Food Stamp Nutrition Education Report

SUMMARY

Background

The purpose of this study is to provide FNS with descriptive information about how States have elected to provide nutrition education and information to food stamp recipients and eligibles. The specific objectives of the study are to:

• Describe the organizational structure and administrative components of the agencies implementing food stamp nutrition education;

• Describe the key design features of food stamp nutrition education activities, including setting goals and objectives, identifying the target audience and developing nutrition education messages;

• Describe approaches being used by States to implement their nutrition education activities, including developing nutrition education materials and designing methods by which nutrition education can be delivered; and

• Describe efforts to assess the effectiveness of the nutrition education programs, including examining barriers identified by the States that have affected their ability to implement their program, identifying some of the lessons learned by the implementing agencies, and discussing efforts made by agencies to conduct evaluations of their programs.

Data were collected through an abstraction of information contained in State nutrition education plans, a mail-out survey to implementing agencies, and follow-up telephone interviews. Data are presented in summary form, with detailed agency responses to key survey questions contained in the appendix.

Organizational Structure and Administration of Food Stamp Nutrition Education

Unlike some programs where a single type of State agency is required to administer the program, food stamp nutrition education provides the opportunity for different types of State governmental agencies to negotiate agreements with the State Food Stamp Agency to become implementing agencies for the program. If they wish, State Food Stamp Agencies can even select more than one implementing agency to administer nutrition education in their State. Key components of the implementing agencies' organizational structure and administration follow.

• Of the 38 States with approved food stamp nutrition education plans, 29 States had only one implementing agency, seven States had two implementing agencies, and two States had three or more implementing agencies.

• Fifty implementing agencies were identified for this study. When examined, six different categories of implementing agencies were identified, including programs operating under 34 Cooperative Extension Services, five State public health agencies, four nutrition education networks, two State welfare agencies, four other university-affiliated programs not attached to Cooperative Extension, and one State Department of Aging. Seven States report having two implementing agencies in their State, while two States report having three or more.

• Twenty-two agencies (44%) use one Statewide approach to nutrition education with activities generally targeting the same audiences, using the same materials, and following similar delivery protocols. Nineteen agencies (38%) use State- level administration, but develop customized plans for different target audiences and geographic areas. Nine agencies (18%) elect to use a system that allows for local administration and implementation of nutrition education activities.

Key Design Features of the Food Stamp Nutrition Education

While agencies take a variety of approaches in designing food stamp nutrition education, they all follow three important steps in preparing their plans. These steps involve setting goals and objectives, selecting the target audience, and selecting specific nutrition education messages to be delivered. Agencies reported the following key design features in these three areas:

• Agencies focus on setting both broad program goals and specific behavioral objectives. Most of the behavioral objectives are designed to help clients select healthful foods on a limited budget and improve on their food preparation skills.

• The target audience selected by the most agencies are families, such as families with young children, single parents, pregnant women or parents of school-aged children. However, some agencies also target special populations, including persons with disabilities, the homeless, unemployed persons, and persons with chronic diseases. In addition, 57 percent of the agencies reported targeting individuals whose primary language is one other than English.

• Nutrition messages are designed to meet the behavioral objectives, so it is no surprise that 80 percent of the agencies report focusing their nutrition messages on purchasing healthy foods and eating a healthful diet. It is interesting to note that 61 percent of the agencies have developed formal data collection methods to help them develop nutrition messages to meet the needs of specific target populations. The most common methods for collecting these data are focus groups, client interviews, and reviewing existing literature.

Materials and Methods Used by Implementing Agencies to Deliver their Nutrition Education Messages

• The study examined the nutrition education materials used by the agencies and the modes of delivery used to present their nutrition education messages. The development of materials and modes of delivering nutrition that are acceptable to the target audience is key to the success of the program. Some of the key materials and methods identified by the agencies are presented below.

• Agencies obtained nutrition education materials through a number of methods, including developing their own nutrition education materials, modifying materials developed by other agencies, or simply using materials from other agencies without any modifications. Sixty-six percent of agencies who reported developing their own material used one or more formal data collection methods to test their materials with their target audiences.

• The methods used by agencies for delivering nutrition education include in- person delivery of nutrition education and mass media. Forty-five (96%) of the agencies reported using in-person delivery of nutrition education, 22 (47%) agencies reported using both in-person and mass media.

• When providing in-person nutrition education, agencies used a combination of three different approaches: structured groups, structured one-on-one delivery of nutrition education; and unstructured individual or group nutrition sessions.

• Agencies tended to select sites for the delivery of in-person nutrition education that were located in the target population's community, rather than in government or university facilities. The most popular site was community- based centers or buildings, which 36 agencies reported using.

• Twenty-two implementing agencies (47%) reported using mass media as a mode of delivering nutrition education. The most common mass media method used was radio. Fifteen of these 22 agencies reported using radio advertisements, radio talk shows, or radio public service announcements as their mass media delivery method.

• The majority of staff providing nutrition education work at the local level. Twenty-eight out of 36 agencies reporting educational level of staff delivering nutrition used peer educators who had a high school diploma/GED or never achieved a high school diploma/GED. A peer educator is a lay individual who has been trained to teach basic nutrition and the educator is a member of the community where he/she works. Agencies using peer educators felt that peer educators would be better accepted in the community and clients would be more accepting of the nutrition information provided.

Barriers and Lessons Learned by Implementing Agencies Conducting Food Stamp Nutrition Education Activities

Some agencies were able to identify the barriers they have faced in developing their activities and reported on the lessons learned from implementing their nutrition education. Some of the important findings include:

• Agencies have faced difficulties with both hiring and retaining staff to provide nutrition education. Finding bi-lingual staff and the low pay scales for nutrition educators were both cited as problems.

• Agencies reported facing challenges trying to reach their target audiences, as many low-income clients are skeptical about the value of nutrition education. This skepticism results in difficulties with both recruiting new clients and with attendance at nutrition education sessions.

• Several agencies reported problems working with collaborative agencies. Because low-income clients are likely to have contact with a number of agencies, both public and private, that provide some form of nutrition education, it is very important for agencies to coordinate their efforts so as to not appear contradictory or repetitive. Agencies reported that time and scheduling constraints most often played a role in their inability to work with collaborators.

Agencies also reported on their own efforts to evaluate their activities. Seventy-eight percent of the implementing agencies reported conducting both process and outcome evaluations. Implementing agencies primarily used the process evaluations to determine the number of clients served and to identify improvements that could be made to their methods of delivering nutrition education and developing their messages.

With regard to outcome evaluations, agencies reported using evaluation information to measure the effect of nutrition education on audience behavior, assess the audience knowledge of nutrition education, measure audience skills, and determine if they had changed audience attitudes. The outcome evaluation methods and units of measure differed so much across States that meaningful comparisons could not be made.

Conclusion

The phenomenal growth of food stamp nutrition education over the last several years is a testament to both its importance and popularity. However, with continued growth, FNS will likely face a number of challenges over the next few years. Some of these potential challenges include:

• The need to ensure better service delivery coordination between the various nutrition education activities sponsored by FNS and other Federal agencies;

• The need to facilitate coordination between agencies delivering in-person nutrition education with agencies delivering nutrition education through social marketing and mass media; and

• The need to develop reporting systems to report both the number of clients being served by agencies and agency progress in meeting goals and objectives.

April 2000

Last modified: 12/04/2008