an evaluation of the fruit, vegetable and physical activity toolbox for community educators...
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An Evaluation of the Fruit, Vegetable and
Physical Activity Toolbox for Community Educators
Presented by
Field Research Corporation
February 6, 2008
2
Background/Objectives
• This is a presentation of findings from the evaluation of The Fruit, Vegetable and Physical Activity Toolbox for Community Educators (Toolbox), a multi-component resource designed to assist community based organizations and direct health centers providing health education.
• The African American Campaign Division of The Network for a Healthy California recently tailored the Toolbox to focus on the health promotion needs of low-income, African American women.
• The Network contracted with Field Research Corporation (Field) to assist in an evaluation of the Toolbox. To evaluate the effectiveness of the Toolbox, Network staff selected six, one-hour lessons representative of the overall Toolbox: three nutrition lessons, two physical activity lessons, and one community empowerment lesson.
3
Background/Objectives (continued)
• The study was designed to test the effectiveness of the revised Toolbox when used with this target audience. Specifically, we were looking to see if women exposed to the Toolbox sessions over a six-week period changed their fruit and vegetable consumption, physical activity practice or the psychosocial determinants of the behaviors.
• Additionally, this study aimed to gather information about Toolbox recruitment and implementation procedures that may impact future strategies for implementing it statewide in California.
4
Methodology
Study Design
• A quasi-experimental design was used for the evaluation; before and after surveys were completed by a sample of women (treatment group) who attended the six one-hour sessions, and a sample of women (control group) who did not receive the intervention.
• Data were collected using a longitudinal design; the same women completed the pre- and post-surveys, over a six-week period in October and November 2007. The pre-survey was administered immediately before the first class. The post-survey was administered directly following the final class.
• The study was conducted in four cities in California: Sacramento, Oakland, Los Angeles, and Fresno.
• All participants were given $100 grocery cards at the completion of the post-survey in appreciation for their time. Treatment women also received a $50 American Express Gift card after the third class.
5
Methodology
Recruitment
• The target audience for this study was low income, African American women. At least 75% of the women recruited for participation were at or below 185% of the Federal Poverty Level.
• Participants were randomly recruited to either the control or treatment group and were not informed that the other was an option.
• A variety of recruitment methods were utilized including: telephone contact of lists of potentially eligible participants, flier distribution, announcements in programs expected to have a high concentration of eligible candidates, and highly targeted, in-person intercepts at appropriate locations.
• In total, there were 171 post-surveys completed for the control group, and 156 for the treatment group.
• The retention rate for women in the treatment section was 84% and 86% for the control group.
6
Methodology
Study Participants
• Women qualified to participate if they were African American, and between the ages of 18 and 54. Women with diabetes, on strict medically prescribed diets, or enrolled in formal weight management programs were ineligible because of potential inability to change fruit and vegetable consumption levels.
• The same eligibility criteria for the treatment group applied to the control group. Demographic characteristics of women across the two samples were compared; there were no significant differences between the two. This strengthens the validity of study findings.
7
Methodology
Analysis
• Our primary analysis was examining change over time in our main outcome measures within the treatment and control groups. Significance tests were conducted to test for statically significant differences between the pre- and post-survey results.
• All significance tests were were assessed at the 95% confidence level, a P-value less than or equal to 0.05 is considered statistically significant by this standard. P-values have been provided throughout the report text.
• The main outcome measures were those assessing knowledge, beliefs, and behaviors related to nutrition, physical activity, and community advocacy.
• This presentation focuses on the primary outcome measures. There were no trends observed in the data that the intervention had different effects across sub-groups.
8
Methodology
Limitations
• Some sensitization among control group participants may have taken place. It is likely that completing the pre-survey and being enrolled in a nutrition and physical activity study caused women to think about their diet and physical activity level. This may result in a change in the control group’s responses over time, even though they did not receive the targeted intervention.
• The intervention for this study required women to participate in an hour-long intervention for six consecutive weeks. Therefore it is plausible that, despite efforts to randomize group assignments, women who completed the intervention were more motivated to participate, interested in the study topics, and/or likely to make the targeted behavior changes than women in the control group.
