Jamie

Greenstein
FSHN 428
Friday December 4, 2015
GENIE Project-Scherr

1.1 The proposed program provides evidence of feasibility. YES

The program provides ample evidence that this intervention can be done. It
is clear to see that throughout the paper, each activity and action is supported by
reasons why. The proposal discusses each stage of the study and how, when and
who is involved. There is numerical data that supports and analyzes the study
outcomes. Many of those on the administrative side of the intervention have had
experience in this field and use past strategies that have been proven as successful.
The program is specifically using the social-ecological approach as well as the social
cognitive theory. There is not just one section of the proposal where I feel feasibility
has been proven. Throughout the paper I feel that this has been proven affectively.

1.2 The proposed program describes why it is well-timed and/or novel. YES
Although this study is not necessarily a new one, it has added ideas that old
programs do not. A lot of the measurement techniques used are from previous
programs that have been deemed successful. This specific intervention incorporates
different aspects of other programs. For example, this intervention involves both
cooking demonstrations as well as a garden laboratory. An important change that
this proposal could have added is a timeline of the specific events. There needs to be
a chronological order of events in order for a program to be effective. The LOGIC
model diagram on page 3 gives somewhat of an order to how this program will flow.

1.3 The proposed program defines the target group and need. YES

The target group in this intervention is clearly stated as fourth grade
students at four different elementary schools in California. There may not be a
specific need to this group but the problem of childhood obesity may be prevalent in
this area. The introduction of this intervention discusses the high prevalence of
childhood obesity and the rising numbers. Fourth grade students at intervention
schools and their parents and teachers (page 1).

1.4 The proposed program justifies that the target group will benefit from the
program or intervention, based on related research, best practice examples,
or a needs assessment. NO

There is no specific evidence written in this proposal that justifies that the
target group will benefit from this program. It is mentioned multiple times that
some of the methods used, especially the assessment ones, had previously been
used in other studies. Though there is possibility that those methods were
successful, we do not know the actual outcomes of those studies. When possible,
previously validated tools will be used (page 6). In order to change this, I would
include the results of the previous studies mentioned. If they were successful or not,
I would change the proposal to match that data. This data from past research studies
only solidifies and justifies that my program might be successful.


2.1 The proposed program promotes healthy eating behaviors. YES

The objective of this entire research program is to improve the eating
behaviors of the fourth graders at elementary schools in California. The promotion
of healthy eating is seen in the program content and the activities planned all
include a nutrition take away. The article describes the research methods for the
Shaping Healthy Choices Program, a model to improve nutrition and health-related
knowledge and behaviors among school-aged children. (page 1)

2.2 The proposed program includes nutrition related goals that address
proximal outcomes. YES

The purpose of this study is to instill in school-aged children the importance
of nutrition and the benefits it has for you. Part of being a healthy person is being
nutritiously conscious in what you are eating. By participating in activities such as
cooking demonstrations and vegetable taste testing promotes knowledge on healthy
eating for the students, which will in turn hopefully cause them to make better food
choices in the future. The article describes the research methods for the Shaping
Healthy Choices Program, a model to improve nutrition and health-related knowledge
and behaviors among school-aged children. (page 1)

2.3 The proposed program includes nutrition related goals that address
intermediate or distal outcomes- if weight is the outcome, including
appropriate physical activity in goals is encouraged. YES

The main distal goal talked about in this intervention proposal is the
decrease of childhood obesity. Sustained weight loss, reduced risk of disease and
decreased health care spending are all distal goals desired by an intervention group
such as this one. Intermediate outcomes in this intervention are trying to change the
behaviors, actions, and decisions of the fourth graders. One way they have tried to
accomplish this is by providing salad bars in cafeterias. This allows for the student
to have the choice to pick a healthier option. Strategies for increasing variety of fresh
fruit and vegetables offered in school meals, coordinated with classroom and garden
activities, will also be discussed with school nutrition program directors. (page 5)

2.4 The proposal program includes measurable goals. YES

All of the tasks accomplished through this intervention can be easily
measured through testing and statistical analyses. Many of the testing methods used
to measure have been used in previous studies that have been successful in their
analysis of programs. Page 6 to page 7 proves this idea.

