SBIR-STTR Award

The American diet is generally unhealthy and characterized by high intake of fat and saturated fat, and low intake of calcium, whole grains, fruits, vegetables and fiber. The most recent USDA Center for Nutrition Policy and Promotion's Healthy Eating Index reveals that only 10% of the U.S. population has a good diet, while 74% have diets in need of improvement and an additional 16% have a poor diets. This suggests an urgent need for nutrition education to help individuals to make better, more healthful choices. This project will develop a training curriculum intended to increase mastery of nutrition concepts and improve teaching skills of NEPs. The instructional modality will be self-paced instruction with mastery testing for each lesson. The curriculum and training materials will be based on current research and best practices to prepare paraprofessionals with appropriate knowledge of nutrition basics and teaching competence to effectively provide nutrition education for their program participants. The pedagogical emphasis will be on acquisition of knowledge and skills appropriate for providing effective instruction to participants in nutrition assistance programs. OBJECTIVES: The goal of the Phase I study is to assess the feasibility of developing an interactive, multimedia CD-ROM that enables paraprofessionals to gain mastery of basic nutrition education concepts commonly used in providing nutrition education instruction to low-income program participants and other consumers. For purposes of demonstrating feasibility, the Phase I study will develop a prototype of a self-paced, interactive nutrition education lesson and a corresponding interactive mastery test and trilingual (English: Spanish, Mandarin) glossary. The specific technical objectives of the Phase I research are to (1) design a prototype lesson, a trilingual glossary and an accompanying mastery test (2) produce an interactive, multimedia prototype lesson, trilingual glossary, and mastery test, and (3) conduct a pilot test of the prototype lesson, trilingual glossary and mastery test. APPROACH: The major tasks corresponding to the technical objectives of this study will be to design, produce and test an interactive, multimedia nutrition education prototype, training tool aimed at paraprofessionals. The project will conduct four major project tasks: (1) design instructional materials. The formulation of a strategy for developing nutrition-training materials for a prototype lesson will be conducted with the assistance of the nutrition education experts that serve as consultants to the project. These consultants will be convened four times over a seven-week period to participate in the design of a training strategy for improving the methods and content for training NEPs. Key considerations in selecting a topic for the prototype lesson are to identify key nutrition concepts, principles, and practices related to the role of diet in maintaining health, and risk factors associated with poor eating habits that are current, evidence-based and address the training needs of paraprofessionals. The criteria for content selection of nutrition education materials includes but is not limited to nutrition principles, healthy diets, nutritional values of specific foods, risk factors associated with high fat and sodium intake and low protein, iron and calcium intake. (2) develop prototype content. As envisioned, the prototype training materials will include a lesson, a mastery test, and a trilingual glossary (English/Spanish/Mandarin). Particular attention will be paid to the scope and sequence of lessons, and the specific multimedia and interactive elements that can optimize the ease of use of the materials, and to make the lessons engaging and instructional for learners. This process will result in identification of key terms, phrases and concepts that will be featured in the trilingual glossary. (3) conduct multimedia authoring. The objective of this task is to demonstrate the feasibility of developing an interactive, multimedia nutrition-education training resource for paraprofessionals. The nutrition education content that has been selected and subsequently designed into appropriate instructional materials will be developed into interactive, multimedia materials. (4) conduct pilot test of prototype. The objective of this task is to demonstrate the viability of an interactive, multimedia nutrition education resource as a training tool. To this end, a pilot test of the prototype nutrition education CD-ROM will be conducted with active NEPs in California. An instrument will be developed for rating each of the instructional elements presented in the CD-ROM; a data management and analysis plan will also be formulated. Key indicators of success are the degree of learner satisfaction with the training process availed by the CD-ROM, and the extent to which the process improved their knowledge. PROGRESS: 2004/05 TO 2004/12 The objective of this SBIR Phase I study was to develop and pilot test an interactive, multimedia nutrition education training tool for nutrition education paraprofessionals. The resulting product of this study was an instructional CD-ROM that presents a prototype lesson designed to foster learning across the wide range of learning abilities of nutrition education paraprofessionals. The CD-ROM contains a seven-part lesson on sugar that presents an introduction on digital video about the presence of sugar in the American diet, five learning units on sugar and nutrition, and a mastery test. Nutrition subject-matter experts that served as project consultants helped to formulate an instructional strategy that guided the design of prototype nutrition education materials. A pilot test of this prototype training tool was conducted with nutrition education paraprofessionals in training as well as nutrition education paraprofessionals from the San Francisco Bay Area and the Los Angeles Basin. A total of 35 respondents were accrued for this pilot study, which included 22 participants enrolled in a junior college Nutrition Assistant Program and 13 participants employed as paraprofessional Nutrition Education Assistants in the FSNEP and EFNEP programs. The former represent new learners while the latter participants represent experienced and advanced learners. The average age for the new learners was 28.18 years compared to 45.69 years for the advanced learners. The average number of years in