Nutrition and Food Safety Education Targeting Rural Older Adults: Using a Volunteer-based Train-the-team Approach

<p>NON-TECHNICAL SUMMARY:<br/> Many older South Carolinians are classified as malnourished because they have one or more chronic diseases, are poor, and/or live in a rural area. These conditions alone or in combination are affecting the overall health of our elders and their ability to live independently longer. The aim of this project is to sustain or improve the health of older South Carolinians so they can live independently longer. The two objectives to achieve this aim are: 1. to determine the effect of training on the ability of eight teams of volunteers (4 teams per group - AARP or SCFCL) to plan and deliver a food safety and nutrition program to rural older adults. 2. to determine if a volunteer-based, train-the-team approach is a feasible method for delivering food safety and nutrition information to older adults. Achieving these objectives will inform a process and
result in a volunteer-based, train-the-team approach that can be further refined and expanded for use across South Carolina to promote safe food handling and good nutrition as a foundation for healthy aging. This initiative will build on an existing program -Cooking Healthy, Eating Smart, funded by USDA in 2009. We believe that this approach is a cost effective way to reach older adults, particularly those in rural areas, with evidence-based food safety and nutrition information.
<p>APPROACH:<br/> Measurement will be at three levels - the individual team member, the team, and the program participants (rural elders). INDIVIDUAL TEAM MEMBER. Two measures will be ascertained pre- and post-training - food safety and nutrition knowledge and self-efficacy. TEAMS. Fidelity to treatment is a critical concern in interventions conducted in multiple sites by multiple persons over time and is essential to the internal validity of any efficacy trial. We will ensure a rigorous five-step process evaluation of fidelity. The steps include: (1) Assuring congruence with study design; (2) Monitoring and improving training; (3) Monitoring and improving delivery of training; (4) Monitoring and improving implementation of program intervention; and (5) Improving enactment of intervention skills. To ensure congruence with study design, we will track contact between
Extension Agents and their assigned teams to assess variations among teams by having Agents maintain a field diary of interactions and contacts with their teams. We will monitor the effect of training by measuring change in knowledge and self-efficacy as described above. To monitor and improve delivery of the program, we will rely on regular interaction between the Extension Agent and the teams. Agents will be asked to record their observation using a field diary and to use a self-report questionnaire. A standardized checklist will be developed to evaluate the delivery of the program that each team develops to be certain that content that is delivered was correct. PROGRAM PARTICIPANTS. To evaluate the outcomes of the program that each team develops, all program participants will receive several measures. All written instruments will be read aloud to, and if needed, will be completed by
other volunteer team members when the study is explained and consent is obtained. Anthropometric measures (weight, height, and waist to hip ratio) and blood pressure will be used to describe the population and will not be collected post-training. BASELINE INSTRUMENT. A 25-item instrument was developed for use with the CHES curriculum and will be used as the pre-exposure instrument. The instrument assesses perceived sense of well-being, dietary habits, and food safety risk factors. A third instrument, the Food Safety Test (FSST), is being tested in the current CHES study and captures primarily food handling techniques. REPEAT INSTRUMENT. Fourteen of the items found on the baseline instrument will be reassessed post-exposure to the training at least one month past the training (see Appendices). The items selected for this instrument were believed to be able to be effected due to exposure
to food safety and nutrition information.