3.1 The proposed program uses research or best practice examples to show
how a model or framework integrates with the program goal. NO

In terms of having a specific model that is integrated with the program goal,
there is not one mentioned. Yet, I believe that this paper is demonstrating the social
cognitive theory. The social cognitive theory has 5 basic assumptions. Those
assumptions are people can learn by watching others, learning is an internal process
that may or may not change behavior, behavior is directed toward a particular goal,

behavior eventually becomes self-regulated, and reinforcement and punishment

have indirect effects as well as direct ones (FSHN 428 Social Cognitive Theory
lecture Oct 14, 2015). The main goal of this program is to change the health
behaviors of fourth graders in order to decrease childhood obesity rates. This
program will mention why they are doing an activity. A great example of this is the
cooking demonstration. The purpose of the cooking demonstration is to stimulate
childrens knowledge of, interest in, and preference of fruits, vegetables and other
healthy food items (page 4). Here we can see that we want the children to be able to
watch as well as participate in some type of healthy cooking activity. By watching an
adult facilitator do this, as well as their peers, the kids will be experiencing the social
cognitive theory. Although it may be simple for a nutrition educator to view this
method, it needs to be stated in this proposal.

3.2 The proposed program includes partnerships with other groups and
explains how these partners aid the program. NO

The proposal mentions family and community partnerships that includes a
family newsletter and community-sponsored health fairs. There is also discussion
about working with local farmers to get fresh fruits and vegetables. Unfortunately
the paper does not mention how the researchers are going to get in contact and
work with these partners. Promotion and reinforcement activities in this component
consist of family newsletters specific to the program and community-sponsored health
fairs at each intervention school (page 4). In order to improve this section, I would
mention how these partnerships would be attained. For starters, there is little
mention of who these partners will even be. Partnerships normally involve some
give and take from both parties. There needs to be mention of who they are
partnering with, why we are partnering with them, and what we are receiving from
them. In order to print a newsletter we are going to need to work with paper
printing companies in order to access the materials to make a newsletter.

3.3 The proposed program meets the needs of the target group. YES

I believe that in this proposal the needs of the target group are met. In order
to determine the needs of a certain group, a needs assessment needs to be done. The
need here is to reduce childhood obesity rates and to promote and change behaviors
of healthier eating for fourth grade students in this area of California. The proposed
program includes and provides many ideas that can promote this healthy eating
lifestyle. For example, there was the establishment of salad bars in the cafeteria as
well as health fairs for support. The overall goal is to meet the need of this group.
The objective of Discovering Healthy Choices is to facilitate student learning nutrition
concepts, nutrition recommendations, and critical thinking skills necessary to make
healthy food and health-related decisions (page 5).

3.4 The proposed program addresses external influences on food and eating.
NO

This proposal has little to no information about the external influences on
food and eating. Part of changing behaviors and attitudes toward healthy eating is
changing external influences. We can implement as many programs and

interventions as we see fit but if the external influences and environment that
surround an individual do not correlate and support those programs, then the
individual may not change their behavior or attitude. In order to implement this
program, there needs to be a section on how to address external influences.
Unfortunately, there is not a section in this paper that develops the idea of
addressing external influences. It is helpful that the parents and school
administrators are involved in the program because they can reinforce the program
outside of the school or home. But as young children, they will definitely voice their
opinions and tastes on certain things to their peers. There should be a training or
seminar that allows the program facilitators to learn how to address these external
influences in order for them to have a lesser effect on the progress of the program.

4.1 The proposed program describes an appropriate setting for target group.
NO

The program does not at all describe an appropriate setting for the target
group. There is mention of facilitating the program through the school but there is
no mention of where in the school. Of course the salad bar would be located in the
cafeteria but that does not seem like an appropriate place for a garden. The
instructional gardens are a great idea in order to promote healthy eating within the
school. But the next question is where and with what money. None of these issues
are addressed in the proposal but these are things that need to be taken care of in
order to appropriately administer this portion of the intervention. Another issue I
found with this proposal was that for the cooking demonstration there was no
location given. Someone reading this proposal is going to ask questions about the
kitchen, what it looks like, the appliances, and other necessities. The proposal
mentions what will happen in these cooking demonstrations but does not mention
the other important facts. In order to change this proposal, I would add details about
the location of the kitchen, pictures of it and other important facts that investors and
participants would be interested in. These demonstrations will feature vegetables
that students grow in the school garden and reinforce concepts that are presented to
the students in previous classroom lessons (page 4).

