Progress 10/01/99 to 09/30/04
Outputs
During this project we developed and tested a conceptual framework describing the relationships between the work context of front-line Community Nutrition Educators (CNEs) and their work attitudes and program effectiveness. Within the Expanded Food and Nutrition Education Program (EFNEP) of New York State (NYS), we conducted and analyzed 26 qualitative interviews with program staff and key informants and then conducted a state-wide survey of all front-line CNEs and EFNEP supervisors. The results were presented in a dissertation, at several professional nutrition meetings, and in presentations to program staff. We have drafted a report with programmatic recommendations for Cooperative Extension and program staff that should be released within the next two months. We have also been preparing manuscripts for submission to peer-reviewed journals and hope to have these accepted for publication within the next year. The key findings of the research were as follows: CNEs were
highly motivated, satisfied, and committed to what they viewed as an extremely valuable program providing practical lessons tailored to the needs of limited-resource families. Paraprofessional CNEs played relatively 'professional' roles with discretion for scheduling and lesson plans, and were not only capable of making these decisions, but relished the autonomy and saw it as critical to their effectiveness, motivation and empowerment. CNEs described 'pressure for numbers', or the need to meet quantitative targets of numbers of graduates, as the greatest source of dissatisfaction. Despite limited program resources and low pay, EFNEP has succeeded in recruiting and retaining staff who combine the advantages of being indigenous (such as empathy and rapport with target population) with professional attitudes toward autonomy and initiative. In regression analysis, CNEs' perceptions of the value of EFNEP were associated with CNE job satisfaction, intentions to stay in their positions, and
participants' behavior change. Other factors enhancing CNE satisfaction included positive work relationships, 'having a voice', and lack of post-secondary education. Managerial practices and program delivery through individual sessions (rather than small groups) were positively associated with rates of reported behavior change among program participants. In summary, the key positive influences within the EFNEP work context were appropriate management practices that facilitate CNE autonomy and effectiveness, supportive work relationships, and in particular, CNEs' belief in the value of the program. This research demonstrates that work context matters to CNEs and suggests that strategies related to job design, program management, team building, and attention to perceptions of program quality could improve work attitudes and help to increase program effectiveness.
Impacts
The research findings have and will continue to be used to guide program decisions within EFNEP NYS and other programs. For example, a newsletter by and for CNEs has been created to provide a forum to celebrate program success and boost morale. The findings will also inform future efforts to understand program effectiveness by conceptualizing the role of management and work context and by adapting and developing methods for investigating work and organizational issues in the nutrition program context. This work provides new tools for assessing and improving the effectiveness of nutrition programs designed to promote healthy dietary practices.
Publications
- Dickin KL, Dollahite JS, Habicht J-P. 2003. Work context matters: Paraprofessional nutrition educators' perceptions of program value and management are related to nutrition program outcomes. Experimental Biology 2003. San Diego, CA, 2003.
- Dickin KL, Dollahite JS, Hammer TH, Habicht J-P. 2002. Can a large-scale program sustain the motivation of front-line nutrition workers? Experimental Biology 2002. New Orleans, LA, 2002.
