AMY LUGINBILLMPH STUDENT

ARIZONA STATE UNIVERSITY

Food PLUS - Living Well:

An Interactive Nutrition Education Program for Elderly CSFP Participants, A Pilot Study

November 2011

Needs Assessment SummaryArizona elderly

population is expected to grow to 28% of the total population by 20301

About 100,000 elderly people in Arizona living in poverty2

Nearly 60% of low-income Arizona seniors have the equivalent of a high school education or less2

Nearly 60% of low-income, elderly individuals in Arizona are overweight or obese2

Over 65% of low-income, elderly individuals in Arizona consume less than 5 fruits and vegetables per day2

Program Need & PurposeNeedSeniors, especially low-income, are at

risk for poor nutritional status3

Physical, mental, and social factors make undernourishment as well as overweight and obesity common in the elderly population3

PurposeEducate the population about diet and healthReduce barriers (real or perceived) towards

eating healthyLearn more about the CSFP population from first

hand experience

Significance & InnovationSignificancePoor nutrition is a

major concern in the elderly because it can cause/impact adverse outcomes: morbidity, mortality, risk of falls, disabilities, infections, anemia,weakness, fatigue, and much more 3

InnovationTo date, there have been

no nutrition education programsprovided for the Phoenix CSFP population

Elderly population does not like to be “taught” or attend “class” – instead Food PLUS-Living well focuses on interactive discussions and activities

Social MarketingStages of Change (Transtheoretical Model)

“ the design, implementation, and control ofprograms seeking to increase the acceptability of a social idea or practice in a target group.”4

Focus on behavioral outcomes

Prioritize consumer benefit Consumer-driven

approach: Build demand for the product

“five stages of change…represent ordered categories along a continuum of motivational readiness to change a…behavior”5

Lessons focus on engaging participants and reducing barriers to change by providing cues to action (recipes, handouts)

Theoretical Models

Food PLUS-Living Well

An interactive nutrition education program

The pilot program will take place over 4 months, from January through April 2012

Outreach: JanuaryHandouts - Flyers, CalendarsPostersWord-of-Mouth

Program Implementation: February - AprilNutrition Education CoursesOffered over a 10 week periodTotal of 6 classesEvery other Tuesday10-11amSt. Mary’s Knight Center

Food PLUS-Living Well: Outreach Material

Flyers to be handed out to CSFP clients by St. Mary’s staff and volunteers

Food PLUS-Living Well: Material

The Food PLUS-Living Well program…Uses educational material developed and provided by

the Elder Nutrition and Food Safety (ENFS) program at University of Florida

ENFS Learning Modules contain background information, lesson outlines, interactive discussions, hands-on activities, and handouts All ENFS material is developed by nutrition and

education professionals and peer reviewed by a panel of experts.

Food PLUS-Living Well: Material

Lesson 1: MyPlate for Older AdultsLesson 2: FluidsLesson 3: FiberLesson 4: Calcium and Vitamin DLesson 5: Folate and Vitamin B12Lesson 6: Review/Popular Demand

Each lesson featuresIcebreaker, discussion, activities, PPT

presentationDemonstrated “recipe-of-the-week” using

foods commonly received in CSFP food boxes

Food PLUS-Living Well: Recipes

Lesson 1: MyPlate for Older Adults*Vegetable Medley, Pasta PrimaveraLesson 2: Fluids*Flavored Water, Creamy Tomato SoupLesson 3: Fiber*Southwestern Rice & Beans, 30 Min. ChiliLesson 4: Calcium and Vitamin D*Mixed Up Macaroni, Cheesy Rice SquaresLesson 5: Vitamin B12 and Folate*Sheppard’s Pie

All recipes feature limited ingredients, little use of spices (as some are costly), and are

diabetic friendly

Program Development: Agency Description

Food PLUS-Living Well: Agencies Involved

Arizona Department of Health Services (ADHS) &Arizona Nutrition Network (AzNN)