4.2 The proposal program describes realistic recruitment and retention of
participants. NO
Aside from choosing the four schools in California there is little mention of
how recruitment and retention of participants will occur. In order to get a program
to work, there needs to not only be participants, but they also have to be willing to
stick around for the whole program. By selecting schools to be part of this program,
the participants are not difficult to find. It is important that students, parents and
faculty are willing to participate in this program but since there is no information on
their willingness to participate in this proposal that is a hard aspect to evaluate. If
this program is mandated through the school than many students may not have a
choice but to partake in it, yet if it is not mandated then there needs to be a
recruitment strategy. To recruit participants, they need to be offered some type of
compensation for their time whether that is monetary or some other good. To keep
participants around for the entirety of the study, there also needs to be some sort of

retention strategy as well. In order to keep people participating in the study, they
need to be happy within the study while it is going on. Using methods such as the
participatory method, will allow evaluation as the study goes on as well as allowing
participants to put their feedback into the program as it is occurring. The
participatory method allows those who are participants of the program to put their
opinions and desires into the program so it can be tailored to make them feel more
involved. This method is difficult to do because it requires a lot of resources but it
will also be culturally appropriate (FSHN 428 International Nutrition lecture Nov 4,
2015). This fluid system will allow for participants to feel comfortable that change
can occur while they keep up with the program.

5.1 The proposed program includes several techniques to promote learning.
YES

This program includes multiple different techniques to promote learning.
Two of the main ones in this program include cooking demonstrations and
instructional gardens. These learning techniques are part of a curriculum called
Discovering Healthy Choices (DHC). DHC is an inquiry-based adaption of Nutrition
to Grow On, which is a fourth-through sixth-grade curriculum developed by this
research group and recognized as a National Cancer Institute Research Tested
Intervention Program. By teaching the children how to grow and cook their own
vegetables, they may be more inclined to do it more often on their own.
The objective of Discovering Healthy Choices is to facilitate student learning of
nutrition concepts, nutrition recommendations, and critical thinking skills necessary to
make healthy food and health-related decisions. (page 5)

5.2 The proposed program includes several techniques to motivate
participants. NO

The proposal lists no techniques that are intended to motivate participants.
Aside from the long-term health benefits, there are no listed motivations that would
encourage participants to participate in the program. Most people, if not all, will not
do something unless there is some type of motivation or benefit to them doing it. In
order to motivate participants, I would include a reward program. For example,
every time a student ate a vegetable or made a healthy choice, they would be
rewarded with a star sticker on a chart. If they got a certain number of stars, they
could be entered into a raffle to win some sort of prize. It would cost a small amount
of money for a poster board and some star stickers. A prize could either be
something donated by a local business or maybe even something that could be
purchased. The money can hopefully come from the budget the program has been
given. This system will motivate students to participate in the program because they
have the opportunity to work towards a prize. The proposal does offer a motivation
technique for the schools to participate. Schools will receive a $250 incentive for
participating in the program. (page 3). A small stipend will be provided for procuring
regionally grown fruits and vegetables for the salad bars (page 5). This monetary gain
is a good incentive to get the schools to participate but it does not offer anything to
the actual participants.

5.3 The proposed program includes several techniques to promote nutrition

behavior change. YES

The purpose of this specific program is to promote nutrition behavior
change. In order to do this, there are a couple different strategies. They include,
cooking demonstrations, instructional gardens, family newsletters, health fairs, and
establishment of salad bars. Each of these programs individually and collectively
works to promote nutrition behavior change. By participating in the entirety of the
program, students will gain greater nutrition knowledge and hopefully change their
behavior. These cooking demonstrations will feature vegetables that students grow in
the school garden and reinforce concepts that are presented to the students in
previous classroom lessons (page 4).

