Source: UNIV OF CONNECTICUT submitted to
SMART NUTRITION PROGRAM TO PROMOTE NUTRITION SECURITY AND HEALTH THROUGH PERSONALIZED NUTRITION AND DIGITAL NUTRITION LITERACY
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
AFRI COMPETITIVE GRANT
Reporting Frequency
Annual
Accession No.
1030019
Grant No.
2023-68015-39601
Cumulative Award Amt.
$969,890.00
Proposal No.
2022-08690
Multistate No.
(N/A)
Project Start Date
Apr 15, 2023
Project End Date
Apr 14, 2027
Grant Year
2023
Program Code
[A1344]- Diet, Nutrition and the Prevention of Chronic Disease
Project Director
Chun, O.
Recipient Organization
UNIV OF CONNECTICUT
438 WHITNEY RD EXTENSION UNIT 1133
STORRS,CT 06269
Performing Department
(N/A)
Non Technical Summary
The overall goal of this integrated project is to improve diet quality and decrease chronic disease risk factors in low-income adults using a multi-level, equity-oriented intervention, combining personalized nutrition education (PNE) enhanced with digital food and nutrition literacy (DFNL), digital food access, and communication ("Smart Nutrition") and community collaboration to improve access to nutritious, culturally acceptable, and affordable diets. For this goal, we propose a three-arm randomized-controlled intervention with three groups (Personalized-Nutrition, Smart Nutrition, and control) in 150 SNAP-eligible adults who are overweight or obese in Willimantic, CT for 16 weeks and 16-week follow-up. The usefulness of the online food access tools will be improved through interactions with community stakeholders to couple our intervention with policy, systems, and environment approaches to strengthen nutrition security. The intervention will engage and educate undergraduate and graduate students in all phases in this project through experiential learning to improve students' knowledge, skills and competence in health equity and healthy food access of low-income individuals at risk for food insecurity, poor diet quality, and diet-sensitive chronic disease.On the short-term, this proposal directly addresses the generation of new knowledge on the effectiveness of DFNL-enhanced PNE for low-income, culturally diverse individuals in improving diet quality, increasing physical activity, and reducing the risk of obesity and chronic diseases. On the long-term, findings from this multilevel study will provide best practices for a multi-state, and then nationwide intervention to improve nutrition security and health risk via increasing healthy food accessibility, diet quality, health of low-income individuals.
Animal Health Component
50%
Research Effort Categories
Basic
25%
Applied
50%
Developmental
25%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
70460993020100%
Knowledge Area
704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
3020 - Education;
Goals / Objectives
The overall goal of this integrated project is to improve diet quality and decrease chronic disease risk factors in low-income adults using a multi-level, equity-oriented intervention, combining personalized nutrition education (PNE) enhanced with digital food and nutrition literacy (DFNL), digital food access, and communication ("Smart Nutrition") and community collaboration to improve access to nutritious, culturally acceptable, and affordable diets. For this goal, we propose a three-arm randomized-controlled intervention with three groups (Personalized-Nutrition, Smart Nutrition, and control) in 150 SNAP participants and eligible adults (SNAP adults hereafter)who are overweight or obese in Willimantic, CT for 16 weeks and 16-week follow-up.We will also engage and educate undergraduate and graduate students in all phases of this equity-oriented and community-engaged nutrition education intervention study to design, implement, monitor, and evaluate strategies to promote the USDA's framework of nutrition security (i.e., food security, diet quality and equity) to reduce diet-related chronic diseases and health disparities among this vulnerable population. Via multi-disciplinary team and community collaboration, we propose foursynergistic objectives:Objective 1. To conduct a feasibility study of DFNL enhanced education with post focus groups to improve acceptability and assess limited efficacy testing. We will first assess the DFNL status and barriers and facilitators of online grocery ordering in SNAP adultsin Willimantic, CT. Based on this information, we will develop a tailored DFNLcurriculum.To test the feasibility of implementing the DFNL education to SNAP adults in our target intervention area, we will conduct an 8-week, single-arm DFNL intervention pilot study. Objective 2.To implement and evaluate the effectiveness of Smart Nutrition, a PNE enhanced with DFNL, digital food access and communication on increasing healthy food access and reducing chronic disease risk.We purpose a three-arm randomized-controlled intervention with three groups: PNE (Personalized-Nutrition), DFNL-enhanced PNE (Smart Nutrition), and control.Objective 3. To work with community stakeholders to couple our intervention with policy, systems, and environment (PSE) approaches to strengthen nutrition security. This includes mapping community food resources relative to public transportation; identifying gaps in access and transportation for community action, including access to culturally diverse foods; making the map available online and accessible through Smartphones; assessing best use practices by the target audience; promoting best use practices of the map through multiple social media and marketing channels; and community-level evaluation of the map including perceived usefulness, opportunities, and plans for change.Objective 4. To implement and evaluate an educational program designed to improve knowledge, skills, and competence of undergraduate and graduate students in supporting nutrition security and health of culturally diverse, low-income individuals who experience food insecurity and diet-related chronic diseases via development and implementation of a learning plan followed by self-assessment and evaluation.
