Source: UNIVERSITY OF GEORGIA submitted to NRP
IMPROVING PROGRAM EVALUATION OF THE OLDER AMERICANS ACT NUTRITION PROGRAM IN GEORGIA
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
HATCH
Reporting Frequency
Annual
Accession No.
0228453
Grant No.
(N/A)
Cumulative Award Amt.
(N/A)
Proposal No.
(N/A)
Multistate No.
(N/A)
Project Start Date
Mar 1, 2012
Project End Date
Feb 28, 2017
Grant Year
(N/A)
Program Code
[(N/A)]- (N/A)
Recipient Organization
UNIVERSITY OF GEORGIA
200 D.W. BROOKS DR
ATHENS,GA 30602-5016
Performing Department
College of Family & Consumer Sci
Non Technical Summary
The aging of the U.S. population and the current economic recession have heightened interest in efficient and effective nutrition and aging services for older people at high risk for food insecurity, hunger, and malnutrition. It is more important than ever to use convincing research designs and methods to provide evidence that nutrition and aging services have beneficial impacts on nutritionally needy older adults. The OAANP has been a primary source of food assistance targeted to older adults with greatest economic and social needs while providing congregate meals (CM) and home delivered meals (HDM). Already unable to meet the program demand, this program is in urgent need to improve accountability, efficiency, and effectiveness. Major challenges in evaluating the impact of the OAANP include how to design and implement an evaluation to sort out need status and program impact and their changes within an older individual across an appropriate time interval and how to establish a system to collect needs and outcome measures of participants at the state and local levels. Based on the process and findings from the collaborative evaluation studies conducted between the GA DAS and UGA during the last 5 years, many exciting changes are currently undergoing in the GA AIMS as well as local aging services to improve the program evaluation of the OAANP in Georgia. One of the unique changes is the adoption of the modified 6-item food insecurity measure which was validated as the direct and sensitive measures of need status for and outcome of the OAANP in older Georgians in our previous evaluation studies. These unique opportunities could enhance the procedures and infrastructure of the state client information system and complementary local program evaluation to collect needs and outcome measures of clients starting from the entry to the exit out of the program using an appropriate time interval and outcome measures. Such established systems could provide a basis to better manage the internal client and service information at the state and local level (e.g., assessing needs, linking clients with services, documenting program demand, planning, etc.) and meet federal accountability initiatives (e.g., Government Performance Results Act). More evaluation studies are needed to examine the feasibility, efficacy, and effectiveness of the newly adopted approaches in the GA AIMS and local aging services, and the utility of the resulting database to improve program evaluation of the OAANP at the state and local aging services network in Georgia.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7036010101030%
7046010101070%
Knowledge Area
703 - Nutrition Education and Behavior; 704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6010 - Individuals;

