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Home visitation programs offer a unique opportunity to implement a novel digital early childhood obesity prevention program. Evaluate usability of a digital infant feeding nutrition education module with key stakeholders (N=21) of a home visiting program in Florida. Home visitors (n=11) and enrolled mothers (n=10) of a home visiting program in Florida participated in a one-time, 45-minute qualitative interview via Zoom with a trained researcher using a semi-structured script based on constructs from the Technology Acceptance Model (TAM) and Social Cognitive Theory (SCT). Participants also completed a modified version of the mHealth App Usability Questionnaire (MAUQ). Interviews were audio-recorded, deidentified, transcribed verbatim and coded by two trained researchers using an inductive thematic analysis approach based on TAM and SCT constructs to develop themes. MAUQ subscales were analyzed using descriptive statistics. Most participants noted that they liked the digital format, and specifically mentioned the visual or interactive components, convenience and accessibility of the information, and general preference for digital information over paper handouts. Home visitors were interested in content related to food allergies and readiness for solid foods, whereas mothers were interested in all of the infant feeding topics. Nonetheless, the majority (90%) reported that they would be very likely to use information in the learning modules as part of home visits. Usability of the module was high across all three MAUQ subscales (mean ratings out of 7±SD: ease of use = 6.88±0.2, interface and satisfaction = 6.90±0.4, usefulness = 6.78±0.1). Limited access to technology by parents, compatibility of the module with various phone types, and necessity of keeping information updated were mentioned by home visitors as limitations that may impact usability. The results revealed that a digital nutrition education module to prevent early childhood obesity was deemed usable by both staff and parents of a home visiting program. Future research is needed to determine impact on parental feeding behaviors and child health outcomes. University of Florida Mowery Innovative Research Fund [ABSTRACT FROM AUTHOR]

Interest exists to standardize and improve data collection and coding in Expanded Food and Nutrition Education Program (EFNEP) classes by switching from a paper-and-pencil 24-hour recall to the Automated Self-Administered 24-hour Recall (ASA24); however, it is important to address the feasibility of putting this into practice. To do an initial pilot test to compare the use of ASA24 with paper-and-pencil recalls with EFNEP participants. Ten EFNEP paraprofessional educators were recruited from three states and trained to use ASA24. Participants were randomized at the class level to complete either ASA24 or a paper-and-pencil recall at program entry and the alternate method at exit. Participants (n = 37 entry, n = 30 exit) and paraprofessionals completed questionnaires about usability, confidence, preference, and perceived accuracy at entry and exit. Seven paraprofessionals participated in online focus groups or qualitative interviews. Questions about usability, confidence, and perceived accuracy were scored on a Likert scale from strongly disagree (1) to strongly agree (5); scores were analyzed using descriptive statistics. Qualitative interviews and focus groups were transcribed, and two researchers coded and developed themes using inductive content analysis. Average scores for usability, confidence, and perceived accuracy were very similar for ASA24 and the paper-and-pencil recall. When asked which method they preferred, both the participants and paraprofessionals were evenly split. In the qualitative interviews, almost all of the paraprofessionals felt that ASA24 would result in more accurate recalls. The major barriers mentioned were lack of computer literacy of some participants and problems with internet connectivity. ASA24 may be comparable to the paper-and-pencil recall in usability, confidence, perceived accuracy, and preference for both EFNEP participants and paraprofessionals. Qualitative analysis indicates that ASA24 may work better with participants who are computer literate, and may yield more accurate results. USDA. [ABSTRACT FROM AUTHOR]

To evaluate the impact of the West Virginia (WV) Kids Market Program on children's knowledge, attitudes and consumption of fruits and vegetables (FV) using a parent survey. Ninety percent of WV adults do not eat five servings of FV daily. Without positive parent role modeling and consistent home access, children are unlikely to develop preferences for FV, putting them at risk for obesity later in life. Repeated exposures and opportunities to taste in a positive environment are needed to encourage acceptance and consumption of FV by children. The program targeted low income children of all ages at SNAP-Ed and EFNEP nutrition education sites and their parents. Each child received $4 vouchers to shop at a farmers market set up at their school, child care center or other youth-based program site. Children received nutrition education and were offered taste tests in conjunction with markets. A 12-question, parent survey was sent home with all children participating in the market. Paper surveys were entered in SurveyMonkey for analysis. A total of 724 were returned (32% response rate). Of those parents returning surveys, 91% said their child ate all the produce they purchased, 77% said their child was more excited about FV, 71% said their child talks about FV more and 78% said their child could identify more FV. Parents reported changes in their child's knowledge, attitude and consumption of FV because of the program which are important factors in development of food preferences. This program offers a replicable model for nutrition education programs focused on increasing FV consumption and access in low income audiences. None. [ABSTRACT FROM AUTHOR]

