.
14.October 17 - a nutrition ideas resource manual, an evaluation resource
package and this final report along with a matrix for effective nutrition
education was mailed to all workgroup and advisory members.
15.At the end of each month, beginning in May, a monthly report was
mailed to Ruby Wolf outlining what the Penn State group had worked on
for the project that month.
16.Darlene Irwin was in regular telephone and email communication with
the Penn State faculty.
Products
The following resources were produced for the NSPI workgroup and advisory board
members for use in the State Agency WIC Programs:
1. A literature review describing the impact of WIC on nutrition-related
behavioral outcomes and summarizing nutrition education research for
preschool aged children in the general population.
2. A nutrition ideas resource manual for nutrition education activities an
the Southwest region.
3. An evaluation resource package for the Southwest region.
4. A good practices matrix based upon length of time available and
effective strategies to use during nutrition education sessions.
5. A series of reprinted research articles describing strategies and
methodologies to consider when developing effective nutrition education
programs.
17
Recommendations
The project faculty met and agreed upon four recommendations for the NSPI workgroup.
The faculty encourages the workgroup to act upon these recommendations in order to
help improve the effectiveness of nutrtition education in the State Agency WIC Programs
in the Southwest Region. The recommendations are:
1. Nutrition education programs must be evaluated. The process
needs to be ongoing as represented in Figure 1. The first step is an initial
baseline evaluation, followed by intervention materials development (2),
pilot testing and revisions (3), implementation (4), and evaluation (5). The
cycle continues over time so that valuable data describing the
accountability of each nutrition education program is always available.
Figure 1 The Nutrition Education Evaluation Cycle
2. Serve all eligible age groups in the WIC Program with nutrition
education. To date, nutrition education has targeted pregnant, and
breastfeeding women as well as the mothers of infants for the majority of
nutrition education sessions. As described in the addendum to the
literature review, preschool children are eager learners. Providing age-
appropriate nutrition education for this group could help to establish many
1. Baseline
Evaluation
2. Intervention Materials
Development
3. Pilot Testing and
Revisions
4. Implementation
5. Evaluate
18
positive eating behaviors. This could be a very rewarding area for WIC
nutrition educators.
3. Use multiple strategies when conducting nutrition education
sessions . As presented in this final report's matrix on good practices in
nutrition education, no one modality is the answer to every nutrition
education situation. One-on-one nutrition counseling along with print
handouts may be the best choice for one situation. Group discussion after
viewing a video may be the most efficacious approach in another situation.
Understand your audience and tailor the message delivery as well as the
message to the audience.
4. Continue to collaborate and share lessons learned i.e., successful
approaches. To stand above the rest, professionals must have a vision
and be willing to take risks. Members of the NSPI workgroup have a
vision, to improve the effectiveness of nutrition education in the
Southwest Region and have been willing to take risks to achieve this goal.
They represent a group of colleagues from five state agencies and 16
Indian Tribal Organizations. They collaborated with colleagues from
Penn State on this project. For the upcoming teleconference, they have
collaborated with speakers from various universities, businesses, and
governmental agencies across the country. Such ongoing collaboration is
vital to continued success after this project is formally over.
Matrix of Good Practices
The following two pages present a matrix of good practices in nutrition education based
upon the length of time, space, personnel, and other available resources. This matrix
should be used only as a guide and a starting point when individual agencies are planning
their nutrition education programs. The matrix also presents opportunities for nutrition
education beyond the clinic setting i.e. experiential learning through growing gardens,
attending Farmers' Markets and supermarket tours.
Conclusion
The past six months have been extraordinarily productive. A large volume of nutrition
education information was presented at the three intensive seminars and in the literature
review. An enormous amount of nutrition education material has been compiled into the
ideas resource manual, the evaluation package and the matrix. Four recommendations
have been made to the NSPI workgroup and its advisory board to help improve the
effectiveness of nutrition education in the Southwest Region. The Penn State faculty
looks forward to the upcoming final meeting in New Orleans, the teleconference, and to
observing positive strides in improving the effectiveness of nutrition education in the
Southwest Region as well as the evaluation of these improvements.
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