Field Of Science
1010 - Nutrition and metabolism;
Goals / Objectives
The overall goal of this study is to improve program evaluation methods to examine the impact of the Older Americans Act Nutrition Program (OAANP) by examining the implementability, acceptability, and utility of the new measures and collection methods adopted in the Georgia Aging Information Management System (GA AIMS). This proposed study will examine following five objectives at the State and the Northeast Georgia Area Agency of Aging (AAA) levels: 1) To understand the new measures, collection methods, and implementation plans of the new GA AIMS, with a special emphasis on those related to provision of meals and their relationship to food insecurity and nutritional status; 2) To examine the implementability and acceptability of the new measures and collection methods adopted in the GA AIMS in terms of both technical and administrative aspects from the perspectives of state and local aging service providers, with a special emphasis on those related to food insecurity and nutritional status; 3) To examine the impact of the OAANP using the dataset derived from the GA AIMS at the state level; 4) To examine the impact of the OAANP using the dataset collected at the Northeast Georgia AAA level; 5) To develop plans for better utilizing the new GA AIMS derived dataset for the OAANP evaluation at the state and local levels, with a special emphasis on those measures related to food insecurity and nutritional status
Project Methods
To achieve each goal, best available and practically feasible quantitative or qualitative research methods will be used. Throughout the project, continuous communication among Georgia Division of Aging Services (GA DAS), Northeast Georgia AAA, and University of Georgia (UGA) will be maintained to lead the collective efforts to improve the program evaluation of the OAANP in Georgia. 1) Objective 1: Systemic content analysis of the new measures, data collection methods and schedules, and implementation plans of the new GA AIMS will be conducted. This analysis will provide a general understanding of the new state client database system and help to determine the actual timeline and the scope of tasks related to each of the following objectives. 2) Objective 2: A qualitative in-depth interview method will be used to gather detailed and descriptive understanding of the implementability and acceptability of the new changes in the GA AIMS from the perspective of state and local aging service providers. The interviews will be conducted in a convenience sample of program providers involved in the GA AIMS at the State office and the Northeast Georgia AAA using semi-structured interview guide by a trained graduate research assistant. The analysis will use constant comparative method while assisted by the qualitative data analysis software Atlas/ti V5 as well as Statistical Analysis System Data (SAS, V9.2, SAS Institute, Cary, NC). All methods and procedures will be approved by UGA Institutional Review Board before any procedures with human subjects are initiated. 3) Objective 3: An extensive data checking, data cleaning, and exploratory descriptive analyses will be performed first to check any response and missing pattern by client characteristics, program type, and participation status. An outcome research analysis will then be conducted to assess the impact of the OAANP while considering potential confounders. All analysis will be conducted by using SAS (V9.2, SAS Institute, Cary, NC) and STATA (V10.1, Statacorp LP, College Station, TX) 4) Objective 4: Local OAANP providers and UGA researchers will carefully examine the short- and long-term goal of the complementary local program evaluation and ongoing program evaluation practices. Most appropriate study design, type of measures, and data collection methods will be devised and implemented to collect local level OAANP performance data. Data quality check and outcome research analyses will be conducted to assess the impact of the OAANP using the resulting dataset collected at the local level by using SAS (V9.2, SAS Institute, Cary, NC) and STATA (V10.1, Statacorp LP, College Station, TX) 5) Objective 5: The findings and lessons learned from this proposed study will be synthesized to provide guidance to best use the new dataset derived from the GA AIMS or other complementary local data collection with the goal of developing and improving the program evaluation system as part of the normal OAANP administrative process.

Progress 03/01/12 to 02/28/17

Outputs
Target Audience: Aging services providers at the state and local levels in Georgia and other states Nutrition and aging researchers Changes/Problems:As reported in the earlier progress report, sub-study 1, 2, and 4 were not conducted due to the much-delayed progress of the new GA AIMS system and local aging service data collection process. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?The findings of this project have been shared with aging services providers at the state and local levels and suggest several strategies enhance the utility of the new GA AIMS derived dataset for the OAANP evaluation, with a special emphasis on those measures related to food insecurity and nutritional status. Some of the findings were presented at the national and state level conferences, and published in peer-reviewed journals or being prepared as manuscripts for submission. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Population aging in the U.S. places greater demands on nutrition and aging services, an alternative long-term care form providing assistance to vulnerable older adults to help them maintain independence, delay disease and disability, and remain living in their homes and communities. The Older Americans Act Nutrition Program (OAANP) is the largest and primary nutrition and aging program targeted to older adults with greatest economic and social needs while providing congregate meals (CM) and home delivered meals (HDM). Already unable to meet the program demand, this program is in urgent need to improve accountability, efficiency, and effectiveness. Appropriate evaluation to understand and monitor participant demands and needs for and performance of OAANP in a timely manner across the aging services network is one of the critical ways to improve the accountability; however, it has not been easy to conduct such evaluations throughout the aging network due to variability and heterogeneity of OAANP provided across the states as well as the lack of funding, technical support, and infrastructure to collect appropriate data at the state and local levels. Building upon the collaborative studies conducted by the Georgia Division of Aging Services (GA DAS) and University of Georgia (UGA) to improve the program evaluation of the OAANP, this project examined the feasibility and utility of the state administrative aging data collected from the updated Georgia Aging Information Management System (GA AIMS) at the state and local level to examine the impact of OAANP with a specific focus on a newly adopted modified 6-item food security measure validated as the direct and sensitive measures of need status for and outcome of the OAANP in older Georgians. Due to the much-delayed progress of the GA AIMS update and implementation of the new food insecurity assessment across the state, the timeline and scope of original five study objectives had to be modified. Therefore, this project focused on examining the impact of the OAANP using the GA AIMS derived statewide aging administrative data between 2012-2014 (around 30,000 participants/year). Extensive descriptive analysis and GIS analysis were conducted to document the characteristics of all older Georgians receiving nutrition and aging services by the type and number of services they received and program usage patterns. The findings provided valuable information on the unique make-up, size, and geographic distribution of subgroups of vulnerable older Georgians in need of different types of nutrition and aging services at the state level. Fixed effects regression analysis was conducted to examine the OAANP and other aging service usage patterns and changes in food security status (i.e., persistent food security, persistent food insecurity, transition either became food secure or food insecure). Overall, 20% of nutrition and aging program participants in Georgia were food insecure between 2012-2014. Among those with all annual food security assessments for three years (n = 6,436), 68% and 3% reported persistent food security and persistent food insecurity, respectively and 20% transitioned from being food insecure to food secure between 2012 -2014. Persistent food secure participants and those who transitioned from food insecure to food secure used more programs than the other groups This study demonstrates the feasibility and utility of the state aging administrative data to serve as a basis to document current OAANP use, delivery, and coordination and to evaluate the impact at the state level as part of the standard administrative process. Such a system along with established methodology and procedures to monitor the needs, use, and outcome of OAANP and other aging services across the aging network is helpful to enhance the capacity, access, effectiveness, efficiency, and accountability of nutrition and aging services and to better meet the long-term care needs of the ever increasing older population in Georgia and other states.

