Changing the Face of Nutrition Education in California Food Assistance Programs

1. University of California, Berkeley Changing the Face of Nutrition Education in California Food Assistance Programs Dana E. Gerstein University of California, Berkeley Center for Weight and Health www.cnr.berkeley.edu/cwh

2. University of California, Berkeley Traditional Teacher-Learner Roles TeacherParticipant

3. University of California, Berkeley

4. University of California, Berkeley Expert Committeerevises 1998 recommendations on childhood obesity For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary ReportSarah E. Barlow, and the Expert Committee. Pediatrics. 120 Suppl. S164-S192. Dec 2007

5. University of California, Berkeley Learner-Centered Education(LCE) Participant Class DesignerTeacher

6. Orientation Overview of FTW Training Program Train the Trainer for Leaders 2cycles On-site FTW inservice for Teachers On-site FTW workshop for Teachers • LCE class • teachers observed Train the Trainer for Leaders

7. University of California, Berkeley CA WIC Acronyms 101 • LCE: Learner-Centered Education • FTW: Finding the Teacher Within • GLP: Global Learning Partners • T4T: Train the Trainer for Leaders • P & P: Principles and Practices

8. University of California, Berkeley Study Question #1 Is LCE approach more effective than traditional, didactic approach for changing WIC families fruit and vegetable consumption behaviors? Δ in perceived barriers to offering more fruits & vegetables, ways in which to offer & movement on stage of change model.

9. University of California, Berkeley Study Question #2 Is it feasible to implement & sustain LCE in CA WIC agencies?

10. University of California, Berkeley

11. University of California, Berkeley Evaluation Tools Participant * Participant Survey * Participant Focus Groups(at follow-up only) Class DesignerTeacher * Leader Interest Survey * Teacher Survey * Class Design Tool * Class Observation * Cost Survey (quarterly) Tool

12. University of California, Berkeley Overview ofData Collection & FTW Schedule

13. Extent LCE p & p have been incorporated Barriers to participating in FTW & implementing LCE Resources necessary to participate in FTW & implement LCE. Benefits & challenges Leaders & teachers satisfaction with education process Community-wide programs aimed to improve participants fruit & vegetable consumption University of California, Berkeley Leader Interest SurveyInterviewed leaders via telephone Baseline n=14; End-point n=11

14. Baseline difference: Control leaders had been working at WIC longer. Barrier: Control teachers who had been working at WIC long time were resistant to change. Follow-up: Intervention agencies integrated more LCE p & p in class design process. FTW promoted dialogue primarily between class designers & teachers, and leaders learned value of staff involvement. University of California, Berkeley Leader Interest SurveyFindings

15. Evaluate extent to which LCE p & p have been incorporated into design. Completed by State staff. Post-intervention data collected using Fruit and Vegetable class. Findings: Intervention agencies adapted class designs given to them by State. Control agencies were not using LCE class designs. University of California, Berkeley Class Design Review ToolBaseline n=10; Endpoint n=9

16. 5 completed through-out study period (every 6 mo). Assessed cost of implementation & sustainability. Findings: $ greater among intervention agencies during implementation period. $ greater among control agencies during sustainability period. Several limitations of data University of California, Berkeley Cost Survey

17. Retention Rates: 76% (intervention) 69% (control) N: 56(intervention) & 60(control) = 116 Assess teachers’ satisfaction with education process & perception of learners’ and educators’ roles in classroom. University of California, Berkeley Teacher SurveyQuantitative survey administered pre- & post-

18. Baseline difference: Age, Length of time employed @ WIC, Previous trainings. At baseline: NO differences in perceptions of role of learner & educator OR satisfaction. INT teachers were 1.7 x more likely than CONTROLS to have↑their opinions of how important it was for: Participants to discuss class topic with each other & learn from each other (RR: 1.70, p=0.081) & Teachers to feel comfortableasking Qs that may not have right or wrong answers (RR: 1.70, p=0.087). University of California, Berkeley Teacher SurveyFindings

19. Evaluate extent to which teacher demonstrated each LCE p & p. Completed by State staff. Post-intervention data collected using Fruit and Vegetable class. Findings: Differences noted between intervention & control agencies at baseline. No LCE p & p was observed very consistently or w/ very skilled application in control at follow-up. University of California, Berkeley Class Observation ToolBaseline n=19; Endpoint n=14

20. Assess change in participants’ fruit and vegetable consumption behaviors & their satisfaction with nutrition education classes. Administered in Spanish, English & Vietnamese. Retention rate: 37% of original sample N : 673 (intervention), 694 (control)=1367 University of California, Berkeley Participant SurveyQuantitative Tool

21. University of California, Berkeley Participant SurveyFindings More intervention participants increased: Opinion of how much they like how they learned from others in the class (RR: 1.22; p=0.17) & How often they ate other vegetables, not potatoes, on average in last month(RR: 1.23, p=0.03).

22. Assess changes in way participants offer fruits and vegetables to their families as a results of attending class & assess satisfaction with class. 6 focus groups (3 intervention & 3 control) with mothers only. Conducted only at follow-up. University of California, Berkeley Participant Focus Group Discussions***

23. Theme 1: INT identified specific reasons why knowledge from class was important in their lives. Theme 2: INT adopted more news ways of offering their families fruits & vegetables. Theme 3: INT remembered more aspects of class & found it more enjoyable. Theme 4: INT felt more comfortable & confident sharing personal experiences in class. Theme 5: INT not only shared but learned from other participants. University of California, Berkeley Participant Focus Group DiscussionsFindings

24. University of California, Berkeley Participant Focus Group DiscussionsFindings – Theme 1 • Intervention pt: I think it helps the kids stay regular. She’s hardly ever constipated because of the vegetables. • Intervention pt: And also they end up more satisfied and don’t go around taking whatever else there is. They don’t eat so much candy. • Control pt: It helps them with everything because each vegetable and fruit has a different vitamin. Some are good for the sight, some for the blood and that is good for their health. It is good that they eat vegetables.

25. University of California, Berkeley Participant Focus Group DiscussionsFindings – Theme 2 • Intervention pt: It really encouraged me to get out there and do a garden. • Intervention pt: Before the class, I used to just eat apples, oranges, and bananas; we didn’t expand to the other fruits like kiwi. I never had kiwi until after this class. Certain vegetable, you know, I didn’t know how to prepare ‘em, so now I’m this amazing mom.

26. University of California, Berkeley Next Steps… Advisory board met a final time this summer to brainstorm “How could this model be incorporated into other Food Assistance Programs?”