Recipe for success: nutrition educators use dialogue to bring home the message for families of modest means.
Subject: Nutrition counseling (Methods)
Educators (Practice)
Nutrition (Curricula)
Author: Hall, Sheri
Pub Date: 03/22/2012
Publication: Name: Human Ecology Publisher: Cornell University, Human Ecology Audience: Academic Format: Magazine/Journal Subject: Health; Science and technology; Social sciences Copyright: COPYRIGHT 2012 Cornell University, Human Ecology ISSN: 1530-7069
Issue: Date: Spring, 2012 Source Volume: 40 Source Issue: 1
Topic: Event Code: 200 Management dynamics Canadian Subject Form: Nutrition counselling
Geographic: Geographic Scope: New York Geographic Code: 1U2NY New York
Accession Number: 294821777
Full Text: More than 22,000 low-income families in New York each year learn about food safety, portion size, and how to stretch their dollars at the grocery store, through a series of nutrition programs given by Cornell Cooperative Extension. In one particularly powerful lesson, nutrition educators ask participants to calculate and measure out the amount of sugar in a variety of beverages. Most people are surprised to see the pile of sugar contained in beverages like fruit juice and soft drinks.

The educational curriculum is compelling and practical--designed to give participants tools they can use to save money and improve their families' nutrition. But less than a decade ago, the program was entirely different.

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"There was very much a teacher-classroom dynamic," said Joan Doyle Paddock, a senior extension associate in the Division of Nutritional Sciences. "Some teachers were lecturing for the whole hour without taking questions. The content was more about the science of nutrition. But our participants don't need to know what vitamin C does in their bodies. They need to know what to buy at the store, and what to do with it when they get home."

In 1999, Doyle Paddock and nutritional sciences associate professor Jamie Dollahite brought together a team of extension professionals to create the training curriculum that became Navigating for Success. The evidence-based training course teaches frontline nutrition educators how to reach New Yorkers of modest means with engaging educational sessions that will help the participants improve their own nutrition and save money.

The course has transformed nutrition education in New York and many other states. According to surveys given to participants before and after they took Navigating for Success, educators' skills have improved and participants in programs led by those educators make significantly greater behavioral changes. The benefits are spreading across the country; Cooperative Extension programs in nine other states have adopted parts or all of the program.

Navigating for Success is used to train community educators who work in two Cornell Cooperative Extension nutrition programs: Expanded Food and Nutrition Education Program (EFNEP) and Eat Smart New York, which educates participants in the Supplemental Nutrition Assistance Program (formerly referred to as food stamps). Both of these programs help families and youth with limited resources follow the national dietary guidelines.

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Lessons that engage the group

For more than 40 years, nutrition educators from Cornell Cooperative Extension (CCE) have visited families in their homes, often preparing a meal with them. But over the past three decades, most nutrition education has shifted from one-on-one to group sessions.

This shift has demanded different skills from nutrition educators. Instead of making a personal connection with participants, they needed to hone their group facilitation skills. But during on-site visits in the late 1990s, faculty members noted that many of the educators' group presentations didn't resonate well with participants.

"The curriculum we were using to train educators was old and outdated," said Jennifer Reardon, a regional coordinator for nutrition education with CCE. "They weren't teaching the type of class that adult learners would enjoy attending."

Reardon was part of the initial team that conducted a nationwide review of adult learning theory and nutrition curricula designed for the general public to find a new way to train frontline nutrition educators.

During their search, they met Joye Norris, a consultant with a doctoral degree in counselor education who envisioned a new way to help adults learn. She designed a model of teaching called the 4-A approach that creates a dialogue in the classroom that encourages learners to share their own experiences. The method's steps: 1) Anchor--participants share personal experiences on the topic, 2) Add--the teacher explains new concepts, 3) Apply--the group uses the new concepts, and 4) Away--students talk about the takeaways from the lesson and how they will change future behaviors.

