GEM NO. 449

A Learn and Serve Nutrition Program: The Food LiteracyPartners Program

Rebecca Rawl, MPH, Brody School ofMedicine at East Carolina University,Greenville, North Carolina

Kathryn M. Kolasa, PhD, RD,LDN,* Nutrition Services and PatientEducation, Departments of FamilyMedicine and of Pediatrics, BrodySchool of Medicine at East CarolinaUniversity, Greenville, North Carolina

Joanne Lee, MPH, RD, LDN, Schoolof Public Health, The University ofNorth Carolina at Chapel Hill, ChapelHill, North Carolina

Lauren M. Whetstone, PhD,Department of Family Medicine, BrodySchool of Medicine at East CarolinaUniversity, Greenville, North Carolina

( J Nutr Educ Behav. 2008;40:49-51)

*Address for correspondence: Kathryn M. KolasaPhD, RD, LDN, Departments of FamilyMedicine and of Pediatrics, 4N70 Brody, BrodySchool of Medicine at East Carolina University,Greenville, NC 27834; Phone: (252)744-1358; Fax: (252) 744-3040; E-mail:kolasaka@ecu.edudoi: 10.1016/j.jneb.2007.04.372

INTRODUCTION

An individual’s health literacy has adirect effect on health status and out-comes.1,2 Healthy People 2010 defineshealth literacy as “the degree to whichindividuals have the capacity to obtain,process, and understand basic health in-formation and services needed to makeappropriate health decisions.”3 TheFood Literacy Partners Program (FLPP)focuses on food and nutrition informa-tion to help individuals make appropri-ate eating decisions. It was designed todeliver evidence-based nutrition infor-mation in a rural community with lim-ited access to nutrition educationprofessionals.4

The FLPP is a “learn and serve”program that provides 20 hours of

food and nutrition education to vol-

unteers in exchange for 20 hours ofcommunity nutrition education ser-vice. Since the program’s 1999launch, 243 adults have graduated.The course appeals to a wide range ofindividuals including nurses and otherhealth professionals, exercise special-ists and personal trainers, teachers andschool volunteers, college students,child nutrition managers, retirees,chefs, lay health advisors, churchwellness committee members, and in-dividuals with a nutrition-relatedchronic condition. The curriculumincludes 14 modules, 11 of which canbe completed either in group trainingsessions led by dietitians or indepen-dently on East Carolina University’sBlackBoard.

Two of the modules, an interac-tive healthy food preparation sessionand a simulated health fair, requirein-person participation as a gradua-tion requirement. Recently, a thirdin-person, optional supermarket tourwas added to practice decision makingbased on the Nutrition Facts labels.Six core modules focus on healthfuleating and weight management infor-mation that can be taught by nonli-censed individuals. Volunteers usethis information to assist professionalsat community and business healthfairs, conduct demonstrations andsamplings at farmers’ markets, andteach healthful eating sessions inclassrooms and churches. When vol-unteers encounter nutrition misinfor-mation, they encourage audiences toseek information from their healthcare providers.

Because of the high rates ofnutrition-related chronic diseases inthis rural community and widespreadmisinformation about diet and dis-ease, the FLPP advisory committeerecommended the course include in-formation about physical activity anddietary strategies to prevent and man-age high blood pressure, type 2 diabe-

tes, selected cancers, osteoporosis, and

cardiovascular disease. Modules onthese topics are offered to increasepersonal knowledge as opposed to ap-plication in volunteer settings. Vol-unteers are instructed to use this in-formation to be informed consumers,not teach this content.

At graduation, participants re-ceive a food and nutrition referencebook, to add to the up-to-date mate-rials and references from credible or-ganizations and sources that are pro-vided with each module. Many ofthese materials can be accessed anddownloaded from reputable Web sites,which enable volunteers to providesound educational information asneeded. They remain enrolled in theBlackBoard course, in which modulesare updated at least annually, receivea monthly newsletter listing volunteeropportunities and testimonials, andare offered a yearly update session. Asresources allow, volunteers are offeredassistance by the FLPP coordinator.

An FLPP Logic Model5 was gener-ated to aid in program evaluation (Fig-ure). This was an effective tool to helpdescribe the program’s potential impacton participants’ nutrition and physicalactivity behaviors, their knowledge andcomfort talking with others about foodand nutrition, and volunteerism.6 Toolsused for the evaluation included keyinformant interviews, individual courseevaluations, the Physical Activity andNutrition Behaviors (PAN) question-naire,7 and an original 31-item surveywith questions about motivation fortaking the course, use of the BlackBoardsite after graduation, value of the super-market tour, and FLPP as a volunteerexperience. All of the participant eval-uation tools were completed anony-mously in an effort to reduce social de-sirability bias.