To determine the feasibility of using the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24-2016) to assess children's diets as reported by parents enrolled in the Expanded Food and Nutrition Education Program (EFNEP). Washington EFNEP collects adult dietary data with a facilitated group 24-hour dietary recall (24HDR) using the form "Food Tracker: What I ate yesterday," supported by the facilitator and visual guides (Townsend et al 2013). The facilitation of ASA24 mirrored the facilitated process with guided instruction and visuals. A sample of English and Spanish speaking parents enrolled in WA EFNEP. As part of a larger study, parents were asked to complete a 24HDR via ASA24 for their youngest child between ages 2-8 at week two and nine of EFNEP classes. A facilitation kit was used to assist participants. All ASA24 data collections were conducted by trained professional staff. Raw data was exported from ASA24 to track the number of successful logins and attempts to enter recalls at each timepoint, total calories consumed, meal times, and food codes. Data collectors recorded errors frequently encountered, adjustments made to specific recalls, and user difficulties. Of the 88 enrolled participants, 62% completed ASA24 entry in Spanish and 38% in English. Fifty four percent (47) successfully completed ASA24, 27% (24) were unable to complete ASA24 and their child recalls were collected on paper, and 19% (17) did not attend the data collection. ASA24 can successfully be used to assess children's diets reported by parents enrolled in EFNEP. However, users may encounter challenges with connectivity, limited participant literacy levels, and technical difficulties within the ASA24 system. Identifying challenges and strategies to overcome them, is critical to inform the advancement and dissemination of this web-based tool. USDA. [ABSTRACT FROM AUTHOR]

Literature has shown a tendency of inadequate eating habits among youth, consequently, nutritional interventions are required. The Transtheoretical Model (TTM) classifies individuals based on their readiness to change. This work aimed to describe how the TTM was applied to nutritional interventions for adolescents. This systematic review followed the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched seven databases for randomized controlled trials and quasi-experimental designs written in English, Spanish and Portuguese that applied the TTM to nutritional interventions targeting adolescents. The primary question was "How was the TTM applied in the nutritional interventions?" The secondar question was "Were these nutritional interventions effective?" Data extraction occurred through the usage of an adaptation of the table model from Melo et al. 2017. That model follows instructions of the Centre for Reviews and Dissemination for Undertaking Reviews in Healthcare. Quality and risk of bias were assessed through a questionnaire, developed by the Effective Public Health Practice Project. The initial search in seven databases yielded 3,779 results, resulting in 10 final included papers. Adolescents were mostly recruited from schools, and the duration of the studies ranged from a month to three years. Eight interventions had positive results regarding improvements in dietary behaviors or TTM's measurements. Nine studies assessed stages of change, seven decisional balance, and five of them measured self-efficacy. The results from assessed studies showed that TTM based nutritional interventions for adolescents are way more effective than those that do not use the model, what is probably because it personalizes the intervention for every participant. This study is useful in the sense that it provides information about the usage of the model for this age group, describing its positive aspects as well as offering alternatives to deal with its weaknesses. [ABSTRACT FROM AUTHOR]

Sorghum is a versatile, gluten-free, whole grain, yet overall human consumption of sorghum is minimal. Whole grains, such as sorghum, substituted for refined grains can enhance the nutrition content of a dish. This research study was to determine the sensory perception and overall food preference of college-aged students when comparing sorghum to rice in a ready-made dish. A quasi-experimental study was conducted in a campus foodservice setting at the University of North Florida. The participants (n = 596) were randomly recruited, using convenience sampling, to blindly taste test two food samples then complete an associated sensory and perception survey. The food samples consisted of recipes identically prepared, with the substitution of sorghum for rice. Paper and electronic sensory analysis (using hybrid hedonic scales) and food preference surveys were available after sampling. A majority of the participants (71.9%) were ages 18-20 years old, with 42.3% selecting their educational classification as a freshman. Participants rated their overall feeling about each dish as to how often they would consume it, the response yielded a significant difference in overall mean (3.66 vs. 3.42, P =.000), with preference given to rice over sorghum. In comparing the two grain based dishes, participants indicated they would eat this every now and then to every opportunity they had with rice (55.2%) to sorghum (48.4%). Yet in response to overall acceptance of sorghum to rice, there was no significant difference. This study provides feedback on the perception of college students on substituting a refined grain for whole grains in ready-made dishes. This preliminary study implies that acceptability for alternative grains is feasible in college-age populations and more research needs to be conducted on overall perception of alternative grains in ready-made dishes. [ABSTRACT FROM AUTHOR]

