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Collecting 'before' and 'after' ratings at the time of post-testing for program evaluation, reduces the likelihood of response-shift bias with a resulting increase in reliability. This method may be promising for program evaluation, especially where overestimation of initial behaviors are likely with a resulting improvement in intervention outcomes. Applying qualitative methods, the objective is to determine client preferences for retrospective approach and format, and implement those results in two tools of varying length. The Nutrition Education Evaluation Model (NEEM) was used to guide selection of approach and development of format for a non-traditional retrospective evaluation. Cognitive interviews were conducted at a food bank in 2006 and at Head Start and EFNEP sites, 2011-2018. Participants were low-income, English or bilingual Spanish speaking and available for an immediate interview. Several strategies were employed: concurrent and retrospective think alouds, paraphrasing probes, response format options and restating text. EFNEP educators offered opinions in unstructured discussions. Study participants and EFNEP educators recommended one of four approaches: the Post then Pre. They preferred the format featuring each question on row along with two sets of response options flanking the centered question, use of a visual to portray each question, use of color to guide tool instructions, and presence of icons to support 'before/then' and 'after/now' concepts. Two examples of the visual retrospective method were produced: Focus of Sweet Drinks...Now and Then for an English speaking low-income audience and Focus on Veggies...Now and Then for a Spanish speaking low-income audience. This qualitative method and the study results can be utilized by other researchers and practitioners. [ABSTRACT FROM AUTHOR]

To address pediatric obesity risk reduction, EFNEP was embedded within medical clinics where pediatricians referred parents to the intervention. The traditional EFNEP intervention was augmented with guided goal setting (GGS), Healthy Kids (HK) obesity risk assessments, motivational modeling, and parenting topics. This investigation focused on assessing goal-setting behaviors of EFNEP participants attending the medical clinic intervention. Pediatricians referred 686 parents (30% Spanish speaking) to the EFNEP intervention. More than one-third (n = 264) of parents referred expressed interest in attending with 195 verbally agreeing to enroll in the intervention anchored with GGS. GGS gives goal choices from a collection of practitioner developed major and minor goals so parents can make their own goal decisions. Parents completed the HK assessment tools during session one, they were guided to select nutrition and parenting minor goals at session two, but at subsequent sessions, were given the options to continue with the same goal, select a new guided goal, modify the existing goal, or create a new goal. Goal selections, effort, and attainment were tracked weekly. Twenty intervention series with parents or caregivers (n = 105, 50% Spanish speaking) were conducted at five medical clinics with 78% of parents completing four or more sessions. All parents engaged in GGS with most making nutrition and parenting goal effort and achievement (Spanish 96%, 74%; English 92%, 69%, respectively). Parents selected fruit and vegetable goal topics frequently and rarely chose contingency management topics. Most parents selected a new goal each session with Spanish speaking parents more likely to select a guided option (72% vs 61%). Parents referred by their child's pediatrician attended the EFNEP intervention and engaged in the GGS activities. Parents reported a high level of goal commitment with Spanish speaking parents attending more classes and reporting higher levels of goal effort compared to English speaking parents. GGS was shown to be a suitable behavioral strategy for Spanish and English speaking parents attending EFNEP within a medical clinic setting. [ABSTRACT FROM AUTHOR]