Western NSW Local Health · PDF fileWestern NSW Local Health District Marang Dhali Eating Well Program Summary Report on Implementation and Evaluation Phase 2 (2011 –

Western NSW Local Health District

Marang Dhali Eating Well Program

Summary Report on Implementation and Evaluation

Phase 2 (2011 – 2013)

Condobolin, Forbes, Peak Hill and Dubbo

Produced by Population Health, Western NSW Local Health District Health Promotion and Germaine Cumming

Marang Dhali Eating Well Program. Summary report on implementation and evaluation, Phase 2 (2011-2013).

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Suggested citation: Cumming, G. Stapleton, R. & O’Leary, L. 2015, Western NSW Local Health District Marang Dhali Eating Well Program. Summary report on implementation and evaluation, Phase 2 (2011 – 2013), Western NSW LHD and Germaine Cumming.

Copyright & Publication details Western NSW Local Health District 23 Hawthorn Street PO Box 4061 Dubbo NSW 2830 Ph: (02) 6841 2222 Fax: (02) 6841 2225 http://www.wnswlhd.health.nsw.gov.au/ This work is copyright. It may be reproduced in whole or part for study or training purposes, subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from Western NSW Local Health District. For Copyright enquiries regarding this publication and for written permission to reproduce all or parts thereof please contact: Lyndal O’Leary Manager Health Promotion Population Health Services Western NSW Local Health District PO Box 4061 Hawthorn St Dubbo NSW 2830 [email protected] Phone: (02) 6841 2370 © Western NSW Local Health District 2015 First Edition August 2015 ISBN: 978-0-9876086-4-2

http://www.wnswlhd.health.nsw.gov.au/


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Acknowledgements The Western NSW Local Health District would like to acknowledge the traditional owners of Country throughout this region. We pay our respects to the people and their culture and to the Elders past and present. Western NSW Local Health District gratefully acknowledges the contributions of the following people and organisations in the development of Marang Dhali - Eating Well: a practical cooking and food program for Aboriginal communities (Marang Dhali - Eating Well Program). The Wiradjuri Program Name ‘Marang Dhali’ is the Wiradjuri language phrase for ‘eating well’. We acknowledge and thank Stanley Vernard “Stan” Grant Snr, AM, an Elder of the Wiradjuri Nation and Language Specialist of the Elders Council, for his advice and permission to use this phrase in the title of our Program. The Artwork

Debbie Calliss from Condobolin created the contemporary artwork in an Aboriginal style and gave us permission to adapt and use images for the Marang Dhali Eating Well Program illustrations and promotion. The Marang Dhali Eating Well Program Marang Dhali Eating Well (MDEW) is a Western NSW Local Health District (Western NSW LHD) healthy food and cooking program designed for implementation across the LHD. Phase 2 was developed and funded by the Health Promotion Team in association with the Aboriginal Maternal and Infant Health Service (AMIHS) and Aboriginal Health. Local Aboriginal Health Workers were trained as MDEW facilitators and, worked together with other health workers and community organisations to run the Program for Aboriginal community members in Condobolin, Peak Hill, Dubbo and Forbes. We especially appreciate the interest and enthusiasm of the Marang Dhali Eating Well Program participants, facilitators and their partners in contributing to Phase 2 and its evaluation. The Evaluation The evaluation has been conducted by Western NSW LHD Epidemiology, Research and Evaluation staff and members of the Health Promotion Team. It was supported by local Aboriginal Health Workers and other project stakeholders. This summary report draws from a comprehensive unpublished evaluation report on MDEW Phase 2 that was written and compiled by Western NSW LHD staff members Linda Mason (Epidemiology, Research and Evaluation), David Meharg (Population Health Trainee), Rosemary Stapleton (Health Promotion) and Clinton Gibbs, (Health Promotion).


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Table of Contents Executive Summary............................................................................................................ 7

The MDEW Program – Phase 2 ................................................................................... 7 Evaluating MDEW – Phase 2 ....................................................................................... 7 Future ......................................................................................................................... 8

Why Food Security? ........................................................................................................... 9

What is MDEW? ................................................................................................................. 9

Logic model............................................................................................................... 11 Who is involved in the project?.......................................................................................... 11

Stakeholder map ....................................................................................................... 13 MDEW facilitator training .................................................................................................. 13

MDEW Food and Cooking Programs ................................................................................ 14

How was MDEW evaluated?............................................................................................. 15

Results............................................................................................................................. 16

Against the objectives ................................................................................................... 16 Data quality and interpretation ................................................................................... 16 Objective 1: Approval from the District and local management for the use of staff and

resources, including funding, to enable MDEW Phase 2 to be implemented in four

communities by June 2013. .................................................................................. 16 Objective 2: Build the capacity of the Aboriginal Health Workers and partners through

training and support to confidently plan, deliver and evaluate the MDEW Programs in

four communities of WNSW LHD by June 2013. ................................................... 17 Objective 3: Develop positive working relationships between facilitators and existing or

new partners and Aboriginal community to support the delivery of the MDEW

Programs by June 2013. ...................................................................................... 19 Objective 4: Increase MDEW Program participant’s food and cooking knowledge and

skill-set in the four communities by trained facilitators and partners delivering the

MDEW Program to be responsive to individual and community needs. .................. 20 Objective 5: Identify broader food disadvantage issues during the delivery of MDEW

Programs in the participating Aboriginal communities by June 2013. ..................... 25 Beyond the objectives ................................................................................................... 26

Facilitator and Partner views ...................................................................................... 26 Participants’ comments.............................................................................................. 27

MDEW – why it matters? .................................................................................................. 27

Professional development component........................................................................ 27 Running local MDEW healthy food and cooking Programs ......................................... 28 Managing project operations and establishing resources ............................................ 29

Conclusion ....................................................................................................................... 29

MDEW today (2013 – 2015).............................................................................................. 29

The future ........................................................................................................................ 30

Recommendations ........................................................................................................ 31 Appendix A: MDEW Phase 2 evaluation framework........................................................... 32

Appendix B: Development and further resources ............................................................... 33

Appendix C: Glossary of terms and acronyms ................................................................... 35


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Executive Summary The importance of adequate nutrition cannot be overstated. A healthy and nutritious diet is

protective against a number of chronic diseases and obesity. Western NSW Local Health

District (WNSW LHD) identified the need to reduce food insecurity in local Aboriginal

communities. More than half of local government areas in WNSW LHD score in the 4 lowest

deciles of the Socio-Economic Index for Area (SEIFA) of relative disadvantage. The District

has a high Aboriginal population, and in NSW 1 in 10 Aboriginal adults experienced food

insecurity in the previous 12 months, and are at a greater risk than other population groups

of poor health due to inadequate nutrition. Food and cooking programs do improve

knowledge and skills, whilst improving social inclusion.

The MDEW Program – Phase 2

The WNSW LHD Health Promotion Team has developed and funded the Marang Dhali

Eating Well (MDEW) Phase 2 project. It aims to build the capacity of Aboriginal Health

Workers (AHWs) to implement the MDEW healthy food and cooking program flexibly in their

communities, increasing participants’ food and cooking knowledge, skills and confidence,

thus supporting healthy food behaviours. The target audience was Aboriginal adults who

were the main food shoppers and cooks of the household. Communities at Condobolin,

Forbes, Peak Hill and Dubbo were selected based on need and interest in food security

matters. The implementation of the project had four main components:

professional development and capacity building of AHWs as MDEW

facilitators;

equipping facilitators with MDEW developed resources (manuals, ingredient

funds and materials) to

successfully and flexibly run, in partnership with local partners, two MDEW

healthy food and cooking programs in each of the 4 selected communities;

and

management of project operations under direction of the Project Organising

Committee (POC) – an overarching group with AHW representation.

Evaluating MDEW – Phase 2

An in-depth comprehensive evaluation took place using a pre-experimental design of pre-

post study, with a mixed method approach enabling triangulation to confirm some early

positive impacts of the project.

All the objectives, which fit under the above project components, were achieved in full and

generally to a high standard. The exceptions were where two communities ran only one

Program (due to facilitator time constraints and local competing priorities) and there was

difficulty eliciting details of any food security issues from participants (in order to gain a

better understanding of, in hindsight, a sensitive topic).

All main stakeholders (participants, partners and facilitators) appeared to have benefited

from the MDEW Program, and it made a difference.

