A coordinated multilevel organizational intervention to improve nutrition and physical activity habits through low literacy health education among Head Start parents, staff and children.
Goal and Objectives
This intervention is to deliver a multi level program on healthy lifestyles for the entire Head Start population, which is at high-risk for obesity.
- To create awareness of important factors in the prevention of obesity through low-literacy health education.
- To empower participants to improve their nutrition and participate regularly in physical activity.
The multi-component program is carefully designed to empower Head Start parents in the care of their families, utilizing low literacy training materials, reinforcement, interactive sessions and hands on training.
In 2009, the Health Care Institute created a low literacy training program on diabetes risk awareness, budget-conscious nutrition, and importance of physical activity. Eat Healthy-Stay Active's goal is to increase knowledge and awareness of important factors in chronic disease prevention among Head Start staff, parents, and children, and to help each participant translate those skills into action. Low literacy materials were developed to explain basic concepts such as MyPyramid, the food groups, portion control, shopping on a budget, and integrating physical activity into daily life.
Eat Healthy-Stay Active is also structured around a Train-the-Trainer model. The chart below explains our logic model and the expected outcomes, and shows how the HCI methodology can be applied to chronic disease management of diabetes and obesity prevention (See Chart 1). During the one day staff training, sessions focused on awareness of obesity-related diseases, food groups, portion control, shopping on a budget, and the importance of physical activity.
After the Train-the-Trainer, staff then delivered a low health literacy curriculum to extended staff, and parents and children. Staff and parent workshops focused on opportunities to be role models for the children and cultivate a healthy environment. This was successfully accomplished by:
- Introducing follow-up activities-including pedometer challenges, visits to farmers markets, growing gardens, exercising with common household items, and cooking demonstrations. All activities reinforce the program principles.
- Providing food baskets, lunch bags, and exercise equipment as program incentives.
- Acknowledging the achievements of the families and staff during a culminating celebration that provides the opportunity to share successes as well as distribute healthier
Children were introduced to "My Pyramid" in the classroom, and teachers used it to lead a variety of lessons on healthy foods, as well as discuss shapes, colors, counting, and other skills. The children's curriculum featured a range of activities that allowed them to explore the importance of healthy living on a daily basis and coincided with the food groups being discussed each week at parent training.
Intervention impacts were measured through surveys, focus groups and physical measurements, and were divided into 3 main categories: Knowledge, Behavior and BMI.
Knowledge: Children, parents and staff showed significant improvements in knowledge related to nutrition and physical activity. More children correctly identified the food pyramid, the five food groups, and various plates consisting of foods from each of the five food groups. Also, 70% of children knew the difference between foods they should eat more often, or less often.
Behavior: Parents and staff improved in behavioral domains related to eating, grocery shopping and physical activity. Post intervention, physical activity significantly increased for parents and staff, 66% increase. These results suggest participants increased duration and frequency of exercise during intervention.
Body Measurements: There was a significant decrease in BMI ranges for parents and staff. The number of participants who were classified as obese decreased by almost four percentage-points, and the number of participants classified as overweight increased by roughly four percentage points (see Chart 2). There was a statistically significant downwards shift in aggregate BMI for parents and staff (decreased from 30.11 to 29.2, p<0.001).
Chart 3 shows the number of children who were classified as obese (BMI-for-age>95th percentile) decreased significantly by 32% following the Eat Healthy, Stay Active intervention (p<0.0001).
The results from Eat Healthy, Stay Active suggests that the intervention was effective in improving knowledge and behavior for parents, and key to the formation of healthy eating habits for themselves and their children. Even more impressive was the increase in the children's knowledge.