<p>PROGRESS: 2010/09 TO 2013/04<br/>Target Audience: Good nutrition, based on safe, healthy food choices and preparation practices, is key to preventing and managing the chronic diseases common to older adults, such as hypertension, high cholesterol, and heart disease. As the number of adults age 65 years and older increases in South Carolina and the US, the need for research-based nutrition and food safety education targeting older adults becomes evident. To address this need, faculty at Clemson University and the Medical University of South Carolina developed a nutrition and food safety curriculum targeting rural older adults living in South Carolina. The nine lesson curriculum, known as Cooking Healthy, Eating Smart (CHES), funded under a previous award, was used to study the feasibility of using volunteers to deliver nutrition and food safety information to rural,
older adults in South Carolina. Seven focus groups (N=65) were conducted with members of the South Carolina Family and Community Leaders (SCFCL) and members of the American Association of Retired Persons (AARP) in the four regions of South Carolina to explore whether volunteers would be able to deliver the CHES curriculum. Results guided the formation of the volunteer teams. Because of the difficulty recruiting volunteers (see section on Changes/Problems) CHES was delivered at four sites rather than eight. Furthermore, two of the teams were comprised of volunteers supervised by the research team and a third team was formed by two members of the research team. CHES was delivered at four sites in South Carolina by the three teams (two in Chapin and Lexington) and the two in upstate South Carolina (Easley and Central). Changes/Problems: ORIGINAL RECRUITING METHODS--During Summer and Fall
2012, two Clemson University investigators made 64 contacts through e-mails and phone calls to members of the SCFCL and AARP in an effort to recruit eight teams of volunteers to deliver CHES. Of those, only one SCFCL district leader (from Laurens, SC, located 70 miles northwest of Columbia) and one AARP chapter leader (from Columbia) showed interest in helping to form teams with their members. Both the SCFCL and the AARP provided letters of support for the CHES program grant application. As requested by the Columbia AARP chapter president, one research team member presented a 10-minute overview of the CHES program at an AARP Columbia chapter meeting to provide information to the entire chapter. Four AARP members were interested in learning more and contacted the chapter president, who gave their names to the campus staff member. A five-hour training (including lunch) was scheduled and
carried out in Columbia by three members of the research team. Four women from the AARP attended, two of whom were expected, one of whom did not realize that it was a training for volunteers and thought she was attending a program, and another of whom was not willing to commit to the amount of time/work required. After most of the training was complete the women expressed that they would not be able to lead a volunteer team and carry out the CHES program by themselves. They said that if provided with help from others, then they might be able to volunteer. MODIFIED RECRUITMENT METHODS--One research team member immediately began calling and emailing churches, senior organizations, and volunteer organizations around Columbia in an effort to recruit more volunteers for that team. Contact with Eat Smart Move More Richland County put the research team member in contact with five graduate
students from the University of South Carolina (USC) Arnold School of Public Health (three of whom committed to volunteering). Contact with Lake Murray Evangelical Church in Chapin, SC (located about 20 miles northwest of Columbia) provided two additional volunteers (members of the congregation) and a location for training of volunteers and delivery of the CHES program. The research team contacted the AARP women who had shown interest before, however, none of them were able/willing to commit to volunteering. Thus, the three USC graduate students and the two church members from Chapin formed one volunteer team. In the meantime, the SCFCL district leader from Laurens maintained contact with the research team and a training was scheduled and carried out by two research team members. Four women from the SCFCL were present at the four-hour training. A second training took place 11 days later.
At the second training an additional volunteer, a resident of Laurelwood Apartments where the training and CHES program was held, was in attendance and was added to the team. An additional resident was added to the volunteer team just prior to the first data collection session, so she was able to participate in the modified Collaborative Institutional Training Initiative (CITI) training that all volunteers (N = 11) received before the data collection sessions at their respective sites (in Chapin and Laurens, SC). Our original goal of recruiting eight teams with eight volunteers each was modified to four teams total (two volunteer-led, two Clemson staff-led) as a result of the difficulties we had in recruiting volunteers, despite the generally positive feedback received in focus groups and the letters of support from the SCFCL and AARP. MODIFIED CURRICULUM DELIVERY TEAMS--As only two