St. Mary’s Food Bank and Distribution Center

Program Development: Agency Involvement

Arizona Nutrition Network

Dana Goodloe (AzNN Program Manager) provided professional guidance for program development

Arizona Department of Health Services provided office materials & equipment, resource materials, and personnel resources required to develop Food PLUS-Living Well

St. Mary’s Food Bank and Distribution

CenterSt. Mary’s Food Bank

donated building space, food, food boxes, tea & coffee, and organizational support for program promotion & implementation

Target Population

Commodity Supplemental Food Supply (CSFP) Program

92-93% of CSFP participants are seniors Caseload is 12,965 (FY2011)CSFP may be serving only about 10% of the

total population in needThere are approximately

1,200 people currently on the Arizona CSFP Wait List(Courtney, S., personal communication, November 8, 2011)

CSFP is called Food Plus at St. Mary’s

Target Population

Most CSFP participants in Phoenix…Are on a fixed income Live alone in HUD housing or low-income

apartmentsAble to read and write (very few cannot)Most Hispanic CSFP participants cannot read or

speak English

(Courtney, S., personal communication [email], September 30, 2011)

Target Population

Of the clients that come to St. Mary’s to pick up their food boxes…

About half drive themselvesAbout half have a friend or family member bring

them

Barriers to Transportation Most elderly participants do not utilize public

transportation (city bus, light rail) because CSFP food boxes are too heavy for them to carry

Other services (Dial-A-Ride) often take too long to arrive

(Courtney, S., personal communication [email], September 30, 2011)

Program Goals, Objectives,& Timeline

Goal Objectives/Outcomes

Specific Activities Timeline

1. To improve the health of CSFP clients through nutrition education

1. Provide CSFP clients with new, easy, healthy recipes that use the foods received in CSFP boxes

2. Increase CSFP client consumption of fruits, vegetables, whole grains, and lean meat

1a. Research available recipes using CSFP foods

1b. Print recipes for handouts

2a. Conduct activities specifically highlighting the benefits of a healthy diet

2b. Provide handouts (cues to action) to clients

1a. 6 Months before program implementation

1b. 1 month before program implementation

2a/2b. During program implementation

Program Goals, Objectives,& TimelineGoal Objectives/

OutcomesSpecific Activities

Timeline

1. To improve the health of CSFP clients through nutrition education [cont.]

3. Provide a social support system for CSFP clients to improve social and mental health

3a. Provide name tags to clients to promote socialization3b. Provide tea and coffee during program to promote relaxed, friendly atmosphere

3a. Obtain name tags 1 month before program implementation3b. During program implementation

Program Impact

Health ImpactsLow-income, elderly CSFP clients in Phoenix, Arizona are

at increased risk for poor nutritional status. Within this population, nearly 60% are overweight or obese and more than 65% consume less than 5 fruits or vegetables each day.2 Food PLUS-Living Well helps resolve this problem by providing nutrition and health education to the population and by highlighting the importance and benefits of maintaining a healthy diet and lifestyle.

Program Impact

Social ImpactsLow-income, elderly CSFP clients in Phoenix, Arizona are

at increased risk for poor social health. Social factors such as poverty, isolation, and subsequent depression, tend to lead to under-nutrition, anorexia, and/or weight loss in this population.3 Food PLUS-Living Well helps resolve this problem by providing a supportive social environment. CSFP clients who attend the program will benefit from the support and connections formed within the group.

Program Impact

Economic ImpactsCSFP clients have an income limit that is at or below 130%

of the Federal Poverty Income Guidelines. Food PLUS-Living Well helps clients stretch their monthly budget by providing education on new ways to make the CSFP food boxes go further. Food PLUS-Living Well provides new recipes and handouts with tips on how to save money while maintaining a healthier diet.

