Amy Luginbill MPH Student Arizona State University

1. Food PLUS - Living Well: An Interactive Nutrition Education Program for Elderly CSFP Participants, A Pilot Study Amy Luginbill MPH Student Arizona State University November 2011

2. Needs Assessment Summary • Arizona elderly population is expected to grow to 28% of the total population by 20301 • About 100,000 elderly people in Arizona living in poverty2 • Nearly 60% of low-income Arizona seniors have the equivalent of a high school education or less2 • Nearly 60% of low-income, elderly individuals in Arizona are overweight or obese2 • Over 65% of low-income, elderly individuals in Arizona consume less than 5 fruits and vegetables per day2

3. Program Need & Purpose Need • Seniors, especially low-income, are at risk for poor nutritional status3 • Physical, mental, and social factors make undernourishment as well as overweight and obesity common in the elderly population3 Purpose • Educate the population about diet and health • Reduce barriers (real or perceived) towards eating healthy • Learn more about the CSFP population from first hand experience

4. Significance & Innovation Significance • Poor nutrition is a major concern in the elderly because it can cause/impact adverse outcomes: morbidity, mortality, risk of falls, disabilities, infections, anemia, weakness, fatigue, and much more 3 Innovation • To date, there have been no nutrition education programsprovided for the Phoenix CSFP population • Elderly population does not like to be “taught” or attend “class” – instead Food PLUS-Living well focuses on interactive discussions and activities

5. Theoretical Models Social Marketing Stages of Change (Transtheoretical Model) “ the design, implementation, and control ofprograms seeking to increase the acceptability of a social idea or practice in a target group.”4 • Focus on behavioral outcomes • Prioritize consumer benefit • Consumer-driven approach: Build demand for the product “five stages of change…represent ordered categories along a continuum of motivational readiness to change a…behavior”5 • Lessons focus on engaging participants and reducing barriers to change by providing cues to action (recipes, handouts)

6. The pilot program will take place over 4 months, from January through April 2012 Outreach: January • Handouts - Flyers, Calendars • Posters • Word-of-Mouth Program Implementation: February - April Nutrition Education Courses • Offered over a 10 week period • Total of 6 classes • Every other Tuesday • 10-11am • St. Mary’s Knight Center Food PLUS-Living Well An interactive nutrition education program

7. Food PLUS-Living Well: Outreach Material Flyers to be handed out to CSFP clients by St. Mary’s staff and volunteers

8. Food PLUS-Living Well: Material The Food PLUS-Living Well program… • Uses educational material developed and provided by the Elder Nutrition and Food Safety (ENFS) program at University of Florida ENFS Learning Modules contain background information, lesson outlines, interactive discussions, hands-on activities, and handouts • All ENFS material is developed by nutrition and education professionals and peer reviewed by a panel of experts.

9. Food PLUS-Living Well: Material Lesson 1: MyPlate for Older Adults Lesson 2: Fluids Lesson 3: Fiber Lesson 4: Calcium and Vitamin D Lesson 5: Folate and Vitamin B12 Lesson 6:Review/Popular Demand Each lesson features • Icebreaker, discussion, activities, PPT presentation • Demonstrated “recipe-of-the-week” using foods commonly received in CSFP food boxes

10. Food PLUS-Living Well: Recipes Lesson 1: MyPlate for Older Adults *Vegetable Medley, Pasta Primavera Lesson 2: Fluids *Flavored Water, Creamy Tomato Soup Lesson 3: Fiber *Southwestern Rice & Beans, 30 Min. Chili Lesson 4: Calcium and Vitamin D *Mixed Up Macaroni, Cheesy Rice Squares Lesson 5: Vitamin B12 and Folate *Sheppard’s Pie All recipes feature limited ingredients, little use of spices (as some are costly), and are diabetic friendly

11. Program Development: Agency Description Food PLUS-Living Well: Agencies Involved Arizona Department of Health Services (ADHS) & Arizona Nutrition Network (AzNN) St. Mary’s Food Bank and Distribution Center

12. Program Development: Agency Involvement Arizona Nutrition Network Dana Goodloe (AzNN Program Manager) provided professional guidance for program development Arizona Department of Health Services provided office materials & equipment, resource materials, and personnel resources required to develop Food PLUS-Living Well St. Mary’s Food Bank and Distribution Center St. Mary’s Food Bank donated building space, food, food boxes, tea & coffee, and organizational support for program promotion & implementation

13. Target Population Commodity Supplemental Food Supply (CSFP) Program • 92-93% of CSFP participants are seniors • Caseload is 12,965 (FY2011) • CSFP may be serving only about 10% of the total population in need • There are approximately 1,200 people currently on the Arizona CSFP Wait List (Courtney, S., personal communication, November 8, 2011) CSFP is called Food Plus at St. Mary’s