teams of volunteers could be formed, one with five volunteers (Chapin) and one with six (Laurens), the research team created their own teams and delivered the CHES curriculum locally, at two locations in upstate South Carolina. As a result, this case study developed four case scenarios: A team composed primarily of SCFCL members, all older adults, delivered the curriculum at an apartment-style home for retired persons (Laurens), a team composed of USC graduate students (younger adults) and local residents (older adults) delivered the curriculum at a rural church (Chapin), a team composed of two research team members (an employee and a graduate student) delivered the curriculum at a congregate meal site before lunch (Easley), and a team primarily composed of one research team member (a graduate student) delivered the curriculum at a congregate meal site before lunch (Central). Of
particular note was the distinction between the two volunteer teams; one comprised of all older adults and another team comprised of intergenerational adults. Due to the challenges we faced in recruiting, we modified our research method to involve four teams including two teams of volunteers, one comprised of members of the SCFCL and community members in Laurens, SC (located about 70 miles northwest of Columbia), one comprised of both graduate students from the University of South Carolina (USC) Arnold School of Public Health and community members in Chapin, SC (located about 20 miles northwest of Columbia), and two teams of Clemson University campus staff. MODIFIED OBJECTIVES--Our objectives, though similar, changed to: 1. Determine if a volunteer-based, train-the-team approach is a feasible method for delivering the Cooking Healthy, Eating Smart (CHES) curriculum to rural older adults
by allowing two teams of volunteers to teach the curriculum, each at their own location, and gathering feedback from the volunteers and the older adults whom they teach and 2. Observe and evaluate the differences between volunteer-led groups and campus staff-led groups as the volunteers and campus staff teach and the participants receive the CHES curriculum by collecting feedback from the volunteers and participants. We also modified our research questions to ask, in relation to our objectives: 1. Is it feasible to deliver a food safety and nutrition curriculum solely using volunteers as the educators? 2. How are volunteers affected by and how do they respond to the planning and delivery of food safety and nutrition information to rural older adults? 3. What are the motivators/incentives necessary for volunteers to properly and effectively deliver the CHES program? 4. To what extent
should paid staff be involved in working with the trained volunteer teams in the delivery of the CHES program? 5. Would recruiting young people along with older community members work as well as or better than recruiting from a service-based group of older adult volunteers (like SCFCL) in the implementation of the CHES program? 6. Is there a difference in outcomes of rural, older adults when exposed to the curriculum taught by volunteers versus when taught by the campus staff team? 7. What are the advantages and disadvantages of using volunteers versus using campus staff to deliver the CHES curriculum? What opportunities for training and professional development has the project provided? The volunteers (N=11) were trained on how to deliver the CHES curriculum. All volunteers also received a modified Collaborative Institutional Training Initiative training about collecting data from human
subjects. The modified training was approved by the Clemson University Institutional Review Board. How have the results been disseminated to communities of interest? The results will be disseminated to the scientific community through the preparation of two manuscripts that are described in the Products section. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported
<p>PROGRESS: 2011/09/01 TO 2012/08/31<br/>OUTPUTS: The Cooking Healthy, Eating Smart (CHES) curriculum was developed and piloted as part of a previously funded USDA RHSE grant. The curriculum was modified based on the pilot results and will be used as the education curriculum for the second phase of this project, which is described hereafter. Two additional educational tools were developed and added to the CHES curriculum--a place mat, based on the USDA food guidance system My Plate, was developed and will be given to each program participant. The second tool developed was a fact sheet that lists the refrigerated shelf-life of foods. The training manuals, which include a copy of the CHES curriculum, as well as directions on how to plan, deliver, and evaluate it, were edited, printed, and assembled. Sixty-two (62) individuals from SC Family and Community Leaders (FCL)
groups and AARP chapters located in the upstate and midlands regions of South Carolina were recruited to serve on a volunteer training team. Of the 62 individuals contacted, nine indicated interest in serving on a volunteer training team; 30 contacts did not respond after multiple attempts of communication. Based on the contacts, two teams comprised of AARP and FCL members were formed. Because we were not able to form four teams of volunteers to deliver the CHES training program, we changed our study design, which is described in the section on "Program Modifications." PARTICIPANTS: Angela Fraser, Ph.D., Associate Professor, Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC; Morgan Getty, M.S. candidate, Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC; Mary Carney, M.S. candidate, Department of Food, Nutrition,
