Development and implementation of client-centered nutrition education programs in a 4-stage framework.

The Texas Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sought to engage the WIC staff and community in the implementation of relevant and effective client-centered nutrition education. The program was implemented in a 4-stage framework. The collaborative process of developing client-centered nutrition education allowed members to learn from one another, thus ensuring commitment to client-centered nutrition education from all levels of staff. The co-created materials and trainings developed during the implementation played a key role. Evaluation feedback started at the infancy of implementation and gave all community members a stake in developing client-centered nutrition education and an opportunity to be invested in its success, which led to increased execution at the local agency level over the implementation stages.

A Survey of Texas HIV, Sexually Transmitted Disease, Tuberculosis, and Viral Hepatitis Providers' Billing and Reimbursement Capabilities.

The Affordable Care Act presents financial challenges and opportunities for publicly funded service providers. We assessed billing practices and anticipated barriers to third-party billing among organizations in Texas that provide publicly funded HIV, sexually transmitted diseases, tuberculosis, and viral hepatitis services. One third to one half of the organizations did not bill for medical services. The most common barrier to third-party billing was lack of staff knowledge about billing and coding. Future research must evaluate options for organizations and communities to maintain access to infectious disease services for vulnerable populations.

Addressing language barriers in client-centered health promotion: lessons learned and promising practices from Texas WIC.

The growing population of nonnative English speakers in the United States challenges program planners to offer services that will effectively reach limited English proficiency (LEP) audiences. This article presents findings from evaluation research conducted with the Special Supplemental Program for Women, Infants, and Children (WIC) to identify best practices and areas of concern for working with LEP clients. Data were collected through online surveys of 338 WIC teaching staff in 2010 and 65 WIC local agency directors in 2011 as part of an implementation evaluation of client-centered nutrition education. Data identified current practices, facilitating factors, and challenges in working with LEP clients. Facilitating factors included cultural competency, material and translation resources, linguistic competency, professional development opportunities, and rapport with clients. Challenges cited included linguistic challenges, lack of cultural competencies, issues related to the client-staff interaction, and insufficient time, materials, and staffing. Best practices inferred from the data relate to developing linguistic standards for bilingual staff, considerations for translating written materials, interpretation services, cultural competency, and staff training. Findings may help inform the development of this and other linguistically and culturally appropriate health promotion programs.

A client-centered nutrition education model: Lessons learned from Texas WIC.

OBJECTIVE: To examine the implementation of client-centered nutrition education in Texas Special Supplemental Program for Women, Infants, and Children as it relates to the Participant-Centered Education (PCE) model and identify additional components relevant to practical application. METHODS: Implementation evaluation at Texas Special Supplemental Program for Women, Infants, and Children state and local agencies, including online surveys, telephone interviews, field observations/interviews, and meeting notes collected from 2009 to 2011. Data analyzed using deductive and inductive coding to investigate research questions. RESULTS: The data aligned with the PCE model domains and suggested elements for practical application. Communication, training, evaluation, and client participation emerged as additional components to support client-centered nutrition education. The new model captures the way the domains influence each other and the importance of 2-way interactions between the client and the other domains. CONCLUSIONS AND IMPLICATIONS: The findings document the model's potential usefulness for programs with similar audiences and goals. This research highlights an expanded PCE model to assist practitioners in implementation of similar client centered programs.

Walk Texas! 5-A-Day intervention for Women, Infant, and Children (WIC) clients: a quasi-experimental study.

This study was conducted to evaluate the Walk Texas! Clinical Counseling Guide for Nutrition, which is a brief, stage-based nutritional counseling guide designed for use in clinical settings. This study utilized a pre-test post-test quasi-experimental design, with two intervention and two comparison clinics that were matched for size and ethnicity. Intervention participants were staged for readiness to meet the 5-A-Day criteria for fruits and vegetables (F&V) and provided stage-based counseling. Women, Infant, and Children (WIC) counselors were trained to utilize the Walk Texas! brief staging instrument and to provide all counseling. Primary measures included: stage of change, barriers to change, attitudes toward F&V, self-efficacy, and self-reports of F&V consumption. These were collected at baseline and during follow-up visits to the WIC clinic. A total of 433 participants completed pre-test data across the four sites. A number of individuals transferred from their original clinic or did not return to their clinic during the study (n=62). Of the remaining 371 participants, a total of 225 participants returned at least two surveys, for a response rate of 60.6%. These were primarily native Spanish speaking, Hispanic women, of low educational level. Results were mixed. Although there was no significant increase in the cognitive constructs (self-efficacy, attitudes, etc.), participants in the intervention clinics reported a significant increase in stage of change and a composite measure of F&V in-take. In contrast, participants in the control clinics reported no change in these variables. Thus, there appears to be some utility in the use of the Walk Texas! Clinical Counseling Guide for Nutrition in this population.