Project Methods
Objective 1:DevelopDFNL curriculum and conduct a feasibility study of DFNL enhanced education with post focus groups to improve acceptability and assess limited efficacy testing1) Assessment of DFNL status and barriers and facillitators in online grocery ordering: Through Qualtrics survey, we will assess the DFNLstatus and barriers and facilitators of online grocery ordering in SNAP adults in Willimantic, CT. Based on this information, we will develop a tailored DFNL curriculum and evaluation tools.2) Development of DFNL curriculum:The curriculum consists of 5 literacy levels from functional literacy to advanced DFNL knowledge and skills using a Chromebook provided by the agency. Each 50-minute session will be offered 3-4 times which covers from basic digital skills to advanced interactive, communication and critical skills on how to select foods by comparing price and nutrient profile, communicate with food retailers online and use of the food access map and public transportation as it is developed.3) Implementation of the DFNL Education and Evaluation: The DFNL curriculum will be taught twice weekly for 8 weeks (16 sessions) in an adult digital education room in Access Agency in Willimantic. Recent graduates of Access adult digital technology education program and UConn undergraduates will provide 1:1 assistance.Participants will be interviewed at the beginning and completion of the DFNL curriculum, including DFNL assessment, diet assessment, and anthropometric measures. At programcompletion, 30 SNAP adults with overweight/obesity will be recruited for 3 focus groups: SNAP adults with (n=10) or without (n=10) previous online grocery ordering experience and those with Spanish as a first language (n=10) to assess acceptability by basic DFNL skills, cultural and/or language barriers.4)Feasibility Test: Feasibility of implementing the DFNL education will be assessed by: i) recruitment - number of screened per months, number of enrolled per month; average time to enroll enough participants to form classes; ii) retention - class-specific retention rates (completion%), reasons for dropouts; iii) adherence - attendance, homework; iv) acceptability - class-specific preference ratings (pre- and postintervention). Feasibility will be compared by participants' sociodemographic characteristics. Qualitative interviews with focus groups will identify potential barriers unique to each group.Objective 2: Implement and evaluate the effectiveness of Smart Nutrition, a PNE enhanced with DFNL, digital food access and communication on increasing healthy food access and reducing chronic disease risk.To assess the effectiveness of the proposed DFNL-enhanced, culturally tailored PNE intervention, we propose a 3-arm parallel intervention study for 16 weeks. The PNE, DFNL-enhanced PNE (Smart Nutrition), and control groups will be evaluated by comparing changes in primary diet and health outcomes including diet quality (sHEIand liking-based diet quality scores) and BMI. We will also measure secondary outcomes that include DFNL knowledge, motivation, and behavioral skills (IMB constructs), food security, skin carotenoid status (proxy of fruit and vegetable consumption) using the Veggie Meter®, reportedSSB intakes, self-reported weekly physical activity levels, WHR, and BP. These outcomes will be measured pre- and post-16-week intervention and after 16 weeks follow-up to assess the effectiveness of the intervention and the adherence to healthier behaviors.Objective 3: Work with community stakeholders to couple our intervention with PSE approaches to strengthen nutrition securityThis includes mapping community food resources relative to public transportation; identifying gaps in access and transportation for community action, including access to culturally diverse foods; making