nutrition education for the advanced learners was 6.75 years and ranged from one to 23 years in the field. Three of the 22 new learners were male while one of the 13 advanced learners was male. The measurement of learner interest and acceptance of the prototype nutrition education lesson employed a five-point Likert scale across eight items related to curriculum and instructional design, three items related to ease-of-use, ten items related to lesson-specific features, and two items related to the mastery test. Learners also responded to seven open-ended questions on user preferences and suggestions for improvements in the design and instruction of the training tool. Ratings for the 23 rating scales were analyzed to determine the extent to which respondents were engaged by the interactive, multimedia prototype lesson. The findings of the pilot test indicate that respondents enthusiastically favored an interactive nutrition education training-tool designed for individualized, self-paced instruction. The ratings of the prototype lesson by new learners averaged 4.26 and ranged from 3.71 to 4.62; advanced learners averaged 4.48 and ranged from 4.0 to 4.85. The average ratings for curriculum and instructional design were 4.15 and 4.55 for new and experience learners, respectively; 4.53 and 4.66 for ease of use experienced by new and experienced users, respectively; 4.21 and 4.49 for lesson-specific ratings for new and experienced learners, respectively, and 4.16 and 4.20 for mastery test ratings for new and experienced learners, respectively. These findings suggest the training-tool was equally appropriate for new and advanced learners. IMPACT: 2004/05 TO 2004/12 The interactive, multimedia CD-ROM developed through this SBIR study adds an innovative instructional resource for training nutrition education paraprofessionals to the repertoire of materials available to the field. If proven effective in the Phase II study, it will improve the level of nutrition knowledge and teaching skills of new and experienced nutrition education paraprofessionals. This improvement in instructional ability of nutrition education paraprofessionals will indirectly impact program participants in USDA food assistance programs, which reach an estimated 27.2 million persons monthly. Studies indicate that individuals with more nutrition information are more aware of the links between poor diet and certain diseases and generally have more healthful diets. Diet is a known risk factor for the three leading causes of death in the U.S. - coronary heart disease, cancer, and stroke - as well as for diabetes mellitus, high blood pressure, and osteoporosis. The annual economic cost to the nation from heart disease and cancer exceeds $150 billion and the annual economic cost of obesity in the Untied States is estimated by the US Surgeon General to be $117.2 billion. In a small but important way, the nutrition education training resource developed and tested by this project will impact diet related diseases and correspondingly the enormous costs in health care and lost productivity of food assistance program participants and others served by nutrition education paraprofessionals with improved knowledge and instructional skills

The nutritional paradox in this nation is that although food is abundant, most Americans eat poorly. The American diet is characterized by high intake of fat and saturated fat, and low intake of calcium, whole grains, fruits, vegetables and fiber. The USDA¥s Healthy Eating Index gauges the adequacy of the American diet. The most recent Index reveals that only 10% of the U.S. population has a good diet, while 74% have diets in need of improvement and an additional 16% have a poor diets. It is evident that the food choices of most Americans are ill informed. The purpose for this study is to develop and test an innovative nutrition education CD-ROM for nutrition education paraprofessionals. It employs interactive multimedia technology to offer individualized, self-paced training. This CD-ROM presents a nutrition-education training curriculum based on authoritative content, sound pedagogical principles and best practices. It features the 2005 Dietary Guidelines for American, the Food Guidance System, different food groups, nutrition labels, food safety, food shopping and meal planning, the importance of nutrition and physical activity to health, and adopting a healthy lifestyle. The training CD-ROM includes (1) a set of nutrition education lessons, (2) mastery tests for each of those lessons, (3) a multilingual glossary of common nutrition terms in Spanish, Chinese, and Vietnamese, (4) a module on instructional strategies, and (5) materials for use by nutrition education paraprofessionals when teaching nutrition to their program participants. OBJECTIVES: The overarching goal of this study is to develop and field test an interactive, multimedia nutrition education training tool for paraprofessionals. The specific objectives of the proposed research are to: (1) select appropriate subject matter by reviewing and evaluating subject matter that responds to the needs for current and authoritative nutrition education training materials, identifying specific content that improves existing training materials and addresses unmet needs for training nutrition education paraprofessionals, and) selecting a full complement of topics for a nutrition education training curriculum for paraprofessionals, (2) design pedagogically sound, multi-part nutrition education lessons for training new and experienced paraprofessionals by organizing the selected nutritional facts, concepts, and nutrition education materials into coherent instructional topics, formulating a strategy for developing those materials into learning units that introduce new information and reinforce existing knowledge to new and experienced paraprofessionals, and developing a nutrition education curriculum based on learning activities that are interesting, enjoyable and appropriate for adult learners in diverse settings and with different learning styles, (3) integrate different media elements into an interactive learning resource for nutrition education paraprofessionals by assembling and digitizing all the pre-produced media elements of the production, including graphic images (photos, line drawings, illustrations, video.), audio (music, sound effects, ambience sound and voice), and animation, configuring the levels of interactivity