9
Major Study Findings
• There is strong evidence of effects that the Toolbox session were effective. Across the majority of measures, in all study topics, there were significant changes over time observed among treatment women and no corresponding change among control women.
10
Major Study Findings
Knowledge
• There was evidence of the intervention’s effectiveness on increasing participants’ nutrition and physical activity-related knowledge. On the majority of knowledge-related measures, there was a significant increase over time in the percent of treatment women that correctly answered the question.
• On the community advocacy knowledge measure, there was no evidence of effects. Only 43% of women were able to correctly identify six steps for community advocacy on the post-test, and there was no significant difference over time in the percent of women who were able to do so.
11
Major Study Findings
Beliefs
• Data indicate that the Toolbox sessions were effective in increasing participants’ beliefs about the importance of healthy eating and physical activity. There were significant increases in the percent of women that strongly agreed with provided statements on all four measures on this topic.
• After attending the Toolbox sessions, women reported stronger self-efficacy beliefs on all measures related to nutrition and community advocacy. Significant increases over time were observed among the treatment women but not among control women. Results from physical activity-related self-efficacy measures were mixed; there was evidence of effects on three of the five measures in this section.
12
Major Study Findings
Behaviors
• There is strong evidence that the intervention was effective in changing participants targeted health behaviors. There were significant increases in the percent of treatment women eating the recommended number of cups of fruit and vegetables, and getting the recommended amount of physical activity between the pre- and post-surveys. No significant changes were observed over time among the control women.
13
Nutrition Knowledge
Recommended amount of fruits and vegetables adults should eat each day for good health
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
2.5-5.5 cups 41.0% 48.7% 42.1% 42.1%
3.5-6.5 cups 22.4 41.0 24.6 33.9
4.5-7.5 cups 13.5 9.6 14.0 14.0
Don’t know/No Answer 23.1 0.6 19.3 9.9
Total 100% 99.9% 100% 99.9% Treatment Sample P-value=0.0001 Control Sample P-value=0.0353
14
Nutrition Knowledge
The number of cups equivalent to a handful of fruits and vegetables
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
¼ Cup 20.5% 8.3% 17.0% 15.2%
½ Cup 35.9 48.7 36.3 40.4
1 Cup 23.7 41.7 26.9 29.8
Don’t know/No Answer 19.9 1.3 19.9 14.6
Total 100% 100% 100.1% 100%
Treatment Sample: P-value=0.0163 Control Sample: P-value=0.3554
15
Nutrition Knowledge
Three factors that determine the amount of fruits and vegetables recommended for a person to consume daily
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
Age, Gender, Weight 32.7% 44.9% 32.8% 46.2%
Age, Gender, PA Level 23.7 46.8 21.6 19.3
Height, Weight, PA Level 23.7 5.1 29.2 22.8
Gender, Weight, Favorite Food 0.6 0.0 1.8 0.0
Don’t know/No Answer 19.2 3.2 14.6 11.7
Total 99.9% 100% 100% 100%
Treatment Sample P-value<0.0001 Control Sample P-value=0.5370
16
Nutrition Knowledge
Best ways to help reduce risk of chronic disease
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
Eating healthy and PA 78.9% 89.1% 91.2% 85.4%
Eating healthy foods 4.5 4.5 2.3 3.5 Being physically active 1.9 1.9 0.6 1.2
Eating low-fat foods 4.5 1.3 1.2 2.9 Don’t know/No Answer 10.3 3.2 4.7 7.0
Total 100.1% 100% 100% 100%
Treatment Sample P-value=0.0057 Control Sample P-value=0.0585