BudgetLine Item Sub-Items Justification Amount

Direct Costs Class materials, travel costs, incentives

Total direct costs to implement programs

$73.00 [broken down a.- h.]

a. Salaries & Wages Program Coordinator & Educator: MPH Student

MPH student (myself) designed and will implement program, St. Mary’s staff provided support services for promotion and implementation of program

$0.00[No payment received, part of graduate requirements]Program Co-

Coordinator: St. Mary’s Staff

b. Benefits None Part of paid job responsibilities by ADHS & St. Mary’s

$0.00

c. Equipment, Supplies, Materials

Food, Food boxes for demonstrations

Food & food boxes used to demonstrate recipes , handouts part of client education, projector & screen for PowerPoint presentation

$0.00[Donated by St. Mary’s and ADHS as part of CSFP contract]

Printed HandoutsProjector & Screen

d. Travel, Transportation

Mileage to St. Mary’s, 1x/week for 16 weeks

20 miles round trip x 16 trips, 20 mpg w/car, $3.30 gallon of gas

$53.00

Budget (cont.)

Line Item Sub-Items Justification Amounte. Participant Support & Incentives

Raffle prizes To increase/maintain client participation

$20.00[1 prize per class]

f. Consultants Program Consultants: ADHS/AzNN Staff

ADHS/AzNN provided consulting services for program development & nutrition material

$0.00[No payment received, part of field experience agreement with ASU]

g. External Contracts for Service

No external contracts for service required

All service provided by MPH student (myself)

$0.00

h. Space, Infra-structure

Room space, 1x/week , 60 minute time slot

Space needed at St. Mary’s Knight Center for program delivery

$0.00[Donated space by St. Mary’s as part of CSFP contract]

Indirect Cost Advertisement materials

To promote program $0.00 [Donated]

Other None ----- $0.00 [No other costs]

TOTAL COST $73.00

Sustainability Past Funding Period

Program Checklist

1. Develop background knowledge of project topic/issue Utilize ADHS resources, St. Mary’s resources Conduct literature review of topic/issue and previous

interventions2. Perform population assessment Utilize available survey/census data3. Perform organizational assessment4. Establish support by ADHS, AzNN, and St. Mary’s5. Develop program6. Obtain required program materials 7. Promote program Hang posters/pass out flyers8. Implement program9. Evaluate/assess program

Project Evaluation

Program participants will be asked to complete an evaluation form after each lesson to assess how effective the lesson was in improving knowledge and promoting behavioral change

Benchmarks for success:Minimum 5 person per lesson attendanceOf those who complete the evaluation forms, 50% indicate they

learned “some” or “a lot” after each lesson, and 50% indicate “yes” they plan to make a behavioral/diet change

Project Limitations

Limitations to this study/program: Inability to follow CSFP/program participants for a

longer period of time to assess behavioral change Small group size Limited external validity (many variables associated

with geographic location, age, sex, disability status, etc.)

Implications for Practice

If successful, Food PLUS-Living Well can be used…Throughout Arizona to be tested with larger groupsIn senior living centers, retirement communities, hospitals,

community nutrition centers, food banks, and/or alnternate CSFP distribution centers

Food PLUS-Living Well is designed to be easily adaptedProgram includes all necessary material (background information,

activities, etc.) thus could easily be implemented by trained volunteers/lay community health workers

Adaptations may be made to target specific racial/ethnic groups, socioeconomic groups, or ages

Thank You!

Questions? Comments?

Please contact Amy Luginbill at amy.luginbill3@gmail.com

References1. Administration on Aging. (2010). Projected Future Growth of the

Older Population. Department of Health and Human Services. Retrieved from http://www.aoa.gov/AoARoot/Aging_Statistics/future_growth/future_growth.aspx#state

2. U.S. Census Bureau; American Community Survey, 2005-2009 Summary Table; generated by Carmon Greene; using American FactFinder; <http://factfinder.census.gov>; (13 September 2011).

3. Harris, D., & Haboubi, N. (2005). Malnutrition screening in the elderly population. Journal of the Royal Society of Medicine, 98, 411-414

4. Kotler, P. (1975). Marketing for nonprofit organizations. Englewood Cliffs, NJ:Prentice Hall

5. Prochaska, J. O., & Velicer, W.F. (1997). The Transtheoretical Model of health behavior change. American Journal of Health Promotion, 12, 38-48