Improving the Quality of Data From EFNEP Participants With Low Literacy Skills: A Participant-driven Model

Published:November 21, 2013DOI:


      Low literacy skills and poor evaluation tool readability combined with the stresses of the classroom environment create a high cognitive load for Expanded Food and Nutrition Education Program (EFNEP) participants, resulting in lower quality data. The authors advocate for 9 strategies for improving the participant cognitive load for the evaluation process using the EFNEP Family Record as an example.

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      1. US Department of Agriculture (USDA), Expanded Food and Nutrition Education Program (EFNEP). Accessed October 30, 2013.

      2. US Department of Agriculture (USDA), Supplemental Nutrition Assistance Program–Education. Accessed May 25, 2013.

      3. US Department of Agriculture (USDA). Food and Nutrition Service. Promoting Healthy Eating: An Accessment in the Future. A Report to Congress, 1999. Accessed April 30, 2013.

        • Townsend M.S.
        Evaluating Food Stamp Nutrition Education: process for development and validation of evaluation measures.
        J Nutr Educ Behav. 2006; 38: 18-24
        • Parikh N.S.
        • Parker R.M.
        • Nurss J.R.
        • Baker D.W.
        • Williams M.V.
        Shame and health literacy: the unspoken connection.
        Patient Educ Counsel. 1996; 27: 33-39
        • Townsend M.S.
        • Schneider C.
        • Ganthavorn C.
        • et al.
        Enhancing quality of EFNEP data: designing a diet recall form for a group setting and the low-literate participant.
        J Nutr Educ Behav. 2012; 44: S16-S17
        • Townsend M.S.
        • Ganthavorn C.
        • Donohue S.
        • et al.
        EFNEP data collection: using cognitive load theory to design a new family record.
        J Nutr Educ Behav. 2012; 44: S75
      4. US Department of Education, Institute of Education Sciences, National Center for Education Statistics. Accessed May 8, 2013.

        • Dollahite J.
        • Scott-Pierce M.
        Outcomes of individual vs. group instruction in EFNEP.
        J Extension. 2003; 41 (Accessed September 9, 2013)
        • Chipman H.
        • Kendall P.A.
        20 Years of EFNEP: changes and challenges.
        J Nutr Educ. 1989; 21: 265-269
      5. National EFNEP Web site hosted by Purdue University. Welcome to the EFNEP Coordinator's Website. Accessed May 31, 2013.

        • Chandler P.
        • Sweller J.
        Cognitive Load Theory and the Format of Instruction.
        Cogn Instruct. 1991; 8: 293-332
        • Johns M.
        • Townsend M.S.
        Client-driven tools: improving evaluation for low-literate adults and teens while capturing better outcomes.
        Forum for Family & Consumer Issues. 2010; 15 (ISSN 15405273) (Accessed September 1, 2013)
        • Bradburn N.M.
        • Sudman S.
        • Wansink B.
        Asking Questions: The Definitive Guide to Questionnaire Design for Market Research, Political Polls, and Social and Health Questionnaires.
        John Wiley & Sons, Newark, NJ2004
      6. Townsend MS, Hersey J (invited speakers), Dharod J. Symposium: Evaluation Roadmap: Measuring our programs and efforts. J Nutr Educ Behav. 2007;39(suppl 4):S88.

      7. Kincaid JP, Fishburne RP Jr, Rogers RL, Chissom BS. Derivation of new readability formulas (Automated Readability Index, Fog Count and Flesch Reading Ease Formula for Navy enlisted personnel). Millington, TN: Naval Technical Training, US Naval Air Station, Memphis, TN. 1975. Research Branch Report 8–75.

        • Flesch R.
        A new readability yardstick.
        J Appl Psychol. 1948; 32: 221-233
        • Townsend M.S.
        Where is the science? What will it take to show nutrient profiling systems work?.
        Am J Clin Nutr. 2010; 91: 1109S-1115S
        • Banna J.C.
        • Vera Becerra L.E.
        • Kaiser L.L.
        • Townsend M.S.
        Using qualitative methods to improve questionnaires for Spanish speakers: assessing face validity of a food behavior checklist.
        J Am Diet Assoc. 2010; 110: 80-90
        • Townsend M.S.
        • Sylva K.
        • Martin A.
        • Metz D.
        • Wooten Swanson P.
        Improving readability of an evaluation tool for low-income clients using visual information processing theories.
        J Nutr Educ Behav. 2008; 40: 181-186
        • Keller J.M.
        Motivational Design for Learning and Performance: The ARCS Model Approach.
        Springer, New York, NY2010
        • Townsend M.S.
        • Donohue S.
        • Roche B.
        • Lamp C.
        • Johns M.
        • Neelon M.
        About Me, version 2 for FY2012-2013, October 2012.
        University of California Cooperative Extension, Regents of the University of California, Davis, CA2012
        • McQuiston C.
        • Larson K.
        • Parrado E.A.
        • Flaskerud J.
        Knowledge and measurement considerations with unacculturated Latinos.
        West J Nurs Res. 2002; 24: 354-372
        • Townsend M.S.
        Patient-driven education materials: low-literate adults increase understanding of health messages and improve compliance.
        Nurs Clin North Am. 2011; 46: 367-378
        • Morrow D.G.
        • Hier C.M.
        • Menard W.E.
        • Leirer V.O.
        Icons improve older and younger adults' comprehension of medication information.
        J Gerontol B Psychol Sci Soc Sci. 1998; 53: P240-P254
        • Townsend M.S.
        • Ganthavorn C.
        • Johns M.
        • Schneider C.
        • Neelon M.
        • Donohue S.
        Food Tracker….What I Ate Yesterday. Version 3 for FY13-14.
        University of California Cooperative Extension, Regents of the University of California, Davis, CA2013
        • Wilson M.
        Readability and patient education materials used for low-income populations.
        Clin Nurs Special. 2009; 23: 33-42
        • Converse J.M.
        • Presser S.
        Quantitative Applications in the Social Sciences.
        in: Survey Questions: Handcrafting the Standardized Questionnaire. Sage Publications, Newbury Park, CA1986: 10
        • Osborne H.
        Health Literacy from A–Z.
        Jones and Bartlett Learning, Burlington, MA2013
        • Nitzke S.
        • Voichick J.
        Overview of reading and literacy research and applications in nutrition education.
        J Nutr Educ. 1992; 24: 261-266
        • Townsend M.S.
        • Ganthavorn C.
        • Wolford B.R.
        • Donohue S.
        • Smith D.
        EFNEP Instruction Guide: About Me. Version 2 for FY2012-13. October 2012.
        University of California Cooperative Extension, Regents of the University California, Davis, CA2012