To implement and evaluate an integrated Spanish-language program to improve nutrition, increase physical activity, and strengthen family function among Mexican-heritage (MH) families. We describe research (stepped wedge cluster randomized controlled trial [SWCRCT] of father-focused, family-centered program), education (experiential learning and innovative teaching), and extension (promotora-led charlas [chats/talks]) components. The SWCRCT consists of clusters of 10-15 families receiving six in-person group sessions (three focused on father-child pairs) and at-home activities. Session include food tastings, interactive lessons, active games, hands-on food preparation, time to eat together, and goal setting. The promotora interventionists were trained using the train-the-trainer approach to gain knowledge and skills related to nutrition and food preparation, physical activity, family functioning, and motivational interviewing. The program actively involved undergraduate and graduate students from Texas A&M University, Baylor University, and Texas State University in experiential training that included material development, participant observation of promotora trainings (cooking and experiential nutrition and physical activity) and family pretesting, and motivational interviewing. Program activities and learnings were included in undergraduate and graduate courses (research methods and evaluation). In the charla program, team promotoras conducted a series of five community-based programs and activities that delivered science-based knowledge and informal educational programs to empower Mexican-heritage children and families to make sustainable healthy decisions. More than 400 participants attended charlas, which took place in community centers, churches, community organizations, and colonia neighborhoods. Data were collected for training, recruitment, process (observations and checklists), and outcome (pre- and post-program surveys, seven-day accelerometer, Veggie Meter®, and interviews/focus groups. Surveys and reflection papers from students were used. Post-charla surveys, debriefs, and a follow-up ripple effect survey (sharing of session materials) was done. This integrated family program enhances the capacity of families, students, promotoras, and community members to incorporate education and skill-building into healthier behaviors. The SWCRCT is a game changer by engaging Mexican-heritage fathers, co-parenting couples, and children and addresses a lacuna in obesity prevention. [ABSTRACT FROM AUTHOR]

Breakfast After the Bell (BATB) has become the unofficial standard in school breakfast, particularly in larger, urban districts. However, there is sometimes concern that students eat at home or buy food before school, therefore eating breakfast twice. Additionally, student perceptions of BATB, its benefits and challenges, remain largely unstudied. To understand if students are eating multiple breakfasts when BATB is served, and to measure students' opinions of BATB. Middle school (MS) students from a low-income urban school district that operates under the Community Eligibility Provision took a paper-and-pencil survey during homeroom. This MS had switched from BATB back to breakfast before the bell midway through the schoolyear (n = 1149). District breakfast participation data were also collected and analyzed. Participants answered questions regarding their perceptions of school breakfast. Participants were also asked their opinions of the traditional model of serving breakfast before the bell compared to BATB. District breakfast participation data and descriptive statistics are presented. The majority of students reported a positive impression of BATB, specifically that they feel better when they eat breakfast (69%); eating school breakfast saves time at home in the morning (56%); and school breakfast saves their family money (53%). In addition, they stated they were more likely to eat breakfast when it was served in the classroom (55%). Importantly, the vast majority of students said that they never, or only sometimes, buy breakfast on the way to school (92%), and only 18% reported that they always eat at home. District breakfast participation data show a significant decrease in breakfast participation after the switch to breakfast before the bell. Overall, students reported many benefits of the BATB model. For most students, BATB was the only breakfast they report eating, which should remove the double-breakfast concern for school administrators. Returning to BATB would likely increase breakfast participation in the MS. Rutgers University Community-University Research Partnership Grant. [ABSTRACT FROM AUTHOR]