Participants reported increased healthy food and cooking knowledge, skills and

confidence. They also reported statistically significant increases in the adoption of

two cooking options that were budget friendly (making meat dishes go further with

legumes or vegetables and using no-name brands) and having learnt new healthy

recipes. Stories confirmed facilitators together with partners made the Program an

enjoyable experience for participants, meeting their expectations as it had the

flexibility to be tailored to their interests and the setting where it took place. There


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was evidence of participants cooking MDEW recipes in their homes and relaying their

skills and knowledge onto their immediate social networks. They also reported

reduced social isolation with new friendships being built.

Facilitators reported an increased knowledge across the MDEW facilitator training

topics, yet confidence increased mostly with each MDEW Program session that was

delivered. Facilitators welcomed the contributions brought to the Program by partners

such as subject matter expertise, assistance with participant recruitment, new

learning and demonstration resources, and networking, to name a few. A need for

further facilitator nutrition training emerged, as well as time to practice recipes and

plan MDEW Programs.

Partnerships worked well generally and were deemed equally beneficial. It allowed

networking and strengthening of links with health services. It enabled partners to

become known and develop better links to the whole local Aboriginal community that

was brokered by facilitators. Partnerships further resulted in exposure to new clients,

access to venues, and more.

The WNSW LHD Health Promotion Team and the Program Organising Committee

structure with AHW representation functioned well. It demonstrated continual

consultation and program improvement being carried out, growing the 2011 pilot into

a well-established service. Arising issues and requirements have been addressed in

an informed and timely manner via this process.

Future MDEW should continue. AHWs are to keep playing their key roles as MDEW facilitators and

retain their representation on the POC to ensure continual consultation and program

development occurs effectively. Delivery of the Program to participants from community

settings ought to be prioritised as greater change in desired outcomes was observed in this

setting. Facilitators will benefit from further support in the form of an additional training

session allowing for more recipe practice and containing an added focus on carrying out pre-

Program planning tasks with their future partners. Furthermore a peer support system is

encouraged for facilitators, such as the introduction of a ‘buddy’ system which uses personal

experiences to help and support the newer facilitators.

Some aspirational directions MDEW may wish to explore are the use of social media to ease

MDEW related communications and make Program effects longer lasting in past

participants. MDEW may also wish to consider piloting a more regular program which

permits for new and past participants to continue benefiting from MDEW and the extended

linkages it creates.


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This report provides an overview of the implementation and evaluation of the second phase of Marang Dhali Eating Well Program, which has been conducted in four communities across Western NSW Local Health District.

Why Food Security? Australia’s Aboriginal people are among the most disadvantaged in the country and are

more likely to experience food insecurity than non-Aboriginal Australia, and are at a greater

risk than other population groups of poor health due to inadequate nutrition (Brown et al

2009; National Aboriginal and Torres Strait Islander Nutrition Working Party 2001). Food

security is defined as existing “when all people at all times have access to sufficient, safe,

nutritious food to maintain a healthy and active life” (WHO 1996). According to the New

South Wales Population Health Survey 2006 to 2009, just over 1 in 10 Aboriginal adults

experienced food insecurity in the previous 12 months (NSW Health 2009).

The importance of adequate nutrition cannot be overstated. A healthy and nutritious diet is

protective against a number of chronic diseases and obesity. Improving food security at a

population level requires a multi-level and multi-strategy approach that addresses each of

the World Health Organisation’s three food security pillars (food availability, food access and

food use). Nutrition education and cooking skills aimed at individual behaviour change need

to be supported by broader approaches that address the wider determinants of health and

the environment (Strategic Inter-Governmental Nutrition Alliance of the National Public

Health Partnership 2001). Interventions, such as food and cooking programs that focus on

developing individual knowledge and skills alone, have not been proven to impact on food

behaviour, choices and insecurity (Mello et al 2010). However, there is evidence that food

and cooking programs do improve knowledge and skills, whilst improving social inclusion

(Frankston Community Health Service 2004). Indeed, locally there is anecdotal evidence of

this within the former Macquarie Area Health Service from the successful Feeding the Family

Kit, an Aboriginal food and cooking program first implemented in 2002-2003 (Toogood 2002-

2003).

The four communities for piloting Marang Dhali Eating Well (MDEW) Phase 2 were selected

based on need and interest in food security. They have a relatively high Aboriginal

population density and are of varying distances from major service centres. Therefore it was

deemed important for health to link with new participants improving healthy cooking

knowledge and skills as well as reducing social isolation.

What is MDEW? MDEW is a food and cooking literacy program for Aboriginal and Torres Strait Islander

people, piloted in Western NSW Local Health District (WNSW LHD). It was implemented

through collaboration between WNSW LHD Health Promotion and Aboriginal Health and

local Aboriginal health staff. The local staff engaged local partners and the local Aboriginal

communities. It consists of three phases of implementation (see Figure 1). Phase 1 involved

the development and piloting in two communities of a cooking and nutrition manual, which

was based on the Quick Meals for Kooris program. It was developed by Healthy Kids

Association (HKA) in partnership with WNSW LHD Health Promotion Team and funded by

WNSW LHD Aboriginal Health Service and Health Promotion. Phase 2, which is being

evaluated here, was rebranded under a new name ‘Marang Dhali1 Eating Well’ which saw a

further development of the Program. The MDEW Phase 2 project was rolled out in the Phase

1 ‘Marang Dhali’ is the Wiradjuri language phrase for ‘eating well’. We acknowledge and thank Stanley Vernard “Stan” Grant Snr, AM, an Elder of the Wiradjuri Nation and Language Specialist of the Elders Council, for his advice and permission to use this phrase in the title of our Program.


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1 pilot communities of Condobolin and Peak Hill, and the two new communities of Dubbo

and Forbes, using a modified manual and healthy cooking program. It also included training

of Aboriginal Health Workers (AHW) as MDEW facilitators and provision of resources to

support the delivery of two Programs in each community supported by Aboriginal Maternal

and Infant Health Service (AMIHS) and Health Promotion funding. Phase 2 of the project

had a Project Organising Committee (POC) made up of Health Promotion staff and AHW

representation driving forward MDEW project activities.

Figure 1: MDEW project timeline and summary of phases.

MDEW Phase 2 aims to build the capacity of AHWs as facilitators to deliver the MDEW

Program flexibly in their communities and increase participants’ food and cooking

knowledge, skills and confidence, thus supporting healthy food behaviour. The target

population was Aboriginal adults, ideally the main meal provider of the household. The

project strategies focus on training AHWs to deliver the MDEW Program to participants

thereby increasing their healthy food knowledge and cooking skills (with partners and project

support available), and equipping participants with some of the materials (utensils, recipes

and tailored information resources) required to enable the newly learned cooking practices to

continue in their homes.

The project Phase 2 objectives were to:

1. Gain approval from the District and local level management for the use of staff and

resources, including funding, to enable MDEW Program Phase 2 to be implemented

in four communities by June 2013;

2. Build the capacity of the Aboriginal Health Workers and partners through training and

support to confidently plan, deliver and evaluate the MDEW Programs in four

communities of WNSW LHD by June 2013;

3. Develop positive working relationships between facilitators, existing or new partners

and Aboriginal communities to support the delivery of the MDEW Programs by June

2013;

4. Increase MDEW Program participant's food and cooking knowledge and skill-set in

the four communities by trained facilitators and partners delivering the MDEW

Program to be responsive to individual and community needs; and to

5. Identify broader food disadvantage issues during the delivery of MDEW Programs in

the participating Aboriginal communities by June 2013.

Phase 1

2010 - 2011

Development of cooking & nutrition manual by HKA, piloting in Condobolin and

Peak Hill, formative evaluation.

Phase 2

2011-2013

Literature review, AHW representation on POC, modification of manual, training of MDEW

facilitators, kitchen & participant kits, piloting in 4 communities, process and impact evaluation

Phase 2 Extension

2013 - 2015

Further Programs in same Phase 2 sites, piloting at new

sites, training of AHW trainees, AMIHS and other

staff & some partners


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The implementation of MDEW project Phase 2 involved four main components:

Professional development and facilitators’ skills training for AHWs, developed and

delivered by Health Promotion;

Establishing resources for facilitators and participants, with ongoing support for

facilitators from WNSW LHD Health Promotion Team;

Running local healthy food and cooking MDEW Programs for participants by the

trained MDEW facilitators and partners; and

Managing project operations under direction of the Project Organising Committee

(POC) – an overarching group with AHW representation.