the map available online and accessible through smartphones; assessing best use practices by the target audience; promoting best use practices of the map through multiple social media and marketing channels; and community-level evaluation of the map including perceived usefulness, opportunities, and plans for change.We propose a phased approach to evaluate access to food via public transportation, distribute a consumer-facing food resource map, and present findings to community leaders and decision-makers. Geographic information system (GIS) technology is a means to identify geographic gaps in access to public health services, including the availability and accessibility of healthy food outlets. Such maps may assist in communicating public health needs to decision makers and community leaders. Consumer-facing maps have been used to connect high-need residents to community resources.Objective 4:Implement and evaluate an educational program designed to improve knowledge, skills, and competence of undergraduate and graduate students in supporting nutrition security and health of culturally diverse, low-income individuals who experience food insecurity and diet-related chronic diseases via development/implementation of a learning plan followed by self-assessment and evaluationThe Departments of Nutritional Sciences and Allied Health Sciences will commence experiential learning from the one-semester Community Nutrition course (NUSC/DIET 3230; Dr. Puglisi). This class covers food insecurity, health disparities, and theory-based nutrition education approaches that are culturally sensitive and appropriate for age, literacy level and health status. Students will be mentored into a series of courses based on their self-assessment and career goals--NUSC 3180 Experience in Community Nutrition, undergraduate/graduate competencies-based DIET 3235 Community Nutrition Practicum I, Diet 4435 Community Nutrition Practicum II (Dugdale, Zigmont), and independent studies. Students use self-assessments to track specific skills and competency in community health nutrition through the courses, from beginner to entry-level competent: (1) Integration of scientific information and research into practice; (2) Beliefs, values, attitudes and behaviors for professional level of practice; (3) Development and delivery of information, products and services to individuals, groups and populations; (4) Strategic application of principles of management/systems in provision of services to individuals and organizations.We will refine a course to improve students': 1) awareness of factors that influence access to healthy foods; 2) ability to examine policy, systems, and environmental approaches to address equitable food access; 3) interest and readiness to support the health of low-income, food insecure families; 4) awareness of obesity and diet-sensitive chronic disease crisis in at-risk communities; 5) knowledge, skills, and competence on developing and implementing interventions to prevent obesity and diet-sensitive chronic diseases in low-income, food insecure families; and 6) ability to tailor nutrition education to underserved populations via leveraging evidence-based, user friendly technology and social media.Graduate and undergraduate students who are trained in nutrition and health education will play a key role as interventionists, following ethical principles of research, data management, and qualitative and quantitative analysis. Students will be trained intensively, including via role play and observation. Students will have the opportunity to help with the intervention and delivery, recruitment and promotion of programs on social media and direct education. Faculty mentors will work with students throughout this process to provide guidance and feedback to ensure integration of academic concepts.