17
Physical Activity Knowledge
Recommended amount of moderate-intensity physical activity adults should get daily
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
At least 15 minutes 14.1% 7.1% 16.4% 12.9% At least 30 minutes 72.4 84.0 72.5 77.1
At least 60 minutes 5.1 5.1 5.9 7.0
At least 90 minutes 2.6 2.6 1.8 0.0 Don’t know/No Answer 5.8 1.3 3.5 2.9
Total 100% 100.1% 100.1% 99.9%
Treatment Sample P-value=0.0063 Control Sample P-value=0.2591
18
Physical Activity Knowledge
Level of intensity of physical activity that makes you breathe hard and sweat
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
Moderate-intensity 34.0% 10.9% 39.2 42.7
Vigorous-Intensity 50.0 82.1 47.4 50.3
Low-Intensity 6.4 4.5 8.8 4.1
Don’t know/No Answer 9.6 2.6 4.7 2.9
Total 100% 100.1% 100.1% 100%
Treatment Sample P-value<0.0001 Control Sample P-value=0.5094
19
Community Advocacy Knowledge
The best steps for advocating for more fruits, vegetables, and physical activity in a community, percent correct
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
Identified the best six steps 35.3% 43.0% 37.4% 42.7%
Did not identify steps 64.7 57.1 62.6 57.3 Total 100% 100.1% 100% 100%
Treatment Sample P-value=0.1091 Control Sample P-value=0.1805
20
Importance of Eating Healthy
Percent agreeing that their family’s health will benefit if they serve more fruits and vegetables
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
Strongly Agree 76.9% 89.7% 83.6% 87.1%
Agree 18.0 7.1 13.5 9.4
Somewhat Agree 1.9 0.6 1.8 1.2
Disagree (Net) 3.2 2.6 1.2 2.3 Total 100% 100% 100% 100%
Treatment Sample P-value=0.0010 Control Sample P-value=0.2580
21
Importance of Eating Healthy
Percent agreeing that they may develop health problems if they do not eat enough fruits and vegetables
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
Strongly Agree 48.7% 68.6% 49.7% 53.8%
Agree 29.5 18.0 23.4 25.7
Somewhat Agree 13.5 7.1 15.8 13.5
Disagree (Net) 8.3 5.8 11.1 7.0
Don’t Know/No Answer 0.0 0.6 0.0 0.0
Total 100% 100% 100% 100%
Treatment Sample P-value=0.0001 Control Sample P-value=0.3467
22
Importance of Physical Activity
Percent agreeing that their family’s health will benefit if they are more physically active
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
Strongly Agree 70.5% 84.6% 77.2% 76.6%
Agree 23.7 9.6 17.0 18.7
Somewhat Agree 3.9 1.3 5.3 2.3
Disagree (Net) 1.9 3.8 0.6 2.3
Don’t Know/No Answer 0.0 0.6 0.0 0.0
Total 100% 99.9% 100.1% 99.9%
Treatment Sample P-value=0.0005 Control Sample P-value=0.8764
23
Importance of Physical Activity
Percent agreeing that they may develop health problems if they are not physically active
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
Strongly Agree 49.4% 67.3% 57.9% 55.6%
Agree 29.5 18.6 22.2 26.9
Somewhat Agree 12.8 8.3 12.3 11.1
Disagree (Net) 7.7 4.5 7.6 6.4
Don't know/No Answer 0.6 1.3 0.0 0.0
Total 100% 100% 100% 100%
Treatment Sample P-value=0.0002 Control Sample P-value=0.5806
24
Self-Efficacy Beliefs About Nutrition
Percent confident that they can prepare a healthy recipe that includes at least a ½ cup of fruits or vegetables per serving
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 60.9% 78.2% 66.1% 64.9%
Medium Confidence 32.7 16.7 23.4 29.2
Low Confidence 4.5 5.1 8.2 5.9
No Confidence 1.9 0.0 1.8 0.0
Don’t know/No Answer 0.0 0.0 0.6 0.0
Total 100% 100% 100% 100%
Treatment Sample P-value=0.0004 Control Sample P-value=0.6473
25
Self-Efficacy Beliefs About Nutrition
Percent confident that they can remember the importance of eating fruits and vegetables when eating away from home
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 60.3% 75.6% 60.2% 59.1%
