This is a proposal to develop and evaluate a nutrition education program to reduce cardiovascular disease risk in persons with low literacy skills. The setting for this study is the Minnesota Extension Service's Expanded Food and Nutrition Education Program (EFNEP), which is a U.S. Department of Agriculture-funded program to improve the nutrition knowledge and behavior of low-income individuals who are responsible for food preparation. The emphasis of EFNEP is on obtaining adequate and nutritious foods, and not on dietary behaviors for the prevention of chronic disease. Because a large proportion of this population has no more than an 8th grade education (30.9% nationally), EFNEP provides access to individuals with low literacy skills and a need for nutrition education for disease prevention. For example, a pilot study indicated that 34 of 42 respondents had never had their blood cholesterol level checked. This study proposes to develop education strategies using focus groups of both EFNEP program participants and the EFNEP paraprofessionals who deliver the program. The intent of the focus groups will be to identify concerns, interests, barriers, and perceived needs for nutrition education for cardiovascular disease prevention. This information will be used to develop effective education strategies that address the needs of the study participants, while accomplishing the study goal of effecting dietary change (specifically, decrease in dietary fat and cholesterol intake) for cardiovascular disease risk reduction. The effectiveness of this nutrition education program will be evaluated in a randomized trial, with pre- and post-intervention measures of dietary fat intake and plasma total and HDL cholesterol as outcome measures. This study will be conducted in Hennepin, Ramsey and Dakota Counties, which have a total adult EFNEP enrollment of about 1,842 people. Because EFNEP enrollment is predominantly female (94%), this study will be limited to adult women, age 18 or older. We propose to randomize all 22 EFNEP paraprofessionals in these counties to intervention and control groups, and estimate that approximately 330 women will be enrolled and complete the study. Randomization will be at the level of paraprofessional to simplify program delivery and to minimize contamination between intervention and control groups. Based on power calculations that account for the fact that paraprofessionals and not individuals are randomized, we estimate that the we have about 90% power to detect a 10% decrease in total fat intake as measured by 24-hour recall, and about 88% power to detect a decrease of 6 mg/dl in plasma total cholesterol in this population. The differential change in fat intake and plasma cholesterol level between the intervention and control groups will be estimated using analysis of covariance, adjusting for within paraprofessional correlation and other potential confounders.
| Hartman, T J; McCarthy, P R; Park, R J et al. (1997) Results of a community-based low-literacy nutrition education program. J Community Health 22:325-41 |
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| Hartman, T J; McCarthy, P R; Park, R J et al. (1994) Focus group responses of potential participants in a nutrition education program for individuals with limited literacy skills. J Am Diet Assoc 94:744-8 |
