1. Nutrition and Food Security: Working with Community Health Workers Prepared by: Marti Woolford for the International Rescue Committee mwoolford@hotmail.com All photos by Marti Woolford

2. Purpose Nutrition and Food Security: Working with Community Health Workers by Marti Woolford The purpose of the Community Health Worker program is to share information on basic nutrition, food safety, and exercise and wellness education with newly resettled refugees.

3. Goals Nutrition and Food Security: Working with Community Health Workers by Marti Woolford The goals of the program are to –Encourage clients to eat foods from each of the food groups –Teach clients the importance and benefits of eating a balanced diet –Introduce clients to healthy American food at each class –Teach food safety –Increase food security –Teach clients the importance of exercise and introduce the group to new forms of exercise –Empower women and build community

4. Definitions Nutrition and Food Security: Working with Community Health Workers by Marti Woolford Food Security –High food security- No reported indications of food-access problems or limitations –Marginal food security- One or two reported indications; typically of anxiety over food sufficiency or shortage of food in the house. Little or no indication of changes in diets or food intake –Low food security- Reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake –Very low food security- Reports of multiple indications of disrupted eating patterns and reduced food intake Source: Nord & Coleman-Jensen, 2009

5. Definitions Nutrition and Food Security: Working with Community Health Workers by Marti Woolford Community Health Worker –Provide their communities with information about health issues that affect them and link individuals with the health and social services they need to achieve wellness. Refugee –A person who “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his or her nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country” Source:http://www.unhcr.org/pages/49da0e466.html

6. Definitions Nutrition and Food Security: Working with Community Health Workers by Marti Woolford WIC –Formal title is the Special Supplemental Nutrition Program for Women, Infants, and Children –This program serves to safeguard the health of low-income women, infants, and children up to age 5 who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating and referrals to health care. Source: http://fns.usda.gov/wic/aboutwic/wicataglance.htm

7. Community Health Workers (CHWs) Nutrition and Food Security: Working with Community Health Workers by Marti Woolford CHWs are usually women, who are not working, and who speak English. CHWs are trained as they attend and provide interpretation for the 8-week nutrition sessions. –Classes are held one time a week for two hours –Classes are held in the CHWs apartment or home –Participants live in the same apartment complex or near by –Participants are from the same cultural group CHWs are introduced and learn how to prepare healthy American food at each class. Upon completion of training CHWs are then ready to teach their communities on their own.

8. Methods Nutrition and Food Security: Working with Community Health Workers by Marti Woolford The CHW administers nutrition and food security, food safety, and healthy eating assessments at the appropriate class. An International Rescue Committee staff member is present during the training period to answer any questions.

9. Nutrition and Food Security Assessment Nutrition and Food Security: Working with Community Health Workers by Marti Woolford The Nutrition and Food Security assessment has two parts 1.Part one collects demographic data, food preparation data, food acculturation questions, transportation use, and food assistance participation. 2.Part two consists of a food security questionnaire.

10. Nutrition and Food Security Assessment Results Nutrition and Food Security: Working with Community Health Workers by Marti Woolford Demographic data –In 12-months the Community Health Worker program trained seven CHWs. CHWs were from Bhutan, Burma, Somalia, and Eritrea. These CHWs in turn assisted in teaching 33 different households about healthy eating, food safety, and exercise and wellness. –Of these 33 households, 39% were Bhutanese, 33% were Burmese, 18% were Somali, and 9% were Eritrean.

11. Percentage of Participants by Country N=33 Nutrition and Food Security: Working with Community Health Workers by Marti Woolford

12. Nutrition and Food Security Assessment Results Nutrition and Food Security: Working with Community Health Workers by Marti Woolford Demographic Data cont. –The average age of group participants was 26 years old with an average household size of 4 people. –Gender of group participants was divided evenly with 15 (45%) being female, 15 (45%) being male, and 3 (9%) not responding to the gender question.

13. Food Assistance Participation N=33 Nutrition and Food Security: Working with Community Health Workers by Marti Woolford

14. Food Security Nutrition and Food Security: Working with Community Health Workers by Marti Woolford Of the 33 participants, 32 answered the food security questionnaire. The food security questionnaire found that 11 (34%) were food secure, 8 (25%) had marginal food security, 9 (28%) had low food security, and 4 (12%) had very low food security.

15. Food Security Questionnaire Results N=32 Nutrition and Food Security: Working with Community Health Workers by Marti Woolford

16. Food Safety & Healthy Eating Assessment Nutrition and Food Security: Working with Community Health Workers by Marti Woolford The assessment asked participants knowledge of specific food safety & healthy eating issues before the food safety lesson and their knowledge after the food safety lesson. A likert scale was used to determine knowledge-1 being no knowledge and 10 being complete knowledge. A change score was then calculated by subtracting the before lesson score from the after lesson score (before score - after score = change score). The median value of all change score was then calculated. Results are shown on the next two slides.

17. Food Safety Assessment Results Nutrition and Food Security: Working with Community Health Workers by Marti Woolford

18. Healthy Eating Assessment Results Nutrition and Food Security: Working with Community Health Workers by Marti Woolford

19. Discussion Nutrition and Food Security: Working with Community Health Workers by Marti Woolford The results of the Nutrition and Food Security assessment indicate that the refugees who attended the CHW classes experienced high rates of food insecurity and as a result may be experiencing difficulty acquiring healthy and nutritious food. The results of the food safety and healthy eating assessments indicate that participant’s knowledge increases after they receive the lessons. The results indicate also that some participant’s arrive in the U.S. with prior food safety and healthy eating knowledge.

20. Contact Information Nutrition and Food Security: Working with Community Health Workers by Marti Woolford Amelia Self Health Program Manager Amelia.Self@theIRC.org 801-328-1091 International Rescue Committee 231 East 400 South, Suite 50 Salt Lake City, Utah 84101