Healthy Choices for Every Body Adult Nutrition Education Curriculum

University of Kentucky

Overview

The Healthy Choices for Every Body (HCEB) is a direct education intervention designed to improve diet quality, physical activity, and food safety practices, as well as enhance food security and food resource management skills. HCEB incorporates lessons and activities that recognize participants’ experiences, skills, and knowledge; explains why, what, and how the nutrition education concepts presented relate to real-life situations; and includes active learning activities, hands-on practice, and demonstrations to help participants understand and apply content.

Target Behavior: Healthy Eating, Physical Activity and Reducing Screen Time, Food Insecurity/Food Assistance, Other: Food resource management skills, food safety practices

Intervention Type: Direct Education

Intervention Reach and Adoption

HCEB targets limited-resource adults in community, workplace, retail, service and faith-based settings. HCEB materials were produced on a 6th grade reading level to accommodate participants with low literacy levels. The curriculum is designed to be adapted and implemented by paraprofessionals from the community. It is being implemented by two agencies in Kentucky.

Setting: Farmers markets, Community (Live), Faith-based community, Food pantries, Health care, Retail (Shop/Eat),USDA program sites (not National School Lunch Program), Worksite (Work)

Target Audience: High School, Pregnant/Breastfeeding Women, Parents/Mothers/Fathers, Adults, Older Adults, Homeless/Food Pantry Clients

Race/Ethnicity: All

Intervention Components

The following critical components should be kept intact to enhance fidelity:

  • 7 required units (there are 10 core units 7 of which are required for graduation): MyPlate; Know the Limits: Added Sugar, Fat, Sodium; Meal Planning: Fruits and Vegetables; Reading Labels; Food Budgeting; Food Safety; Breakfast: Dairy
  • Each required unit is implemented as a single unit/lesson for about 45-60 minutes—i.e., 2 or more required units cannot be combined into a single unit—to ensure that adequate instructional time is dedicated to each unit.
  • Implementation of at least one of the recipes accompanying each unit
  • Adherence to implementation guidelines stipulated in curriculum materials, in particular, Overview and Facilitator’s Guide
  • Evaluation instruments: The EFNEP FPAQ, an 8-item Food Behavior Survey, and 24-Hour Food Recall administered at entry, after 7 required lessons, and at graduation
  • In-class food demonstrations—paraprofessionals may prepare some ingredients ahead of class if implementing in a facility without a full kitchen

Intervention Materials

Curricular Materials

  • Overview Guide
  • Unit Facilitators’ Guides
  • Publications & Handouts
  • Recipes for Food Demonstrations
  • Adult Education Strategies Information
  • Background Materials
  • Guided Script for Teaching
  • Icebreakers
  • PowerPoint Slides
  • Learning Activities

Marketing materials

  • Program Brochure
  • Partnership Flyer with Program Overview
  • Recipe Cards with Next Meeting Reminder
  • Flyers
  • Newsletter Articles
  • Facebook Posts
  • PSAs
  • News Releases

Intervention Materials

Materials are available at no cost.

Evidence Summary

A 2016 quasi-experimental study found that HCEB was effective for improving the food resource management skills and food safety practices of participants. Propensity score matching showed baseline similarities and statistical balance between the characteristics of intervention and comparison groups. Independent-samples t tests and ANCOVA models showed that food resource management and food safety gain scores were statistically significantly higher for the intervention group (P < .001), with large effect sizes (d = 0.9). The group differences persisted even after controlling for race and age (manuscript).

A longitudinal evaluation of the impact of HCEB on participants’ food resource management skills indicated maintenance of outcomes. Findings of multilevel linear models showed a curvilinear trend where participants’ food resource management increased linearly over time, but the rate of increase slowed down as time progresses.

Evidence-based Approach: Research-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 LT1, LT2, LT3, LT4
Environmental Settings
Sectors of Influence
  • MT1c: 70% of graduates showed pre-post improvements in eating more than one kind of fruit while 65% showed pre-post improvements in eating more than one kind of vegetable.
  • MT1l, MT1m: 47% of graduates increased the cups of fruits consumed per day (by average of 0.75 cups) while 49% increased the cups of vegetables consumed per day (by average of 0.65 cups).
  • MT1g, MT1i: 66% of graduates showed pre-post gains in their daily consumption of water (i.e., drinking at least 6 cups everyday); 52% drank soda less often; 46% drank other sweetened beverages less often; and 66% consumed low fat milk and dairy products more often.
  • MT1j: 47% of graduates reduced their consumption of refined grains.
  • MT2a: In 2018, 67% of graduates more often think about healthy choices when deciding what to feed their families) while 77% showed pre-post improvements in using Nutrition Facts to make food choices.
  • MT2g: In 2018, 35% of graduates improved their food security status by being less likely not to have enough food for the month.
  • MT2h: 64% of graduates reported pre-post improvements in comparing prices before buying foods. Also, 67% used shopping lists more often; 60% showed pre-post gains in buying foods on sale; and 65% showed gains in using coupons for grocery shopping.
  • MT3a:62% showed pre-post improvements in exercising for at least 30 minutes more days a week; 70% improved in making small changes to be more active; and 53% increased their involvement in strengthening exercises.
  • MT4a: 47% washed their hands (before preparing food) more often, and 46% improved in cleaning item/surfaces after contact with raw meat/seafood. Also, 74% showed pre-post gains in the use of meat thermometers; and 72% thawed food at room temperature less often.

Evaluation Materials

HCEB evaluation materials include the EFNEP Food and Physical Activity Questionnaire, an 8-item Food Behavior Survey, a 24-Hour food recall instrument, and a demographic survey. Data is collected at program entry, after the required 7 lessons, and at exit. HCEB also provides a fidelity survey to assess the extent to which the curriculum is implemented as intended.

Additional Information

Website: The HCEB website includes registration and terms of use agreement forms. Once complete, electronic access to all of the curriculum materials is provided.

Contact Person(s):
Brooke Jenkins-Howard
Extension Specialist
859-257-2948
bjenkins@uky.edu