Progress in educating those with low literacy levels about CVD risk factors related to nutrition has been hampered by the lack of appropriate materials and programs. It is questionable whether the traditional methods of education used with literate, middle-income populations are generalizable to low literate, lower-income populations. While past work has demonstrated significant associations between dietary practices and risk for CVD--in the form of hypercholesterolemia, obesity, and hypertension--as well as alterations in risk when dietary practices are changed, effective educational methods for low literate populations who are at high risk for CVD are still in their infancy. The proposal outlines a randomized, controlled trial using a cluster design with two conditions, special intervention (SI) and usual care (UC). The clusters will be comprised of small groups of multi-ethnic, low-income individuals who are predominantly women aged 20-35 with low-literacy levels. The source of these groups will be from the Expanded Food and Nutrition Education Program (EFNEP), a program of the USDA and Cooperative Extension Services of the University of California. EFNEP provides basic, non-CVD specific nutrition information to approximately 1000 low-income families in Santa Clara County, CA annually in conjunction with job training programs and specialty schools for low-literate individuals. Twenty-four groups will be matched in pairs for group size and type of setting and one of each pair will be allocated randomly to receive the UC or SI. The UC group will receive a currently utilized eight one-hour classroom curriculum covering nutrition information on the basic food groups, meal planning and food purchasing, delivered primarily through lecture and print materials. The Sl will involve designing an innovative CVD nutrition program, composed of distinct education modules, that uses face-to-face, participatory education and mediated materials for low-literate adults. Participants will learn to modify their own family menus, select and prepare low cost foods obtained from the USDA or food stamps, and will receive specially adapted and newly developed materials that rely little on written communication that are sensitive to cultural dietary beliefs. Summative evaluation will involve testing whether the SI groups have a greater change in CVD nutrition knowledge and behavior (as measured by self-report) 24 hour diet recalls, and serum cholesterol) from baseline to an 8 week post-test, and through a 5 month maintenance period. The generalization phase of the research will test a revised version of the program in a non-classroom setting with Head Start families, and will intervene at the community level to modify the food selection and preparation practices of organizations (such as soup kitchens, food banks, and homeless shelters) that provide food to low-income/low-literate groups. As the concluding aspect of the study, we will explore the feasibility of disseminating the nutrition program and education modules to local and national groups serving low-literate populations.
| Howard-Pitney, B; Winkleby, M A; Albright, C L et al. (1997) The Stanford Nutrition Action Program: a dietary fat intervention for low-literacy adults. Am J Public Health 87:1971-6 |
| Winkleby, M A; Howard-Pitney, B; Albright, C A et al. (1997) Predicting achievement of a low-fat diet: a nutrition intervention for adults with low literacy skills. Prev Med 26:874-82 |
