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A Pilot Study for the Development of a Nutrition Education Program

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A Pilot Study for the Development of a Nutrition Education Program CALIFORNIA STATE UNIVERSITY, NORTHRIDGE Healthy Families for Healthy Communities: A Pilot Study for the Development of a Nutrition Education Program A graduate project submitted in partial fulfillment of the requirements for the degree of Master of Science in Family and Consumer Sciences By Diana Uribe-Tanus August 2016 The graduate project of Diana Uribe-Tanus is approved: _________________________________________ _______________ Annette, Besnilian, EdD, RDN, CLE, FAND Date _________________________________________ _______________ Elizabeth J. Sussman, PhD, RDN Date _________________________________________ _______________ Setareh Torabian, Dr. PH, MS, RDN, Chair Date California State University, Northridge ii ACKNOWLEDGEMENTS I would like to thank my committee members who supported my efforts in writing this graduate project. I recognize the value of your commitment, encouragement and time. You are the guiding force that pushes me to great accomplishments. To my chair: Dr. Setareh Torabian: Thank you for your assistance and feedback throughout my academic career. To Dr. Annette Besnilian: Thank you for encouraging me to push ahead with my project and for not giving up on me. To Dr. Elizabeth Sussman: Thank you for your assistance in helping me complete my degree and for accepting to be part of my committee at short notice. To all the instructors that help me implement the program: Thank you for all of your support, feedback and commitment to the success of the program. iii DEDICATIONS This graduate project is dedicated with love and gratitude to all my family, but especially to: My husband Jonathan for his ongoing support, patience and understanding. My son Eliel, for giving my life purpose. My mother, Maria Del Rosario, who has consistently and whole-heartedly been available to help in every way, so I could continue my studies. My father, Antonio, for always encouraging me to complete my studies. My parents in-laws Jose Luis and Miriam, for always supporting Jonathan and me and for always being there for our son. iv TABLE OF CONTENTS Signature Page ii Acknowledgments iii Dedications iv Abstract vii CHAPTER I – INTRODUCTION Statement of the Problem 1 Purpose 3 Research Questions 4 Assumptions 4 Limitations 5 CHAPTER II – REVIEW OF LITERATURE Obesity Overview 7 The Social - Ecological Model 9 Interventions for the Treatment of Overweight and Obesity in Children 10 Interventions for the Treatment of Overweight and Obesity in Adults 16 CHAPTER III – METHODOLOGY Phase 1: Needs Assessment 24 Phase 2: Planning and Development 26 Phase 3: Implementation 31 Phase 4: Evaluation 32 CHAPTER IV – RESULTS Results from the Evaluation by the Participants 35 Results from the Evaluation by the Experts 37 CHAPTER V – DISCUSSION Discussion of the Findings and Modifications 41 Limitations and Recommendations for Future Research 42 Implications and Conclusion 43 REFERENCES 45 APPENDIX A. HFHC: Pre-Test English/Spanish 54 B. HFHC: Post-Test English/Spanish 58 C. Formative Evaluation Survey for Panel of Experts 62 D. Summaries of Participants Pre/Post-Test & Formative Evaluation 65 E. HFHC: Week 1 Agenda 71 F. HFHC: Week 1 72 G. Building a Healthy Plate and Physical Activity Log 83 H. HFHC: My Wellness Journal…Getting Started! 84 v I. HFHC: Week 1 (Spanish) 86 J. Building a Healthy Plate and Physical Activity Log (Spanish) 98 K. HFHC: My Wellness Journal…Getting Started! (Spanish) 99 L. HFHC: Week 1 Kids Handouts 101 M. HFHC: Week 2 Agenda 108 N. HFHC: Week 2 109 O. HFHC: Week 2 (Spanish) 119 P. HFHC: Week 2 Kids Handouts 129 Q. HFHC: Week 3 Agenda 138 R. HFHC: Week 3 139 S. HFHC: Week 3 (Spanish) 145 T. HFHC: Week 3 Kids Handouts 152 U. HFHC: Week 4 Agenda 159 V. HFHC: Week 4 160 W. HFHC: Week 4 (Spanish) 167 X. HFHC: Week 4 Kids Handouts 174 Y. HFHC: Week 5 Agenda 184 Z. HFHC: Week 5 185 AA. HFHC: Week 5 (Spanish) 195 BB. HFHC: Week 5 Kids Handouts 205 CC. HFHC: Week 6 Agenda 210 DD. HFHC: Week 6 211 EE. HFHC: Week 6 (Spanish) 216 FF. HFHC: Week 6 Kids Handouts 221 GG. Additional Resources 224 vi ABSTRACT Healthy Families for Healthy Communities: A Pilot Study for the Development of a Nutrition Education Program By Diana Uribe-Tanus Master of Science in Family and Consumer Sciences No single or simple solution can solve this obesity epidemic, but a possible way to help reverse the obesity epidemic is through the partnership between families and communities. The community can help parents learn to bridge the gap between school and home, the gap caused by the lack of education, economical status, and limited health care resources. The purpose of this graduate project was to help bridge this gap by developing a bilingual (English and Spanish) family and community-based program aimed at educating the entire family on healthy nutrition and physical activity. A second objective of this project was to develop a curriculum that contains detailed instructions for how to lead the structured lessons, thus allowing inexperience instructors to easily