Limiting sugar-sweetened beverages served to children can help decrease childhood obesity risk. Early Care and Education (ECE) providers are key to promoting these beverage policies because they play a role in establishing healthy habits among young children. As a majority of Americans have Internet access, eLearning would be an appropriate format for a beverage policy training platform for ECE providers. The specific aim of this study was to determine the preferred eLearning format of ECE providers in Georgia to inform the development of an eLearning beverage policy training. The target population for study included licensed and license exempt ECE providers in GA serving children ages 0-5. A randomized, stratified sample of facilities was selected. ECE providers completed an electronic or paper survey evaluating the degree in which their program implemented beverage policy recommendations and their eLearning preferences. Mock prototypes for preferred eLearning formats were developed. A convenience sample participated in semi-structured interviews to yield preferences for the development of the eLearning training. Descriptive statistics were calculated to determine eLearning preferences. Qualitative data analysis was conducted to reveal themes from interviews. A total of 646 respondents completed the eLearning survey. Sixty eight percent of ECE providers reported participation in the Child and Adult Food Care Program. Participants had access to the internet (98.5%) and 44% would use the internet for a 15-minute educational session. Eighty five percent of participants reported having no beverage policy training. The preferred eLearning formats identified online were interactive video (46.8%), podcast (37.5%) and video-based learning (31.7%). A subset of ECE providers participated (N = 20) participated in interviews. Most participants chose interactive videos as the most effective training format. Findings showed that effective trainings should be engaging, concise, and hold trainees accountable. Study results revealed that most participants have not received a beverage policy training. eLearning trainings is a promising method to educate ECE providers and improve the quality of beverages served to young children. None. [ABSTRACT FROM AUTHOR]

This study examined the acceptability and feasibility of Facebook to provide ECE support on a nutrition curriculum, WISE. Parents and community members were targeted with a WISE component located in grocery stores. Nutrition interventions targeting children in early childcare are often intended to improve consumption and access in care and at home. For quality implementation of curriculum early childcare educators (ECE) need ongoing and on-demand support. Improving the nutritional environment in the community may result from public access to intervention components. ECEs (N = 776) attending WISE training were randomly assigned to receive support via Facebook. Most ECEs were White (63.0%), lead teachers (61.3%), and had a Bachelor's degree (39.5%). WISE communities (N = 8) were randomly assigned for retail intervention over a two year cohort. Cohort 1 (n = 4) received in-person support to implement and cohort 2 (n = 4) received online support. The sites were selected based on the ratio of children in WISE-trained centers to population. The poverty level of children (<18) ranged from 13.9% - 39.0%. Facebook statistics were used to assess the success of acceptance including the number of invitees that a) accepted the invitation to 'friend' the project Facebook page, b) that engaged, and c) that initiated. Retail engagement was assessed by the response of the store management to the project (location of display, willingness to engage with project staff), number of WISE handouts distributed or downloaded (cohort 2), and requests to continue or expand. Few ECEs (3.9%) accepted invitation, engaged (53%) or initiated (6%) activities even when offered incentives, polls, and alterations in security settings. All retail managers were enthusiastic to the project, asked for permission to expand, and continue after support was reduced to online. One thousand ninety two paper handouts were disseminated and online handouts reached 406. In our study, Facebook was not acceptable based on the lack of engagement by ECEs. This preliminary evidence suggests that retail connections are feasible and acceptable. 2016 [ABSTRACT FROM AUTHOR]

Mobile applications ('apps') for WIC families are becoming increasingly prevalent, especially in states that have transitioned from paper vouchers to electronic benefits transfer (EBT) for WIC. Apps and other digital technologies can improve the WIC experience by helping participants check their benefit balance, scan food items to determine WIC eligibility, streamline service delivery, and provide additional nutrition education. The Children Eating Well (CHEW) app aims to maximize redemption of WIC foods and improve overall diet quality of preschool-aged participants by facilitating benefit redemption at the store and providing easy, practical ways for parents to increase consumption of healthy foods through healthy recipes, quizzes, and goal setting features. The objective is to report on the findings of user testing and development during the preparation of version 2.0 of the CHEW app. Our team conducted qualitative interviews families of WIC children aged 2-4 years in an iterative process to inform user-centered development of version 2.0 and to maximize usability of the app. Using a sorting activity, participants were asked to rank potential in-app features by importance then place the cards into natural groupings of similar features. Participants were also asked to form mental models about using recipes, shopping lists, using WIC benefits, and checking their WIC balance. We will report on qualitative findings that informed the user interface, improvement of shopping tools, and format of nutrition education features. We will also describe how we are collaborating with partners and outline ways that potential partners can collaborate with the CHEW team to disseminate existing nutrition education content to WIC participants through the CHEW app in the future. The CHEW 2.0 app will be implemented in WIC clinics across the state of Tennessee as a supplemental education tool for families to use at home, with plans for future dissemination to other states. These formative findings can also inform the development of other technology applications for the WIC program. 2017-68001-26352. [ABSTRACT FROM AUTHOR]