14. Target Population Most CSFP participants in Phoenix… • Are on a fixed income • Live alone in HUD housing or low-income apartments • Able to read and write (very few cannot) • Most Hispanic CSFP participants cannot read or speak English (Courtney, S., personal communication [email], September 30, 2011)

15. Target Population Of the clients that come to St. Mary’s to pick up their food boxes… • About half drive themselves • About half have a friend or family member bring them Barriers to Transportation • Most elderly participants do not utilize public transportation (city bus, light rail) because CSFP food boxes are too heavy for them to carry • Other services (Dial-A-Ride) often take too long to arrive (Courtney, S., personal communication [email], September 30, 2011)

16. Program Goals, Objectives,& Timeline

17. Program Goals, Objectives,& Timeline

18. Program Impact Health Impacts Low-income, elderly CSFP clients in Phoenix, Arizona are at increased risk for poor nutritional status. Within this population, nearly 60% are overweight or obese and more than 65% consume less than 5 fruits or vegetables each day.2 Food PLUS-Living Well helps resolve this problem by providing nutrition and health education to the population and by highlighting the importance and benefits of maintaining a healthy diet and lifestyle.

19. Program Impact Social Impacts Low-income, elderly CSFP clients in Phoenix, Arizona are at increased risk for poor social health. Social factors such as poverty, isolation, and subsequent depression, tend to lead to under-nutrition, anorexia, and/or weight loss in this population.3 Food PLUS-Living Well helps resolve this problem by providing a supportive social environment. CSFP clients who attend the program will benefit from the support and connections formed within the group.

20. Program Impact Economic Impacts CSFP clients have an income limit that is at or below 130% of the Federal Poverty Income Guidelines. Food PLUS-Living Well helps clients stretch their monthly budget by providing education on new ways to make the CSFP food boxes go further. Food PLUS-Living Well provides new recipes and handouts with tips on how to save money while maintaining a healthier diet.

21. Budget

22. Budget (cont.)

23. Sustainability Past Funding Period

24. Program Checklist 1. Develop background knowledge of project topic/issue Utilize ADHS resources, St. Mary’s resources Conduct literature review of topic/issue and previous interventions 2. Perform population assessment Utilize available survey/census data 3. Perform organizational assessment 4. Establish support by ADHS, AzNN, and St. Mary’s 5. Develop program 6. Obtain required program materials 7. Promote program Hang posters/pass out flyers 8. Implement program 9. Evaluate/assess program

25. Project Evaluation Program participants will be asked to complete an evaluation form after each lesson to assess how effective the lesson was in improving knowledge and promoting behavioral change Benchmarks for success: Minimum 5 person per lesson attendance Of those who complete the evaluation forms, 50% indicate they learned “some” or “a lot” after each lesson, and 50% indicate “yes” they plan to make a behavioral/diet change

26. Project Limitations Limitations to this study/program: • Inability to follow CSFP/program participants for a longer period of time to assess behavioral change • Small group size • Limited external validity (many variables associated with geographic location, age, sex, disability status, etc.)

27. Implications for Practice If successful, Food PLUS-Living Well can be used… Throughout Arizona to be tested with larger groups In senior living centers, retirement communities, hospitals, community nutrition centers, food banks, and/or alnternate CSFP distribution centers Food PLUS-Living Well is designed to be easily adapted Program includes all necessary material (background information, activities, etc.) thus could easily be implemented by trained volunteers/lay community health workers Adaptations may be made to target specific racial/ethnic groups, socioeconomic groups, or ages

28. Thank You! Questions? Comments? Please contact Amy Luginbill at amy.luginbill3@gmail.com

29. References 1. Administration on Aging. (2010). Projected Future Growth of the Older Population. Department of Health and Human Services. Retrieved from http://www.aoa.gov/AoARoot/Aging_Statistics/future_growth/future_growth.aspx#state 2. U.S. Census Bureau; American Community Survey, 2005-2009 Summary Table; generated by Carmon Greene; using American FactFinder; <http://factfinder.census.gov>; (13 September 2011). 3. Harris, D., & Haboubi, N. (2005). Malnutrition screening in the elderly population. Journal of the Royal Society of Medicine, 98, 411-414 4. Kotler, P. (1975). Marketing for nonprofit organizations. Englewood Cliffs, NJ:Prentice Hall 5. Prochaska, J. O., & Velicer, W.F. (1997). The Transtheoretical Model of health behavior change. American Journal of Health Promotion, 12, 38-48