Parents and Teachers Acting as Change Agents: The Influence of Nutritional Knowledge to Support the
Development of Healthy Behaviors in Children in Rural Appalachia
C. Anstrom, D. Kimberlin, K. Sunnarborg, K. Albrecht, R. Fosdal, K. Brown, S. Ray, L. Grove, H. Peterson, T. Ray, E. Troupe,
Introduction
Over the week of March 5-13, 2016, undergraduate dietetic students from
Olivet Nazarene University participated in a mission trip with Appalachia
Service Project in Guyan Valley, West Virginia. During this time, students
partnered with Head Start to share their knowledge and skills in nutrition
by holding educational sessions for parents of young children, ages 3-5,
and Head Start staff. Olivet dietetic students offered a variety of skills and
experiences that were valuable in enhancing the nutrition knowledge base
for parents and staff at Head Start.
Background
Student’s conducted a literature review to identify pertinent health related
issues for this population. It was discovered that, 37% of WV children
aged 2-4 participating in WIC were overweight, and 14.1% were obese
(CDC, 2010). Through communication with the Mountain Heart
administrative staff, a needs assessment was completed. It was confirmed
that parents of toddlers and staff of Head Start would benefit from
education on toddler nutrition to address identified needs. The results of
the literature review and the needs assessment led to:
1. The development of an evidence based educational intervention.
2. A search to find a tool that allowed collection of data to identify the
knowledge base of staff and parents pertaining to healthy habits.
The Behavior and Attitudes Questionnaire for Healthy
Habits (Henry, Smith & Ahmad, 2013) was used to
measure change in knowledge and attitudes about healthy habits.
The intervention was healthy behavior education provided to parents and
staff to address high risk behaviors that could result in childhood obesity.
Objectives
This work addressed two objectives. The first was to provide nutrition
education in a way that is understandable and applicable while taking into
consideration the current dietary customs of the Appalachia region. These
customs included:
 High consumption of energy-dense foods (sweets) in place of
healthier options (fruits and vegetables) (Hovland, et al., 2010).
 Reliance on convenient foods such as fast foods rather than home-
cooked meals (Tessaro, et al., 2006).
 Purchasing energy dense foods due to the perception of healthy
foods being too expensive (Tessaro et al., 2006).
The second objective was to provide students with the experience of
conducting undergraduate nutrition-related research and to identify
nutritional needs in the Appalachia region. Students:
 Completed a needs assessment
 Worked through Institutional Review Board (IRB) approval process
 Conducted a Mixed Methods design research project
The educational sessions provided to parents and staff sought to promote a
healthy community in the Appalachia region through taking steps to fill the
nutritional knowledge gap.
RESEARCH POSTER PRESENTATION DESIGN © 2015
www.PosterPresentations.com
M. Anstrom
Olivet Nazarene University and Mountain Heart Head Start
Methods
An attempt was made to recruit all parents, teachers and other interested
staff at each of the 10 Mountain Heart Head Start centers. All centers
received a flyer describing the education intervention. Administrative staff
advised the potential for an overall sample population of 90 sets of parents
and 10 to 20 teachers. A convenience sample recruited from 6 of 10 Head
Start sites for a total of n = 37.
Baileysville (n=4) Glen Forks (n=5) Hanover (n=10)
Kopperston (n= 1) Mayben (n=3) Oceana (n=14)
Students explained the purpose of the study and obtained consent. The
Behaviors and Attitudes Questionnaire for Healthy Habits (Henry et al.,
2013) was administered twice, prior to the start of the educational
intervention and immediately following educational intervention. The
questionnaire was carefully coded so results of the pre and post data could
be compared. Education intervention was held in a variety of available
rooms including a library, a cafeteria, and head start classrooms.. All
(n=37) questionnaires were completed, then analyzed using paired-samples
t-tests. Two open-ended questions were assessed for themes.