Logic model The project logic model (Figure 2 overleaf) describes how the MDEW Phase 2 elements plan

to contribute to achieving the project’s aim and objectives. It considers the inputs and

activities through to the outputs and outcomes, illustrating sequential steps and connections

along the way. This planning tool is particularly important in highlighting the expected (and

possible) project effects at every level. It represents an extension to the list of objectives

(above), and describes the context of the project. MDEW focuses on only a small part of the

food security equation, and contributes to several wider District, State and National plans

and agreements and their sub targets outlined in the logic model’s long term outcomes. The

final column of the logic model contains long-term outcomes that are too aspirational for

MDEW alone (Figure 2). MDEW run by Health Promotion is only one of the many

collaborators and efforts required in achieving these positive health outcomes. Support

beyond health and broader approaches that address the wider determinants of health and

environment are needed to maximise effects and achieve the full long-term outcomes. This

is out of scope and does not feature in MDEW Phase 2.

Who is involved in the project? Phase 2 has been conducted in strategic partnerships between:

WNSW LHD Health Promotion Team (planning, funding, coordination,

implementation and evaluation);

Aboriginal Health Workers (advice as members of POC);

Aboriginal Health and AMIHS (funding and support);

Local participating site health management (release of staff);

Population Health (planning, research and evaluation);

District Executive (approval).

Operationally the main stakeholders in the four communities were:

Aboriginal Health Workers (facilitators in local Program delivery);

‘Partners’ (staff from local health services and community organisations who

supported the facilitators in delivering MDEW Programs);

‘Participants’ (invited Aboriginal people from selected communities taking part); and

Health Promotion Team (development, training, evaluation, funding, resource

distribution and support).


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Figure 2: MDEW logic model.


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Stakeholder map Figure 3: MDEW Phase 2 stakeholders and relationships.

MDEW facilitator training Facilitator training was provided to AHWs with an interest in nutrition and healthy food

behaviours, some with past experience of facilitating groups. The 2 day training was

delivered by Health Promotion staff and staff from Centre for Rural and Remote Education

(CRRE) on 15 & 16 September 2011 in Parkes. Twelve AHWs, from the four communities,

attended.

The MDEW Program Facilitator Training content focused on four key messages:

1. Eating healthy is good for lots of health problems

2. Cooking skills are a good way to encourage people to eat healthy

3. You as a AHW are capable of running a MDEW Program in your community

4. The trainers will support you to run MDEW in your community.

Training was structured around the MDEW manual Marang Dhali Eating Well: A practical

cooking and food program for Aboriginal communities. It provided guidance to facilitators on

how to plan and deliver interactive cooking sessions focusing on buying, storing and

preparing healthy affordable food.

MDEW was promoted as a flexible program to relay healthy food and cooking behaviours in

a choice of two main formats (participatory cooking vs demonstration style). The training

emphasized the ease with which the MDEW Program activities could be adapted to various

settings, participant needs, levels of experience and their interests.


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AHWs’ feedback about the training has been extremely positive. Overall, following training,

the greatest increase in knowledge was on food hygiene, storage and safety, followed by

increases across the confidence categories (Figure 4). Areas where facilitators reported

little increase in knowledge were still seen as useful ‘reinforcement’ which further increased

their confidence.

Figure 4: AHW self-reported improved knowledge and perceived increased confidence following training.

All facilitators enjoyed the training sessions, with the majority (83%) indicating that MDEW

Programs would likely be well received by their communities. Their comments about the

MDEW training suggest it was well structured, well presented by the trainers, and backed

with a supportive, clearly written, and easy to understand MDEW Manual.

The Health Promotion Team immediately began constructing and assembling an electronic

resources support pack for facilitators known as the e-pack (or Marang Dhali Eating Well

Facilitator’s Package), which was an unanticipated need identified during the facilitator

training. It contained specific information and guides to further support Program

implementation.

MDEW Food and Cooking Programs The ‘MDEW Food and Cooking Programs’ (from here on referred to as MDEW Program or

Program) were delivered in each of the four communities by MDEW facilitators with the help

of suitably identified partners. Before starting a Program facilitators were encouraged to hold

a planning day with their partners to map out how the Program would be run. This would

also provide partners with an overview of the MDEW Program. A MDEW Program was to

include 4-6 consecutive weekly sessions. The key aspects of MDEW Programs were:

1. Demonstration and practice of use of simple recipes and healthy ways to cook; 2. Provision of hints about best shopping practices; 3. Demonstration of safe food preparation and food storage practices; 4. Meal planning; and 5. Food budgeting by using cheaper food alternatives.

0% 10% 20% 30% 40% 50% 60% 70% 80%

Knowledge of working with groups

Knowledge of food hygiene, storage andsafety

Knowledge of food for healthy and activefamilies

Knowledge of budget shopping

Confidence in presenting information

Confidence in delivering healthy eatinginformation

Confidence in delivering cookingdemonstrations

Proportion of facilitators reporting an increase following training


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The cooking sessions could be delivered

either as a cooking demonstration by

facilitators or participatory cooking where

participants were directly involved in the

cooking and tasting activities. Each MDEW

Program also decided on which types of meals

and recipes that were selected as long as the

Program content was covered and key

messages were relayed to participants.

‘MDEW Kitchen Kits’ were provided which

enabled the Program activities to proceed

(Figure 5). A budget for cooking ingredients

was made available at local supermarkets.

Participants received ‘Participant Packs’

(Figure 6) at a time during the delivery of the

Program determined by the MDEW facilitators.

These packs enable the implementation of

their newly acquired skills in the home.

How was MDEW evaluated? A comprehensive evaluation was carried out for Phase 2 (see Figure 1 boxed components,

and Appendix A Evaluation Framework). Its aim was to assess the impact of MDEW Phase

2 and to determine if the objectives were being achieved. This process and impact

evaluation was considered a quality improvement activity and part of the core business for

the effective ongoing delivery of this health promotion program.

The evaluation had a pre-experimental design, using a rigorous and extensive mixed method

approach. MDEW facilitators, partners, participants and trainers were all involved.

Information was collected at baseline, final session and 2 months post Program through self-

assessed paper-based evaluations (questionnaires), semi-structured face-to-face interviews

or focus groups and telephone interviews involving the stakeholder groups (Appendix A).

The focus groups and interviews used a specifically developed semi-structured script,

guided by the work of Diana Eades (1982), a linguistic researcher, for the purpose of using

Aboriginal communication approaches. To arrive at stories, this method steered away from

utilising direct questioning styles and interrogation formats. It enabled comfortable two way

interaction and respectful encouragement of sharing of information by Aboriginal

stakeholders involved in MDEW Programs.

Participant baseline and post-Program questionnaire responses were analysed using

Mantel-Haenzel chi-square test and Fisher’s exact tests as appropriate (SAS Enterprise

Guide 5.2). Due to two Programs recruiting from outside the intended target population of

people who shopped and cooked for their families, results had to be stratified and further

inferential statistics were not carried out. The data was stratified according to baseline

participant characteristics creating two strata: participants from Programs run in community

settings who tended to be the main food shoppers and cooks of the family, and participants

from Programs run in school settings who were past or current teenage students with little or

no prior involvement in family food provision.

Narrative data was analysed manually. The cut and sort method of thematic analysis was

used (Ryan & Bernard 2003).

Figure 6: Participant Pack.

Figure 5: Kitchen Kit.


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Results Against the objectives

Data quality and interpretation Quantitative analyses of pre and post MDEW Program questionnaire responses (see Figure

7a-j) together with qualitative thematic analyses of the narratives have enabled the

assessment of the performance of MDEW. Process and impact evaluation results are

reported against their relevant project objectives below. Additional impact evaluation results

identified in the outcomes section of the logic model (Figure 2) are also described under their

relevant objectives.

Data quality was mainly affected by small sample sizes following stratification. Some direct

questioning occurred during the narratives instead of only using the Eades’ recommended

communication approaches which may have limited the range of information obtained and its

depth. The following results and their interpretations were arrived at due to observed

patterns appearing to be consistent when cross-checked against the stories. Consistency of

results can provide powerful evidence of success and insights into the processes of

observed change.

