NC1169: EFNEP Related Research, Program Evaluation and Outreach
Statement of Issues and Justification
Stakeholder Need - The Expanded Food and Nutrition Education Program (EFNEP) was established by Congress in 1968, when the plight of low-income American families, including hunger and malnutrition, came to public attention. The goal of EFNEP is to assist low-income audiences in acquiring the knowledge, skills, attitudes, and changed behaviors necessary for nutritionally sound diets, and to contribute to their personal development and the improvement of the total family diet and nutritional well-being.In 1969, the primary nutritional problems of EFNEPs participants were energy inadequacy and vitamin and mineral deficiencies which resulted in growth deficits (Carpenter, 2003). Current nutritional problems of limited-resource families include energy excess, resulting in overweight and obesity, and early development of chronic diseases (CDC, 1985-2006). Further, the science of nutrition has revealed new diet-disease relationships, national dietary guidelines continue to evolve, and new food choice behaviors emerge as more food is purchased and consumed away from home.
Given these significant societal changes, the methods EFNEP currently uses to evaluate dietary quality and program impact need to be reexamined. EFNEP and Extension leaders recognize the need to verify the validity of current approaches and/or develop new approaches for evaluating the EFNEP.
Importance and Consequences of the Work - Currently program impact is determined by changes in dietary intake and selected food related behaviors. Trained EFNEP paraprofessionals conduct 24-hour dietary recalls as part of pre/post assessments. Collecting dietary information using a 24-hour dietary recall is relatively quick, when compared to a food record, and is more appropriate than a food frequency questionnaire for populations with diverse diets and/or limited education (Pao & Cypel, 1996). The method is considered valid for estimating the food and nutrient intakes of large groups but is generally not sufficient for understanding an individuals intake. Disadvantages of the method include a reliance on memory, a tendency for people to provide socially acceptable responses and an underestimation of quantities consumed (Pao & Cypel, 1996).
The 24-hour dietary recall is best conducted by a well-trained professional. There are questions about this method being used by EFNEP paraprofessionals. The newer Multiple Pass Method, a five stage process for questioning about food (Conway et al., 2003), and conducting the recalls with groups complicate the process. Consistent, accurate and reliable impact data are critical to program accountability and ultimately to continuation of funding.
Participation in EFNEP, for both educators and participants, also leads to reported changes beyond improvements in diet and nutrition, including pursuing additional education, enhanced employment or health status, and greater community involvement. Arnold and Sobal (2000) examined food practices and nutrition knowledge after participants graduation from EFNEP and observed that EFNEP may have broader impacts beyond food and nutrition, influencing other domains of the lives of participants, and that those impacts may provide increased personal capabilities and confidence that enable people to improve both nutritional and non-nutritional practices.
A continuing strength of EFNEP is its delivery by paraprofessionals, hired not for their subject matter knowledge but for their life experiences and their ability to relate to participants. The effect of the paraprofessional relationship with the EFNEP participant and the familys Quality of Life (QOL) has been anecdotally noted as a benefit of the program, but has not been measured. Nor has the programs impact on the paraprofessionals Quality of Life been assessed, i.e., EFNEPs influence on their future education, employment and life satisfaction. Technical Feasibility Assessment of diet quality has long been part of EFNEP evaluation. Information is reported annually at the state and national levels and has been used to successfully maintain funding for the program. The dietary data collected from the 24 hour recall are entered into a software program and sent to a central data base. Reports are generated that provide information on an individuals general dietary status as well as EFNEP participants in total.
The Behavior Checklist for the EFNEP Nutrition Education Evaluation and Reporting System (NEERS 5) is composed of 10 mandatory questions designed to evaluate food related behaviors not captured by 24-hour recalls. Each question is answered using a five point Likert scale. The conceptual domains of the Behavior Checklist include Food Resource Management, Nutrition Practices, and Food Handling and Safety.
The original committee that developed the Behavior Checklist convened in 1990. The core 10 questions were finalized in 1993 after undergoing tests to establish construct validity, reliability, sensitivity and difficulty. In spite of this testing, some states expressed concerns about some questions. In 1994-97, a committee worked to review and revise the EFNEP Behavior Checklist. During this time, the Reporting System was modified to include an additional, optional bank of questions; states could select from this set of questions to add to the core based on their programs goals and objectives.
Existing EFNEP data confirm the existence of self-reported behavior changes. For example, behavior checklist data show clearly that some behaviors change dramatically in their frequency of occurrence (eating breakfast, reading labels, comparing prices) while others change much less (running out of food, letting foods sit out).
Many years of accumulated dietary intake and behavioral checklist data are accessible to the multistate research team which consists of experts in EFNEP programming and/or research as well as research colleagues with expertise in evaluation, dietary assessment, biological assessments, qualitative research methodology, and data mining.
Multi-State Effort - A multistate approach is essential for this project because it brings together the varied expertise needed to comprehensively address complex issues. In addition, each state has access to unique groups of limited-resource EFNEP participants that would not be available from any single state. Variables that differ across states include proportion of urban versus rural participants and mixes of racial/ethnic groups. With multi-state involvement and input, we will have a more complete understanding of cultural and other impacts on our diverse participant groups.
Likely Impact from Successful Project - The accurate assessment of EFNEP impacts is critical to program success. This project will provide updated valid, reliable methods for measuring dietary quality in the EFNEP population. In addition, we will determine which of these methods are most specific and sensitive to change, and least burdensome for EFNEP participants. Burden may pertain not only to time required for completing the instruments, but also to issues of format, clarity, complexity, cultural appropriateness, and literacy level. These methods will not only document program performance, but also provide valuable needs assessment data to inform future program planning and implementation.
This project will also lead to a better understanding of the non-dietary impacts of EFNEP. Both qualitative and quantitative methods will be used to assess the Quality of Life of participants and paraprofessionals, allowing EFNEP to quantify these non-dietary impacts for the first time in the programs nearly 40 year history.
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