Measuring the Success of Nutrition Education and Promotion in Food Assistance Programs

Family Economics and Nutrition Review, Summer, 1998

When USDA's Food and Nutrition Service (FNS) began focusing on incorporating nutrition education into all its food assistance programs, FNS needed a means

of measuring program effectiveness to ensure the best possible use of its limited resources. FNS was also looking for ways to identify what worked best--which program components, under what circumstances, and at what costs. The objective was to help those at the program-delivery level provide the best, most cost-effective nutrition programs possible.

As a result, a conference entitled "Charting the Course for Evaluation: How Do We Measure the Success of Nutrition Education and Promotion in Food Assistance Programs?" was held July 13-14, 1995, in Arlington, VA. Nutrition educators, market researchers, and health promotion evaluation experts, brought together to identify and promote the state of the art in evaluating nutrition education and promotion efforts, were asked to evaluate a range of nutrition education, health promotion, and social marketing programs.

Session Summaries

* Contemporary Budget and Policy Realities: The State of Nutrition Education in USDA and the Importance of Evaluation, Eileen Kennedy, executive director, USDA Center for Nutrition Policy and Promotion--Three questions are relevant to the discussion of evaluating nutrition education programs: (1) What works? (2) In what context does nutrition education work? and (3) At what cost? To answer these questions, the mix of programs offered must be evaluated. Also, nutrition educators are headed toward a multifaceted approach to intervention strategies. Evaluation strategies must be multifaceted and must include formative, process, and outcome evaluation research.

Section I. Where We've Been

* Overview: A Review of the Role of Evaluation in Recent Nutrition Education Research and Interventions, Isobel Contento, coordinator, Program in Nutrition and Education, Teacher's College, Columbia University--A USDA-contracted review of 217 studies found a wide range of outcome measures used to evaluate nutrition education effectiveness, illustrating the complexity of dietary change and the difficulties of measuring such change. The review found that nutrition education works and is a significant factor in improving dietary practices when behavior change is the goal and educational strategies are designed with that as a purpose.

* Confounding Issues in Evaluations of Nutrition Interventions, William Smith, executive vice president, Academy for Educational Development--The complexity of human behavior, thinking about programs as prevention "vaccines," and other factors confound our understanding of the relationship of how different human behaviors relate to health, evaluation, and research. Identifying the determinants of a behavior is key to understanding behavior. Determinants can be identified by comparing those who do and those who do not engage in a behavior. Improving the balance between basic evaluation and marketing or clinical research may be useful.

Section II. Charting a New Course: Using Communication and Behavior Models in Designing Evaluations

* Health Belief Model, Arlene Caggiula, associate professor, Nutrition and Epidemiology, Graduate School of Public Health, University of Pittsburgh--In the two studies reported, the health belief model predicted adherence to eating patterns low in cholesterol and total fat. The type of population, intervention program, and adherence measure affected the relative importance of the components.

* Social Learning Theory, Kim Reynolds, associate professor, Department of Health Behavior, University of Alabama at Birmingham--Social learning theory is useful in intervention design and in measurement--it defines mediators and guides professionals toward different measures that can be used. Social learning theory was used in the design and intervention of the High Five program in Alabama, part of the 5 A Day program.

* Stages of Change: The Transtheoretical Model, Marci Kramish Campbell, assistant professor, Department of Nutrition, University of North Carolina at Chapel Hill--This model has been applied to a variety of behaviors such as smoking cessation, addictions, weight loss, and dietary change. Several studies have shown that stage of dietary change correlates with dietary intake, particularly for dietary fat, fiber, fruits, and vegetables.

* Persuasion and Social Marketing, Alan Andreasen, professor, Department of Marketing and associate dean, Faculty Affairs, School of Business, Georgetown University--Social marketing is an adaptation of commercial marketing technologies to programs designed to influence the voluntary behavior of target audiences to increase individual well-being and/or that of society. Social marketing focuses on behavior change and on market research in the formative, pretesting, and monitoring stages.

* Using Formative Evaluations to Identify Target Populations, Elizabeth Howze, chief, Health Interventions and Translation Branch, Centers for Disease Control and Prevention--The Nutrition and Physical Activity Communications Project (NuPAC) is a communications campaign designed to focus on nutrition and physical activity. Desired behaviors include a diet high in fruits and vegetables and low in fat and 30 minutes or more of moderate physical activity most days of the week.