implement the program at various community locations and reach a larger population. The Healthy Families for Healthy Communities (HFHC) program was created in four phases: needs assessment; planning and development; implementation; and evaluation. The program’s curriculum was designed to include nutrition education lesson plans, physical activity sessions, cooking demonstrations and self-monitoring resources to help change and sustain healthy behaviors. In addition, the lesson plans were written in dialogue to help guide the instructor during teaching process; therefore, enhanced the teaching and learning experienced. vii The program was implemented as a pilot study integrated into a six week structured program administered once a week that took place at multiple community locations within the West San Fernando Valley. The effectiveness of the program was not evaluated due to the small size of the sample; however, participant’s knowledge and feedback was analyzed with the use of quantitative and qualitative date. In addition, the relevance and overall usefulness of the curriculum design was evaluated by a panel of experts using a formative evaluation. Feedback regarding the program was obtained and helped make improvements and modifications to the program and its curriculum. The program was well received among the participants and both participants and experts confirmed that they would recommend the implementation of the curriculum as means to educate families on topics related to healthy lifestyle behaviors. Further research is suggested to evaluate the overall effectiveness of the program and its tools on healthy behavioral changes. viii CHAPTER I INTRODUCTION Statement of the Problem Obesity is a health problem affecting communities throughout the United States (U.S.) (Benjamin, 2010). Findings from the National Health and Nutrition Examination Survey (NHANES) conducted by the Centers for Disease Control and Prevention (CDC) demonstrated that there has been an increase in obesity among adults in the U.S over a period 1990-2012, and that currently more than one third of adults are obese (34.9%). Furthermore, obesity prevalence among children and adolescents has almost tripled since 1980; approximately 17% or 12.5 million of children and adolescents age 2 to 19 are now obese in the U.S. Obesity contributes too many public health issues and place a heavy burden on the U.S. heath care system. It has been conclusively demonstrated to increase the risk of high blood pressure, high cholesterol, type II diabetes (DMII) and its complications, coronary heart disease (CHD), stroke, gallbladder disease, osteoarthritis, sleep apnea, and respiratory problems as well as certain cancers (CDC, 2015). The CDC also reported that in 2008 the U.S. health care system spent $147 billion dollars medical care related to obesity. In addition, the Office of the Surgeon General reported that obesity contributes to an estimated 112, 000 preventable annual deaths (Benjamin, 2010). Behavior, environmental, and genetic factors seem to play a role in obesity (CDC, 2015). However, the Office of the Surgeon General pinpointed changing behavior and the environment as the most likely effective actions in the fight against obesity (Benjamin, 2010). For these reasons, experts have directed their attention to behavioral and environmental factors that help influence people’s lifestyles and offer people 1 opportunities for positive health outcomes. Studies have shown that nutrition education has been a useful tool in the treating and preventing obesity. Initiatives such as Michelle Obama’s Let’s Move campaign and Healthy People 2020 are examples of programs dedicated to solve the obesity epidemic by promoting change in the home, at schools, childcare centers, in the community and within the government through public policy. Although many nutrition programs have been implemented in the U.S over the years, obesity continues to affect all groups especially non-Hispanic Blacks and Hispanic communities (CDC, 2015). As reported by the CDC, non-Hispanic Blacks and Hispanics have the highest age-adjusted rates of obesity, 47.8% and 42.5% respectively, compared to non-Hispanic Whites (32.6%) and non-Hispanic Asians (10.8%). Furthermore, findings from 2011-2012 showed that the prevalence among children and adolescents was higher among Hispanics and non-Hispanic Blacks, 22.4% and 20.2% respectively, compared to non-Hispanic Whites (14.1%). In addition to these national statistics, the prevalence of adult obesity in the Los Angeles County has also increased from 13.6% in 1997 to 22.2% in 2008 and among school-aged children increased from 18.9% in 1999 to 23.0% in 2008 (County of Los Angeles Public Health, 2011). Furthermore, when looking at the adult obesity prevalence by city within the Los Angeles County, the San Fernando Valley prevalence among adults is 23.6 to 29.0% (County of Los Angeles Public Health, 2011). The San Fernando Valley is mostly comprised by Hispanic families. No single or simple solution can solve this obesity epidemic, but a possible way to help reverse the obesity epidemic is through the partnership between families and communities.
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