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<OL> <LI> Complete a thorough review of the literature to identify all existing valid and reliable methods appropriate for measuring dietary quality among EFNEP participants, and develop qualitative and quantitative criteria to use in the evaluation and selection of the best dietary quality assessment(s) for EFNEP, considering sensitivity to change and burden on the participants. <LI>Through qualitative, quantitative, and biomarker research, test the most promising of these measures for use with EFNEP audiences, evaluate them using the criteria in Objective 1, and select the best measure(s). <LI>To determine which quality of life constructs are affected by EFNEP for both participants and paraprofessionals
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Outputs: A critical literature review of dietary assessment methods tailored to limited resources audiences and a set of criteria with which to identify the most appropriate methods for use by EFNEP. Selection of the most viable methods of those identified in Output 1 relative to sensitivity and validity in the context of EFNEP data collection procedures. Identification of quality of life indices that are most influenced by the EFENP for paraprofessionals and participants. A searchable, bibliographic data base of all past research related to EFNEP.
NON-TECHNICAL SUMMARY: 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. Given significant societal changes in diet and health (e.g. obesity), 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. Expected Outcomes/Impacts: A new, modified set of evaluation tools/techniques for EFNEP will yield assessment data for this Federal Program that has increased credibility.In addition to dietary quality and food related behavior data, program leaders will be able to report non-nutrition outcomes such as increased quality of life indicators. The use of more sensitive evaluation tools should lead to the development of more effective nutrition education materials and teaching methodologies. A better understanding of the influence of education on behavioral change among low-income populations.Clearer programmatic/research linkages, connecting science and practice. Stronger assessment measures that can better inform national data collection and, thus, decision making. Because elements of this work will be conducted with low-income populations beyond EFNEP, research findings may have potential for broader applications to nutrition education with low-income audiences. In the long term, improvements in EFNEP could potentially lead to a better informed society relative to nutrition, food safety and food resource management contributing to a healthier society, requiring less intervention from the health care system. This better-informed society might be more food secure thus, improving their health status and reducing their needs for emergency food assistance. An improved health status will result in less demand for emergency medical resources, improved school outcomes as children are more food secure and experience less absenteeism due to illness.
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APPROACH: Methods will include several techniques. Free-listing: This technique will permit primary audiences (paraprofessionals and participants) to help define issues affecting their quality of life prior to conducting interviews and focus groups, ensuring that the topics discussed will reflect concerns of the primary audiences. Free-listing is a semi-structured method used to identify common domain descriptors. The number of respondents needed depends on the domain(s) of interest; the more agreement about a domain, the fewer respondents are needed. Rank order will change with the addition of each new respondent. When the ranks remain relatively stable, no new respondents will be added. Qualitative Phone Interviews: In-depth or unstructured interviewing is a primary means of data collection in qualitative research. We will interview EFNEP professionals and paraprofessionals, community partners and former EFNEP participants who experienced significant quality of life improvements after participation in EFNEP. Focus Groups:Focus groups are an effective technique to collect data regarding perceptions, opinions and insights on pre-identified topics that other techniques (surveys, interviews) would not uncover. Identification of group norms and values is more successful using group interviews and additional insights on the thinking of a particular target audience is often better revealed through focus group discussions than one-on-one interviews. 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. Indiana will be an active participant in all of these research activities.