Families Eating Smart and Moving More (FESMM)

NC Division of Public Health: Nutrition Services Branch and Community and Clinical Connections for Prevention and Health Branch; NC State Extension, NC State University

Overview

Families Eating Smart, Moving More (FESMM) is a direct education intervention designed to improve dietary intake, increase daily physical activity, and improve home food safety practices, food resource management, and food security. FESMM is a curriculum package that is evidence-based and hands-on.The intervention provides interactive nutrition education sessions that were developed based on a community needs assessment of existing data showing diet and physical activity behaviors, food resource management skills, food safety practices, and food security practices among low-income, low-resource adults living in NCThe lessons in the curriculum include recipes along with physical activities that help participants learn simple solutions to eat smart and be active every day. FESMM addresses key behaviors linked to obesity by helping families learn how to increase fruit and vegetable intake, eat together as a family, reduce screen/sedentary time, control portion sizes, and limit consumption of sugar-sweetened beverages. 

 

Target Behavior: Healthy Eating, Physical Activity and Reducing Screen Time  
Intervention Type: Direct Education 

Intervention Reach and Adoption

FESMM targets low-income parents, pregnant, and breastfeeding women. FESMM incorporates hands-on food preparation using simple recipes that require minimal ingredients, and little equipmentIn 2019, 41 county governments partnered with EFNEP (Expanded Food and Nutrition Education Program) in North Carolina to fund peer educators. Program delivery partners included 32 Adult Education & Training sites, 26 faith communities, 32 community centerstwo Emergency Food Assistance sites, three farmers markets, one food store, 12 Head Starts, 16 Health Care sites, four libraries, five schools, 15 public housing sites, three shelters, two WIC clinics, two worksites and seven other organizations serving low-income families with children. 2,647 participants enrolled in the program.  

 

Setting: Farmers markets, Community (Live), Faith-based community, Food pantries, Health care, Retail (Shop/Eat), School (Learn), USDA program sites (not National School Lunch Program), Worksite (Work) 
Target Audience: Pregnant/Breastfeeding Women, Parents/Mothers/Fathers. 
Race/Ethnicity: All 

Intervention Components

FESMM’s critical components include 

  • Dialogue around lesson topics that engage and value participant experiences 
  • A food activity that includes a tasting, recipe demonstration, or hands-on preparation, modified for budget and facility 
  • Participation in a physical activity that is modified for ability or setting 
  • A goal setting component for participants 

Each lesson of FESMM uses dialogue that helps meet participants where they are in considering behavior change. Through dialogue, food, and physical activities, participants are encouraged to consider a small change they want to make. Strategies to overcome potential barriers to change are also discussed. Educators are provided “media moments” that assist with follow-up between lessons via closed Facebook group, text, or email. Participants are encouraged to share progress on meeting their goals during each session. To support individual behavioral change, educators are provided prompts to engage partners who are positioned to affect PSE changes that support healthy eating and physical activity.  

FESMM includes 21 lessons with a minimum of six lessons to achieve impacts. Each lesson includes a recipe that can be implemented through a guided tasting, demonstration, or hands-on preparation. Recipe videos walk participants through the recipe, substitutions, and suggestions to save money. Simple preparation techniques that consider participant time, food costs, preparation skills, and kitchen equipment help participants learn how to prepare and eat more meals at home. Physical activities are included in each lesson. The curriculum visuals (PowerPoints, participant handouts, videos) are available in both English and Spanish. 

Intervention Materials

Families Eating Smart and Moving More curriculum includes:  

  • A leader guide 
  • 21 evidence-based, scripted lessons 
  • PowerPoint presentations with embedded recipe, physical activity, and concept videos (English and Spanish) 
  • Teaching kit with lesson review activities (English and Spanish) 
  • Four research-developed guides to help facilitators adjust their approach for specific audiences 
  • Participant handouts (English and Spanish) 
  • Recruitment tools (English and Spanish)  

More information about available materials and a sample lesson can be found at:  https://ncefnep.org/partners-materials.php  

You can order materials by completing an order form found online here (https://ncefnep.org/links/order/FESMM_order_form.pdf ) and emailing it to Lorelei Jones at lorelei_jones@ncsu.edu.  

