Changing Attitudes and Knowledge Toward SNAP Application.

PURPOSE: To examine effectiveness of an educational intervention on attitude and knowledge related to accessing and qualifying for the Supplemental Nutrition Assistance Program (SNAP). DESIGN: Cross-sectional survey. SETTING: Community sites (38) in North Carolina. PARTICIPANTS: Low-income adult participants who provided data (n = 558). INTERVENTION: Participants completed pre- and postsurveys for the 45-minute program. MEASURES: Theoretically based surveys measured knowledge requisite to the decision to apply for SNAP benefits. ANALYSIS: Paired sample t tests tested the hypothesis of "no difference" in postintervention knowledge. RESULTS: Knowledge gains were statistically significant on all questions ( P < .01) including the amount of food a minimum benefit could purchase, how to apply for SNAP, how the electronic benefit transfer card and benefits work, eligibility restrictions, and how to receive application assistance. Subsequent percentage change analyses revealed the strongest intervention effects to be how to apply and accessing application assistance. CONCLUSION: Effective theory-based programs can improve knowledge and dispel myths concerning SNAP participation among low-income participants.

Nutrition education for cardiovascular disease prevention in individuals with spinal cord injuries: study protocol for a randomized controlled trial.

BACKGROUND: Individuals with chronic spinal cord injuries (SCIs) have an increased prevalence of cardiovascular disease (CVD) and associated risk factors compared with age-matched control subjects. Exercise has been shown to improve selected CVD risk factors in individuals with SCI, but using nutrition education as an intervention has not been evaluated in this population. This paper describes our research plan for evaluating the effect of nutrition education on individuals with SCI. In the present study, called Eat Smart, Live Better, we are using a randomized controlled design to test an intervention adapted from an existing evidence-based program that showed a positive effect on nutrition knowledge and behavior of older adults from the general population. There will be an inpatient group (n = 100) and a community group (n = 100). The aims of our study are to compare the intervention and control groups for (1) changes in nutritional behavior, nutritional knowledge, and dietary quality by participants in the program; (2) levels of adiposity and metabolic CVD risk factors at 12-month follow-up; and (3) differential effects among individuals with SCI in the acute rehabilitation setting and those living in the community. METHODS/DESIGN: This is a randomized controlled trial of nutrition education. The treatment groups receive six nutrition education sessions. The control groups receive the one "standard of care" nutrition lecture that is required by the Commission on Accreditation of Rehabilitation Facilities. Treatment groups include both an inpatient group, comprising patients who have been admitted to an acute rehabilitation facility because of their recent SCI, and an outpatient group, consisting of community-dwelling adults who are at least 1 year after their SCI. A total of 200 participants will be randomized 1:1 to the intervention or control group, stratified by location (acute rehabilitation facility or community dwelling). DISCUSSION: To our knowledge, this will be the first reported study of nutrition education in individuals with SCI. The low cost and feasibility of the intervention, if shown to improve nutritional behavior, suggests that it could be implemented in rehabilitation facilities across the country. This has the potential of lowering the burden of CVD and CVD risk factors in this high-risk population. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02368405 . Registered on February 10, 2015.

Use of song as an effective teaching strategy for nutrition education in older adults.

The objective of this study was to explore whether singing an educational song would be effective in improving older adults' knowledge about nutrition. We used a randomized controlled design to determine whether singing an educational song would result in increased nutrition knowledge in a low-income population of older adults compared to a control group of similar adults who did not sing the song. Eighteen congregate nutrition sites were randomly assigned to the treatment or control group. Analysis via independent samples t -test showed the knowledge gain mean scores for the treatment group were significantly ( P  < 0.05) greater than those of the control group. This study supports a unique new approach to increasing nutrition knowledge of older adults by using music.

Weight loss and self-regulatory eating efficacy in older adults: the cooperative lifestyle intervention program.

