Recipient Organization
TEXAS A&M UNIVERSITY SYSTEM,THE
200 TECHNOLOGY WAY, STE 2079
COLLEGE STATION,TX 77845
Performing Department
Health Promotion Community Hlt
Non Technical Summary
The burden of chronic disease disproportionately affects marginalized populations, such as limited-resource children and families who reside in rural and remote areas of the North Olympic Peninsula of Washington. These areas are occupied by a growing population of people who are low-income non-Hispanic white, Native American, and Hispanic; have dissimilar heritage, beliefs, customs, and language; and similar socioeconomic standing, low health literacy, and limited access to services and resources. They experience unacceptably high rates of poverty, financial stress, and food insecurity; greater reliance on emergency food sources (e.g., food banks) as a regular food source; and limited access to culturally-responsive nutrition education and affordable, healthy foods such as fresh fruits and vegetables. Rural Clallam County presents an opportunity to provide much-needed primary chronic disease prevention to economically and geographically disadvantaged households. There is substantial evidence that a single dietary change, such as increasing fruit and vegetable (F&V) consumption has been associated with decreased incidence and mortality from a variety of chronic diseases: diabetes, cardiovascular diseases, stroke, hypertension, obesity and certain types of cancer. This is especially critical for low-income children and youth in limited resource rural areas, who are at increased risk for developing chronic disease and having to manage for a lifetime. Further, a healthy lifestyle consisting of diet high in F&V early in life helps establish healthy behaviors and prevent chronic diseases in adulthood.Empowering Rural Communities and Families (ERCF) will: 1) focus on increasing consumption of F&V, which is critical in the prevention of chronic diseases, such as type 2 diabetes, cardiovascular disease, and some cancers; 2) utilize a food co-op/CSA-approach, which has gained popularity is an appropriate mechanism for offering a variety of local, high-quality produce and an important component in a comprehensive behavior change program; 3) link F&V distribution with culturally-responsive nutrition education, which will facilitate the improvement of education, skills, competency, and behaviors; 4) target environmental factors (availability and accessibility in the home, family and peer influences), behavioral factors (parents' knowledge of intake recommendations and skills, child involvement in preparation of meals and snacks, pre-preparation of fruit and vegetables for children), and personal factors (food preferences, fruit and vegetable preferences, and preferred preparation styles), which will increase children's fruit and vegetable behaviors; 5) provide nutrition education that takes into account that the consumption of fruit and that of vegetables are clearly different behaviors, with different influencing factors, and that strategies need to be aimed at making these behaviors habitual.The program will be delivered in monthly sessions by WSU Clallam Extension to parent-child dyads in the following community settings: East (Sequim and Jamestown), Central (Port Angeles and Lower Elwha), and West End (Forks, Neah Bay, and Clallam Bay/Sekiu). Overall Objectives: 1) Modify and adapt (culturally and linguistically) components of Brighter Bites to improve nutrition knowledge, nutrition health literacy, attitudes, competency, and behaviors for rural parent-child dyads; 2) Implement in community settings in seven rural and remote areas of Clallam County; 3) Evaluate the individual (child), interpersonal (parent), and environmental (home) changes that influence the initiation and maintenance of dietary behavior changes in rural Clallam County children; 4) Develop and implement a dissemination and sustainability plan for Clallam County and other rural counties in Washington State.One goal will be to transfer knowledge and skills to community partners to empower their full participation in chronic disease prevention planning and implementation, and engagement in their own activities. Wide dissemination of results will build a shared understanding of awareness, knowledge, attitudes, and skills through local, state, and national networks. We plan to implement teaching initiatives to increase awareness and disseminate innovative solutions to rural and remote communities; and to increase economic return to rural farmers and communities by identifying and directing funding. We envision adding rural and rural agriculture components to current and to be developed undergraduate and graduate courses and to provide community workshops.