Performance against the project’s objectives is assessed using the original Renaissance

model, a scale which introduces the least bias and consistently demonstrates inter assessor

reliability/agreement. The scale describes three levels of performance: “3” = measure or

target fully achieved, “2” = partially achieved, and “1” = measure or target not met.

Objective 1: Approval from the District and local management for the use of staff and resources, including funding, to enable MDEW Phase 2 to be implemented in four communities by June 2013.

Measure/target Actual Rating All appropriate management and financial support at the District and local level to implement MDEW Program is gained.

Appropriate sign off received from stakeholders. Authorisation for implementation received. Funding identified and allocated.

3

3

3

3 = yes, fully met, 2 = yes, in part, 1 = no, not met, DK = don’t know /not applicable

Local health service managers were very supportive in releasing AHWs to undertake MDEW

Facilitator training and deliver up to six MDEW Programs successfully across the four

selected communities.


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Objective 2: Build the capacity of the Aboriginal Health Workers and partners

through training and support to confidently plan, deliver and evaluate the

MDEW Programs in four communities of WNSW LHD by June 2013.

Measure/target Actual Rating Modification of MDEW Program Manual. Assembly of MDEW Program resource support folder. Distribution of tools to all facilitators.

Updated, user friendly MDEW Program manual available. E-pack resource support materials assembled and sent to facilitators. (100%)

3

3

Recruitment and training of 12 AHWs as MDEW Program facilitators across the four locations.

Training package developed and delivered. 12 AHWs recruited and trained across the four locations.

3 3 3

Facilitators understand their roles and are confident in planning, delivering and evaluating their MDEW Programs.

100% response rate on baseline and post-training facilitator evaluations. 9/12 facilitators ran MDEW Programs. 6/8 MDEW Programs run. 1/6 pre-Program planning meetings with partners occurred. Facilitators evaluated 5/6 MDEW Programs.

3

2 2 2

2 Facilitator confidence increased by at least 50% (post training).

58% of facilitators reported an increase in confidence in relation to delivering MDEW Program in their communities immediately post training (Figure 4). Confidence grew further following delivery of a second Program.

3

100% of communities are provided with cooking resources.

All communities were equipped with complete functioning ‘MDEW Kitchen Kits’, MDEW Program resources and had access to ingredient supplies via local supermarket credits. (100%)

3


Following training facilitators were positive about the MDEW Program. Facilitators generally

agreed on the value of a food and cooking program for the local Aboriginal community. They

thought it was well structured, and generally agreed that the Program and its resources,

particularly the MDEW Manual, were an improvement on earlier phases.

‘We’ve learnt more from this Program than we have from other programs we have run before.’

‘If I had to run a session, I would. If they asked me a question, I would use the resources to

get back to them with the answer….. because the resource has everything in it.’

They especially valued the MDEW Program’s flexibility:

‘That’s the beauty of the Program, isn’t it; like that it is not regimented. Yes, the flexibility of it

is fantastic.’

A partner agreed that it could be modified to meet the needs of the community:

‘You can tailor the Program to suit your target group…..the target group for the first Program

is completely different to the next group.’

Nine out of 12 trained facilitators ran Programs, six proceeded to run a second Program

during Phase 2. The latter benefited most in terms of increased confidence in running

MDEW Programs, though most facilitators reported increased confidence midway through

their first Programs.

‘If I did it again it would be easier.’


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Facilitators were able to confidently adapt the flexible MDEW Program to their participants’

desires and interests, thereby adding to the enjoyment of delivering the Program. They

demonstrated flexibility and resourcefulness.

‘In the second week they started asking about different recipes, they wanted apple crumble,

and we made that.’

‘We made the Kangaroo stroganoff. The clients wanted it and the dietician brought along the recipe.’

‘It’s difficult to plan exactly what ingredients to be used on the day. For example, one day

broccoli was an exorbitant price and so I used frozen instead.’

Facilitators were effective at planning and delivering MDEW Programs. However partners

and facilitators acknowledged the significant input that was required prior to delivery of the

Program. Some facilitators said other tasks outside of sessions were ‘time consuming’, such

as shopping for ingredients, providing transport and reminding participants the morning of

the Program.

‘go around on the morning of the sessions and remind each of the participants. I wouldn’t

always have time …. because it would take time to pack the cook ing equipment into the car and … to get the food and by that time it was 10.30. ’

Partners from a couple of Programs mentioned that if more planning or practising of recipes

had occurred prior to Program delivery, it would be more organised. This reinforced the

importance of holding a pre-Program planning meeting with partners, which only occurred for

one of the six Programs.

Participant feedback was very positive:

all enjoyed the MDEW Programs;

agreed that the Program covered what they wanted to learn;

found the venues provided a good learning environment;

considered the timing (mostly mornings) suitable and allowed sampling of

dishes/meal sharing at lunchtime;

felt they could ask their facilitators questions; and

most participants acknowledged that their questions were answered.

The perceived lack of confidence experienced by facilitators (specifically in relation to

‘teaching’ and answering ‘nutrition questions and that’) was not apparent to participants.

Participants noted that in the event of facilitators not knowing an answer, the question would

be answered satisfactorily at the following session. One participant saw the facilitators of

their Program as: ‘Little knowledge books, these guys…. They’ve been our backbone.’

Facilitators mostly complied with the MDEW Program evaluation requirements although the

quantity that needed to be completed was considered challenging by most stakeholders.

‘getting that together was difficult.’

Facilitators did appreciate the usefulness of information collected from participant surveys in

planning their MDEW Programs. At project level, survey data was received and analysed for

five out of the six MDEW Programs, although participant narratives covered all six delivered

Programs. These provided valuable knowledge where survey information was not available.


Page 19 of 36

Objective 3: Develop positive working relationships between facilitators and

existing or new partners and Aboriginal community to support the delivery of

the MDEW Programs by June 2013.

Measure/target Actual Rating

Each Program has engaged appropriate partners to plan and deliver MDEW.

All facilitators had identified partners with whom to jointly deliver MDEW Programs. 1/6 Programs held a planning day with partners. 6/6 partners engaged with MDEW Programs.

3

2

3

80% of local MDEW Program partnerships are assessed as being positive.

Local MDEW Program partnerships worked well, 5/6 (83%) Programs had very positive partnerships with one Program having partners express some concern.

3

100% of MDEW facilitators are supported.

LHD trainer support was available to all facilitators. A dedicated Health Promotion Team phone number was provided for queries and questions which facilitators made use of. Several reports from facilitators/partners expressed a desire for more support, particularly in the area of pre-Program organisation and planning.

3


Overall suitable partnerships were developed which worked well, appearing equally

beneficial to facilitators as well as to the partners (Box 1). Partners were typically members

of, or those working within, the communities. They included renal and community health

dietitians, community health nurses, a school home economics teacher, family support

workers, local church workers, a volunteer from an earlier Program, a neighbourhood centre

support worker and Indigenous social inclusion staff.

Box 1: Summary of partnership benefits. Facilitators benefited from

assistance with participant recruitment due to new and direct links to potential target groups which some partners provided

partners possessing and sharing subject matter expertise and being able to answer the more technical nutrition and health information questions

partner access to venues, childcare and/or transport which had a positive effect on participant attendance

introduction of new resources particularly visual aids and games which were helpful in obtaining greater participant engagement

working with different groups in the local Aboriginal community networking

Partners benefited from strengthening links with health services

becoming known and developing links to the local Aboriginal community that facilitators brokered

exposure to new clients they normally would not come into contact with, increasing participant access to health services

gaining a better rapport with their Aboriginal client population thanks to being involved with MDEW

AHW cultural knowledge

content and format of MDEW Program which complimented other existing programs being run by partners, describing partnerships as a good fit

networking


Page 20 of 36

Participants and partners noted the welcoming environment that facilitators created and that

this encouraged engagement and built relationships between and within all stakeholder

groups.

‘I felt comfortable with the place and people.’

Partner involvement was committed and most were willing to be involved in future Programs:

‘They [partners] were fighting over who got to go. They were playing ‘Paper, scissors, rock’ to

come aboard……. They were very keen.’