Intervention
The following topics were presented during the educational interventions:
 MyPlate food groups & serving sizes
 Healthy meal options with sample recipes
 Budget-friendly fruits & vegetables
 Packing healthy kids lunches
 Healthy snacks
Students preparing for nutrition intervention
Students interacting with staff & children at Head Start
Debriefing session
Results
Parents and staff knowledge and attitudes increased significantly
regarding: child’s portion sizes post intervention (M=4.58, SE =.230)
versus baseline (M=4.16, SE=.265), t(35) = -2.21, p<.05, d = -0.36; child
is eating healthy foods post intervention (M=4.88, SE=.191) versus
baseline (M=4.54, SE=.193), t(34) = -2.32, p<.05, d = -0.39; talking about
the value of a healthy diet post intervention (M=4.50, SE=.216) versus
baseline (M=3.94, SE=.210), t(35), p<.05, d = -0.46 (See Figure 1). Open-
ended questions revealed the following: a) participants identified cost and
availability of healthy foods as barriers to improving family health; b)
exercise and playing with their children can improve family health.
Figure 1.
Q8aB/Q8aA-Decide my child’s portion sizes
Q8bB/Q8bA-Decide if my child is eating healthy foods
Q8gB/Q8gA-Talk about the value of a healthy diet
Participants rated attitudes and behaviors on a 6-point Likert scale
Thematic coding of qualitative data revealed:
Q9-Things that make it hard to help my family’s health are:
 Cost of food
 Lack of availability of healthy food
 Picky eating
“Food prices and lack of farmer’s market in area”
“Grocery store price of fresh fruits and vegetables”
“We love unhealthy foods which we know is bad”
Q10-Things I would like to do to improve the food and physical
activity habits of my family:
 Playing
 Going outside
 Exercise/being active/walking
 Eating healthy food
“Walk, go to the park, stop eating out as much”
“Play more outside”
“Eat better and exercise more”
Conclusions
Educational intervention resulted in a positive difference in knowledge and
attitudes regarding portion sizes, eating healthy foods and value of a
healthy diet. During the debriefing session, students indicated an
increased appreciation of the research process.
Limitations
 Small sample size
 Inability to conduct focus groups due to time constraints
 Inconsistencies in logistics
Recommendations for Future Research
 To measure the effect of community-based initiatives that address
identified barriers
 To measure student attitudes towards experiential learning and
conducting community-based research.
References
CDC Division of Nutrition, Physical Activity, and Obesity. (2010).
Pediatric nutrition surveillance system. Retrieved from
http://www.cdc.gov/pednss/pednss_tables/tables_health_
indicators.htm
Henry, B. W., Smith, T. J. & Ahmed, S. (2013). Psychometric
assessment of the Behavior and Attitudes Questionnaire for healthy
habits: Measuring parents’ views on food and physical activity.
Public Health Nutrition, 17(5), 1004-1012.
Hovland, J. A., Mcleod, S. M., Duffrin, M. W., Johanson, G., Berryman,
D. E. (2010). School-based screening of the dietary intakes of third
graders in rural Appalachian Ohio. Journal of School Health, 80(11),
536-543. doi:10.1111/j.1746-1561.2010.00539.x
Tessaro, I., Rye, S., Parker, L., Trangsrud, K., Mangone, C., McCrone,
S., & Leslie, N. (2006). Cookin’ up health: Developing a nutrition
intervention for a rural Appalachian population. Health Promotion
Practice, 7(2), 252-257. doi:10.1177/1524839905278887
Acknowledgements
We want to thank the entire Mountain Heart Head Start community
for their overwhelming hospitality and support of this research and
of the dietetic program at Olivet Nazarene University. We also want
to thank the Psychology Department at Olivet for their support in
reviewing statistical procedures. Finally, we thank Dr. Diane
Richardson, Family & Consumer Sciences Department Chair for
her financial support in this endeavor.
Funding Disclosure: None