OBJECTIVES: Using the weight efficacy lifestyle questionnaire (WEL), we examined whether a group-mediated intervention for weight loss among older, obese adults resulted in changes in self-regulatory self-efficacy for eating behavior and whether these changes mediated weight loss. METHODS: This was a randomized controlled design, and 288 older adults received 1 of 3 treatments for 6 months: physical activity only (PA), weight loss + physical activity (WL + PA), or a successful aging (SA) health education program. The WEL was administered prior to randomization and again at the 6-month follow-up visit. RESULTS: A significant treatment effect was observed for the WEL, F (2249) = 15.11, p < .0001, partial eta2 = .11, showing that improvement occurred only in the WL + PA group as compared with PA and SA. Changes in WEL scores partially mediated the effects of the WL + PA intervention on weight loss. DISCUSSION: These results illustrate that WL + PA can be effective in improving older adults' self-efficacy for the self-regulation of eating behavior and that these changes are prospectively related to the amount of weight loss. Further research is warranted on an expanded concept of self-efficacy as well as controlled experimental studies on eating behavior in older adults.

Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health.

BACKGROUND: Limitations in mobility are common among older adults with cardiovascular and cardiometabolic disorders and have profound effects on health and well-being. With the growing population of older adults in the United States, effective and scalable public health approaches are needed to address this problem. Our goal was to determine the effects of a physical activity and weight loss intervention on 18-month change in mobility among overweight or obese older adults in poor cardiovascular health. METHODS: The study design was a translational, randomized controlled trial of physical activity (PA) and weight loss (WL) on mobility in overweight or obese older adults with cardiovascular disease (CVD) or at risk for CVD. The study was conducted within the community infrastructure of Cooperative Extension Centers. Participants were randomized to 1 of 3 interventions: PA, WL + PA, or a successful aging (SA) education control arm. The primary outcome was time to complete a 400-m walk in seconds (400MWT). RESULTS: A significant treatment effect (P = .002) and follow-up testing revealed that the WL + PA group improved their 400MWT (adjusted mean [SE], 323.3 [3.7] seconds) compared with both PA (336.3 [3.9] seconds; P = .02) and SA (341.3 [3.9] seconds; P < .001). Participants with poorer mobility at baseline benefited the most (P < .001). CONCLUSION: Existing community infrastructures can be effective in delivering lifestyle interventions to enhance mobility in older adults in poor cardiovascular health with deficits in mobility; attention should be given to intervening on both weight and sedentary behavior since weight loss is critical to long-term improvement in mobility. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00119795.

Nutrition education among low-income older adults: a randomized intervention trial in Congregate Nutrition sites.

Nutritional well-being among older adults is critical for maintaining health, increasing longevity, and decreasing the impact of chronic illness. However, few well-controlled studies have examined nutritional behavior change among low-income older adults. A prospective, controlled, randomized design examined a five session nutrition education module delivered to limited-resource older adults (N = 703) in Congregate Nutrition sites by Cooperative Extension agents. Experimental group participants were significantly more likely than control group participants to increase multivitamin use, to increase calcium supplement use, to read labels of dietary supplements, to carry a supplement and/or medication list, and to discuss such use with their health care professional. The study addresses weaknesses in the literature by using a theoretically derived education component, implementing the intervention within a setting regularly used by low-income older adults, employing randomized assignment to intervention and control conditions, and using hierarchical linear modeling to deal with "nested" data.

Using a theory-driven approach to design a professional development workshop.

The objective of this study was to show how a theory- driven approach to program planning was used to design and evaluate a professional development workshop. Our method was to demonstrate modeling of theory use as a teaching strategy. The Theory of Planned Behavior was used to structure all components of a 6-hour workshop. This workshop significantly increased participants' intention to use theory in designing programs (P <.0001). Educators can apply the methods demonstrated here to systematically use theory in the development, implementation, and evaluation of their workshops, staff training, and curricular materials for professionals and consumers.

Extending the reach of nutrition education for older adults: feasibility of a Train-the-Trainer approach in congregate nutrition sites.

Low-income older adults are difficult to reach with nutrition education. This study examines the feasibility of a Train-the-Trainer approach using congregate nutrition site (CNS) managers to deliver nutrition education. The study suggests that CNS managers were receptive to the role of trainer, CNS participants were satisfied with this method, and the acceptability of managers as trainers did not vary with participants' levels of risk of malnutrition. Although the sample size (53 participants and 4 managers) and convenience sampling method limit generalizability, the promising results suggest the potential benefits of this method and the need for further study.