Facilitators found the partnerships non-interfering and supportive in advice and assistance received when needed, particularly in relation to delivery of nutrition and health information. In some Programs, facilitators took a leadership role in the delivery of the MDEW Programs with partners providing background support. In others, partners had a significant input in the earlier MDEW Programs until confidence grew in the more inexperienced facilitators. Objective 4: Increase MDEW Program participant’s food and cooking

knowledge and skill-set in the four communities by trained facilitators and partners delivering the MDEW Program to be responsive to individual and community needs.

Measure/target Actual Rating MDEW Program is delivered twice in each community [100%].

MDEW Program was delivered twice in 2 communities and once in the remaining 2 communities. [6/8, 75%]

2

Participant packs received by all participants. All participant packs were handed out to participants, sometimes at the end of the Program as an attendance incentive.

3

Evidence of participant input into Program delivery.

Facilitators developed and adjusted local MDEW Programs in response to participant needs, interests and requests. 65% of participants reported having had a say about recipes (Figure 7j).

3

3

80% of participants self-report having learned new cooking skills by the end of the Program.

96% reporting having learned new cooking skills (Figure 7j).

3

Participants attend 80% of the MDEW Program (as delivered in their community).

Where attendance records were available participants attended 85% of the MDEW Program. Participant retention rate was estimated at being at least 60% at the final session and up to 70% at 2 month follow-up based on returned surveys (Figure 7a).

3


Overall MDEW Participant results Six out of eight Programs ran in Phase 2. Facilitators from two communities did not fit in a

second Program due to local competing priorities and strain of heavy AHW caseloads. Most

Programs were 4 weeks in duration although a 5 week and a 7 week Program were also run.

The results are largely based on the five MDEW Programs which returned questionnaire and

final session evaluation data, representing a total of 43 participants at baseline and 30 at 2

month follow up post Program. Program size varied from 4 to 15 participants per group at


Page 21 of 36

baseline (Figure 7a). A wide range of strategies were used to recruit participants, which all

worked well.

Participants were asked questions about food shopping, cooking and their expectations of

the Program at baseline and again at 2 month follow up post Program. Overall results show

that all participants enjoyed the Programs and MDEW delivered statistically significant

differences to participants in two areas: using two cooking options that were budget friendly

and meeting and exceeding certain Program expectations. Participants were significantly

more likely to make meat dishes go further by adding legumes and vegetables (OR 3.6,

p<0.05) and to use ‘no name’ brands to replace market brands (OR 3.2, p<0.05) (Figure 7h).

Of practical significance, there was a 17% increase in use of eggs as a cost effective

substitute for meat. Expectations were significantly exceeded in the area of learning new

healthy recipes (OR 3.3, p<0.05) (Figure 7b). Chatting to and meeting new people in

participants’ communities also exceeded participant expectations recording an increase in

excess of 10%.

Stratified MDEW Participant results Two of the Programs were carried out in school settings which were larger (approx. 12-15

participants per Program) and had younger participants, aged <20yrs (Figure 7a: Programs

‘D’ and ‘E’). One of these was successful in involving girls who had already left school. The

remaining three Programs took place in community settings where group size was around 6

participants, all were female and aged 20+ years (Figure 7a, 7c, 7d).

Figure 7: MDEW Program participant characteristics and survey results comparing baseline with 2 month follow

up post Program.

(a) Participant registration and retention, MDEW Phase 2

No survey data was available for one Program. Programs A, B and C were run in community settings. Programs D and E were run in school settings. At baseline there were 43 participants in total (community setting = 16, school setting = 27), and 30 participants at 2 month follow up post Program (community setting = 12, school setting = 18 participants).

(b) What participants hoped to and learnt with MDEW

Learning new recipes has surpassed expectations of participants from Programs run across both settings. Participant desired MDEW Program outcomes were largely met by participants from school settings. Some participants from community settings reported not learning the skills/knowledge hoped to at the outset of the Program.

0

2

4

6

8

10

12

14

16

A B C D E

Nu

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ipan

ts

MDEW Program

Baseline (survey)

Final session (survey)

Post Program (2 month followup survey)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

improve/learn

new cookingskills

improve/learn

good foodbudgeting skills

chat and meet

people in mycommunity

learn new

recipes

community setting community settingschool setting school setting


Page 22 of 36

(c) Age disribution of MDEW participants

All participants aged <20yrs were from school settings, and those aged 20+ yrs were all from Programs run in community settings.

(d) Overall sex distribution of MDEW participants

Note: Males were all participants aged <20yrs, from Programs run in school based settings.

(e) Main food shoppers and/or main cooks in their

households, by setting, prior and post Program

School setting participants were significantly less involved in the provision of food and evening meals to households than participants from Programs run in community settings.

(f) Average frequency of particpants cooking evening

meals, by setting, prior and post Program

School setting participants cooked less frequently than participants from Programs in community settings. There was a shift towards increased frequencies of cooking in the latter.

(g) Participant confidence in cooking an evening meal, by

setting, prior and post Program

Participants from the community setting had a greater increase in confidence following MDEW than those in the school setting.

(h) Participants using the following food budgeting

options, by setting, prior and post Program

Both settings showed increases in using powdered milk, stretching meat dishes, substituting eggs and using ‘no

name’ brands, but more community setting participants used

these budgeting strategies.

62% 19%

5%

11%

3%

<20yrs

20-34yrs

35-49yrs

50-65yrs

>65yrs

Male, 15%

Female, 85%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Main food supplier Main cook

communitysetting baseline

communitysetting post

school settingbaseline

school settingpost

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Every day 5 - 6 times

a week

3 - 4 times

a week

1 - 2 times

a week

Hardly ever

community setting

community setting

school setting

school setting

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

unsure/notconfident

confident very confident

community setting

community setting

school setting

school setting

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

powdered milk

instead of fresh

stretch meat

dishes withlegumes or veg

substitute eggs

for meat

use 'no brand'

names

community setting

community setting

school setting

school setting


Page 23 of 36

(i) Percentage of participants who prepare or serve the following evening meal options, by setting, prior and post

Program

Overall increases of practical significance (>10%) were recorded in the ‘casseroles or stews’,‘stir fry’, ‘pasta/noodle’ and ‘rice dishes’, and ‘cold sandwiches or salads’ meal options for the community setting participants. The decline in meat dishes with vegetables reflects the adoption of the other new alternative meal types introduced via MDEW. Participants from school settings reported largest decreases in the use of ‘frozen meals’ and ‘meals using prepared ingredients’ post Program, otherwise there was little change observed in this setting.

(j) Participant evaluation responses, by setting, at final Program session

Evaluation responses and comments were very positive. Participants from the two settings had different exposures to cooking and food experiences prior to the MDEW Programs, for example more participants in the school setting (who had relatively limited cooking experiences compared to other participants) learnt more new cooking skills and food safety information, whilst the community setting participants who had the role/responsibility and behaviour of being main food shopper and cook, went on to try the recipes at home more and use them again following the MDEW Program.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mea

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ken

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ith

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ls

community setting community setting

school setting school setting

50% 60% 70% 80% 90% 100%

Venue suitable

Enjoyed MDEW

Could ask questions

Questions were answered

MDEW expectations met

Learnt new cooking skills

Learnt food safety information

More aware of food affecting health

Liked the recipes the group prepared

Deemed recipes appropriate

Had a say about recipes used in Program

Tried new recipes at home

Will use recipes again in future

Recommend MDEW to others

Interested in assisting with future Programs

community setting participants school setting participants


Page 24 of 36

Participants from the Programs run in community settings were the main food shoppers for

the household and also largely the main cooks (94% and 75% respectively vs 7% and 18%

reported by participants from school settings [Figure 7e]). The former cooked at least 3 times

per week at baseline with frequency increasing further after the Programs. This pattern was

not seen in the school setting participants (Figure 7f). The stratified descriptive analysis

shows that MDEW performs differently in a school setting, highlighting some setting specific

issues. Participants from school settings who were generally less experienced around food

and cooking at baseline, had the greatest gains in knowledge and skills at the 2 month

follow-up. However participants from community settings proceeded to demonstrate most

change after having completed a Program. As well as their frequency of cooking increasing

further there was a larger shift towards trying new, healthy alternatives to meats and

vegetable dishes with increases in stews, noodle and rice dishes, stir fries and salads being

prepared; and community setting participants reported having tried the recipes at home

more; and were more inclined to using the recipes again in the future. This analysis provides

valuable additional project feedback which may have implications towards prioritising certain

settings over others in future Program roll outs.

