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Title: Evaluating behavior change among participants of the Hawaiʻi Expanded Food and Nutrition Education Program (EFNEP) 
Author: Pulver, Margaret J
Date: 2008
Abstract: Poor diet has been shown to be associated with the major causes of morbidity and mortality among people in the United States. Lifelong consumption patterns of various nutrients have been linked to the development and progression of certain chronic conditions and diseases (1). Thus, developing and maintaining good dietary habits is essential for long-term health and well-being. In 1980, the U.S. Departments of Agriculture and Health and Human Services developed a set of national recommendations known as the Dietary Guidelines for Americans. The guidelines were developed to assist Americans in relating scientific nutrition information to practical food choices and related behaviors. The sixth and most recent edition of the Dietary Guidelines, published in 2005, consists of nutrition recommendations that promote health and reduce the risk for chronic disease (1). Currently, many Americans, especially those of lower income and socioeconomic status (SES), do not meet the recommendations specified in the Dietary Guidelines (1-5). In response, efforts are made through nutrition education and outreach to inform individuals about the relationship between diet and health. The assumption is that individuals can and will make better nutrition- and food-related choices through the implementation of these programs. Established in 1969, the Expanded Food and Nutrition Education Program (EFNEP) provides nutrition education to low-income individuals. EFNEP's goal is to improve the well-being and health of participants and their families through 1 improved dietary practices and behaviors (6). Using a hands-on, learn by doing approach, local paraprofessionals teach homemakers about the fundamentals and importance of basic nutrition, food safety and preparation, and family resource management In 2006, EFNEP reached 150,270 adults and 409,389 youths directly, while impacting more than half a million family members indirectly nationwide (7). Nationally, more than 70% of EFNEP participants are minorities, with the majority being Hispanic American or African American (7). Hawai'i EFNEP differs from the National level with regard to the breakdown of its ethnic minority groups, in that 70% of EFNEP participants are of Native Hawaiian, , Pacific Islander, and Asian ethnicities. Nutrition education programs such as EFNEP utilize millions of U.S. tax dollars every year. Therefore, evaluating the effectiveness of these programs at improving the nutrition-related behavior of participants is essential for justifying continued federal funding. Such evaluations can be challenging because the effectiveness of nutrition education interventions depends on many factors, and few gold standards exist for evaluating nutrition-related behaviors (8,9). While there is a large amount of information available regarding the effectiveness of nutrition education programs among the larger minority groups in the U.S. (e.g., African and Hispanic Americans), only a very small amount of data pertaining to Asian, Native Hawaiian, and other Pacific Islander Americans is currently presented. Additionally, a lack of data sets large enough to make interethnic distinctions possible in multivariate analyses has resulted in these populations being analyzed as either one (Asian Americans and Pacific 2 Islanders) or two (Asian Americans or Native Hawaiian/other Pacific Islanders) large aggregated groups. This may have masked the high degree of diversity in socioeconomic, immigrant, and health status that exists between ethnic and cultural subgroups of Asian, Native Hawaiian, and Pacific Islander Americans. Hawai'i is an ideal location for investigating these ethnic groups in epidemiological research, because they constitute a large proportion of the State's population. Furthermore, Hawaii EFNEP provides an opportunity to examine the effectiveness of nutrition education among less aggregated ethnic groups within these broader categories. Research Goal and Objectives: The goal of this study was to evaluate the ability of the Hawaii EFNEP and the EFNEP paraprofessionals to facilitate behavior change among program participants. The objectives of this research were to: (1) learn which ethnic groups, if any, differed significantly in behavior change after completing the Hawai'i EFNEP series, and (2) determine if paraprofessional instruction had any significant effect on participant behavior change, based on the pre- and post- EFNEP behavior checklist questions.
Description: Thesis (M.S.)--University of Hawaii at Manoa, 2008. Includes bibliographical references (leaves 86-105). xii, 105 leaves, bound 29 cm
URI: http://hdl.handle.net/10125/20770
Rights: All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.

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