5.4 The proposed program explains why the planned teaching time and dose
are adequate/fitting use related research or best practice examples as
support. NO

We can see from the social cognitive theory that people learn from watching
others. In this proposal, the cooking demonstrations allow students to watch and
observe how to properly cook vegetables. It is also effective due to the fact that the
students themselves also grew these vegetables. These demonstrations will feature
vegetables that students grow in the school garden and reinforce concepts that are
presented to the students in previous classroom lessons (page 4). Although this is a
good start there is definitely an area that can be amplified. An improvement to this
section would be adding a timeline of events, like a list of all the vegetables they will
cook each week. It is also important to remember that these are younger children
who may not be able to pay attention for long periods of time so it is crucial these
workshops are fun, interactive and timely.

6.1 The proposed program content relates to program goals. YES

The content proposed relates very well to the program goals. The goal of the
program is to improve students dietary intake and physical activity behaviors while
simultaneously creating a community-based support system to prevent childhood
obesity (page 2). Gardening, cooking and other interactive measures allow students
the opportunity to engage in healthful activities that can translate into healthy
behaviors.

6.2 The proposed program content is based on best practice examples or
related research with citations from relevant research or government/health
society guidance. YES

There are a few points in this paper that reference content based on best
practice or related research with citations. One example of this is in the assessment
methods section of the paper. Many of the tools used to assess this program were
used previously in validated studies. When possible, previously validated tools will be
used (page 6). There is another section in the paper that uses a vegetable testing
method to evaluate participants and their taste in vegetables. The vegetables
preferences assessment, originally developed by Birch and later modified and
published for use with Nutrition to Grow On by this research group, will be used to

gather vegetable preference data (page 6). In addition to these studies and their
citations, there is also governmental data in this proposal. In order to provide
nutritional knowledge, this proposal uses the U.S. Department of Agriculture
MyPlate system. All of these methods have been previously used and validated and
can be used successfully in a program such as this one. Methods of validation and
reliability are included as references within each tools description (page 6).

6.3 The proposed program content is supported by experts or key informants.
YES

As discussed in 6.2, there are a lot of different reliable sources used in this
proposal. When possible, previously validated tools will be used (page 6). I think one
of the most significant experts in this proposal would be the U.S. Department of
Agriculture. A government-funded initiative, such as MyPlate, is a really good
resource to use to in a study such as this one.

7.1 The program cites and explains that the materials have social and cultural
relevance including language, reading level, food likes/dislikes, household
status, food/diet needs, interests, age/development stage matched, learning
style and/or format. NO

There is little to no evidence that expresses this component of program
proposals. The only portion in the study that allowed for preference was the
vegetable testing section in which participants were asked to try vegetables and rate
them based on their taste. Students will be asked to rate the taste of the vegetable if
they tasted it and whether they would it again (page 6). According to the American
Academy of Allergy Asthma & Immunology website, the rise in prevalence of allergic
diseases has continued in the industrialized world for more than 50 years (AAAA
website, 2015). With the rise of allergies, it is crucial that nutrition education
programs can be flexible and fluid in order to provide those with allergies the same
opportunity and experience as others involved in the program. This is also holds
true for those with other dietary diseases and restrictions. The children
participating in this study are so young that their food likes/dislikes are extremely
varied. Many of these students will not be interested in eating vegetables and fruit
and even if they are, their pickiness may be extreme. With all of these listed social
and cultural aspects it is important to be aware and understanding of these
differences. In order to become culturally aware and accepting, facilitators should
go through a training process that allows them understand the certain illnesses,
preferences, and other aspects of a person they might have to deal with. A facilitator
needs to be able to work with a group that is culturally diverse without issue.

8.1 The proposed program includes measurement tools that address program
goals. YES

The measurement tools used in this program relate well to the program
goals. As stated before, the measurement tools in this study have been tested before
in other studies. Methods of validation and reliability are included as references
within each tools description (page 6). In order to assess the physical activity of the
students, researchers use a monitor system called PolarActive. Students are

instructed to wear the wristwatch-like device for 24 hours a day for 5 days. This is
to measure the daily expenditure and steps the child takes and expends per day.
PolarActive has been validated for use in children (page 6). One goal of the program is
to reduce childhood obesity and by tracking the physical fitness level of the
students, it allows researchers to collect data on this matter.

