Evaluating a Nutrition Education Program in an Era of Food Insecurity

Effectiveness of Expanded Food and Nutrition Education Program in Changing Nutrition-Related Outcomes Among Adults With Low Income: A Systematic Review

OBJECTIVE

To review the effect of the Expanded Food and Nutrition Education Program (EFNEP) in changing nutrition-related outcomes.

METHODS

Relevant research conducted before December 2020 was identified using PubMed, Web of Science, Google Scholar, and the EFNEP Research Database. The methodological quality of each eligible study was assessed.

RESULTS

Of the 406 studies found, 30 were eligible; 26 studies were on EFNEP, and 4 included both EFNEP and Supplemental Nutrition Assistance Program Nutrition Education (SNAP-Ed). The sample sizes ranged from 35 to 122,961. Outcome measures included consumption of food groups, nutrients, other nutrition-related behaviors, and food security. At least 1 immediate behavior change (P < 0.05) was reported in each study, but long-term maintenance of behavior change was not evident.

DISCUSSION

This review found a consistent, immediate improvement in nutrition behaviors after program participation but poor retention over time. Overall, variation in programming and outcome measures, incomplete reporting, and generally low study quality by modern standards precluded strong conclusions.

IMPLICATIONS FOR RESEARCH AND PRACTICE

This review identified the need for control groups, improved reporting of program protocols, theory-based curriculum, and measurement of long-term outcomes.

Food Insecurity and Associated Challenges to Healthy Eating Among American Indians and Alaska Natives With Type 2 Diabetes: Multiple Stakeholder Perspectives

Objective: To examine stakeholder perspectives on food insecurity and associated challenges to healthy eating among American Indian and Alaska Native (AI/AN) adults with type 2 diabetes (T2D). Methods: Focus groups and interviews were conducted with purposively selected stakeholders: AI/ANs with T2D, their family members, healthcare administrators, nutrition and diabetes educators, and national content experts on AI/AN health. Two coders analyzed transcripts using the constant-comparison method. Results: Key themes included (1) rural- and urban-dwelling AI/ANs experience different primary food security and associated challenges; (2) factors contributing to food insecurity extend beyond cost of healthy food; and (3) barriers to consuming fresh, healthy food include cost, preparation time, limited cooking knowledge, and challenges with gardening. Discussion: Resources for AI/ANs with T2D who experience food insecurity and associated challenges to healthy eating should be tailored based on urban versus rural location and should address cost and other barriers to consumption of fresh fruits and vegetables.

Supplemental Nutrition Assistance Program-Education Improves Food Security Independent of Food Assistance and Program Characteristics

The purpose of this project was to determine whether consistent food assistance program participation or changes in participation over time mediated or moderated the effect of federal nutrition education through the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) on food security and determine the associations of SNAP-Ed program delivery characteristics with change in food security. This secondary analysis used data from a randomized controlled trial from September 2013 through April 2015. SNAP-Ed-eligible participants (n = 328; ≥18 years) in households with children were recruited from 39 counties in Indiana, USA. The dependent variable was one year change in household food security score measured using the United States Household Food Security Survey Module. Assessment of mediation used Barron-Kenny analysis and moderation used interactions of food assistance program use and changes over time with treatment group in general linear regression modeling. Program delivery characteristics were investigated using mixed linear regression modeling. Results showed that neither consistent participation nor changes in food assistance program participation over time mediated nor moderated the effect of SNAP-Ed on food security and neither were SNAP-Ed program delivery characteristics associated with change in food security over the one year study period. SNAP-Ed directly improved food security among SNAP-Ed-eligible Indiana households with children regardless of food assistance program participation and changes over time or varying program delivery characteristics.

The Effectiveness of the Expanded Food and Nutrition Education Program (EFNEP) on Diet Quality as Measured by the Healthy Eating Index

The objective of the study was to assess the relationship between participation in the Expanded Food and Nutrition Education Program (EFNEP) and food-related behavior change, as measured by the Healthy Eating Index (HEI)-2005, using a single-state, case study approach. Pre-EFNEP and post-EFNEP participation HEI scores as well as demographic, geographic, socioeconomic, and program participation characteristics from fiscal years 2013-2016 were analyzed using summary statistics and Ordinary Least Squares regressions. HEI scores were adjusted for age, sex, race, rural/urban residence, county, highest grade achieved, income, number of children, public assistance programs, and number of hours in EFNEP in the analysis. The total HEI score and several HEI subscores improved from pre-EFNEP to post-EFNEP at the 5% significance level or better. Sodium and total grains scores decreased post-EFNEP: P = .003 and P = .05, respectively. Participation in Women, Infants, and Children or the Supplemental Nutrition Assistance Program had no effect on HEI scores or changes in scores post-EFNEP. Spending less than 7 hours in the program was associated with a smaller improvement in total HEI score (P = .05) and an increased intake of sodium (P = .03), compared with spending 7 to 16 hours in the program. Overall, EFNEP participation was associated with improvements in diet quality.