Animal Health Component
85%
Research Effort Categories
Basic
0%
Applied
85%
Developmental
15%
Goals / Objectives
The goals of Empowering Rural Communities and Families (ERCF) are to reduce the risk for nutrition-related chronic diseases in limited resource rural communities through increased consumption of fruits and vegetables (F&V); and deploy, evaluate, and sustain culturally- and socio-economically-responsive, evidence-based approaches that provide much-needed experiential nutrition education through WSU Clallam County Extension to limited-resource children and families in the three regions within rural Clallam County, WA. The proposed project provides a window of opportunity for well-established partnerships serving vulnerable populations in Clallam County to collaborate and leverage the individual strengths of each partner into a coordinated effort to improve nutritional health for at-risk children and adults.Our multilevel framework that includes child, parent, and household changes in knowledge, skills, and behaviors recognizes that changes in children are not sustainable if family system and home environment remains unchanged. The following objectives support our long-term goals of preventing and managing chronic disease in low-income non-Hispanic white, Hispanic, and Native American children and their families in rural and remote areas through consumption of fresh F&V:1. Develop ERCF as an adaptation of the evidence-based Brighter Bites program in response to unique resources, cultural beliefs and traditions, family practices, and other sociocultural factors that influence the lives of low-income children and their families in rural and remote areas of Clallam County, WA.2. Implement ERCF with 220 parent-child dyads in seven rural and remote areas through WSU Clallam County Extension3. Complete an evaluation of ERCF outputs and outcomes4. Develop a sustainability plan for ERCFThe situation (challenges and opportunities) in rural and remote areas of Clallam County demonstrates a great need in Clallam County to support rural children and their families' learning in healthy eating due to: need for more experiential learning with both children and their families; diverse low-income population (non-Hispanic white, Hispanic, and Native American; limited access to fresh produce, especially affordable fresh produce; insufficient reach of nutrition education classes; limited engagement on West End and with Native American populations; area-specific challenges; and the desire to reduce the risk for chronic disease. All activities are designed to lead directly to outputs, which lead to outcomes.
Project Methods
The proposed project recognizes complex interactions at multiple levels of the social ecology; children are nested within families which are nested within communities and policies. This project also looks to Cooperative Extension's National Framework for Health &Wellness partners (community organizations, engaged communities, public sector, private sector, and engaged university system), priorities (chronic disease prevention and management, health literacy, and integrated nutrition, health, environment, agricultural systems), social-ecological model (health and safe food choices and healthy and safe food environments), and outcome (increase the number of persons who consume the recommended F&V). The proposed ERCF adapts components of the urban school-based program Brighter Bites to a rural community-based Extension program. Brighter Bites and ERCF look to Social Cognitive Theory (Bandura, 1986) and the Theory of Planned Behavior (Ajzen, 1991) constructs of behavioral capability, self-efficacy, environment, attitudes, beliefs, and social support to provide access to fresh F&V and experiential nutrition education to low-income children and their families.This proposed project, Empowering Rural Communities and Families (ERCF) will address the significant gap in the availability of community-based, culturally- and socioeconomically-responsive experiential education programs for the prevention of nutrition-related chronic disease in rural and remote areas of Clallam County (WA) by modifying an evidence-based program, Brighter Bites and implementing ERCF in rural and remote communities. As part of the ERCF strategy, a community champion from each of seven communities (Jamestown S'Klallam, Sequim, Port Angeles, Lower Elwha Klallam, Forks, Neah Bay Makah Tribe, and Clallam Bay/Sekiu) will join the team and participate in making the program culturally responsive to their particular area and will collaborate to: establish a community advisory board in each area; reach underserved Tribal and non-Tribal populations; deliver an evidence-based program and other resources to adults and children; increase nutrition knowledge, skills, competency, and behaviors; support healthy changes in home and community environments; and assist in the sustainability of the program in the community. The experiential nutrition education will include a produce model akin to Community Supported Agriculture (CSA) approach in the form of Good Food Bags (GFB) utilizing pre-subscribed produce from local farms, hands-on preparing and cooking with local produce (GFB), recipe cards (linked to GFB produce), kids' kitchen, and knowledge