8.2 The proposed program includes measurement tools that are reliable,
valid, and chosen based on related research or best practice. YES

As Ive mentioned before, this proposal has done an outstanding job at
proving that their measurement tools were reliable, valid and chosen based on the
best practice. Methods of validation and reliability are included as references within
each tools description (page 6). Most, if not all, of the measurement tools were use
from previous studies that had success with these methods.

8.3 The proposed programs evaluation method is cited, based on related
research, best practice or includes pilot testing to support its use. NO

This proposal does not have ample use of the evaluation method. There is a
lot of analysis of the data from the study, but minimal usage of the evaluation
method. If there were to be any sort of evaluation method, it should be listed at the
end of the paper but unfortunately it is not. In my opinion an appropriate evaluation
method for this program would be an outcome evaluation. An outcome evaluation is
a type of interpretation of a program that evaluates the reactions and feelings,
learning, changes in skills and effectiveness of a program (FSHN 428 Evaluation
lecture Sept 11, 2015). This type of evaluation can be used in order to determine
how successful a program may have been. In this study, there is mention of
measurement methods used that were cited from previous studies but nothing
about how the program as a whole was evaluated.

8.4 The proposed program includes process evaluation to check that the
program is being implemented as planned. NO

The program does not include any sort of process evaluation. There are
absolutely measures taken for data collection during the process of the program but
nothing is evaluated at that time. Height, weight, and waist circumference measures
will be collected for all participating students (page 6). A process evaluation
determines whether your program is effectively reaching the target population
(FSHN 428 Evaluation lecture Sept 11, 2015). Assessments will be used to determine
overall effectiveness of each component because of the integrated, comprehensive
study design (page 6). This evaluation will be continuous with the program in order
to make changes. I believe that a process evaluation would be positive for this
program especially in aspects such as cooking demonstrations. If it is something that
the students do not like or are not interested in, then it is something that can be
changed to keep them engaged and involved with the program.

8.5 The proposed program includes outcome evaluation measures for

proximal goals. YES

As stated before, an outcome evaluation is a type of interpretation of a
program that evaluates the reactions and feelings, learning, changes in skills and
effectiveness of a program (FSHN 428 Evaluation lecture Sept 11, 2015). There is
testing of nutrition knowledge and basic science process skills. Although it is
important to have testing, the proposal did not include enough information on how
they would test these students. The Test of Basic Science Process Skills 35-point
instrument will be administered to assess science process skills in 6 domains (page 6).
Unfortunately, this is about all the information about the testing given in the
proposal. To edit, I would add how often we test the students and what an
appropriate score would be to pass. These are important details to add in order to
determine if the program was successful or not.

8.6 The proposed program includes outcome and/or impact evaluation
measures for intermediate or distal goals. NO

Although the hopes of this study were to accomplish the distal goals, there
was no information listed in the proposal on the results of the program or what the
predictions are. Impact evaluation identifies long term and unintended program
effects (FSHN 428 Evaluation lecture Sept 11, 2015). As Ive said previously, there is
little to no evidence of what the results of the program may be or how we will
evaluate them. Impact evaluation is important to understand how this effective this
program was. In order to do this, the proposal should be changed to include this
type of evaluation. We need to be able to test the changes in both intermediate and
distal goals. The only mention of evaluation other than the ones listed in previous
responses are as follows: to determine whether and to what extent the intervention or
control groups demonstrate significant changes in any dependent variables, change
scores will be calculated by subtracting baseline scores from follow-up scores (page 7).
To do improve the program, I suggest there be more testing done at the end of the
program. For example, a great test would be another vegetable tasting activity.
When the program has ended, we can determine if their scores of likability change
from the first time they tried the vegetable until the end of the program. To test
distal goals such as weight, we will need to calculate the numbers and prepare them
in a generalizable way to determine if the program was a success or not.

8.7 The proposed program evaluates outcome/impact at multiple points. NO

As mentioned above, there is little to no evaluation of outcome/impact in this
proposal. Aside from collecting data, there are no check-ins throughout the duration
of the program. The study follows a pretest/posttest, randomized, controlled
intervention design (page 2). There is no mention of continuous involvement and
check-ins throughout the study, just a pre and posttests. To improve both impact
and outcome evaluations, there should be some sort of weekly check-in. This will
allow the team to collect data on what the participants like and dislike about the
program and what they can do to improve it. This way when it comes time for the
program to end, there is ample evidence to show success in the program. If we are
able to make our program fluid, we can change things as we go to make it more

enjoyable for our participants if they are able to voice their opinions on it. This
strategy will only better the program and make evaluation easier.

