Effectiveness & Maintenance – Maintenance of Behavioral Changes

Long-term indicators inform whether SNAP-Ed participants continue to demonstrate targeted behavioral changes even after graduating from a direct education program. LT1–LT4 indicators measure which behaviors are sustained at a minimum of 6 months post-intervention. The maintenance stage of the Transtheoretical (Stages of Change) Model lasts from 6 months to 5 years.

As LT2 assesses the maintenance (6 months or longer) of behavior changes resulting from smarter shopping and food resource management (FRM) strategies, SNAP-Ed agencies should use the same survey and data collection tools used in MT2 to assess behavior change before and after participation in a series of nutrition education and food resource management classes.

Long-term follow-up adds rigor to the evaluation of SNAP-Ed interventions not yet published in peer-reviewed journals. Interventions designated as practice-tested (i.e., evidence derived from practice in the form of evaluation data or reports) or emerging (i.e., practice-based interventions that show promise based on initial implementation and delivery but have yet to undergo full evaluation) would especially benefit from long-term follow-up.

Locating SNAP-Ed participants after the completion of a series-based program requires meticulous records of participants’ follow-up information. Participants can be reached through a telephone, mail, email, or face-to-face survey and may require a list of collateral contacts, such as family, friends, or neighbors to help locate them. Local SNAP-Ed agencies may seek to host a follow-up or booster educational session or activity for participants who return to complete a long-term assessment of their behaviors.

Long-term follow-up for school-age children could occur during a subsequent semester or school year. Adults or transitional-age youth who reside in group living arrangements can potentially be contacted in the same residence. SNAP-Ed agencies should consult with their Institutional Review Boards to ensure human subjects protections are in place.

The additional benefit of long-term follow-up of SNAP-Ed participants is determining through surveys or interviews how changes in food and physical activity environments measured in the Environmental Settings chapter impact participants’ behaviors. Changes in pricing, availability, and marketing of healthy foods and physical activity resources will impact the extent to which participants can continue to practice the skills and behaviors they learned in direct education programs. SNAP-Ed agencies should consider aligning their long-term follow-up of program participants with the long-term measures of maintenance and effectiveness in Environmental Settings (see LT5 and LT6).

LT1. Healthy Eating Behaviors
LT2. Food Resource Management Behaviors
LT3. Physical Activity and Reduced Sedentary Behavior
LT4. Food Safety Behaviors

See Medium-Term Indicators MT1–MT4 for complete write-ups.

Older adults, adults, adolescents, children, preschoolers and toddlers (via parents or child care providers)

Emerging
Follow-up
Practice-tested
Transtheoretical Model

Wardlow MK, Baker S. Long-Term Follow-up of EFNEP and SNAP-Ed. The Forum for Family and Consumer Issues (FFCI). Fall 2012, Vol. 17(2). https://www.theforumjournal.org/wp-content/uploads/2018/05/Long-term-evaluation.pdf