The Cornell team was intrigued by Norris's approach and decided to apply the principles in New York. They spent five years creating a new course called Navigating for Success that puts the 4-A approach to work twice first when training the extension educators, and second when the educators teach program participants.

"It's really engaging people head-on from the minute you're with them, but related to the topic at hand," Reardon said. "One of the rules is that we don't call on people, but allow them to join the conversation when they feel comfortable. A lot of our participants may not have done well in school or may have low self-confidence. When they see we're not going to put them on the spot or tell them they're wrong, they're much more willing to participate."

The curriculum includes 19 units designed to teach educators who don't have formal nutrition training how to facilitate group presentations. Nutrition educators learn to include a food experience with every lesson. In one session, educators learn to lead a class where participants plan meals for an entire week and make a shopping list for those meals. In another, educators show participants displays of how germs grow and spread in their kitchens.

In 2004, CCE piloted the program with newly hired nutrition educators and then evaluated the new curriculum. At the beginning and end of every nutrition education series, participants take a survey about their grocery shopping, food preparation, and eating behaviors. The evaluations also ask about specific behaviors, such as whether participants wash their hands before eating or if they use a shopping list.

"We're not interested in them just gaining knowledge; we're looking for them to apply the information in their lives, making behavioral changes," Dollahite explained.

The new curriculum showed a clear improvement over the old one. Once educators were trained in Navigating for Success, participants in their nutrition programs reported about 10 percent greater change in behaviors than did participants in programs led by educators not trained in this approach, a statistically significant increase. The new evidence made it clear: Cornell Cooperative Extension needed to implement Navigating for Success with the entire nutrition education staff--more than 300 people statewide.

"Some people were right on the bandwagon from the beginning, and others weren't," Reardon said. "But as the staff experienced the lessons taught in this different way, they began to see the value.

"The curriculum is really interactive," she said. "People participate more, they ask more questions, you can see participants' minds moving. It's been an amazing transition. Now I can't imagine going back."

Neither can Tina Snyder, a frontline nutrition educator in Tompkins County. "When the program first came along, we were all a bit reluctant," she said. "The teaching method seemed redundant. But the repetitiveness helps it become part of how you deliver your programming. You get so much conversation going as a result, and people really enjoy the lessons more."

A culture shift across the nation

Once Navigating for Success was fully implemented in New York, the Cornell team began sharing the curriculum with extension professionals in other states. "The response has been extremely positive," Dollahite said. As far as we know, it was really the first program of its kind in the nation."

In the past five years, Cooperative Extension programs across the nation have implemented parts or all of the curriculum. Among them is Ohio State University Extension. Joyce McDowell, an associate professor in the Department of Human Nutrition at Ohio State, heard about Navigating for Success through a colleague who saw a Cornell presentation at a professional meeting.

McDowell and her colleagues had already hosted workshops on the 4-A process for their frontline nutrition educators, but the organization couldn't change educators' teaching style from lecture to dialogue-based sessions.

"We were looking for a systematic way to make this change," she said. "Up to that point, we used a single-session approach to training. This was the first series of training classes that we adopted."

The course translates well to other states because it uses universal principles for facilitating adult education and teaches many of the principles outlined in the U.S. federal dietary guidelines.

In 2009, all of Ohio's frontline nutrition educators had been through the Navigating for Success program. As in New York, Ohio is using behavioral surveys to measure the impact of the curriculum, and they've seen significant improvement in participant behavior change.

"Land-grant universities have a responsibility to use science-based curricula and to document the quality of program outcomes," McDowell said. "All of our nutrition educators have completed the training, and we're seeing great results."

The Cornell team has also worked with Cooperative Extension leaders in eight other states, helping them to integrate the approach into their programs.

"To say that we've been pleased with the results is an enormous understatement," Dollahite said. "It's changed the culture across the nutrition programs in Cornell Cooperative Extension, and now other states as well."

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For more information:

Jamie Dollahite

jsd13@cornell.edu

Joan Doyle Paddock

jed36@cornell.edu

Jennifer Reardon

jdr38@cornell.edu
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