Progress 04/15/23 to 04/14/24

Outputs
Target Audience:SNAP eligible adults from a low-income, low-food access CT county; The potential target audience of the study will also include researchers in community nutrition and public health science areas, federal and state public health policy makers, community nutrition educators, and low-income households, and anyone interested in increasing nutrition security of low-income populations through enhancing digital food and nutrition literacy and increasing healthy food access. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? All staff and students named on the project completed CITI Program training to increase understanding of and compliance with human subject research guidelines. Daniela C. Avelino, M.S, leading PhD student: All the work that she and her team have done not only for developing the survey tool itself, but also the training she's done for all individuals on the research project team regarding administering the survey has provided lots of professional development for Daniela. Research papers related to nutrition education, lesson plans, behavior change, policy, systems and environment work and emergency food assistance were provided to support experiential aspects of students' work. Students had the opportunity to assist in qualitative data collection and analysis, through taking part as notetakers in interviews,transcribing recorded interviews and developing the thematic codebook. Donna Zigmont (Project Coordinator): Supporting faculty for NUSC 3180 has provided professional development for her regarding development of the NUSC 3180 course syllabus, self-assessment surveys, and tracking document as well as promoting communication and collaboration across UConn departments. Students received mentoring and training for their experiential learning activities. Students have had the opportunity to develop nutrition education materials, assist in developing lesson plans, providing nutrition education to individuals and groups and assisted in evaluation of nutrition education lessons. Instructors worked with students to strengthen scientific writing and critical evaluation of research for a final paper, focused on research related to the work completed in the field. How have the results been disseminated to communities of interest?We have had meetings in which our preliminary findings and next project plans were shared with our long-standing strategic partners and stakeholders who value promoting health equity and increasing access to affordable healthy foods: Vivica Kraak and Sarah Misyak at Virginia Tech Kathleen Krider at the CT Access Agency Sydney Clements at Windham Food Network: food resource map Sally Milius at Grow Windham Sarah Ullom-Minnich, Governor's Fellow, CT Commission for Educational Technology and Lauren Thompson, Digital Equity Program Manager, CT Commission for Educational Technology, Department of Administrative Services: Digital Equity in CT Ashley Burkell, CT Foodshare Network Relations Representative Xiang Chen, : ArcGIS Food Map Meeting Christian Duborg, Food & Nutrition Policy Analyst at the CT Commission on Women, Children, Seniors, Equity, and Opportunity: discussion on Northeastern CT food security studies What do you plan to do during the next reporting period to accomplish the goals?(Aim 1) We are currently conducting the online DFNL survey with demographic, food insecurity, self-reported health, and measures of diet quality with 300 low-income adults (150 English speaking, 150 Spanish speaking). In this online survey, we will assess if the conceptual DFNL framework is supported by construct validity testing, if there is variability in testing, and if DFNL level explains variability in self-reported health and diet quality. In addition, based on the information collected during Year 1, we will develop a tailored DFNL curriculum. Then, to test the feasibility of implementing the DFNL education to SNAP adults in our target intervention area, we will conduct an 8-week, single-arm DFNL intervention pilot study. (Aim 3) We plan to make the map online and accessible through smartphones, assessing best use practices, promoting best use practices through multiple social media and marketing channels; and conduct community-level evaluation of the map including perceived usefulness, opportunities, and plans for change. We also plan to expand this community food access map by adding physical activity resources. (Aim 4) We will continue to engage and educate undergraduate and graduate students in all phases in this project through experiential learning to improve students' knowledge, skills and competence in health equity and healthy food access of low-income individuals at risk for food insecurity, poor diet quality, and diet-sensitive chronic disease.

