Formative Evaluation of EFNEP Curriculum: Ensuring the Eating Smart • Being Active Curriculum Is Theory Based.

The project reported here served to assess a curriculum for EFNEP to ensure theory compliance and content validity. Adherence to Adult Learning Theory and Social Cognitive Theory tenets was determined. A curriculum assessment tool was developed and used by five reviewers to assess initial and revised versions of the curriculum. T-tests for differences in mean responses from initial review to follow-up for each tenet and Cronbach’s α for internal consistency of each tenet were conducted. Reviews found that the Eating Smart • Being Active curriculum successfully incorporated tenets of both theories and content remained true to Dietary Guidelines. Introduction Nutrition education can be defined as “any set of learning experiences designed to facilitate the voluntary adoption of eating and other nutrition-related behaviors conducive to health and well-being” (Contento et al., 1995). Nutrition education programs should include communication and educational strategies to build knowledge and motivation, behavioral change strategies to guide desired outcomes, environmental components to eliminate obstacles and enhance behavior change, and community activation (Contento et al., 1995; Higgins & Barkley, 2003). Programs designed to change behavior Elana Natker Nutrition Communications Consultant Enlighten Nutrition Oak Hill, Virginia elana@enlightennutriti on.com Susan S. Baker Associate Professor/Extension Specialist Department of Food Science and Human Nutrition Colorado State University Fort Collins, Colorado Susan.Baker@colostat e.edu Garry Auld Professor Department of Food Science and Human Nutrition Colorado State University Fort Collins, Colorado Garry.Auld@colostate. edu Kathryn McGirr Research Associate Department of Food Science and Human Nutrition Colorado State University Fort Collins, Colorado Kathryn.McGirr@colost ate.edu Barbara Sutherland Associate Staff Scientist Children’s Hospital & Research Center Oakland, California [email protected] Katherine L. Cason Professor Department of Food, Nutrition, and Packaging Sciences Clemson University Clemson, South Carolina [email protected] are most successful when rooted in appropriate behavior change theories or combination of theories (Achterberg & Miller, 2004; Baranowski, Cullen, & Baranowski, 1999; Bird & McClelland, 2010; Brownell & Cohen, 1995; Contento, Randell, & Basch, 2002; Franz, 2007; Rayner, 2003). The mission of the Expanded Food and Nutrition Education Program (EFNEP) is to improve nutrition knowledge, skills, attitudes, and behaviors of low-income families (Burney & Haughton, 2002; USDANIFA, 2009). EFNEP employs experiential learning through curricula designed to help participants make healthy food and lifestyle choices (USDA-NIFA, 2009). The lessons in EFNEP curricula are based on current Dietary Guidelines for Americans (DGA), which are updated every 5 years (US Dept. Health and Human Services, 2010). The DGA released in 2005 included many changes as compared to previous versions of the DGA. Major recommendation changes included increased emphasis on whole grain consumption, choosing fruits and vegetables in a variety of colors, the inclusion of physical activity and expanded food safety information, and shifting from using “servings” to cup and ounce equivalents (US Dept. Health and Human Services, 2010). The release of the 2005 DGA required that nutrition-based curricula for programs such as EFNEP and the Supplemental Nutrition Assistance ProgramEducation (SNAP-Ed) be updated. Rather than updating existing curricula, the EFNEP in Colorado and California used the opportunity to partner and create a new curriculum for their program participants: Eating Smart • Being Active (ESBA). Developers decided this new curriculum would incorporate both the Adult Learning Theory (ALT) (Knowles, 1984) and Social Cognitive Theory (SCT) (Bandura, 1986) and be appropriate for use by Extension paraprofessionals. SCT is often used in interventions with low-income audiences and serves as the basis for the desired behavior change outcomes, whereas ALT was used to define the andragogical approach used in both the classroom setting and the written materials and instructions for the paraprofessionals. Nationally, EFNEP uses a paraprofessional model. According to Norris and Baker, paraprofessionals are “usually hired, not for their degrees or knowledge of subject matter, but for their life experiences, cultural, social, and economic backgrounds, and their ability to relate to clients.” This ability to relate to clients is termed “empathy” and has been a significant reason the paraprofessional model has been so successful in EFNEP (Norris & Baker, 1999). During the time Colorado and California EFNEP coordinators were starting to develop the new curriculum, representatives from more than 25 states expressed interest in the curriculum; these representatives indicated that their states were not going to develop