Medium Confidence 34.6 19.9 32.2 34.5
Low Confidence 3.9 1.9 5.9 5.3
No Confidence 0.6 1.9 0.6 1.2
Don’t know/No Answer 0.6 0.6 1.2 0.0 Total 100% 99.9% 100.1% 100.1%
Treatment Sample P-value=0.0020 Control Sample P-value=0.7389
26
Self-Efficacy Beliefs About Nutrition
Percent confident that they can buy more fruits next time they shop
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 68.6% 82.1% 70.8% 74.9%
Medium Confidence 26.3 13.5 22.8 22.2
Low Confidence 3.9 2.6 4.7 2.9
No Confidence 0.6 1.3 1.2 0.0
Don’t know/No Answer 0.6 0.6 0.6 0.0
Total 100% 100.1% 100.1% 100%
Treatment Sample P-value=0.0018 Control Sample P-value=0.2498
27
Self-Efficacy Beliefs About Nutrition
Percent confident that they can buy more vegetables next time they shop
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 73.7% 84.0% 76.0% 80.7%
Medium Confidence 22.4 12.8 18.1 17.0
Low Confidence 1.9 2.6 5.9 1.2
No Confidence 0.6 0.6 0.0 0.6
Don’t know/No Answer 1.3 0.0 0.0 0.6
Total 99.9% 100% 100% 100.1%
Treatment Sample P-value=0.0390 Control Sample P-value=0.2278
28
Self-Efficacy Beliefs About Nutrition
Percent confident that they can plan meals or snacks with more fruits
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 61.5% 74.4% 64.3% 70.2%
Medium Confidence 32.7 22.4 29.8 27.5
Low Confidence 4.5 2.6 5.3 1.8
No Confidence 0.6 0.6 0.0 0.6
Don’t know/No Answer 0.6 0.0 0.6 0.0
Total 99.9% 100% 100% 100.1%
Treatment Sample P-value=0.0056 Control Sample P-value=0.1573
29
Self-Efficacy Beliefs About Nutrition
Percent confident that they can plan meals or snacks with more vegetables
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 58.3% 75.0% 66.7% 72.5%
Medium Confidence 36.5 20.5 26.9 22.8
Low Confidence 3.2 1.9 5.9 1.8
No Confidence 0.6 1.3 0.6 0.6
Don’t know/No Answer 1.3 1.3 0.0 2.3
Total 99.9% 100% 100.1% 100%
Treatment Sample P-value=0.0008 Control Sample P-value=0.0704
30
Self-Efficacy Beliefs About Nutrition
Percent confident that they can add more fruits or vegetables as snacks at work
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 55.1% 76.3% 62.0% 67.3%
Medium Confidence 39.1 19.9 30.4 27.5
Low Confidence 3.9 1.3 6.4 4.1
No Confidence 0.6 1.9 0.0 0.6
Don’t know/No Answer 1.3 0.6 1.2 0.6
Total 100% 100% 100% 100.1%
Treatment Sample P-value<0.0001 Control Sample P-value=0.2076
31
Self-Efficacy Beliefs About Nutrition
Percent confident that they can find out about how many cups of fruits and vegetables they need every day for good health
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 66.0% 80.1% 66.7% 64.3%
Medium Confidence 29.5 16.0 25.2 29.8
Low Confidence 3.2 1.9 7.6 4.1
No Confidence 1.3 1.3 0.6 1.2
Don’t know/No Answer 0.0 0.6 0.0 0.6
Total 100% 99.9% 100.1% 100%
Treatment Sample P-value=0.0008 Control Sample P-value=0.6682
32
Self-Efficacy Beliefs About Nutrition
Percent confident that they can use the Fruit and Vegetable Scoreboard to help set a goal to meet their recommended amount of fruits and vegetables
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 56.4% 69.9% 55.0% 53.2%
Medium Confidence 37.2 26.9 33.3 39.2
Low Confidence 5.1 1.3 9.4 4.7
No Confidence 0.6 1.9 2.3 2.9
Don’t know/No Answer 0.6 0.0 0.0 0.0
Total 99.9% 100% 100% 100%
Treatment Sample P-value=0.0056 Control Sample P-value=0.6858
33
Self-Efficacy Beliefs About Physical Activity
Percent confident that they can use the Physical Activity Scoreboard to create a weekly physical activity routine
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 42.3% 57.1% 43.9% 45.6%
Medium Confidence 47.4 35.9 40.9 45.6
Low Confidence 9.0 5.8 12.3 6.4
No Confidence 1.3 1.3 2.9 2.3
Total 100% 100.1% 100% 99.9%
Treatment Sample P-value=0.0010 Control Sample P-value=0.6473