required for different nutrition education lessons, designing and calibrating navigation controls that are intuitive and user-friendly, and enable learners to easily access the information they need, and producing an interactive, multimedia CD-ROM designed for self-paced, individual instruction for nutrition education paraprofessionals, and (4) conducting a field test to assess the efficacy of the interactive, multimedia nutrition education training tool to determine the extent to which learners were able to use the nutrition education resources in their workplace settings, measure levels of user-satisfaction of nutrition education paraprofessionals with the nutrition education training tool, assess knowledge gains as a measure of the instructional efficacy of the nutrition education training tool and assess self-efficacy gains, i.e., outcome expectations, of learners perceived ability to apply their new skills and knowledge in their conduct of nutrition education classes. APPROACH: This study will develop an innovative nutrition education training CD-ROM for nutrition education paraprofessionals based on authoritative nutrition education content and sound pedagogical principles. The curriculum and training materials will be based on current research and best practices. The training curriculum will be designed for individual, self-paced learning through an interactive, multimedia CD-ROM. Learners will receive on-screen instruction and will be able to proceed at their own pace; they will be able to stop and then continue instruction at a later time. The interactive, multimedia training CD-ROM will feature nutrition education lessons, a corresponding mastery test for each lesson, a multilingual glossary of common nutrition terms in several non-English languages, an instructional strategies module, and collateral materials to enhance the teaching of nutrition basics by nutrition education paraprofessionals to their program participants. The training curriculum will include the 2005 Dietary Guidelines for American, the Food Guidance System, different food groups, nutrition labels, food safety, food shopping and meal planning, adopting a healthy lifestyle, and nutrition and physical activity. Each lesson will conclude with an interactive mastery test that identifies incorrect answers and returns the learner to the corresponding section of the lesson so they can review it and gain mastery before proceeding to the next lesson, thus optimizing learning. The mastery test will take the form of an interactive multiple-choice quiz that flags incorrect answers and automatically returns the learner to the corresponding section of the lesson for another opportunity to learn the materials before proceeding to another lesson. The curriculum also will include a vocabulary list of key nutrition education concepts and terms in Spanish, Chinese, and Vietnamese to ensure that paraprofessionals use language-appropriate terms when instructing non-English speakers. The training CD-ROM will also include instructional materials for use by nutrition education paraprofessionals to teach program participants. Selected segments of the instructional materials will be designed for use by the nutrition education paraprofessionals when providing instruction to their program participants in settings equipped with computers. PROGRESS: 2005/09 TO 2006/09 The goal of this Phase II SBIR grant was to develop a self-paced, interactive, multimedia CD-ROM training tool for paraprofessionals that combines audio narrative, music, graphics, animation and digital video to engage users in an active learning process that increases interest in the information presented and fosters learning across the wide range of learning abilities of nutrition education paraprofessionals. The training curriculum will include current, authoritative information and cover key nutrition education themes, including but not limited to adopting a healthy lifestyle, nutrition and physical activity, different food groups, food labels, food safety, food shopping and meal planning. Each lesson will have an interactive mastery test that flags incorrect answers and returns the learner to the corresponding section of the lesson for review before proceeding to the next lesson, thus optimizing learning. The English-language curriculum will include a glossary of key nutrition education terms in Spanish, and Vietnamese to ensure that paraprofessionals use language-appropriate terms when instructing non-English speakers. The CD-ROM will also include information on instructional strategies to help paraprofessionals improve their teaching methods, and instructional materials they can use to enhance the quality of their teaching materials. The project is progressing on schedule and on budget. The objective for the first year of the project was to develop a curriculum and design lessons for development into an interactive training CD-ROM. The development of the curriculum for the training CD-ROM was scheduled for completion by September 29, 2006. This curriculum was been developed on schedule with advice and assistance from two subject-matter experts. This curriculum is currently being scripted into interactive lessons, which are scheduled for completion by October 26. To date, half of the lessons have already been scripted and reviewed and approved for production by the subject-matter experts. The remaining lessons are expected to be completed on schedule. The objectives for the second and final years of the project are to (1) produce an interactive, multimedia nutrition training CD-ROM, and (2) conduct an evaluation of its effectiveness with paraprofessionals in a randomized controlled study. The preproduction tasks are currently underway. The evaluation instruments are currently being designed. All indications suggest these two tasks will be performed on time. IMPACT: 2005/09 TO 2006/09 The training materials for this project are currently being developed and thus have not been evaluated for impact. An evaluation of the materials is scheduled for the second and final year of the project. PUBLICATIONS (not previously reported): 2005/09 TO 2006/09 The work on this project is not yet complete, and no manuscripts have been submitted to academic journals for consideration at this point. However, we presented a poster sesssion at the 39th Annual Conference of the Society for Nutrition Education scheduled to be held in San Francisco on July 15-18, 2006