sessions for adults and children. Experiential learning is an effective strategy for improving healthy eating in elementary school children. Through a county-wide partnership, this project will engage a culturally-diverse population of rural Washingtonians and increase nutrition knowledge, skills, competency, and behaviors related to chronic disease prevention. The project will benefit from existing, successful WSU-Clallam Extension engagement throughout the county, active involvement of the Sequim Food Bank, linkages with local produce farmers, the work of the PFC and its member food banks, the OPHCC and its almost thirty member organizations, and the Tribal Nations of Clallam County. WSU Clallam County Extension and community partners will provide children and their families with the knowledge and skills to navigate their rural and remote areas and empower them to make healthier food choices. ERCF stresses that diets, especially F&V consumption are important determinants of health; and known to promote health and prevent diseases.Delivery methods: As part of the program, implement a "mosquito fleet" mobile refrigerated trailer as a new resource for intra-county transportation of local produce from farmers to food banks and to community settings. Experiential sessions will be delivery face-to-face by WSU Clallam Extension, separately and jointly for parent-child dyads, and will include monthly distribution of Good Food Bags (fresh produce), nutrition handbooks, cooking sessions, planning, tasting, handouts, recipes, and newsletters. The handbooks would include culturally-responsive food preparation techniques, food storage and safety, healthy meals and snack recipes, menu planning, innovative ways to cook with produce, nutrition label reading, food purchasing, eating out, knowledge about food selections, values about health and nutrition, sense of personal control over choices, supportive home environment, engaging children in learning and cooking.EvaluationAlthough the RFA focuses on outcome evaluation, we believe it is important to integrate both process (implementation) and outcome (improve outcomes) evaluation in a comprehensive framework. This combined approach is particularly beneficial in assuring conclusions made about effectiveness and outcomes are due to the project by ruling out implementation errors (or Type III Error). Our process-evaluation plan assesses six key elements: Fidelity (extent to which the program was implemented as planned); Dose delivered (assurance that program lessons were implemented in the intended order and for the amount of time planned); Dose received (the extent to which the program was well received by the participants); Reach (attendance, participation, and barriers); Recruitment (procedures used to approach and attract participants and maintenance of participant involvement); and Context (aspects of the environment that may influence the program implementation or outcomes). All activities will include process evaluation elements and will focus on answering questions related to program implementation and people served. Fidelity will be evaluated between the planned and actual implementation of the program for each of the sessions, using direct observation checklist (session objectives, elements, tasks, and activities for each lesson) that would be marked as being completed or not completed. Tally sheets will be completed for each lesson by a field coordinator and participating parent-child dyads, which provides different vantage points. Dose delivered will be measured through field notes to document whether each program site received each lesson in the appropriate order; each lesson will be timed. Dose received will measure both exposure and satisfaction; exposure will involve tracking participant engagement across lessons and sessions; and satisfaction pertains to participants' perceptions of program feasibility and acceptability. To evaluate Reach, we will record attendance at each session at each site by a field coordinator. Context will be evaluated in two ways: 1) field coordinator will use field notes to document the presence of any competing or similar programs implemented during the course of the program that could introduce bias to any outcome measure; and 2) children will be asked to report the number of times they were taught at school or home about healthy eating. This is an important measure because of the importance of repeated exposure on changing behaviors. Project data collection forms include observation checklists, structured field notes, satisfaction surveys, attendance and telephone logs, and participant surveys. Outcome Measures: Outcome evaluation assesses a program's ability to produce desired outcomes (Rossi et al., 2004). Outcomes include (both parent and child) nutrition knowledge, skills, and consumption, and improved home food environment. We will use appropriate and validated measures of change in home food environment (availability and accessibility of F&V), family (meals, F&V at mealtime), parent (self-efficacy, role modeling, food purchase, food preparation, F&V consumption), and child (self-efficacy, expectations, skills, choices, and behaviors). Measures will include the National Cancer Institute's Fruit and Vegetable Screener.