34
Self-Efficacy Beliefs About Physical Activity
Percent confident that they can apply the principles of exercise safety to their physical activity routine
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 51.9% 70.5% 54.4% 58.5%
Medium Confidence 39.1 25.6 35.1 37.4
Low Confidence 8.3 3.2 7.0 1.8
No Confidence 0.0 0.6 2.3 1.8
Don’t know/No Answer 0.6 0.0 1.2 0.6
Total 99.9% 99.9% 100% 100.1%
Treatment Sample P-value=0.0001 Control Sample P-value=0.3657
35
Self-Efficacy Beliefs About Physical Activity
Percent confident that they can use walking as a form of physical activity at work
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 68.6% 75.0% 71.4% 73.1%
Medium Confidence 26.3 23.1 24.0 25.2
Low Confidence 3.2 0.6 2.9 0.6
No Confidence 1.9 0.6 1.2 1.2
Don’t know/No Answer 0.0 0.6 0.6 0.0
Total 100% 99.9% 100.1% 100.1%
Treatment Sample P-value=0.0858 Control Sample P-value=0.7576
36
Self-Efficacy Beliefs About Physical Activity
Percent confident that they can use walking as a form of physical activity at home
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 69.9% 76.9% 73.1% 76.6%
Medium Confidence 26.3 19.2 20.5 22.2
Low Confidence 1.9 1.9 5.9 0.0
No Confidence 1.3 0.6 0.6 0.0
Don’t know/No Answer 0.6 1.3 0.0 1.2
Total 100% 99.9% 100.1% 100%
Treatment Sample P-value=0.0858 Control Sample P-value=0.7576
37
Self-Efficacy Beliefs About Physical Activity
Percent confident that they can find out how many minutes of physical activity they need for good health
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 68.6% 80.8% 70.8% 73.1%
Medium Confidence 26.9 17.3 23.4 24.6
Low Confidence 3.2 1.3 5.3 1.2
No Confidence 1.3 0.0 0.6 1.2
Don’t know/No Answer 0.0 0.6 0.0 0.0
Total 100% 100% 100.1% 100.1%
Treatment Sample P-value=0.0038 Control Sample P-value=0.5371
38
Self-Efficacy Beliefs About Advocacy
Percent confident that they can identify things in their neighborhood that make it difficult to find and eat fruits and vegetables
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 46.2% 65.4% 52.1% 48.5%
Medium Confidence 39.7 25.6 38.6 40.5
Low Confidence 9.6 6.4 5.3 7.6
No Confidence 4.5 2.6 4.1 3.5
Total 100% 100% 100.1% 100.1%
Treatment Sample P-value=0.0002 Control Sample P-value=0.4142
39
Self-Efficacy Beliefs About Advocacy
Percent confident that they can identify at least one way to overcome those things that make it difficult to find and eat more fruits and vegetables
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 51.3% 64.7% 51.5% 49.1%
Medium Confidence 41.0 29.5 39.2 42.7 Low Confidence 5.8 3.2 5.3 4.1
No Confidence 1.9 2.6 2.9 4.1 Don’t know/No Answer 0.0 0.0 1.2 0.0
Total 100% 100% 100.1% 100%
Treatment Sample P-value=0.0063 Control Sample P-value=0.5002
40
Self-Efficacy Beliefs About Advocacy
Percent confident that they can talk with people about the things in their community that make it difficult to find and eat more fruits and vegetables
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 41.0% 59.0% 46.8% 42.1% Medium Confidence 47.4 29.5 39.2 48.5 Low Confidence 8.3 7.1 10.5 5.9
No Confidence 3.2 4.5 3.5 2.3 Don’t know/No Answer 0.0 0.0 0.0 1.2
Total 100.1% 100.1% 100% 100%
Treatment Sample P-value=0.0002 Control Sample P-value=0.3270
41
Self-Efficacy Beliefs About Advocacy
Percent confident that they can identify things in their community that make it difficult for them to be more physically active
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 52.6% 62.2% 59.1% 60.2% Medium Confidence 37.8 30.8 29.2 30.4 Low Confidence 6.4 3.9 9.4 7.6
No Confidence 2.6 3.2 2.3 1.2 Don’t know/No Answer 0.6 0.0 0.0 0.6
Total 100% 100.1% 100% 100%
