Positive Change in Healthy Eating Scores Among Adults With Low Income After Expanded Food and Nutrition Education Program Participation.

OBJECTIVE: Using 24-hour dietary recalls, compare Healthy Eating Index (HEI)-2005 scores of Expanded Food and Nutrition Education Program participants before and after 8-12 weekly lessons. DESIGN: Analysis of preexisting 24-hour dietary recalls information collected from October, 2012 through September, 2014. PARTICIPANTS: Participants with complete pre-post dietary data (n = 122,961); subset of those with complete demographic data (n = 97,522). MAIN OUTCOME MEASURES: Change in HEI-2005 scores (total and components). STATISTICAL ANALYSIS: Linear regression model fit separately for total HEI and 12 components. The response variable was changed in the HEI-2005 score; predictor variables included age, education, sex, and race/ethnicity. RESULTS: The mean total HEI scores were 51.1 (SD, 13.7) at entry and 56.5 (SD, 13.7) at exit, with a change of 5.4 (SD, 16.2). Nine of 12 component scores increased. Changes were greater as age increased, with increasing education, and in women. Hispanics had the greatest improvement (mean ± SE) in total HEI score (8.3 ± 0.1). CONCLUSIONS AND IMPLICATIONS: Although diet quality remained poor, participation in the Expanded Food and Nutrition Education Program resulted in improvement in dietary quality. The degree of improvements varied among demographic groups, but all groups improved.

Similar 24-Hour Dietary Recall Results from Low-Income Women When Collected by a Paraprofessional Nutrition Educator or Registered Dietitian Nutritionist.

BACKGROUND: The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded, community nutrition education program that assists the low-income population in acquiring knowledge and skills related to nutrition, food safety, food resource management, food security, and physical activity. Evaluation of EFNEP includes a 24-hour dietary recall (24HDR) administered by paraprofessional educators, yet protocols for most large-scale nutrition research studies employ registered dietitian nutritionists (RDNs) or individuals with educational backgrounds in nutrition or related fields to collect dietary recalls. OBJECTIVE: To compare 24HDRs collected by trained paraprofessional educators with recalls collected by an RDN. DESIGN: Exploratory cross-over study comparing same-day 24HDR in a one-on-one setting collected by paraprofessional educators and an RDN. Paired recalls were separated by at least 1 hour. PARTICIPANTS AND SETTING: The participants (n=41) were volunteer women who were eligible for participation in EFNEP in two states. MAIN OUTCOME MEASURES: The 24HDRs were compared for energy, macronutrients, micronutrients, and food groups. STATISTICAL ANALYSIS PERFORMED: Mixed-model analysis to account for repeated measures. Intraclass correlation and Spearman correlation coefficients to determine interrater agreement. RESULTS: No difference in 24HDR was seen when compared by interviewer (paraprofessional vs RDN) or by site (Colorado vs North Carolina). There were significant differences in four components (energy, total fat, saturated fat, and solid fats-added sugar) based on recall order, with a higher intake in the second recall compared with the first. CONCLUSION: The results of this preliminary study suggest that a well-trained paraprofessional educator using a valid methodology can collect a 24HDR that is similar to a recall collected by an RDN. The paraprofessional educator can be employed for dietary data collection, allowing the RDN to focus on more advanced aspects of scope of practice, such as data evaluation and program development.

Collection Methods for the 24-Hour Dietary Recall as Used in the Expanded Food and Nutrition Education Program.

OBJECTIVE: Identify practices for the collection of the 24-hour dietary recall (24HR) as used by the Expanded Food and Nutrition Education Program (EFNEP) to assess the fidelity with which dietary data are collected. METHODS: An electronic survey sent nationally to all 75 EFNEP coordinators to assess methodology for collection, staff training, and coding of 24HR. RESULTS: A total of 67 surveys were returned, 53 of which were usable: 57% of programs used multiple collection periods (previous day vs previous 24 hours), 36% did not use a consistent number of passes in recall collection; only 17% exclusively used the validated 5-pass method; 88% trained paraprofessionals for ≤8 hours on recall collection and >6 different training programs were used; and 86% of programs used multiple coders. CONCLUSIONS AND IMPLICATIONS: The wide variation in reported collection, training, and coding practices raises concerns about the validity of the recall data and the appropriateness of combining data from multiple programs. To improve consistency, EFNEP could establish standardized methods for training, data collection, and data entry for the 24HR. These results may encourage the national program office to establish programmatic change that will support the fidelity of collection methods across all programs.