8.8 The proposed program includes an appropriate analysis plan. YES

This program has a great data analysis plan. I was really impressed with all
the plans they had laid out for analysis once the data had been collected. The
entirety of page 7 discusses all the types of analyses the program includes. One in
particular is the statistical plan. All variables will be compared between intervention
and control at baseline using t tests for continuous variables and chi-square tests for
categorical variables (page 7). These analyses will be effective in determining
numerical data. We will be able to generalize the data into categories to understand
the ultimate results of the program.

9.1 The proposed program addresses the potential for the program to
continue. NO

There is no such evidence that I found in the paper that strongly persuades
us that the program can continue. I think that there is evidence here that shows the
program can be replicated. Many of the events the program wishes to host, such as
gardening and cooking demonstrations, may become tedious and boring, especially
for younger children. A UCCE nutrition educator will be employed to deliver the 15 1hour lessons from the Discovering Healthy Choices curriculum at intervention schools
(page 4). According to this except from the proposal, there will be 15 sessions. As we
know with younger, developing children, it is difficult to hold their attention for long
periods of time. If a program like this were to continue, we might lose interest in our
participants. I would suggest that we adapt the program as needed. This program
should be replicated on different groups of children as well. I would suggest coming
up with future programs that involve students of one possible ethnic or racial group,
or of different ages. This way we are able to compare our data.

9.2 The proposed program is supported by evidence of prior/current program
success. NO

Unfortunately there is not much evidence of prior/current program success.
Most of the proposal is written in the future tense. As we have previously seen, there
has been usage of previous studys methods. When possible, previously validated
tools will be used (page 6). This could be amplified though. To improve this proposal,
I would suggest adding in the results of those previous studies and compare them to
what we are trying to accomplish from this study. This way, we are able to prove
that these methods worked and know that they are reliable for us to use.

9.3 The proposed program describes shared roles and duties of program
partners. NO

The program incorporates the usage of partners such as family and the
community. These are both great resources to use for this program, yet we do not
necessarily see what the roles of these two groups are. Promotion and reinforcement
activities in this component consist of family newsletters specific to the program and
community-sponsored health fairs at each intervention school (Page 4). In order to

improve this document, there needs to be a list of the roles these groups play and
what those roles do at specific times. This way going into the program we are aware
of how to make the most out of the resources we have.

9.4 The proposed program implies potential for broader reach, replication
and growth. YES

A program such as this one is extremely capable of broader reach, replication
and growth. However, it is anticipated that by improving health-related behaviors of
children, at an early age, the program will influence their future BMI percentile
trajectory (page 8). The future of this program is bright and offers a lot of different
options in categories to explore. For example, instead of using fourth graders like we
did in this program, we could use kindergarteners in another. We can see the
potential in it through events they are interested in implementing in schools.
Though these activities may need to be modified to fit the age group, there is
definitely potential to improve the program.

9.5 The proposed program addresses the collective program impact within
the community and/or among program partners. NO

Collective program impact is the commitment of a group of organizations
from different sectors to a common agenda for solving a problem (GENIE). In order
to sustain a program, it is important to work with other resources and programs in
the community. Working together can help achieve a common goal between both
groups. I suggest that this group pairs up with local government officials to attempt
to write legislation that will continue to make our school lunches healthier. Some
sort of advancement of the physical education program at schools in the area can be
written into legislation as well. There are many different community groups that
this program can pair with, though this is just one example. It is important to
expand the network of our program in order to help the surrounding community
and those participating in our program as well.

References

Allergy Statistics | AAAAI. (n.d.). Retrieved December 4, 2015, from

http://www.aaaai.org/about-the-aaaai/newsroom/allergy-statistics.aspx

Chapman-Novakofski, K. (2015, September 11). Evaluation. Lecture, Urbana.

Chapman-Novakofski, K. (2015, October 14). Social Cognitive Theory. Lecture,
Urbana.

Chapman-Novakofski, K. (2015, November 4). International Nutrition. Lecture,
Urbana.