Participant packs (Figure 6) were well received by participants. The contents were deemed

really useful by participants, the equipment as well as the cookbooks.

‘We got our equipment, cooked up a storm for our k ids.’

‘I always wanted a measuring spoon. Bowls and containers are expensive to buy. Mum

wanted them, but I wanted to keep these for when I move.’

‘Especially the muffin trays, I learned to make muffins, I didn’t realise that they were so easy. I

make them now for the k ids after school.’

There is good evidence that participants had input into the delivery of MDEW (Figure 7j).

This was mostly in the Programs in the community setting in the form of recipe suggestions,

menu planning and requests for health information topics.

‘yes we had choices: we could bring in our own recipes or use the recipe books.’

Ninety six per cent of participants reported learning new cooking skills at the end of the

Programs (Figure 7j). This figure fell slightly at the 2 month post Program follow-up mark

(Figure 7b).

Participants mostly appreciated the cooking skills, meal planning and nutrition knowledge

components of the Program.

‘We’re a little group of “Master Chefs”.’

‘Nah! Healthier cooks.’

Many felt that they were not only learning or improving their cooking skills, but at the same

time, they were gaining an understanding of meal preparation and food safety that could

potentially improve the health of themselves and their families.

‘I learnt a lot about nutrition.’

‘I have cut back on the salt and the butter because they are bad for high blood pressure.’

‘food storage, we learnt about that, how to store your food in the fridge and handle it

hygienically to make sure it doesn’t go off, food poisoning or anything like that.’


Page 25 of 36

There were numerous realisations that healthier recipes could taste good, be cheaper and

that you did not have to purchase the most expensive brands to get good quality.

‘My stepfather likes what I cooked; he said the fish cakes were better than the ones in the shop. We normally buy the frozen ones and I think you get 4 for $6. But the fresh home-made

ones are better and you can get 12 to 14 from a mixture.’

These packs of pizza bases are $4 for 16 bases and then all you need to do is buy your

toppings’ and ‘I have the pizzas now for the k ids’ afternoon tea rather than junk food and the

k ids love it.’

The Programs were successful in getting 80% of participants from community settings and

64% participants from school based settings to try new recipes at home. All participants from

community settings and 82% of participants from school based settings were committed to

using the recipes again in the future (Figure 7j). Participants talked about how this had a

wider impact on their family.

‘It is like a snowball effect….We have taken it home to our family and you have taught me

and I am one of 5 so that information is passed onto 5 people not just one. My daughters’

girlfriends wanted to cook muffins so off they went and got the book and cooked them. So

now they have passed the information onto their friends.’

Facilitators and partners saw that the MDEW Program was making a difference in participant

confidence. Their confidence in cooking evening meals increased fairly consistently across

both settings (Figure 7g).

‘They got more confident as the weeks rolled by with the equipment.

When they first started [they said],

‘What is this one like the

measurement, what is this and

that?’ But by the end they knew.’

‘One of the older ladies had no

confidence and she was just so shy.

It was her husband that said we

cook out of the cookbook all the

time now.’

Objective 5: Identify broader food disadvantage issues during the delivery of MDEW Programs in the participating Aboriginal communities by June 2013. Measure/target Actual Rating

Completed food security issues logs from all MDEW Programs.

4/6 MDEW Programs completed and returned Food Issues Logs.

2

Identification of local food disadvantage issues.

Exploration of local food disadvantage issues was carried out in narratives.

2


Figure 8: Condobolin MDEW participants from a

Program run in a school based setting.


Page 26 of 36

No food availability issues were noted in the largest town. The returned Food Issues Logs

contained information related to food availability issues experienced by facilitators in the

more isolated communities, not that experienced by participants. It is very likely that these

same issues would also be faced by the people living in those communities. The narratives

explored this topic further, though limited information was elicited. There was some

discomfort associated with discussing food insecurity.

Foods in smaller communities were often not the ‘freshest produce’ nor of good quality, and

the higher fresh food costs were also an issue. To circumvent these issues strategies such

as replacing fresh foods with frozen, dried and canned equivalents were used, as well as

grocery shopping in larger towns.

Beyond the objectives Facilitator and Partner views Facilitators and partners felt the MDEW Program was a good fit in regard to other services

being run in their communities. It was seen as a tool which can complement and support the

delivery of other local programs.

‘…..it fits in well with our chronic disease and for us to be able to offer….the cooking Program

as well as the exercise program that is great for us.’

A partner in another community found the partnership with the MDEW Program useful as

they:

‘….. wanted Community Health to do something around the Healthy Lifestyle component of

the Program I was running. ……..It was nice and simple and worked in well with the theory

that we were running.’

Partners from more than one community identified the need for the Program to be ongoing

providing participants a ‘refresher’ ‘6 months down the track’ as a follow-up, further

supporting lifestyle changes, ‘changing habits.’

Overwhelmingly facilitators expressed a desire to learn more about nutrition and be better

informed.

‘They are going to have nutrition training coming up soon, this program, aren’t they? I would

like to learn more about that.’ ……‘Yes, I would like to know more about nutrition.’

‘It has been quite a while since AHEOs [Aboriginal Health Education Officers] have done any k ind of formal training with nutrition. So that we can actually present stuff ourselves.’


Page 27 of 36

Participants’ comments Participants liked the participatory approach of all Programs and the value of experiential

learning. They also felt that facilitators created atmospheres where one could ask questions

(open and inclusive) about health and nutrition.

‘It was just a fun and friendly

environment too and with the

k itchen and stuff. You weren’t

made to feel like what you were already doing is wrong. You

were made to feel that we were

all learning together. You didn’t

get sat down and pointed the

finger at. We would sit down at the start and have a chat, but as

we were cook ing and doing stuff

that is when the questions and

talk ing would happen.’

There was evidence of MDEW Programs reducing social isolation, with friendships and close

bonds developing between some group members.

‘It got me out of the house. I enjoyed socialising and learning different recipes. I got to know the girls a bit more.’

‘We have become really good friends too through it. If the next group gets even a small part of

what we got out of it then it’s a 100% worthwhile doing it.’

MDEW – why it matters? The in-depth evaluation activities were well planned and mostly occurred in a timely manner

throughout MDEW Phase 2 stages. Using an appropriate mix of methods which permitted

triangulation to occur meant that findings and patterns, despite their data quality limitations,

were reaffirmed and valuable information was gained where gaps in quantitative data

existed. It was possible to assess the project against its objectives and outcomes, deeming it

successful.

Professional development component MDEW Phase 2 was successful in building capacity of AHWs as facilitators to deliver the

MDEW Program flexibly in their communities. ‘The development of sustainable skills,

harnessing the required organisational structures, resources and commitment to health

improvement, to prolong and multiply health gains many times over', as described by Hawe

et al 2001, is being achieved.

Facilitators increased in confidence the more sessions they delivered. They were highly

regarded and respected by participants who were very satisfied with their performance . A

feedback mechanism for relaying this back to facilitators is required to enable positive

reinforcement to increase confidence delivering a drive and desire to deliver more Programs.

Some facilitators reported they needed to be better equipped with more nutritional

knowledge and also suggested they needed more [recipe] practice prior to delivering

Programs. This was echoed by some partners, who also requested more planning occur

before Programs. This is a current gap.

Figure 9: Dubbo MDEW participants from an Elders Group

Program run in a community setting.


Page 28 of 36

The format and content of MDEW and the facilitator training empowered facilitators to take

leadership in engaging local partners to assist in delivering MDEW Programs. Having local

knowledge, creating positive partnerships, recruiting participants, and being in charge of all

local organisational aspects of MDEW demonstrated a high level of AHW competency in

program management, placing them perfectly in the key MDEW facilitator role.

Running local MDEW healthy food and cooking Programs Two out of eight planned Programs were not run. This compares favourably to an evaluation

carried out on uptake and delivery of ‘Quick Meals for Koori’ cooking programs where three

out of four respondents did not run programs (Gui & Lau 2007). Similar reasons were

observed such as lack of time and other projects being more pertinent. Gui and Lau reported

that respondents did not see the relevance of the program in their area of work, whilst

MDEW facilitators and partners who ran Programs recognised MDEW to be a good fit,

complimenting existing services.

