Improving the Quality of Data From EFNEP Participants With Low Literacy Skills: A Participant-driven Model

Townsend, Marilyn S.; Ganthavorn, Chutima; Neelon, Marisa; Donohue, Susan K.; Johns, Margaret

doi:10.1016/j.jneb.2013.10.004

Cited by 21 publications

(16 citation statements)

References 15 publications

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“…Usual behaviors assessed using a questionnaire are cognitively easier for low-literacy respondents to report, as opposed to more detailed forms of dietary assessment such as 24-hour recalls. 9,10 Assessing FV intake rather than FV behaviors presents a unique challenge, particularly with regard to accurately measuring quantity of FV consumed and with low-literate program participants, with corresponding consequences for validity assessments. 11 FV consumption is often determined using food frequency questionnaires, which provide crude information on intake over time, such as 3 months or 1 year, rather than more precise measurements at one 24-hour time point.…”

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confidence: 99%

Considerations for Evaluation of Fruit and Vegetable Intake in Low-Literate Spanish-Speaking Participants in USDA Food and Nutrition Education Programs

Banna¹

2018

American Journal of Lifestyle Medicine

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Rates of obesity and associated chronic disease are high in Hispanics in the United States. Nutrition education interventions promoting dietary change in underserved populations have been shown to have positive effects on behaviors such as fruit and vegetable (FV) intake, thereby reducing the chronic disease burden. Evaluation tools in the Spanish language to assess the dietary behavior changes made in response to the intervention are important in determining the success of such efforts. Currently, there are no Spanishlanguage tools focused exclusively on FV intake and behaviors that include features to enhance readability for use in low-literacy participants of US Department of Agriculture (USDA) food assistance and education programs. There is a need for such tools to determine the degree to which programs are able to promote behavior change. In designing these tools, researchers should take into account potential issues that may arise when administered. For example, respondents may have difficulty estimating consumption for mixed dishes and vegetables added to food. To address such issues, researchers should employ strategies to assist respondents to understand what constitutes FV and appropriately identify amount consumed. Addition of images to tools or development of accompanying instruction guides may be helpful. Once developed and tested, such scales may be used with Spanishspeaking participants of USDA food assistance and education programs aimed at improving FV behaviors and ultimately, intake.

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confidence: 99%

Considerations for Evaluation of Fruit and Vegetable Intake in Low-Literate Spanish-Speaking Participants in USDA Food and Nutrition Education Programs

Banna¹

2018

American Journal of Lifestyle Medicine

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“…Pragmatically starting with a valid and reliable behaviour checklist tool for measuring change was advantageous for two reasons; firstly, it provides a way to develop a questionnaire in which the funding body requires evaluation to commence shortly after the program delivery has commenced and secondly where there is not sufficient time or resources to develop a questionnaire using extensive research processes [ 16 , 29 , 51 ]. The strength of the EFNEP behaviour checklist tool for this study is the focus on its ongoing development [ 52 ], including regular review to continue to improve evaluation to document effectiveness in changing behaviours in adults [ 29 , 31 , 32 , 39 ]. The evaluation tool presented in this paper has been constructed for this program in an Australian context, and this may not be directly applicable for other programs.…”

Section: Discussionmentioning

confidence: 99%

“…Methods used assessed acceptability and comprehension of the items in the target population, such as literacy; numeracy of the target groups; and testing of the cognitive load, defined as the amount of mental effort used in working memory. The method used to establish how the target group understood questions included observation and discussion with participants whilst completing questionnaires pre- and post-program to establish face validity [ 32 ]. Participants provided feedback on the wording of questions and relevance of some of the food literacy behaviours.…”

Section: Methodsmentioning

confidence: 99%

“…The extensive testing process including validity and reliability considerations has included validation with serum carotenoids (criterion validity) and 24 h recalls (convergence validity) data [ 16 , 19 , 29 ] in addition to exploratory factor analysis [ 28 , 30 ]. Through focus groups and other research to assess usability and readability, the questions have been re-worded to elicit the information needed and the format of the questionnaires tested [ 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation Tool Development for Food Literacy Programs