Publications

  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2017 Citation: Bhargava, V., Lee, J. S. (2017). Feasibility of State Aging Administrative data to examine the impact of Older Americans Act Nutrition and other Home-and Community-based programs in Georgia. Will be presented at the American Society for Public Health Annual Meeting 2017. Atlanta, GA. (Nov 4-Nov 8, 2017) (Poster).
  • Type: Other Status: Other Year Published: 2016 Citation: Lee, J. S. Food Insecurity in Older Georgians. Plenary Presentation at the Georgia Senior Hunger Summit. September 27, 2016, Atlanta, GA
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Lee, J. S., Shannon, J. Brown, A. (2015). Characteristics of older Georgians receiving Older Americans Act Nutrition Program and other home and community-based services. J Nutr Gerontol Geriatrics, 34(2), 168-188. doi:10.1080/21551197.2015.1031595
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Shannon, J., Lee, J. S., Holloway, S., Brown, A., Bell, J. (2015). Evaluating the relationship between food access, urban environment, and food security in Georgias older population. Appl Geog, 60, 224-229. doi:10.1016/j.apgeog.2014.10.013
  • Type: Theses/Dissertations Status: Published Year Published: 2014 Citation: Smith, K. D., (2014). The prevalence and distribution of food insecurity among older Georgians receiving aging services. MS Thesis. Department of Foods and Nutrition, University of Georgia.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Lee, J. S., Shannon, J., Brown, A. (2014). Living in food deserts was associated with food insecurity in a statewide sample of older adults in need of aging and food assistance programs in Georgia. J Acad Nutr Diet, 114(9, Suppl 2):A12.


Progress 10/01/15 to 09/30/16

Outputs
Target Audience: Nothing Reported Changes/Problems:As reported in the earlier progress report, Sub-study 1 and 2 will not be conducted due to much-delayed progress of the new GA AIMS system. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?Some preliminary findings from the longitudinal analysis of the GA AIMS data between 2011-2014 were presented at the 2016 Georgia Senior Hunger Summit hosted by the Georgia Department of Human Services on September 27th in Stone Mountain, Georiga. The presentation provided unprecedented data on changes in food insecurity and aging service usage patterns in all older Georgians receiving Home and Community Based Services (n=66,096), 2011--2014, which has a potential to guide evidence-based nutrition and aging programs and policy decisions. What do you plan to do during the next reporting period to accomplish the goals?I will complete the new GA AIMS data as well as Northeast Georgia AAA data and develop plans for better utilizing the new GA AIMS derived dataset for the OAANP and Home and Community based Program evaluation at the state and local levels,