Indeed flexibility was a key theme that led to the success of the MDEW Program together

with AHWs as the facilitators. It enabled:

Programs to be run with a range of partners from facilitators’ local communities;

Target groups and participant numbers to vary;

Use of delivery modes that best suited participants;

Adaptation of Programs in response to input from participants and partners; and

Number of sessions to vary as well as Programs adapting to venues.

MDEW Programs were very well received by participants. This was demonstrated by the

excellent feedback received via surveys, final session evaluations and narratives.

Although survey data was inconclusive in ascertaining whether there had been a shift

towards preparing or serving healthy meals, the stories confirmed this change was taking

place in several households. Data from Programs run in community settings supported

increases in the number of home cooked meals, perhaps due to increased confidence which

appeared to follow a similar pattern. These participants were also more likely to have tried

the recipes at home, were more committed to using them again in the future, benefited from

reduced social isolation, and increased links with health and other partner services than

participants from Programs run in school settings.

Most participants regardless of setting gained new cooking skills, learnt new recipes and

about food safety, how food affects health, and practical tips on food budgeting. A

statistically significant proportion of participants have adopted cooking options that were

budget friendly following completion of MDEW Programs.

MDEW Phase 2 succeeded as a food education program across both settings. Its aim of

supporting healthy food behaviour changes was noticed primarily in the participants from

Programs run in community settings. As MDEW tends to yield greater short-term benefits

when run in community settings, resource allocation for future MDEW Programs ought to

prioritise this setting.

Common barriers of many health promotion programs are the logistics: availability of

appropriate venues, provision of transport and child-minding facilities to enable participants

to attend and take part. MDEW has provided these and experienced high attendance rates.

A more established program with identical aims called ‘Koori Community Kitchen’ reported

similar challenges and successes as MDEW (Malie & Robertson 2011). The program was

established long before MDEW, uses one fixed venue, has developed its own recipe book,


Page 29 of 36

delivered similar activities on a weekly basis, and more recently expanded to include a

community garden. It may be interesting to learn from their experiences and that of others,

together with local consultation, in shaping future directions of MDEW.

Managing project operations and establishing resources

There were anecdotal reports of improvement in MDEW project management activities and

communication following the formation of the POC with AHW representation. Having AHWs

on the committee provided direct, timely feedback which facilitated an Action Research

approach to project management. This enabled a more fluid two way communication

between planning and implementation, and a collaborative way of problem-solving issues as

and when they arose.

Informal observations also highlighted some MDEW challenges which occurred from a

project management perspective. Capturing the smallest nuances and measuring impacts

arising from MDEW Programs through the qualitative evaluation methods was more

resource intensive than anticipated (particularly the transcriptions and analyses). The

evaluation data issues may have been overcome had there been more systematic follow up

of questionnaires and feedback from facilitators. Project support may want to build in an

additional check prior to facilitators running a Program to ensure partner planning meetings

have taken place before a new Program begins. This will assist Programs having a smoother

start through partners and facilitators having a better understanding of each other’s delivery

modes, roles and division of tasks. The POC and a certain level of project support therefore

need to remain in place throughout the life span of MDEW in order to oversee and maintain

activities (estimated at 0.3FTE, or greater, if the project enters a new development phase).

Conclusion The information collected showed that MDEW strongly achieved its objectives scoring ‘3’

against most measures. It also reported early successful outcomes of the Program. Process

evaluation determined that MDEW project implementation activities occurred and their

outputs (trained facilitators, MDEW Manuals, e-packs, Participants packs, Kitchen Kits, and

delivered Programs) were generally created to a high standard. The evaluation found that

the Program was well structured, yet flexible enough to accommodate the local needs of the

participants and available resources. MDEW Programs were well attended with a high

retention rate and were culturally appropriate. All stakeholders appeared to benefit from

involvement in MDEW. There were clear signs of progress towards the ultimate aim of

supporting healthy food behaviour, despite addressing only one pillar of the food insecurity

equation. Furthermore, MDEW has been a valuable community engagement tool, creating

numerous links between Aboriginal people and other health and partner services, and

reducing social isolation.

MDEW today (2013 – 2015) Since the MDEW Phase 2 in-depth evaluation, the project was extended and it has grown to deliver more MDEW Programs across a variety of communities by an increased number of trained facilitators. Still operational today, Box 2 summarises the current format of MDEW and highlights some changes that were made in response to the in-depth evaluation and ongoing project monitoring, analysis and redesign.


Page 30 of 36

The current iteration has addressed many issues identified at the time of the evaluation. The

areas that required strengthening which appear to have been met through the Program

iterations were:

the need for suitable information handouts for participants on commonly raised topics

(particularly nutrition and chronic care);

the need for further nutritional training for facilitators;

a reduction in the burden of reporting, the ‘paperwork’;

an increase in support for facilitators; and

a decreased reliance on Kitchen Kits (which were reported to be bulky, heavy and

cumbersome to use) in favour for accessing venues already equipped with suitable

cooking equipment.

The future MDEW has clearly advanced from its pilot stage in Phase 2 and has continued to train new

MDEW facilitators who are delivering MDEW Programs in an increasing number of

communities across WNSW LHD. Health Promotion have continued to fund and to project

manage MDEW activities (including performance improvement) turning the pilot project from

2011, into today’s well-established service.

Recognising that several modifications made along the way have addressed issues

identified via the in-depth evaluation, the list of recommendations which follows outlines only

those that presently apply.

Box 2: MDEW Phase 2 extension: 2013 – 2015 MDEW facilitator resources

Manual finalised, facilitators’ e-pack reviewed and updated, and new set of forms adapted for teenage student audience.

CD of Aboriginal specific nutrition resources and Chronic Care facts sheets developed.

Fewer Kitchen Kits needed, some venues contain required equipment. Participant packs

Resources in packs have been scaled back. Initial budget for packs was excessive.

MDEW facilitator training

TAFE nutrition course organised and funded. Nutrition now included as a core subject in TAFE AHW Traineeship. More AHWs trained, including AMIHS workers, AHW Trainees and some

partners. Presentation Skills training (Day 2 of MDEW facilitator training) has stopped.

MDEW Programs Continue to be funded by WNSW LHD Health Promotion Team.

More Programs run in more communities (26 Programs, across 10 communities from Bourke to Bathurst, with over 120 participants).

Program monitoring & improvement

‘Sharing Day’ held to bring facilitators together to share experiences.

MDEW champions introduced to increase support for the Program.

Reports back of positive unintended consequences from partnerships. Participant feedback shortened and reduced to one Program Review filled out

by facilitators at the end of the Program consolidating participant feedback and facilitator reflections.

Staff turnover is an issue, mainly arising with trainees and normal staff changes such as new roles and retirements, and work priorities.


Page 31 of 36

Recommendations 1. Keep running MDEW, it makes a real difference.

2. Retain AHWs as MDEW facilitators and their representation on the POC. They

play a pivotal role.

3. Prioritise Programs in community settings when resources are scarce in order to

maximise the benefits in participant outcomes.

4. Further increase facilitator support prior to and during delivery of Programs

through introducing2:

a. Ongoing nutrition training for new facilitators without previous training

b. A second facilitator training session devoted to a broader strategy for

planning, particularly pre-Program planning with partners and practicing

recipes prior to commencing a Program

c. Peer support for facilitators, such as a ‘buddy’ system which uses

personal experiences to help and support the newer facilitators.

5. Local health managers should continue to promote professional development

opportunities for AHWs, and continue to support them in implementing the

Programs in their communities by integrating MDEW into their services, making it

more relevant.

Suggested future developmental and aspirational activities for MDEW: Consider designing a MDEW refresher at 6 months or 1 year mark for past

participants, or sustain participant support beyond the MDEW Program via social

media (providing a dedicated live and local resource which current and past

participants can access for the latest seasonal and regional healthy cooking,

recipe and shopping tips). This is an effective way of making MDEW effects

longer lasting and thereby maximising benefits.

Identify opportunities for expansion into other food security strategies by an

exploratory project aimed at obtaining a more detailed local situational awareness

of all three food security pillars, including availability and access. This will deliver

clearer strategic directions to tackle local food disadvantage issues experienced

in WNSW LHD.

Consider piloting a more regular ongoing version of MDEW.