Impacts
What was accomplished under these goals? During the first year of the project, we made significant progress via multi-disciplinary team and community collaboration on Objectives 1, 3 and 4 to tailor digital food and nutrition literacy (DFNL) education and PSE changes to improve nutrition security in low-income adults, while engaging students in experiential learning: Objective 1 To conduct a feasibility study of digital food and nutrition literacy (DFNL)-enhanced education with post focus groups to improve acceptability and assess limited efficacy testing In Year 1, we assessed the perceived food environment and diet quality of low-income adults living in our target areas(Willimantic/North Windham, CT) using a quantitative online survey (276 adults) and qualitative structured interviews. From an online survey, highest diet quality was associated with healthier perceived home food environments and multiple food assistance program participation. Ordering groceries online interacted with perceived food environments--poorest diet quality was reported by adults who reported not ordering groceries online and perceiving less healthy store and home food environments. Structured interviews with SNAP participants and stakeholders have provided deeper exploration of these quantitative findings. In work to developa tailored DFNL curriculum to improve diet quality of our target population, we have developed and pilot tested an online DFNS survey that aligns with behavior change theories. We are testing the DFNL in English and Spanish for construct validity (does the survey measure conceptual levels of digital and nutrition literacy), criterion validity (does the level of digital and nutrition literacy associate with diet quality and health), and does the survey identify behaviors the participant is willing to work on to improve digital and nutrition literacy. Objective 3 (To work with community stakeholders to couple our intervention with PSE approaches to strengthen nutrition security) We have developed an online community food access map in collaboration with geographers at UConn and community stakeholders. We developed an interactive GIS map of community food resources relative to public transportation, including emergency food resources, identifying gaps in access and transportation, including access to culturally diverse foods, The project reveals that transportation is the primary barrier to healthy food access that meets cultural food patterns for low-income adults. Food prices and perception of food pantry availability also play a crucial role in food procurement behaviors and healthy diets. Objective 4. (To implement and evaluate an educational program designed to improve knowledge, skills, and competence of undergraduate and graduate students in supporting nutrition security and health of culturally diverse, low-income individuals) We developed and offered experiential learning courses (NUSC 3180; 5314. Professional Development Project; 5317. Professional Development Practicum; 5335. Community Nutrition Education and Behavioral Intervention Delivery for At-Risk Groups) that includes self-assessment of community nutrition knowledge, skills, and competence for individualized student learning and tracking progress in project-associated experiences aligned with USDA's framework of nutrition security. An online self-assessment student evaluation has been developed to evaluate the changes in students' knowledge, skills, and attitudes via a baseline and post-survey that reflects upon experiential learning programs offered through participating in community nutrition projects. Progress toward achieving entry level competence in public health/community nutrition was assessed using a modified Core Competencies for Public Health Professionals (https://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Health_Professionals_2021October.pdf) and was assessed via a self-monitoring tracking document. NUSC 3180 (5 students enrolled in Fall 2023 & 8 students enrolled in Spring 2024): Summary of student evaluations for Fall 2023: Using the 5-point Likert scale, students reported the following: 100% of students strongly agreed/agreed that they understand disparity issues related to food access and health risk of low-income communities. 75% of students increased their sensitivity to the psychological, cultural, and social factors that affect low-income families' nutrition and health status. 100% of students strongly agreed/agreed that they have a good understanding of their role as a community member and are confident in situations where they must interact with community partners in our target communities. 100% of students said they improved their ability to assess the needs of the target audience based on various factors such as their education/literacy level, income level, language barriers, health status/risk, willingness to change healthy behaviors, and access to healthy foods. 50% of students reported that they improved their confidence in developing nutrition education materials that are culturally sensitive and tailored for low-income audiences. Competencies to continue to develop upon further implementation of the research project include: recruitment and screening of research participants; data collection, reporting, and analysis; coaching low-income, culturally-diverse individuals on nutrition, physical activity, and health risk reduction; and development of nutrition education materials.

Publications

  • Type: Journal Articles Status: Published Year Published: 2023 Citation: Daniela C. Avelino, Valerie B. Duffy*, Michael Puglisi, Snehaa Ray, Brenda Lituma-Solis, Briana M. Nosal, Matthew Madore, and Ock K. Chun*. Can ordering groceries online support diet quality in adults who live in low-food access and low-income environments? Nutrients 2023, 15(4), 862; https://doi.org/10.3390/nu15040862.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2023 Citation: Manije Darooghegi Mofrad, Briana M. Nosal, Daniela C. Avelino, Kate Killion, Michael Puglisi, Valerie B. Duffy and Ock K. Chun. Food resource management and healthy eating focus associate with diet quality and less impact of COVID-19 on body weight in adults from a low-income, Northeastern CT community. 2023 ASN Nutrition Conference, Nutritional Epidemiology Session. July 22-25, 2023. Boston, MA.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2023 Citation: Lisbeth M. Lucas-Mor�n, Manije Darooghegi Mofrad, Briana M. Nosal, Ock K. Chun. The dietary quality, nutritional and health status, food resource management skills, and changes in food behavior during the pandemic of low-income Hispanic and non-Hispanic populations in the Willimantic and North Windham areas in Connecticut. CAPS Research Conference. July 26, 2023.