and Packaging Sciences, Clemson University, Clemson, SC; Elaine Amella, Ph.D., Professor, College of Nursing, Medical University of South Carolina, Charleston, SC; and Martina Mueller, Ph.D., Associate Professor, College of Nursing, Medical University of South Carolina, Charleston, SC TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: We contacted 62 individuals from AARP and FCL and nine indicated they could help deliver the CHES program. After training four AARP members from the Columbia, SC, area, we realized they would not be able to deliver the program without additional help. We e-mailed a summary of the CHES project to various list serves including the University of South Carolina (USC) School of Public Health. As a result, five USC graduate students contacted CHES staff members with their interest in helping the volunteers deliver
the program. Because of our strict timeline, all the volunteer trainings needed to be completed prior to January 2013. As a result, a CHES staff member contacted the secretary to the senior pastor, and lead elder of her church in Chapin, SC. With its higher concentration of rural, older adults and relatively close proximity to Columbia, Chapin was an ideal location for the second volunteer CHES program to be delivered by the AARP members and the USC graduate students. Because we were not able to form four teams of volunteers, we changed our study design. Instead of comparing two AARP teams to two FCL teams, we are now comparing two volunteer groups (one comprised of members of a church in Chapin SC and the second FCL members) to two groups lead by CHES team members. In addition to the changes to the study design, changes were made to the CHES team roster. Clemson University experienced
major losses to their budget. As a result, Extension Agents who were originally to help with this project were redirected to other activities. Therefore, two graduate students and a half-time staff member were hired to oversee completion of the project.
<p>PROGRESS: 2010/09/01 TO 2011/08/31<br/>OUTPUTS: The aim of this project is to sustain or improve the health of older South Carolinians so they can live independently longer. The two objectives to achieve this aim are: (1) to determine the effect of training on the ability of teams of volunteers - AARP or SCFCL) to plan and deliver a food safety and nutrition program to rural older adults and (2) to determine if a volunteer-based, train-the-team approach is a feasible method for delivering food safety and nutrition information to older adults. Clemson and MUSC project team members met with partners, AARP, SC Office on Aging, and SC Family Community Leaders to review project aim and objectives. Extension Agents met to review the Cooking Healthy, Eating Smart (CHES) curriculum, developed through funds from the USDA RHSE initiative. Based on feedback from Clemson Extension
Agents, the CHES curriculum, the curriculum for this project, was expanded to nine lessons. The food safety content was removed from the eighth lesson and a separate lesson was created. Lesson Nine will be a review of all content and will include a Bingo Game. Several recipes were modified and pilot tested with older adults to determine if they were appropriate for the audience. A one-day review session was then held on February 2, 2011, with all Extension Agents who will train teams. The timeline was reviewed and challenges addressed and solutions presented. Team Member roles were identified and job descriptions developed. The knowledge assessment test and self-efficacy instruments were developed to measure knowledge and self-efficacy of volunteer team members. The Volunteer Training Manual, which will serve as the base for planning the outreach program, was finalized. The project
coordinator convened eight focus groups with SCFCL and AARP members to determine the challenges of volunteers planning and delivering a food safety and nutrition program to older adults. The team followed methods for qualitative data preparation and transcription protocol. Two team members transcribed the recordings and then reviewed the transcriptions. A third team reviewed the transcriptions against the recording, and later a fourth member reviewed the transcripts. The transcriptions and notes taken by the assistant were then uploaded to NVivo. The moderator and another team member coded the transcriptions for reacquiring themes. PARTICIPANTS: Angela M. Fraser, Ph.D., Associate Professor/Food Safety Specialist, Clemson University, Clemson, SC Ashley Rivers, M.A., Project Coordinator, Clemson University, Clemson, SC Melissa Macher, B.S. student, Clemson University, Clemson, SC Elaine
Amella, Ph.D., Professor, MUSC, Charleston, SC Martina, Mueller, Ph.D., Associate Professor, MUSC, Charleston, SC TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Due to significant changes in the structure of Clemson University Extension and several retirements, Extension Agents are no longer able to train the teams and oversee delivery of the training program. Therefore, two external food safety and nutrition professionals will be hired to provide oversight to the teams of volunteers.