2018

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Food literacy is described as the behaviours involved in planning, purchasing, preparing, and eating food and is critical for achieving healthy dietary intakes. Food literacy programs require valid and reliable evaluation measures. The aim of this paper is to describe the development and validation of a self-administered questionnaire to measure food literacy behaviours targeted by the Food Sensations® for Adults program in Western Australia. Validity and reliability tests were applied to questionnaire item development commencing with (a) a deductive approach using Australian empirical evidence on food literacy as a construct along with its components and (b) adapting an extensively-tested food behaviour checklist to generate a pool of items for investigation. Then, an iterative process was applied to develop a specific food literacy behaviour checklist for program evaluation including exploratory factor analysis. Content, face, and construct validity resulted in a 14-item food behaviour checklist. Three factors entitled Plan & Manage, Selection, and Preparation were evident, resulting in Cronbach’s alpha 0.79, 0.76, and 0.81, respectively, indicating good reliability of each of these factors. This research has produced a validated questionnaire, is a useful starting point for other food literacy programs, and has applications globally.

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“…35,36 As discussed in systematic reviews of HL 34,35 and by recent viewpoints specifically related to HL within the context of nutrition and food education, 37,38 in order to facilitate behavior change, the incorporation of HL into nutrition interventions must extend beyond readability and building knowledge and into the development of individual skills and confidence to engage in complex, behavior-specific skills, including accurate self-monitoring skills. The findings from this study builds evidence that teach-back – an adaptable and participant-accepted HL technique – can be employed to both reinforce both knowledge and behavior-specific skill.…”

Section: Discussionmentioning

confidence: 99%

Using Teach-Back to Understand Participant Behavioral Self-Monitoring Skills Across Health Literacy Level and Behavioral Condition

Porter

Chen

Estabrooks

et al. 2016

Journal of Nutrition Education and Behavior

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Objective To assess differences, by health literacy status and behavioral condition, in participants’ abilities to accurately self-monitor behaviors and recall key behavioral messages using data from a teach-back call. Design Cross-sectional. Setting Rural, southwestern Virginia. Participants Adults (n=301). Majority (81.1%) were female, 31.9% had ≤high school education, 66.1% earned <$25,000 per year, and 32.9% were low health literate. Intervention First class session of two community-based behavioral interventions: SIPsmartER (reduce sugar sweetened beverage intake) or MoveMore (increase physical activity). Main Outcome Measures Reported accuracy of behavioral diary completion, proportion of behavioral messages recalled during the first round of teach-back, and rounds of teach-back. Analysis Descriptive statistics and GLM. Results Low health literate participants were significantly less accurate in diary completion (P<.001), recalled fewer behavioral messages correctly (P<.001), and needed more rounds of teach-back (P<.001) than high health literate participants. Compared to SIPsmartER participants, MoveMore participants more accurately completed diaries (P=.001), but recalled a lower proportion of behavioral messages correctly (P<.001) and required more rounds of teach-back Conclusions and Implications Health literacy status and behavioral target impact ability to self-monitor and recall key concepts. Researchers should consider using teach-back early in the intervention to assess and reinforce participants’ ability to self-monitor.

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Improving the Quality of Data From EFNEP Participants With Low Literacy Skills: A Participant-driven Model

Cited by 21 publications

References 15 publications

Considerations for Evaluation of Fruit and Vegetable Intake in Low-Literate Spanish-Speaking Participants in USDA Food and Nutrition Education Programs

Considerations for Evaluation of Fruit and Vegetable Intake in Low-Literate Spanish-Speaking Participants in USDA Food and Nutrition Education Programs

Evaluation Tool Development for Food Literacy Programs

Using Teach-Back to Understand Participant Behavioral Self-Monitoring Skills Across Health Literacy Level and Behavioral Condition

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