Evaluation Indicators: Environmental Settings: Short Term

Stanford Youth Diabetes Coaching Program

The Stanford Youth Diabetes Coaches Program (SYDCP) facilitates partnerships between medical training programs and high schools serving youth from socioeconomically disadvantaged and underrepresented minority communities. The SYDCP is a “train the trainer program” in which medical residents (and other health professional trainees) train high school students to coach family members with diabetes or other chronic illnesses. The program consists of 8 tightly scripted, interactive PowerPoint based lessons that incorporate evidence-based approaches to chronic disease management, highlighting healthy eating and physical activity. The curriculum is based on Kate Lorig’s Adult Chronic Disease Self-Management Model, Social Cognitive Theory, and peer health coaching, and is designed to address the burden of chronic disease in underserved communities by focusing on health knowledge, communication skills, goal setting, problem solving, and healthy behaviors. 

Please Note: Medical nutrition therapy is not allowable for SNAP-Ed. We strongly recommend you partner with a healthcare professional to provide those components of this intervention. Components focused on healthy eating and physical activity are appropriate for SNAP-Ed. 

Target Behavior: Healthy Eating, Physical Activity and Reduced Screen Time 

Intervention Type: Direct Education

Steps to Health’s PSE Toolkit: The Ingredients for a Welcoming Farmers Market

The Ingredients for a Welcoming Farmers Market Toolkit is a PSE change intervention that uses best practices to contribute to a more welcoming farmers market environment for all community members. The Toolkit outlines a 7-step process designed to assist with data collection, analysis, and action planning. The baseline assessment determines whether the market is implementing the healthy practice in question or if the market needs some improvement in that area. The resource guide helps staff better understand why questions are included in the assessment, and how the market can improve its practices related to each question. Using the Community Food Survey included in the Toolkit, staff collect responses from community members to better understand why individuals might not attend the farmer’s market or what foods they might be interested in buying at the market.  

Target Behavior: Food Insecurity/Food Assistance 

Intervention Type: PSE Change 

The State Nutrition Action Council: Farmers Market Initiative

The State Nutrition Action Council: Farmers Market Initiative (SNAC) is policy, systems, and environmental change intervention designed to:

  • Increase knowledge of Food and Nutrition Service (FNS) programs available at farmers markets.
  • Increase knowledge of locally grown fruits and vegetables and how to use, cook, and store them.
  • Increase the use of Market Match and CalFresh redemption vouchers to support low-income shoppers in maximizing their purchasing power.
  • Increase state and local partnerships of FNS funded programs to support a welcoming market environment that accepts multiple FNS food benefits. 

In 2018, SNAC focused on increasing low-income shoppers’ utilization of their food and nutrition program benefits at local Farmers Markets, and in 2019, SNAC expanded its Farmers Market Initiative (FMI) into additional counties and markets, as well as added an on-site navigator component. The navigator model was tested at three markets, and the CalFresh Healthy Living (CFHL) Navigators were found to address barriers to shopping at farmers markets, including lack of knowledge and comfort using food assistance benefits. CFHL Navigators provided support to shoppers by distributing materials, promoting accepted FNS benefits, providing information on how to use FNS benefits, explaining Market Match, and providing interactive nutrition and health education activities on-site at the market for six consecutive weeks. The FMI has continued to expand into new counties in California since 2019 and increases in food benefit redemptions at FMI markets has sustained. 

Target Behavior: Healthy Eating, Food Insecurity/Food Assistance

Intervention Type: PSE Change

Nutrition Pantry Program (NPP)

The Nutrition Pantry Program (NPP) is a trauma-informed PSE change intervention designed to improve the food environment and client engagement within food pantries and other charitable distribution environments. NPP provides training and resources to support the implementation of strategies for increasing access and utilization of healthy food by pantry clients, increasing engagement of clients and other stakeholders, and sustaining healthy changes over time. Implementers are encouraged to follow a four-stage process; Planning, Needs & Current Work Assessment, Implementation, and Certification & Maintenance. SNAP-Ed implementers work in collaboration with food pantry staff, volunteers, and other stakeholders to use the NPP framework and resources to organize and complete the intervention. Pantry Need and Readiness is assessed and supported using a validated Healthy Food Pantry Assessment, a Client Needs Assessment questionnaire, and client feedback strategies. Based on needs and input, a work plan of PSE changes is created. NPP resources are available to support a variety of PSE changes. Pantries completing the NPP process are recognized and awarded as Bronze, Silver or Gold Certified Nutrition Pantries and celebrated in the community. 

Target Behavior: Healthy Eating, Food Insecurity/Food Assistance  
Intervention Type: PSE Change 

Veggie Van (VV) Toolkit

The Veggie Van (VV) Toolkit is a policy, systems, and environmental change intervention designed to:

  • Increase access to healthy, affordable fruits and vegetables in lower income and/or food insecure communities
  • Help the target population improve their diets through skill building
  • Address the interplay between the physical food environment, individual perceptions of that environment, and self-efficacy
  • Address multiple dimensions of access to fresh produce for lower-income and under-served communities, including availability, affordability, accessibility (geographic and financial), and accommodation
  • Improve self-efficacy for finding, purchasing, and preparing fruits and vegetables or other healthy foods via cooking and nutrition education interventions

VV achieves these goals via mobile farmers markets that present cooking demonstrations, recipes, taste tests, and nutrition education to help customers better use the produce they receive. VV mobile markets also accept SNAP benefits, electronic benefits (EBT), and other relevant local food incentive and benefit programs, as well as employ a bundling model in addition to a la carte purchasing. The bundling model allows the VV mobile markets to sell more items at a lower cost and expose participants to a greater variety of fruits and vegetables. Markets operate a minimum of 10 months out of the year and typically source produce locally or regionally.

