1. wrnece.colostate.edu/ Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University extension.usu.edu Multi-disciplinary methods for effective, sustainable, and scalable evaluations of nutrition education programs Carrie Durward, PhD RD Project Director Assistant Professor and Extension Nutrition Specialist Utah State University December 17, 2015

2. Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University wrnece.colostate.edu/extension.usu.edu Effective nutrition education can reduce health disparities by reducing the risk of chronic disease. For EFNEP and SNAP-Ed to be effective and sustainable, rigorous evaluation tools are needed. Overarching Rationale:

3. Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University wrnece.colostate.edu/extension.usu.edu Develop two assessment tools: –QualMART TM toolset –Automated Self-administered 24-hour Recall (ASA24) for use in low-income populations Use these assessment tools to conduct a longitudinal evaluation of SNAP-Ed and EFNEP. Primary Goals

4. Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University wrnece.colostate.edu/extension.usu.edu Assess the quality and cost of household grocery food purchases 12 months before and after program participation. Objective 1 Grocery Sales Database QualMART Food Quality Tool Healthy Eating Index 2010 Household grocery quality score

5. http://wrnece.colostate.edu/ Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University 1a. Update, improve, and then re-validate the existing QualMART TM grocery food quality model. –Incorporate the new USDA food-group database (i.e., the Foods Patterns Equivalents Database – FPED). –Add a new food group for sugar-sweetened beverages (SSBs). Objective 1

6. http://wrnece.colostate.edu/ Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University 1b. Assess impact of EFNEP and SNAP- Ed on household grocery food quality and expenditures –Control group of income-matched non- participant households –Collect data in five states: CO, ID, UT, WY, and TN Objective 1

7. Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University wrnece.colostate.edu/extension.usu.edu QualMART TM Strengths –Low participant burden –Scalable and inexpensive –Minimizes reporting bias –Directly measures grocery purchase –Validated against NHANES data Objective 1

8. Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University wrnece.colostate.edu/extension.usu.edu Primary Deliverables –Building evidence base: Long-term (1-year) controlled trial of SNAP-Ed and EFNEP on grocery purchasing behavior –Demonstration of a novel, scalable, inexpensive, objective assessment methodology Objective 1

9. http://wrnece.colostate.edu/ Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University Evaluate the effectiveness of EFNEP by assessing diet quality before and after program participation using ASA24. Objective 2

10. http://wrnece.colostate.edu/ Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University 2a. Assess feasibility and validate ASA24 for use in the low-income population –Mobile ASA24 on tablet computers –Two modes of administration Independently as designed Assisted small group –Controlled feeding trial Objective 2

11. http://wrnece.colostate.edu/ Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University 2b. Evaluate effect of EFNEP participation on dietary intake using original or assisted ASA24. –Pre- and post-intervention –Income-matched non-participant control group –Data collected in UT, ID, WY, and TN –WebNEERS will be programmed to accept ASA24 data Objective 2

12. Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University wrnece.colostate.edu/extension.usu.edu ASA24 Strengths –Standardized collection, coding, and analysis of 24-hr recall data –Reduces program cost and effort Objective 2

13. Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University wrnece.colostate.edu/extension.usu.edu Primary Deliverables: –Building the evidence base: Mid-term (pre-post) controlled trial of EFNEP impact on individual dietary behavior –Validation of ASA24 in the low-income population –ASA24 training manual for paraprofessionals Objective 2

14. Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University wrnece.colostate.edu/extension.usu.edu Year 1 Revise and validate QualMART TM Recruit participants and controls for objective 1 ASA24 validation study Year 2 Collect grocery Sales Data Recruit participants and controls for objective 2 Collect ASA24 data for objective 2 Year 3 Analyze and report grocery sales data results Analyze and report ASA24 results Timeline

15. Regional Nutrition Education and Obesity Prevention Center of Excellence-Western Region at Colorado State University wrnece.colostate.edu/extension.usu.edu Project Team Susan Baker Colo. State Karen Franck U. Tenn Paul McCawley U. Idaho Mindy Meuli U. Wyoming Amy Subar NCI John Hurdle U. Utah Patricia Guenther U. Utah Heidi LeBlanc USU Paula Scott USU Thea Zimmerman Westat Mateja Roskos USU Deirdre Douglass Westat