Treatment Sample P-value=0.0508 Control Sample P-value=0.6744
42
Self-Efficacy Beliefs About Advocacy
Percent confident that they can identify at least one way to overcome those things that make it difficult to be more physically active
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 46.2% 66.0% 59.1% 50.3% Medium Confidence 45.5 26.9 31.6 44.4 Low Confidence 5.1 4.5 8.2 2.9
No Confidence 2.6 1.9 1.2 1.2 Don’t know/No Answer 0.6 0.6 0.0 1.2
Total 100% 99.9% 100.1% 100%
Treatment Sample P-value<0.0001 Control Sample P-value=0.0579
43
Self-Efficacy Beliefs About Advocacy
Percent confident that they can talk with people about the things in their community that make it difficult to be more physically active
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
High Confidence 43.6% 61.5% 50.3% 48.5% Medium Confidence 43.6 28.9 36.8 44.4 Low Confidence 9.6 5.1 8.8 5.3
No Confidence 2.6 4.5 4.1 1.8 Don’t know/No Answer 0.6 0.0 0.0 0.0
Total 100% 100% 100% 100%
Treatment Sample P-value=0.0001 Control Sample P-value=0.6744
44
Individual Change in Nutrition-Related Behaviors
Reported change in the amount of fruit purchased over the past 6 weeks
Total Sample
Treatment Sample Control Sample
Post- Post-
N = 156 171
More (Net) 90.4% 68.4%
Much more 49.4 31.6
A little more 41.1 36.8
Same/Less 9.6 31.6
Total 100% 100%
P-value=0.0001
45
Individual Change in Nutrition-Related Behaviors
Reported change in the amount of vegetables purchased over the past 6 weeks
Total Sample
Treatment Sample Control Sample
Post- Post-
N = 156 171
More (Net) 85.9% 74.9%
Much more 50.6 36.3
A little more 35.3 38.6
Same/Less 13.5 24.6
Don’t know/No answer 0.6 0.6
Total 100% 100%
P-value=0.0124
46
Individual Change in Nutrition-Related Behaviors
Reported change in the amount of meals or snacks prepared with fruit over the past 6 weeks
Total Sample
Treatment Sample Control Sample
Post- Post-
N = 156 171
More (Net) 83.3% 66.7%
Much more 43.6 31.6
A little more 39.7 35.1
Same/Less 14.7 32.8
Don't know/No answer 1.9 0.6
Total 99.9% 100.1%
P-value=0.0005
47
Individual Change in Nutrition-Related Behaviors
Reported change in the amount of meals or snacks prepared with vegetables over the past 6 weeks
Total Sample
Treatment Sample Control Sample
Post- Post-
N = 156 171
More (Net) 86.5% 75.4%
Much more 50.6 36.8
A little more 35.9 38.6
Same/Less 13.5 22.8
Don't know/No answer 0.0 1.8
Total 100% 100%
P-value=0.0110
48
Individual Change in Nutrition-Related Behaviors
Reported change in the number of times fruits or vegetables were ordered as part of a meal or snack while dining out over the past 6 weeks
Total Sample
Treatment Sample Control Sample
Post- Post-
N = 156 171
More (Net) 76.3% 63.7%
Much more 43.6 32.8
A little more 32.7 31.0
Same/Less 23.1 36.3
Don't know/No answer 0.6 0.0
Total 100% 100%
P-value=0.0137
49
Individual Change in Nutrition-Related Behaviors
Reported change in the number of times fruits or vegetables were eaten as a meal or snack at work over the past 6 weeks
Total Sample
Treatment Sample Control Sample
Post- Post-
N = 156 171
More (Net) 85.3% 65.5%
Much more 55.8 32.8
A little more 29.5 32.8
Same/Less 14.7 33.3
Don't know/No answer 0.0 1.2
Total 100% 100%
P-value<0.0001
50
Individual Change in Nutrition-Related Behaviors
Percent of respondents in stages of contemplation regarding eating more fruits
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
Action/Maintenance (Net) 39.1% 61.5% 41.5% 57.9% Maintenance 13.5 17.3 17.0 19.3 Action 25.6 44.2 24.6 38.6
Preparation 29.5 21.8 32.2 18.7 Contemplation 26.3 10.9 22.8 19.9 Pre-contemplation 3.9 4.5 2.9 2.3
Don’t know/No Answer 1.3 1.3 0.6 1.2 Total 100.1% 100% 100% 100%
Treatment Sample P-value=0.0001; Control Sample P-value=0.0004