Impacts
What was accomplished under these goals? I have received the long-awaited longitudinal GA AIMS datasets and Northeast Georgia AAA dataset needed for the Sub-study 3 and 4 in June, 2016. I have been conducting extensive data cleaning and management and just started the longitudinal analysis from September, 2016. Some preliminary findings from this analysis were presented at the 2016 Georgia Senior Hunger Summit hosted by the Georgia Department of Human Services on September 27th in Stone Mountain, Georiga. The presentation provided unprecedented data on changes in food insecurity and aging service usage patterns in all older Georgians receiving Home and Community Based Services (n=66,096) between, 2011--2014, which has a potential to guide evidence-based nutrition and aging program and policy decisions.

Publications


    Progress 10/01/14 to 09/30/15

    Outputs
    Target Audience: Nothing Reported Changes/Problems:As reported in the earlier progress report, Sub-study 1 and 2 will not be conducted due to much-delayed progress of the new GA AIMS system. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest?The findings reported in the two journal articles were further shared with the Georgia Division of Aging Services and Georgia Aging Services Network to better plan and implement needed nutrition and aging services across the State. What do you plan to do during the next reporting period to accomplish the goals?I am waiting to receive the longitudinal GA AIMS datasets and Northeast Georgia AAA datasets needed for the Sub-study 3 and 4. I will continue to work with the Georgia Division of Aging Services and the Athens Community Council on Aging to get these datasets as soon as possible. Once these data are available, I will be able to complete the proposed tasks related to the Sub-study 3 and 4

    Impacts
    What was accomplished under these goals? Using the first ever statewide food insecurity data collected from the GA AIMS, I was able to publish two journal articles. The findings reported in these publications clearly demonstrate the feasibility and utility of the state aging administrative data to serve as a basis to document current OAANP and other Home and Community Based Services (HCBS) use, delivery, and coordination at the state level as part of the standard administrative process. Furthermore, these publications suggest selected methodology and procedures to monitor the needs and use of OAANP and HCBS across the aging network which is helpful to enhance the capacity, access, effectiveness, efficiency, and accountability of OAANP and HCBS to better meet the needs of the ever increasing older population in Georgia and other states.

    Publications

    • Type: Journal Articles Status: Published Year Published: 2015 Citation: Lee, J. S., Shannon, J. Brown, A. (2015). Characteristics of older Georgians receiving Older Americans Act Nutrition Program and other home and community-based services. J Nutr Gerontol Geriatrics, 34(2), 168-188. doi:10.1080/21551197.2015.1031595
    • Type: Journal Articles Status: Published Year Published: 2015 Citation: Shannon, J., Lee, J. S., Holloway, S., Brown, A., Bell, J. (2015). Evaluating the relationship between food access, urban environment, and food security in Georgias older population. Appl Geog, 60, 224-229. doi:10.1016/j.apgeog.2014.10.013


    Progress 10/01/13 to 09/30/14

    Outputs
    Target Audience: Nothing Reported Changes/Problems:As reported in the earlier progress report, substudy 1 and 2 will not be conducted due to much delayed progress of the new GA AIMS system. What opportunities for training and professional development has the project provided?This project provided an oprotunity for my MS student to develop a thesis project focusing on the prevalence and distribution of food insecurity among low-income older Georgians. How have the results been disseminated to communities of interest?The findings from the thesis project were shared with the Georgia Division of Aging Services and Georgia Aging Services Network to better plan and implement needed nutrition and aging servies across the State. Some of the findings were submitted and accepted for an oral presentation at the Academy of Nutrition and Dietetics Association Annual Meeting Food & Nutrition Conference & Expo 2014 in Atlanta, GA on October 19, 2014. What do you plan to do during the next reporting period to accomplish the goals?I will prepare and submit two mansucripts based on the desriptive analsyis by the end of 2014. The longitudinal GA AIMS datasets and Northeast Georgia AAA datasets needed for the substudy 3 and 4 will be released in early 2015. I will continue to work with the Georgia Division of Aging Services and the Athens Community Council on Aging to get these datasets as soon as possible. Once these data are available, I will be able to complete the proposed tasks related to the substudy 3 and 4.