Target Behavior: Healthy Eating, Food Insecurity/Food Assistance

Intervention Type: PSE Change

PSE Readiness Assessment and Decision Instrument (PSE READI)

The PSE READI intervention was designed with guidance from SNAP-Ed and public health practitioners in Ohio to promote successful implementation of community nutrition Policy, System, and Environmental (PSE) programs as a broader strategy for obesity prevention. Practitioners can take the online PSE Readiness Assessment and Decision Instrument (READI) to assess their community’s readiness and capacity to implement community nutrition PSE changes. The PSE READI can be completed by an individual or the practitioner can invite community members to share their input in a team assessment. The four different PSE READIs currently available include: Farmers’ Markets, Healthy Food Retail, Farm to School, and Healthy Eating Policies in Childcare, with current plans to add two new areas to the tool in 2022: Food Pantries and K-12 Schools. After completion of your PSE READI, a report will be generated with three recommendations. These recommendations will help practitioners and teams plan next steps and guide community nutrition PSE implementation tailored to local community readiness and capacity. The PSE READI website includes a curated resource library with over 1,000 toolkits, guides, and other evidence-based PSE resources that provide guidance to help end-users put into action their community nutrition PSE implementation.  

Target Behavior: Healthy Eating  
Intervention Type: PSE Change 

Heart Smarts

Heart Smarts is a direct education, PSE change, and social marketing intervention that combines healthy food access, nutrition education, and health and social services for individuals to improve their health and reduce their risk of diet-related disease. The program offers nine lessons for use in retail environments covering topics like fruits and vegetables, whole grains, sodium, sugar-sweetened beverages and making healthy choices along with nutrition-focused tip sheets. Each lesson includes taste tests, recipes, healthy food incentive coupons* and health screenings* (for blood pressure, weight checks, and healthy lifestyle counseling and referrals). Technical assistance and training is provided to site staff and storeowners to support PSE changes including healthier stores, businesses and communities.

Target Behavior: Healthy Eating

Intervention Type: Direct Education, Social Marketing, PSE Change

*These Heart Smarts components (health screenings, including blood pressure and BMI; counseling and referrals; and healthy food incentive coupons help participants choose heart-healthy items at the site) are not allowable by SNAP-Ed. Heart Smarts lessons and food tastings can be used without these additional components. Screenings and coupons can be funded by grants or partnered organizations.

FoodShare

FoodShare is a PSE change intervention designed to improve food security and health outcomes through fresh food access and affordability. Every 2 weeks residents can order a Fresh Food Box using cash or SNAP/EBT. The program is a SNAP Healthy Bucks site (a state SNAP healthy incentives program), which allows SNAP recipients to receive a $10 healthy incentive to go towards the cost of their box. Each Fresh Food Box contains 12-14 varieties of culturally appropriate fruits and vegetables, always with a mix of more common items (e.g., apples) and less common items (e.g., radishes). A recipe card that is culturally relevant to participants and based on the produce in the box in a given week is also included. The program is situated within an academic medical center and community-based hospital system. A screening and referral process was created that links patients to FoodShare.

Target Behavior: Healthy Eating, Food Insecurity/Food Assistance

Intervention Type: PSE Change

Create Healthy Choices: Thumbs Up for Healthy Choices – Food Pantries (Thumbs Up)

Create Healthy Choices: Thumbs Up for Healthy Choices – Food Pantries (Thumbs Up) is a policy, systems, and environment (PSE) change intervention designed to improve the visibility and appeal of healthy choices for pantry users, leading to an increased selection of these healthy choices. Thumbs Up utilizes low-cost nudge strategies to make healthy choices easier in pantries. Prior to implementing Thumbs Up, educators evaluate the pantry’s readiness for change by conducting a baseline assessment using an adapted version of Illinois Extension’s Nutrition Environment Food Pantry Assessment Tool (NEFPAT). Once the baseline is established, educators work with pantries to identify areas the pantry management is interested in improving. Educators then use nutrition criteria outlined in the toolkit to identify foods that are low in sodium, added sugar, and saturated fat. At the end of a pantry’s partnership with SNAP-Ed, or the end of the fiscal year, the NEFPAT is used again to track changes made to improve the visibility and appeal of healthy items.

Target Behavior: Healthy Eating

Intervention Type: PSE Change

Let’s Eat Healthy: Teens (Online)

Dairy Council of California’s Let’s Eat Healthy: Teens (LEH Teens) is a direct education intervention, which consists of four online lessons that seek to improve high school students’ awareness of their food environment and the link between food and health. The lesson content is accessible online and includes a teacher guide with instructional slide presentations to inform and engage high school students through common technology platforms. The program aligns with the Dietary Guidelines for Americans and the California Health Education Content Standards, encouraging self-reflection, goal setting, and balanced eating habits. 

Target Behavior: Healthy Eating, Physical Activity and Reducing Screen Time

Intervention Type: Direct Education