Recipient Organization
UNIVERSITY OF GUAM UOG STATION
(N/A)
MANGILAO,GU 96913
Performing Department
Experiment Station
Non Technical Summary
Fruit and vegetable intake remain below recommendations for children and adults in the US, and limited research in Guam indicates a similar trend, despite the long-standing community nutrition education programs, like SNAP-Ed. Community Supported Agriculture (CSA) is a feasible component for programs to provide fresh fruits and vegetables to under-resourced communities. Similar food retail outlets, like direct farm-to-consumer approaches, have increased fruit and vegetable intake and other preventative health behavior changes enhanced with infrastructure investments and consumer engagement. Lack of awareness and lack of interest were identified barriers in similar groups. However, barriers and facilitators to CSAs have not been documented. Therefore, this project aims to identify the perceived barriers and facilitators to community supported agriculture (CSA) participation and evaluate the effect and feasibility of CSA participation on fruit and vegetable (FV) intake among (SNAP-eligible or limited-resource) adults in Guam.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Goals / Objectives
The overall goal of this project is to determine the most feasible CSA approach to improve FV intake in Guam. The objectives of this project are to: 1) Identify the perceived barriers and facilitators to participating in a CSA program, 2) Examine change in fruit and vegetable intake after CSA participation with and without nutrition education, 3) Determine the feasibility of a SNAP-Ed CSA program.
Project Methods
Before participant recruitment and data collection begins, researchers will obtain the University of Guam Institutional Review Board approval.Recruitment will be in collaboration with the SNAP-Ed program to reach adults in Guam and among the SNAP-Ed target audience with a goal of 135 adult participants. Social media and distribution of flyers will be used to recruit potential participants. In this pre-post quasi-experimental design, participants will be assigned to one of three groups based on the channel they were recruited. Group A (n=45) will receive (SNAP-Ed) nutrition education only and will be recruited through SNAP-Ed outlets, Group B (n=45) will receive CSA shares only and will be recruited through research project outlets, and Group C (n=45) will received both, (SNAP-Ed) nutrition education and CSA shares and will be recruited through SNAP-Ed and/or research project outlets (refer to Table 1). Inclusion criteria includes 18 years or older, Guam resident, SNAP-Ed eligible (no less than 55% of total recruitment), able to read, write, and speak English, and no food allergies to or diet restrictions of local fruits and vegetables (in Guam).Objective 1: Identify the perceived barriers and facilitators to participating in a CSA programFor this objective, we propose to administer an (online) survey of food-buying habits, meal planning strategies, and local produce perceptions. Additional data for this objective will be collected from the Supplemental Nutrition Assistance Program - Education (SNAP-Ed) direct adult education (online) survey administered before and after nutrition education (described later). This series of questions assesses eating habits and food choices, which will assist with identifying potential barriers and facilitators of food purchasing habits. The information collected from this study will be consolidated and disseminated to farmer's markets, farm-to-consumer stakeholders, Extension & Outreach, and published.Objective 2: Examine change in fruit and vegetable intake after CSA participation with and without nutrition educationIn this pre-post quasi-experimental design, we propose to compare fruit and vegetable intake before and after each intervention arm's research activity(ies). Participants will receive (SNAP-Ed) nutrition education and/or CSA shares respective to the research group they are assigned and outlined in Table 2. The primary hypothesis is that Group C will have a higher fruit and vegetable intake after receiving CSA shares and nutrition education than Groups A and C. A secondary hypothesis is that Group B will have a higher fruit and vegetable intake than Group A.For CSA participation, participants assigned to Groups B and C (n=90) will obtain bi-weekly (during Weeks 1 and 3) CSA shares with scheduled curbside pick-up or scheduled contact-less drop-off with research staff and determined upon consent. Participants will sign out each share received. For nutrition education, participants will be scheduled for one nutrition lesson per week to complete the curriculum (total of four lessons) that will be conducted using an online platform (e.g., Facebook Live, Zoom) and/or in-person (complying with safety protocols) at a designated scheduled time. Nutrition education attendance will be recorded for each class session.Table 1 - Pre-post quasi-experimental study design with research activities and timeline for each intervention arm (i.e. Groups A-C).Week 1Week 2Week 3Week 4Group An=45Pre-assessmentPost-assessment24-hr Recall24-hr RecallNutrition ClassNutrition ClassNutrition ClassNutrition ClassGroup Bn=45Pre-assessmentPost-assessment24-hr Recall24-hr RecallReceives CSA shareReceives CSA shareGroup Cn=45Pre-assessmentPost-assessment24-hr Recall24-hr RecallNutrition ClassNutrition ClassNutrition ClassNutrition ClassReceives CSA shareReceives CSA shareObjective 3: Determine the feasibility of a SNAP-Ed CSA programFor this objective, questions will be added to the SNAP-Ed post-test. Questions will be developed to assess the likelihood of continuing a CSA program for those who received a share, ability to utilize a weekly delivery of produce in their household, current eating habits, familiarity with Guam's fruits and vegetables, and efforts in prioritizing farmer's markets.Data CollectionAll participants will be asked to provide consent to participate in research activities and will have the option of discontinuing any or all of the research activities at any time. After consent, participants will provide demographic and household information (i.e., age, sex, race/ethnicity, village residence, income, household size, food responsibilities, and mode(s) of transportation). Personal information collected will be managed and stored separately from other study forms (i.e. CSA Perception Survey, Nutrition Education Pre-Post Tests, and 24-hour Recalls). Each participant will be assigned a unique ID number that will be entered each form described here. All study data will be secured in a locked box, filing cabinet, and/or password protected computer in a locked office at the University of Guam accessible to researchers and research staff.CSA Perception Survey All participants will be asked to complete the CSA Perception Survey. The CSA Perception Survey will be developed to be completed as an online (encrypted) form or hard copy and include questions from validated surveys capturing self-reported information in similar studies. The survey will include a combination of multiple-choice and short open text questions that will take 20-minutes or less to complete. For hard copy surveys, research staff will coordinate contact-less pick-up and/or drop-off a time most convenient for participants - likely, during the same time CSA shares are obtained.Nutrition Education Pre-Post TestsAs a regular activity of the (SNAP-Ed) nutrition education program, a food and physical activity behavior checklist is provided to participants before and after each session (at lesson one and lesson four). This checklist is only available in English and is a self-report of eating habits, food choices, and other lifestyle factors. Responses are on a 5-point Likert scale from "never" to "almost always" for each behavior assessed. All participants will complete each assessment upon consent - including Group B, which does not include nutrition education - to include in study analysis for all intervention's arms.The Post-Test will include feasibility survey questions on CSA participation as part of existing nutrition education programs following the study. Information from these questions will be used to inform future programs in Guam.24-hr Recalls (24HR)After providing consent each participant will self-report their 1-day intake through an interview-administered 24-hour recall diet assessment conducted over the phone with research staff or digital 24-hour recall form exchanged over encrypted email with a follow-up call by research staff to ensure completeness. All data collected will be de-identified using unique IDs for each participant and recorded on all forms. Digital visuals to assist the 24HR data collection will be sent to participants by email or web-based texting system. Each participant will complete two (2) 24HR before and after the intervention.