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Progress 01/01/02 to 12/31/02
Outputs
This was a mixed methods investigation of perceived work context, worker attitudes, and program outcomes, among paraprofessional Community Nutrition Educators (CNEs) implementing the Expanded Food and Nutrition Education Program (EFNEP) in New York State (NYS). The underlying assumption was that because effective interpersonal nutrition education interventions depend on the ability of front-line workers not only to teach, but also to motivate and enable behavior change, it is essential to understand what motivates the workers themselves. In 2002, we continued data analysis of the survey data, completing the site-level analysis of the relationships of work context to program outcomes measured by the EFNEP Evaluation and Reporting System. These analyses included 30 EFNEP sites throughout NYS, excluding New York City. Program effectiveness was measured as mean reported behavior change among EFNEP graduates in each program site, assessing change in scores on six items on
practices related to diet and food resource management. In regression models controlling for the effects of entry score on the behavioral assessment, behavior change was higher in sites where a greater percentage of participants received individual instruction, and where CNEs gave higher scores to the value of the program and to their supervisor's managerial practices. The significant categories of managerial practices were planning, problem-solving, clarifying of roles and objectives, motivating and inspiring, and monitoring. Analysis of the number of program graduates per full-time equivalent (FTE) worker showed that this variable was positively related to population size and program delivery through small group sessions rather than through individual instruction. In a sub-sample of 25 rural and urban sites with populations less than 300,000, higher numbers of graduates per FTE were produced in sites where CNEs reported lower scores perceptions of the value of the program. This
suggests that strategies aimed at maximizing the number of program graduates produced may be associated with less favorable work attitudes among front-line personnel. This relationship was not seen in the 5 metropolitan sites. Graduates per FTE was originally selected to be an indicator of program efficiency, because the stated program criteria for graduation included participants' attainment of program goals. Upon closer examination, it was found that graduation criteria varied by site, with some programs graduating participants on the basis of attendance at a minimum number of sessions, making graduates per FTE more a measure of program output than of efficiency in these sites. These findings have been submitted in an abstract for the Experimental Biology (EB) Meeting in 2003 and were also presented to the Division of Nutritional Sciences at Cornell University. Results of earlier analyses on CNEs' job satisfaction and intention to leave the position were presented at the EB Meeting
in 2002 and to a state-wide meeting of EFNEP supervisors. The research results are being written up for communication within the program and for publication in peer-reviewed journals.
Impacts
This was the first study of how front-line community nutrition educators' (CNEs') perceptions of their work context are related to work attitudes and program outcomes. CNEs' belief in the value of the program was found to be a particularly influential aspect of the work context. Autonomy, participation in decision-making, management, and supportive work relationships were also important to paraprofessional nutrition educators. Strategies related to job design, program management, team building, and attention to educators' views of program quality may help to increase nutrition program effectiveness through the attraction and retention of front-line nutrition workers with the values and skills needed to transform nutrition knowledge into meaningful behavior change.
Publications
- No publications reported this period
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Progress 01/01/01 to 12/31/01
Outputs
In 2001, we initiated and completed quantitative data collection in 32 sites of the Expanded Food and Nutrition Education Program (EFNEP) in New York State (NYS). Detailed questionnaires were developed for EFNEP Nutrition Teaching Assistants (NTAs) and their supervisors, based on results of our earlier qualitative research and a literature review. Cognitive testing was conducted in three sites to pre-test the questionnaires, which were then modified accordingly. The survey was implemented in March-June 2001, covering 116 NTAs and 36 supervisors (96% of all NTAs and 100% of supervisors). The survey was administered in person to about 70% of the sample, and by phone and/or mail to the remainder. Next, we used factor analysis to refine the scales and operationalize all variables in our conceptual framework. We performed descriptive analyses of work context variables, worker attitudes, and background characteristics, and detailed regression analysis of the determinants of
NTA job satisfaction. Alhtough a relatively minor part of our original proposal, this latter analysis has proved to be more complex and informative than expected, and is now seen as a major contribution of the research. Our final regression model explains about 70% of the variation in NTA satisfaction, as a function of work context variables and some background characteristics (ethnicity, educational level, and sociability). NTAs' perceptions of the value of the program is the strongest predictor of satisfaction, and is very high among EFNEP staff in NYS. Other work context factors found to be important include relationships in the work team and the broader organization (i.e. local Cooperative Extension Association), as well as perceived workload. Among managerial practices, the most important predictor of NTA satisfaction was the frequency with which the supervisor consulted NTAs on decisions affecting their work. We also tested our hypothesis that aspects of the sense of empowerment
of NTAs would mediate these relationships, and found that self-determination and sense of purpose mediated some of the influence of work context and background variables on NTA satisfaction, but self-efficacy did not. We are currently continuing with data analyses to assess the impact of work context on program outcomes, such as EFNEP graduation rates and reported behavior change among program participants. We presented the preliminary results of our research in Sept 2001 at 'Nutrition Education for Diverse Audiences', a national conference for Cooperative Extension nutriton education programs. We have submitted an abstract and plan to present our regression results at the Experimental Biology Meeting in April 2002, the primary annual conference attended by nutrition researchers in the US. We will also disseminate our findings to EFNEP staff in NYS, most of whom participated in the survey. We will make a presentation to all EFNEP supervisors in NYS at an annual retreat in May 2002,
and will prepare a summary report to mail to all EFNEP NTAs in NYS, once analyses are complete. For wider dissemination of results, we are preparing three or more manuscripts for publication in peer-reviewed journals.