51
Individual Change in Nutrition-Related Behaviors
Percent of respondents in stages of contemplation regarding eating more vegetables
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
Action/Maintenance (Net) 41.0% 58.3% 43.9% 62.6% Maintenance 17.3 17.3 21.6 21.6 Action 23.7 41.0 22.2 40.9
Preparation 31.4 26.3 35.7 19.3 Contemplation 24.4 9.6 18.7 14.6 Pre-contemplation 1.3 4.5 1.2 2.3
Don’t know/No Answer 1.9 1.3 0.6 1.2 Total 100% 100% 100.1% 99.9%
Treatment Sample P-value=0.0006; Control Sample P-value<0.0001
52
Individual Change in Physical Activity-Related Behaviors
Percent of respondents who were physically active for 5 or more days in the past week
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
5-7 Days 34.0% 59.0% 36.3% 42.1% 0-4 Days 66.0 41.0 63.7 57.9
Total 100% 100% 100% 100%
Treatment Sample P-value<0.0001 Control Sample P-value=0.1579
53
Individual Change in Physical Activity-Related Behaviors
Percent of respondents who report being physically active for 5 or more days in a usual week
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
5-7 Days 37.2% 60.3% 39.2% 46.2% 0-4 Days 62.8 39.7 60.8 53.8
Total 100% 100% 100% 100%
Treatment Sample P-value<0.0001 Control Sample P-value=0.0832
54
Individual Change in Physical Activity-Related Behaviors
Percent of respondents in phases of contemplation in regard to being more physically active
Total Sample
Treatment Sample Control Sample
Pre- Post- Pre- Post-
N = 156 156 171 171
Action/Maintenance (Net) 41.0% 55.8% 36.3% 52.6% Maintenance 8.3 14.7 11.1 19.9 Action 32.7 41.0 25.2 32.8
Preparation 26.3 28.2 32.8 26.9 Contemplation 28.2 9.6 25.7 18.1 Pre-contemplation 1.9 5.8 5.3 1.8
Don’t know/No Answer 2.6 0.6 0.0 0.6 Total 100% 100% 100.1% 100%
Treatment Sample P-value=0.0035; Control Sample P-value<0.0001
55
Conclusions
• Overwhelmingly, data collected illustrate that the revised Toolbox was effective when used with its target audience, low-income, African American women
– There was a significant increase in the percent of women who correctly answered most knowledge questions regarding physical activity and nutrition after participating in the intervention.
– Data indicate that the treatment women were more likely to believe that eating fruits and vegetables and being physically active are important for their own health and the health of their families on the post-survey than they were before attending the Toolbox lessons.
– Participants in the Toolbox were more likely to display self-efficacy beliefs across all nutrition related and to community advocacy related measures.
56
Conclusions (continued)
– There were large increases in the percent of women physically active for at least five days a week after participation in the Toolbox sessions.
– There were significant changes over time in the purchasing behaviors, meal and snack preparation, and in the actual consumption of fruits and vegetables by women who attended the Toolbox sessions.
57
Conclusions (continued)
• There were a few areas in which the intervention seemed to be less effective:
– Women were unable to correctly identify the six best steps one should use for advocating for fruits, vegetables and physical activity in their neighborhood.
– While there were significant increases in the nutrition knowledge among treatment women, less than half of the women, treatment and control, correctly answered questions about consumption recommendations and serving size on the post-survey.
– On a number of the measures of self-efficacy related to physical activity, similar effects were observed among treatment and control women.
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