  • Type: Conference Papers and Presentations Status: Submitted Year Published: 2024 Citation: Daniela C. Avelino, Brenda Lituma-Solis, Nikki Santillo, Maya Wolanin, Michael J. Puglisi, Ock K. Chun, and Valerie B. Duffy. Protocol to develop and validate an Online Digital Food and Nutrition Literacy Survey for tailoring interventions to improve diet quality in low-income adults. Submitted to 2024 ASN Nutrition Conference, June 29-July 2, 2024. Chicago, IL.
  • Type: Conference Papers and Presentations Status: Submitted Year Published: 2024 Citation: Ock K. Chun*, Xiang Chen2*, Zachary M. Hoffman, Xiran Chen, Weixuan Lyu, Sydney Clements, Michael J. Puglisi, Valerie B. Duffy*. Integrating GIS with Stakeholder Voices for Improving Food Access for a Low-Income Community in Northeastern CT. Submitted to 2024 Society for Nutrition Education and Behavior (SNEB) Annual Meeting, July 29-August 1, 2024, Knoxville, TN.
  • Type: Conference Papers and Presentations Status: Submitted Year Published: 2024 Citation: Valerie B. Duffy*, Daniela C. Avelino, Brenda Lituma-Solis, Xiran Chen, Manije D. Mofrad, Dea Ziso, Briana M. Nosal, Donna Zigmont, Michael J. Puglisi*, Ock K. Chun*. Multi-level intervention combining digital food and nutrition literacy education with PSE changes to improve nutrition security. Submitted to 2024 USDA AFRI Diet, Nutrition, and Prevention of Chronic Diseases Program Project Directors meeting during the Society for Nutrition Education and Behavior (SNEB) Annual Meeting, July 29-August 1, 2024, Knoxville, TN.
  • Type: Journal Articles Status: Submitted Year Published: 2024 Citation: Manije Darooghegi Mofrad, Briana M. Nosal, Daniela C. Avelino, Kate Killion, Michael Puglisi, Valerie B. Duffy and Ock K. Chun. Food resource management skills and healthy eating focus are associated with diet quality and reduction of unhealthy behaviors during the COVID-19 pandemic in adults from a low-income northeastern CT community: A cross-sectional study. Submitted to Journal of the Academy of Nutrition and Dietetics (Submitted on Dec 12, 2023; JANDJRL-D-23-00854)
  • Type: Conference Papers and Presentations Status: Published Year Published: 2023 Citation: Lauren Pinto, Daniela Carolina Avelino, Kate Killion, Michael Puglisi, Ock K. Chun, Valerie Duffy. Developing an online tool to assess functional and interactive digital nutrition literacy for tailored intervention reaching low-income adults. 2023 annual UConn Center for mHealth and Social Media (CHASM) Conference: Health is Social: Leveraging the Metaverse to Improve Public Health. May 18, 2023.
  • Type: Conference Papers and Presentations Status: Submitted Year Published: 2024 Citation: Daniela C. Avelino, Nikki Santillo, Maya Wolanin, Brenda Lituma-Solis, Ock K. Chun, Michael Puglisi, Valerie B. Duffy. Protocol to develop and validate an Online Digital Food and Nutrition Literacy Survey for tailoring interventions to improve diet quality in low-income adults. UConn One Health Conference, April 1, 2024.
  • Type: Conference Papers and Presentations Status: Submitted Year Published: 2024 Citation: Daniela C. Avelino, Nikki Santillo, Maya Wolanin, Brenda Lituma-Solis, Ock K. Chun, Michael Puglisi, Valerie B. Duffy. Measuring Digital Food and Nutrition Literacy to Improve Diet Quality in Low-Income Adults. UConn CAHNR Graduate Student Research Forum, April 20, 2024.