Intervention Costs

A small fee helps offset the cost of development and revision. The current total cost is $675 for the curriculum and teaching kit. States can reproduce as many copies as they need. 

Evidence Summary

The program collects success stories annually, and each year these stories include successes individual participants have made in controlling an existing chronic disease, such as high blood pressure or diabetes. Although FESMM is not a weight loss program, several participants report losing weight each year. Success stories are included in our annual reports and can be found athttps://ncefnep.org/partners-successes.php. This includes the current year’s state, district, and county reports, as well as archived reports dating back to 2012. Challenges lie in participant recruitment and partner negotiation for time, food supplies, and space. To address participant recruitment, it is recommended to utilize technology for blended face-to-face and online lessons (6 lessons are currently available) and to have flexible work hours. Negotiations with partners for time, food supplies, and space should be based on common goals and outcomes desired, best practices for achieving goals/outcomes, and partner buy-in equity. 

FESMM was piloted 2006-2007 in North Carolina with positive results for targeted behaviors. FESMM has produced consistent positive behavior changes in dietary intake, physical activity, food resource management, and food safety (https://reeis.usda.gov/reports-and-documents/efnep). Developers and Contributors consist of Extension and Public Health professionals with expertise in adult education, nutrition, physical activity, food safety, and resource management. Revisions (2007, 2011, 2016) of the curriculum go through both an internal and external review. FESMM participated in research projects that helped inform the adoption of new strategies during each revision. Guides for specific settings, media moments, and PSE prompts were informed by research. poster presented at the National EFNEP included 3 of the PSE changes achieved.  

 

Evidence-based Approach: Practice-Tested 

Evaluation Indicators

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

Readiness and Capacity – Short Term (ST) Changes – Medium Term (MT) Effectiveness and Maintenance – Long Term (LT) Population Results (R)
Individual MT1, MT2, MT3, MT4
Environmental Settings
Sectors of Influence

In 2019:  

MT1: Healthy Eating 

  • MT1l: 52% of participants completing an entry and exit food recall increased their daily fruit consumption by an average of 0.4 cups 
  • MT1d70% of participants completing an entry and exit Food and Physical Activity Behavior Questionnaire reported eating red and orange vegetables more often each week and 68% reported eating dark green vegetables more often each week 
  • MT1h54% of participants completing an entry and exit Food and Physical Activity Behavior Questionnaire reported drinking regular soda less often and 53% reported drinking other sweetened beverages less often 
  • MT1j: 44% of participants completing an entry and exit food recall reported an increase in their consumption of whole grains 

MT2: Food Resource Management 

  • MT2j: 65% of participants completing an entry and exit Food and Physical Activity Questionnaire reported shopping with a list more often 

MT3: Physical Activity and Reduced Sedentary Behavior  

  • MT3a: 67% of participants completing an entry and exit Food and Physical Activity Questionnaire reported exercising for at least 30 minutes, more days week 
  • MT3a: 70% of participants completing an entry and exit Food and Physical Activity Questionnaire reported making small changes to be active more often 
  • MT3c60% of participants completing an entry and exit Food and Physical Activity Questionnaire reported doing muscle strengthening activities, more days a week 

MT4: Food Safety 

  • MT4c: 69% of participants completing an entry and exit Food and Physical Activity Questionnaire reported using a meat thermometer more often 

Evaluation Materials

Developed initially for EFNEP, FESMM addresses the four primary goals of the program. Impact data collection tools are the standard tools used for EFNEP.The 24-hour recall and the Food and Physical Activity Behavior Questionnaire are available on efnepdigitalresources.org. Data are collected at entry and at exit and are analyzed using WebNEERS, a national web-based reporting system for EFNEP. https://reeis.usda.gov/reports-and-documents/efnep shows NC’s FESMM produces consistent results since 2007.

Additional Information

Website: The FESMM website (www.ncefnep.org) includes more about the program and living a healthy lifestyle. 

Contact Person(s):
Lorelei Jones, MEd
Phone919-515-9140 
Email: lorelei_jones@ncsu.edu