    Impacts
    What was accomplished under these goals? I was finally able to obtain the long awaited new GA AIMS dataset including the first ever statewide food insecurity data among low-income older Georgians using aging services in January, 2014. I have carefully examined the quality of the data and conducted proposed descriptive secondary data analyses under the substudy 3. One of my MS students also used this dataset for her thesis project. I was able to secure additional funding to support this analysis from the Georgia Department of Human Services (GA DHS Contract#:427000-373-0000022618; $10,000; 8/1/2013-3/31/2014).

    Publications

    • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Lee, J. S., Shannon, J., Brown, A. (2014). Living in food deserts was associated with food insecurity in a statewide sample of older adults in need of aging and food assistance programs in Georgia. J Acad Nutr Diet, 114(9, Suppl 2):A12.
    • Type: Theses/Dissertations Status: Published Year Published: 2014 Citation: Smith, K. D., (2014). The prevalence and distribution of food insecurity among older Georgians receiving aging services. MS Thesis. Department of Foods and Nutrition, University of Georgia.


    Progress 01/01/13 to 09/30/13

    Outputs
    Target Audience: Nothing Reported Changes/Problems:Due to much delayed progress of the new GA AIMS system, GA DAS and UGA decided to drop sub-study1 and 2 to better plan the realistic timeline and to achieve the overall goal and scope of the whole project. What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?With the release of the newly collected 2012 data scheduled early 2014, I look forward to conducting sub-study 3 along with a MS student who will use this data for her MS thesis project.

    Impacts
    What was accomplished under these goals? During January 1 and September 31, 2013, the actual timeline and the scope of each sub-study proposed in this project have been carefully reevaluated given the much delayed implementation of the new measures and collection methods adopted in the GA AIMS. I have been regularly and closely communicating with the Georgia Division of Aging Services (GA DAS) and Athens Community Council on Aging regarding the status of the implementation of the GA AIMS system at the state and local levels. The new GA AIMS data collected during 2012 are still undergoing processing and will be released by early 2014. Once the new GA AIMS data are available, I will be able to complete the proposed tasks related to the sub-study 3.

    Publications


      Progress 03/01/12 to 12/31/12

      Outputs
      OUTPUTS: The actual timeline and the scope of each sub-study proposed in this project are greatly affected by the status of implementation of the new GA AIMS systems and new data collection schedules across the aging service network in Georgia. During the period between March 1 and December 31, 2012, the progress of this project has been delayed mainly due to slower than anticipated implementation of the new measures and collection methods adopted in the GA AIMS. However, I have been regularly and closely communicating with the Georgia Division of Aging Services and Athens Community Council on Aging regarding the status of the implementation of the GA AIMS system at the state and local levels. The new GA AIMS data collected during 2012 are still undergoing processing. Once the newly collected data are available from the Georgia Division of Aging Services for this project, I will be able to complete the proposed tasks related to the sub-study1 and better plan the realistic timeline and the scope of other sub-studies to best achieve the proposed objectives. PARTICIPANTS: This project is being conducted in collaboration among the University of Georgia, Department of Foods and Nutrition (Jung Sun Lee), Georgia Division of Aging Services (Dr. James Bulot, Director; Mr. Arvine Brown; Ms. Gwenyth Johnson), and Athens Community Council on Aging (Ms. Eve Anthony, Chief Operating Officer). TARGET AUDIENCES: The findings and lessons learned from this project will be used to improve nutrition, health, and overall well-being of low-income older Georgians in need of food assistance programs. PROJECT MODIFICATIONS: As described earlier, the actual timeline and scope of each sub-study proposed in this project need to be modified depending on the status of implementation of the new GA AIMS systems and new data collection schedules.

      Impacts
      This collaborative project based on the newly developed measures and data collection system is still at the stage of refining the scope and realistic timeline of each sub-studies. With the release of the newly collected 2012 data scheduled early 2013, I look forward to exploring how this project could best achieve the proposed outcomes and impacts.

      Publications

      • No publications reported this period