The PAN questionnaire was ad-ministered to a subset of more recentparticipants, both before (baseline)and after completing the training.

The survey was e-mailed to 186 grad-

odel.

50 Rawl et al./THE FOOD LITERACY PARTNERS PROGRAM

uates with active e-mail addresses, and39% completed the questionnaireposted on Survey Monkey.8 The re-spondents reported behavior changes:51% ate more vegetables; 49% atemore fruit; 31% consumed less sodaand sweetened beverages; and 36%engaged in more physical activity.These self-reported behavior changeswere complemented by survey re-sponses that indicated increasedknowledge and attitudes about thenutrition and physical activity topicscovered in the FLPP. Graduates re-ported using the information theylearned at work (62%) and in day-to-day conversations (75%). They mettheir volunteer commitments at work(46%) and other venues. Overall, thegraduates highly recommended thetraining and supermarket tours. Grad-uates found that both on-line trainingand in-person class training were ef-fective delivery modes. There hasbeen a dramatic increase in use of theon-line modules in recent years as

Figure. Food Literacy Partners Program logic m

more people have become comfort-

able with on-line learning and havemore limited time to attend classes inperson. More than 3500 hours of vol-unteer service were completed, whichwas, on average, more than double thenumber of required hours. Many grad-uates chose not to report hours be-yond their requirement.

It is possible for a nutrition “learnand serve” program to prepare volun-teers to deliver nutrition education toconsumers in rural areas. Graduatesfind that they are able to quickly findways to pass on their newly acquirednutrition knowledge at home and inthe community.

NOTES

1. Some of the course materials canbe previewed by guests at http://ecu.blackboard.com (Click on“Course Catalog” button, type“Food Literacy Partners Program”into the search box, click on

course title).

2. Approval was obtained from theUniversity and Medical Center In-stitutional Review Board.

3. Major developmental funding forFLPP was provided by the NorthCarolina Nutrition Network. Con-tinuing support has been providedby the Pitt Memorial HospitalFoundation, Nutrition and Physi-cal Activity Partners of PittCounty, Pitt Medical Society, EastCarolina University and theViQuest Wellness Center.

SUPPLEMENTARY DATAThe Physical Activity and NutritionBehaviors Monitoring Form is avail-able online at www.jneb.org under thelabel “Add-ons” within the onlineversion of the article.

REFERENCES

1. Berkman ND, DeWalt DA, Pignone MP, etal. Literacy and Health Outcomes. Evidence

Report/Technology Assessment No. 87

Journal of Nutrition Education and Behavior ● Volume 40, Number 1, January/February 2008 51

(Prepared by RTI International–Universityof North Carolina Evidence-based PracticeCenter under Contract No. 290-02-0016).AHRQ Publication No. 04-E007-2.Rockville, Md: Agency for HealthcareResearch and Quality; January 2004.

2. Vastag B. Low health literacy called a prob-lem. JAMA. 2004;291:2181-2182.

3. Healthy People 2010: Understanding and Im-proving Health. 2nd ed. Washington, DC: USGovernment Printing Office, November 2000.

K. Food Literacy Partners Program: astrategy to increase community food literacy.Top Clin Nutr. 2001;16:1-10.

5. Kellogg Foundation. Logic model develop-ment guide. Available at http://www.wkkf.org/Pubs/Tools/Evaluation/Pub3669.pdf.Accessed December 10, 2007.

6. Rawl R, Kolasa K, Daugherty J, Lackey C.The Logic Model as a framework for com-munity program evaluations. The Food Lit-eracy Partners Program. Fam Med. 2006;38:

7. North Carolina Division of Public Healthand the University of North Carolina atChapel Hill. Physical Activity & NutritionBehaviors and Body Mass Index MonitoringForm. Monitoring and Evaluation Subcom-mittee of the North Carolina Child and Ad-olescent Overweight Prevention Initiative(North Carolina Healthy Weight Initia-tive); 2003.

8. Survey Monkey. On-line survey software.Available at: http://www.surveymonkey.com.

4. Kolasa KM, Peery A, Harris NG, Shovelin 690-691. Accessed Sept 28, 2006.

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