Impacts
Our research will explicate the relationships between work context (including supervision, work relationships, and program design) and the work attitudes and performance of front-line nutrition educators, and also examine relationships with overall program effectiveness. Results will be reported to program management and staff, and State EFNEP management are already planning to use results to guide training and other actions to improve management, staff morale, and monitoring of program results. Similarly, other nutrition programs can learn from this study of EFNEP, adapting the findings to their own context. Research publications on our results will be some of the first on program management issues in the field of nutrition, focusing attention and further research on questions of how to maximize program effectiveness via improvements in program design, implemention, and management. We also plan to refine our research instruments, use the results of this research to
design new projects to address questions raised by this research, and test the program management strategies that our results suggest.
Publications
- No publications reported this period
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Progress 01/01/00 to 12/31/00
Outputs
Completed 24 in-depth interviews with 9 front-line nutrition educators (each interviewed twice), 3 supervisors and 3 key informants in 3 program sites in New York State and Cornell University. Analyzed results using qualitative techniques. Preparing final report on Phase I results to inform program management of workers' perspectives on the organizational and program environment and their attitudes about their work. Key findings: NTAs are motivated by their strong sense of the value of EFNEP (Expanded Food and Nutrition Education Program) and their desire to help participants improve their lives. While the focus is on nutrition, most NTAs' true goals are to help participants develop skills and self-confidence to make choices that will increase family well-being in broader ways. Although they are 'paraprofessionals', NTAs have a large amount of freedom in how they perform their roles. This maintains their interest, and they feel that this allows them to be more
effective by tailoring lessons to the needs of participants. NTAs reported that the freedom to use their own judgement is the most empowering aspect of their work and most credited their supervisor as the source of this autonomy. The least empowering aspects were management's interest in reaching numeric targets, resulting in pressure and prioritizing the quantity of program output above the quality of services. When asked about empowerment of participants and the keys to successful education to change behavior, most NTAs first mentioned expressing appreciation for participants' accomplishments, to build rapport and self-confidence. The importance of giving participants choices was also mentioned frequently. NTAs varied in their perceptions of communication and relationships at work. In some counties, there is a high degree of team spirit among the NTAs that contributes greatly to enjoyment of work and perceived effectiveness. Other sites lack such strong relationships. Similarly ,
the degree to which NTAs feel a part of the county Extension office and respected by staff of other departments varies widely. We are currently writing up results of literature review on empowerment and related constructs and preparing for Phase II of data collection using a series of questionnaires based on the results of Phase I and literature review. The largest questionnaire is designed for the NTAs and covers individual characteristics, perceptions about their work context, dimensions of empowerment, and outcomes such as job motivation and satisfaction. This instrument is being pre-tested and will soon be administered to all EFNEP NTAs in New York State. This questionnaire is complemented by shorter instruments for supervisors to assess job characteristics and provide descriptive information on the county programs, and for Executive Directors to provide descriptive information on the county Extension Associations. Dependent variables will be indicators of program effectiveness
based on EFNEP monitoring data.
Impacts
This research will help to identify the work conditions that contribute to positive work attitudes and performance of front-line nutrition educators, and examine relationships with overall program effectiveness. Results will be applicable within EFNEP and other Extension programs, but also in the broader nutrition education community, contributing to the implementation of nutrition programs that better meet the needs of participants, particularly low income families.
Publications
- No publications reported this period
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