new materials but intended to use this new curriculum. Given this widespread interest, the national implications for Extension were significant. Thus, curriculum developers wanted to take the necessary steps to ensure that the content was accurate and the potential for behavior change was strong to improve the likelihood of positive participant outcomes. Curriculum Development The process of developing a new curriculum for a nutrition education program can be a complex, often laborious task to ensure that the curriculum is designed to achieve the intended outcomes, keeping in mind the needs of the intended audience and the method of delivery best suited to the audience Research in Brief Formative Evaluation of EFNEP Curriculum: Ensuring the Eating Smart • Being Active Curriculum Is Theory Based JOE 53(1) ©2015 Extension Journal Inc. 1 (Higgins & Barkley, 2003). Research suggests that nutrition education programs with the goal of behavior change are most successful when rooted in appropriate behavior change or learning theories (Rayner, 2003; Achterberg & Miller, 2004; Brownell & Cohen, 1995; Contento, 2007; Baranowski, Cullen, & Baranowski, 1999). Although many of the most widely used theories in nutrition education involve similar constructs, no one theoretical model is used as a standard in nutrition education to impact behavior; in fact, some experts advocate the use of a polytheoretical model (Achterberg & Miller, 2004). A limitation of nutrition education program development is that no program can provide all the necessary information an audience needs to make healthful nutrition-related choices (Contento, Randell, & Basch, 2002). Rather, curriculum developers must prioritize the key concepts to be addressed, taking into account the amount of time available, attention span of the audience, and other factors (Contento et al., 2002). Ideally, when developing any new program or education materials, a detailed formative evaluation should be completed to improve the chances that the program/materials will be accepted and effective (Windsor, Clark, Boyd, & Goodman, 2003). A good formative evaluation has numerous steps, including determining if the materials are acceptable to the target audience and educators, gathering feedback from experts, confirming that program objectives are appropriate, and conducting a pilot study. The process of developing Eating Smart • Being Active took several years. The steps of developing the curriculum are detailed below and include many typical formative evaluation steps (Figure 1): Figure 1. Evaluation of the Eating Smart • Being Active Curriculum Research in Brief Formative Evaluation of EFNEP Curriculum: Ensuring the Eating Smart • Being Active Curriculum Is Theory Based JOE 53(1) ©2015 Extension Journal Inc. 2 1. EFNEP staff in Colorado and California (heretofore referred to as the authors) started by polling EFNEP educators in the states in which the curriculum was to be piloted (California, Colorado, Iowa, and South Carolina) about their favorite recipes, activities and key topics from existing curricula. Research in Brief Formative Evaluation of EFNEP Curriculum: Ensuring the Eating Smart • Being Active Curriculum Is Theory Based JOE 53(1) ©2015 Extension Journal Inc. 3 2. Next, authors organized the activities, recipes, and key topics into content areas that could support potential lesson themes. 3. The authors, utilizing years of program experience, decided that the curriculum would be designed with the following parameters in mind: a. The core curriculum would contain no more than eight lessons. This decision was based upon how many lessons people are typically willing to attend in EFNEP, and the national average of lessons taught in an EFNEP class series (USDA-NIFA, 2012). Authors planned on writing additional optional lessons specific to maternal, infant, toddler, and preschool nutrition topics so the number of core lessons was limited to eight to allow for flexibility in implementation. b. The eight core lessons would be taught consecutively so that concepts could build throughout the series. c. All lessons would be learner-centered (ALT), with hands-on activities to reinforce concepts. d. Physical activity, food safety, and label reading would be introduced early in the series of lessons and incorporated throughout each lesson thereafter to support these important yet complicated topics while limiting the number of lessons. e. Nutrition and physical activity would be represented as two equal parts of a healthy lifestyle, with both concepts appearing in every lesson. f. Each lesson would include a food preparation activity. g. Participant materials would be full-color, include photographs instead of clipart, and represent people of different ages, ethnicities, and body sizes. h. Participant materials would be written at a 6th to 8th grade reading level. 4. Authors then determined lesson titles and goals and objectives of each lesson. The main messages of both the DGA and MyPyramid were used to create the lesson titles: