The Nutrition Challenge Program was developed by the Southern Nevada Health District – Office of Chronic Disease Prevention & Health Promotion (OCDP&HP). The program is a 12-week, web-based program that provides nutrition education specifically focusing on the importance of fruit and vegetable consumption. An evaluation of the program showed statistically significant improvements in fruit and vegetable intake and stage of behavior change among participants utilizing pre- and post-program survey responses.
Fruits and vegetables are a vital component of a healthy diet. The general recommendation for youth and adults is to consume between 5 and 9 servings of fruits and vegetables each day. In Nevada however, only 22% of adults are currently meeting that recommendation, most at the low end (BRFSS, 2005). Research has indicated that individuals who consume healthy diets rich in fruits and vegetables lower their risk of developing chronic diseases such as obesity, cardiovascular disease and certain types of cancer.
The overall goal of the Nutrition Challenge Program is to increase fruit and vegetable consumption among adults in Clark County, Nevada. Specific objectives include:
Develop a simple, web-based program to provide nutrition education with a focus on fruit and vegetable consumption that can be used by residents to track and log their servings of fruits and vegetables.
Promote the Nutrition Challenge program to the priority population.
Enroll at least 500 participants and demonstrate improvements in participants’ behavior change stage and consumption of fruits and vegetables at the conclusion of the program.
While obesity and overweight are complex chronic health conditions, a major contributor to the overweight and obesity epidemic is the poor nutritional habits of youth and adults. Besides overweight and obesity, poor nutrition is a risk factor for a number of chronic conditions including cancer, heart disease and diabetes. A review of available nutritional data indicates Nevada has reason to be concerned. Recently the US Government released updated dietary recommendations. New recommendations now urge Americans to consume between five and nine servings of fruits and vegetables a day. Yet less than one quarter of adults in Clark County (22%) are meeting the low end of that recommendation (BRFSS, 2005). In Nevada, only 37% of middle school students report eating one or more fruits per day, and less than one quarter of high school and middle school students report eating one or more vegetables a day (YRBS, 2003).
A closer look at available obesity data indicates certain racial and ethnic groups suffer disproportionately from overweight and obesity related health risks. According to the 2002 Nevada BRFSS, 61% of Blacks are at risk for health problems related to being overweight, followed by Hispanics (55%), American Indians (54%), Whites (52%) and Asian or Pacific Islanders (35%). If we are to be successful in stemming this epidemic of obesity, we need to start with the basics. All Nevadans must be encouraged to make proper nutritional choices, including eating a minimum of five servings of fruit and vegetables a day.
Although there are similar programs in existence that encourage the consumption of fruits and vegetables, the Nutrition Challenge is free, offers new content each week and is also available in Spanish. Several programs were researched before the Nutrition Challenge was developed. The Nutrition Challenge is innovative because the program brought several nutritional resources such as label reading, serving sizes, healthy recipes, and guidelines together into one program. The Nutrition Challenge was developed prior to the release of My Pyramid Tracker online programs and was based on the Planned Approach to Community Health (PATCH) model. When My Pyramid Tracker programs became available, links to these programs were added from the Nutrition Challenge. Because the Nutrition Challenge is a web-based program, nutrition content is easily updated and sustainable. Also, the time it takes to track servings of fruits and vegetables online is minimal.
Agency Community RolesSNHD, OCDPHP was the lead in the development, implementation and evaluation of the Nutrition Challenge Program. SNHD staff was responsible for developing the content, creating the concept, promotion and evaluation of the Nutrition Challenge program. SNHD staff also oversaw the contractor hired to develop the technical aspects of the program. One of the objectives of the project was to provide nutrition education to the community, in particular to communities at higher risk for nutrition-related health disparities.
To plan for the implementation of the program, SNHD staff worked with two community coalitions; LUCES a community coalition founded by SNHD in 2001 that works to ensure health promotion programs, particularly those related to chronic disease are available to the Latino community, and the Community Partners for Better Health Coalition (CPBH), a community coalition whose focus is to eliminate health disparities in communities of color. Both of these coalitions are comprised of representatives from health care, academia, governmental agencies, community based organizations, the business community and concerned citizens. SNHD staff sought input and feedback from members of both the LUCES and CPBH coalitions during the planning phase and throughout the entire project. The Nutrition Challenge Program was also developed in Spanish and input from LUCES coalition members was critical in insuring that the program content was culturally and linguistically appropriate. As a result of the existing relationship with the community, both coalitions agreed to help promote the program and distribute culturally and linguistically appropriate nutrition information to the communities that they serve.
Costs and ExpendituresThe initial start up cost for development of the program totaled $4,000 and included a contract with a computer programmer. In addition, OCDP&HP also contracted with a translator to translate the program into Spanish (total cost of contract was $1,000). Staff budgeted $1,800 for the purchase of incentive items related to the program including gift certificates to restaurants with fruit and vegetable based menus, and a fruit of the month club membership. A total of $3,000 was budgeted for printing to copy educational materials for individuals who didn’t have access to a computer and for miscellaneous office supplies. Thirty six thousand dollars was budgeted to promote the program via a paid radio campaign.
Staff time to develop program content and oversee the development and implementation of the program was provided in-kind with an estimated value of $38,000. The initial program development and promotion was funded by a grant received through the Nevada Trust Fund for Public Health in the amount of $51,000. The program has since been supported and sustained by the Southern Nevada Health District (SNHD) – Office of Chronic Disease Prevention & Health Promotion (OCDPHP).
ImplementationSNHD staff developed and followed an implementation strategy for the project. Each time period had certain milestones and deliverables.
November 2005 – January 2006
During this period, staff developed the program and consulted with and sought input from community partners and coalition members. Specific milestones and deliverables included:
Researched model nutrition programs and scientific literature.
Initiated an agreement with a web programmer to develop the technical elements of the program. The program was tested and went live March 1, 2006.
Initiated a contract with a certified translator to translate the program into Spanish. The program was translated into Spanish and the Spanish version went live on the Get Healthy website in May 2006.
Met with several community partners and coalition members from LUCES (Latinos Unidos Celebrando Salud) and Community Partners for Better Health to solicit feedback into the development of the program and develop dissemination strategies for promotion of the online nutrition program.
February – May 2006
Conducted a public information campaign to promote the program and partnered with two local radio stations. The 8-week radio promotion began in April and ended in May 2006.
Created flyers to promote the Nutrition Challenge program and utilized grassroots contacts and networks to distribute the flyer via e-mail. Coalition partners including LUCES and Community Partners for Better Health assisted with dissemination of flyers and nutrition information into the community, specifically communities of color.
Met with several community partners to discuss strategies to promote the online nutrition program including City of Henderson, City of Las Vegas and other local employers that agreed to promoted the program with their employees.
Nutrition Challenge Program information was included in a Healthy Hearts/Community Partners for Better Health newsletter and was distributed to churches, community centers, businesses and individuals with the African American community being the focus of the distribution.
June – August 2006
Developed and ordered several nutrition educational handouts and created nutrition logs so that individuals without Internet access could also participate.
Promoted Spanish version of the Nutrition Challenge via a one week radio campaign on a popular Spanish radio station. An ad was placed in “The News” newspapers that reached 200,000 households in Las Vegas. Staff was able to get free ad space in the Senior Living Magazine for the Nutrition Challenge program.
Utilized grassroots contacts and networks to distribute the Nutrition Challenge program flyers via e-mail.
With the assistance of coalition and community partners, distributed over 6,500 pieces of nutrition information and Nutrition Challenge flyers at health fairs, community events, community venues, and to parents of Head Start students and local businesses.
Objective 1:Develop a web-based program adults can use to learn about nutrition and track servings of fruits and vegetables.
Performance Measure: Development of web-based program.
Feedbcak: SNHD staff oversaw and monitored the development of the technical aspects of the program. SNHD staff was responsible for creating the content of the program and ensuring that the program was accessible. The Spanish version was modified slightly to relate to cultural food preferences. It was also translated into Spanish. The promotion plan was modified to promote the English version first, then promote the Spanish version two months later.
Outcome: The Nutrition Challenge Program was developed, tested and implemented. The program is still being utilized in the community and is housed on the “Get Healthy” website (www.gethealthyclarkcounty.org)
Objective 2: Promote the Nutrition Challenge program to the priority population
Performance Measure: Reach at least 150,000 people with message on nutrition and the Nutrition Challenge Program.
Feedback: SNHD staff worked with the media consultant to compile reach and frequency data related to the media campaign to promote the Nutrition Challenge program and provide nutrition information. Staff also worked with our coalition partners to monitor and track distribution of program flyers and nutrition information to the community.
Outcome: Through our media efforts, we were able to reach over 350,000 people who heard a radio PSA about the program and nutrition information at least 3 times. These figures were documented in reach and frequency data. Working with our coalition partners, we were able to disseminate over 7,000 pieces of nutrition information in the community.
Objective 3: Enroll at least 500 participants and demonstrate improvements in participants’ behavior change stage and fruits and vegetable consumption.
Performance Measure: Enroll at least 500 people in the web-based program. Using pre and post tests, demonstrate improvements in consumption and behavior change stage.
Feedback: SNHD staff monitored the registration database containing Nutrition Challenge program users registration and post-program responses. SNHD worked with a University partner to conduct an analysis of the program data base.
Outcome: An analysis of the participant data indicated that there were statistically significant improvements in both consumption and behavior change stage. These findings were recently published in the on-line journal of the Nevada Public Health Association (www.nphaonline.org)
SustainabilityBecause the Nutrition Challenge Program is primarily a web-based program, after the initial development, it became essentially a self-sustaining program. SNHD leveraged in-kind resources, including the existing “Get Healthy” website (www.gethealthyclarkcounty.org) as the host of the program, thus ensuring exposure and utilization after funding for the project was over. SNHD has also leveraged other resources to ensure sustainability and utilization of the Nutrition Challenge Program after project funding ended including promotion of the program though existing resources such as e-mail distribution lists, community partnerships, and community events. SNHD has also provided resources for incentives for program participants and has leveraged existing relationships with the community to secure donated incentive items.
SNHD leveraged relationships with community coalitions to ensure that information about the program and general nutrition information is disseminated to the community. Nutrition Challenge Program flyers and educational materials in English and Spanish have been distributed by coalition members at several community events. The CPBH coalition includes a column on nutrition in their quarterly newsletter and includes information about the Nutrition Challenge program in each edition. Through these partnerships and leveraging of resources SNHD has been able to ensure that the program has been sustained and continues to be utilized by the community.