2 These strategies are in addition to that currently provided by Health Promotion Team and the newly implemented Sharing Day.

Figure 10: Dubbo MDEW participants receiving certificates from their two facilitators at

completion of a MDEW Program that was run in a community setting during Phase 2 extension.


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Appendix A: MDEW Phase 2 Evaluation Framework Facilitator Training Workshop Evaluations

1. Facilitator Baseline Survey Questionnaire completed by phone interview before Training Workshop

2. Facilitator Training Day 1 Evaluation

Self-administered questionnaire completed at the end of Day 1 of training

3. Facilitator Training Day 2 Evaluation

Self-administered questionnaire completed at the end of Day 2 of training

4. Trainer’s Training Review Self-administered questionnaire completed by trainers after the 2 day Training Workshop

MDEW Program Facilitator and Partner Evaluations

1. Planning Day Evaluation Questionnaire completed at the end of the planning day held for each MDEW Program, by facilitators and partners together

2. Program Review Questionnaire completed at the end of each session, by facilitators and partners together

3. Food Issues Log Questionnaire completed at the end of each session, by facilitators and partners together

4. Narrative Post Program Evaluation

Focus groups or semi-structured interviews conducted 2 months post Program. Facilitators and partners interviewed separately

MDEW Program Participant Evaluations

1. Participant Baseline Evaluation Self-administered questionnaire completed at the start of the first MDEW session by participants

2. Session Attendance Sheet Attendance roll filled in at the start of each session by participants

3. Participant Final Session Evaluation

Self-administered questionnaire completed at the end of the final MDEW session

4. Participant 2 month Follow Up Evaluation

Self-administered questionnaire completed, by participants at the start of the narrative focus group or interview, to be held 2 months post Program

5. Narrative Post Program Evaluation

Focus groups or semi-structured interviews conducted 2 months post Program with participants


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Appendix B: References and Resources Aboriginal Health & Medical Research Council 2009, 10 out of 10 Deadly Health Stories –

Nutrition and physical activity, ISBN: 978-0-9805159-1-6.

Browne, J Laurence, S & Thorpe, S 2009, ‘Acting on food insecurity in urban Aboriginal and Torres Strait Islander communities: Policy and practice interventions to improve local access and supply of nutritious food’, viewed on 04.01.2013, www.healthinfonet.ecu.edu.au/health-risks/nutrition/other-reviews

Central Coast Health NSW 2008, Quick Meals for Kooris Program kit, compiled by Jasmine Harris Public Health/Community Nutrition Team, Nutrition Department & Nunyara Aboriginal Health Unit, Fourth Edition, May 2008, ISBN 1 74139 0052, http://www.healthpromotion.com.au/Documents/Aboriginal_Health/QM4K.pdf

Centres for Disease Control and Prevention Program Performance and Evaluation Resources http://www.cdc.gov/eval/index.htm and http://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/logic_model.htm

Eades, D 1982, 'You gotta know how to talk ......information seeking in South-East Queensland Aboriginal Society.’ Australian Journal of Linguistics vol. 2 pp. 61-82.

Frankston Community Health Service 2004, Frankston Community Kitchens Pilot Project (CAFCA Promising Practice Profile) viewed on 04.01.2013, www.aifs.gov.au/cafca/ppp/profiles/la_community_kitchens.html

Fredericks, A 2013, ‘“We eat more than kangaroo tail or dugong you know…”: Recent Indigenous Australian Cookbooks’, M/C Journal, vol. 16, no. 3.

Gui, G & Lau, Q 2007, 'Quick meals for Kooris': an evaluation. Aboriginal and Islander Health Worker Journal, vol. 31, no. 4, pp. 20-21.

Hawe, P King, L Noort, M Gifford, SM & Lloyd, B 2001, ‘A Framework for Building Capacity to Improve Health’, SHPN: (HP) 990226, ISBN: 0 7347 3124 8. New South Wales Health Department State Health Publication No. 990099, Sydney.

Malie, S & Robertson, L 2011, ‘Planting a seed and watching it blossom - Koori Community Kitchen making a difference’, Aboriginal and Islander Health Worker Journal, vol. 35, no. 6, pp. 4-7.

Mason, L Meharg, D Stapleton, R & Gibbs, C 2014, ‘Marang Dhali Eating Well Program Evaluation Report’, internal project report, Western NSW Local Health District, Dubbo, NSW, Australia.

Mello, JA Gans, KM Risica, PA Kirtania, U Strolla, LO Fournier, L 2010, ‘How Is Food Insecurity Associated with Dietary Behaviors? An Analysis with Low-Income, Ethnically Diverse Participants in a Nutrition Intervention Study.’ Journal of the American Dietetic Association, vol. 110, no.12, pp. 1906-1911.

http://www.healthinfonet.ecu.edu.au/health-risks/nutrition/reviews/other-reviews



http://www.healthinfonet.ecu.edu.au/health-risks/nutrition/other-reviews

http://www.healthpromotion.com.au/Documents/Aboriginal_Health/QM4K.pdf

http://www.cdc.gov/eval/index.htm

http://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/logic_model.htm

http://www.aifs.gov.au/cafca/ppp/profiles/la_community_kitchens.html


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National Aboriginal and Torres Strait Islander Nutrition Working Party 2001, National Aboriginal and Torres Strait Islander Nutrition Strategy and action plan: a summary 2000-2010. National Public Health Partnership 2003, viewed on 04.01.2013, http://www.nphp.gov.au/publications/signal/natsinsa1.pdf

New South Wales Department of Health 2011, New South Wales Population Health Survey 2006-2009 (HOIST), Centre for Epidemiology and Research, NSW Department of Health, http://www.healthstats.nsw.gov.au/

Ryan GW, Bernard HR 2003, ‘Techniques to identify Themes’ Field Methods vol. 15, no. 1, pp. 85-109.

Strategic Inter-Governmental Nutrition Alliance of the National Public Health Partnership 2001 ‘Eat Well Australia: An Agenda for Action for Public Health Nutrition’, viewed on 14.01.2014 http://www.nphp.gov.au/publications/signal/eatwell1.pdf

Toogood, M 2002 ‘Feeding the Family’ Macquarie Area Health Service (NSW), viewed on 31.07.2013 http://trove.nla.gov.au/work/11522192?q&versionId=13533584

World Health Organisation Food Security Definition Trade, foreign policy, diplomacy and health: Food Security, WHO, viewed on 04.01.2013 http://www.who.int/trade/glossary/story028/en/

http://www.nphp.gov.au/publications/signal/natsinsa1.pdf

http://www.healthstats.nsw.gov.au/

http://www.nphp.gov.au/publications/signal/eatwell1.pdf

http://trove.nla.gov.au/work/11522192?q&versionId=13533584

http://www.who.int/trade/glossary/story028/en/


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Appendix C: Glossary of terms and acronyms AHEO Aboriginal Health Education Officer

AHW Aboriginal Health Worker

AMIHS Aboriginal Maternal and Infant Health Service

Baseline measurement A measurement taken prior to commencement of Program, e.g. on the morning of Day 1

District Western NSW Local Health District

FTE Full time equivalent

Health Promotion Western NSW Local Health District Health Promotion Team in roles of MDEW Project Manager and MDEW support staff, MDEW facilitator trainers, and MDEW evaluators

HKA Healthy Kids Association is a non-profit, non-government health promotion charity based in Sydney, Australia with a mission to promote and influence healthy food choices for children. http://healthy-kids.com.au/

LHD Local Health District

Marang Dhali ‘Marang Dhali’ is the Wiradjuri language phrase for ‘eating well’. Stanley Vernard “Stan” Grant Snr, AM, an Elder of the Wiradjuri Nation and Language Specialist of the Elders Council, provided advice and permission to use this phrase in the title of the Program.

MDEW Program The local cooking and healthy food programs delivered to Aboriginal communities by facilitators and partners. Also referred to as ‘MDEW Food and Cooking Program’ or the ‘Program’

POC Project Organising Committee

Post Program measurement A measurement taken two months after the Program has been completed (at 2 month follow up)

Program evaluation measure A measurement taken at the end of the final session of the Program, reflecting on delivery of the Program and its immediate effects.

Project LHD level project management of the MDEW initiative

WNSW LHD Western NSW Local Health District

http://healthy-kids.com.au/


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