P089 A Retrospective Pretest-Posttest Design as an Alternative Evaluation Method for EFNEP


      The Expanded Food and Nutrition Education Program (EFNEP) evaluates its behavioral outcomes using prospective pretest-posttests, which can be prone to response shift bias. A retrospective survey design can be a potential solution.


      To examine program participants’ understanding and preferences regarding retrospective versions of the EFNEP Adult Questionnaire (AQ).

      Study Design, Setting, Participants

      One-on-one, semi-structured interviews were conducted with 23 EFNEP adult participants/graduates in four US states/territories in 2020-2021. Participants were shown retrospective pretests and posttests in the “side-by-side” and “separate page” formats, which included one question from each of the AQ domains of diet quality, physical activity, food resource management, food safety and food security. AQ questions were modified by adding “Before EFNEP” for the pretest and “Now” for the posttest timeframes.

      Measurable Outcome/Analysis

      Demographic characteristics (e.g., age, gender, education), and AQ format preferences were collected. Audio transcripts were analyzed using template analysis and NVivo 1.5.


      Most of the participants were female (87%) and high school graduates (70%); their mean age was 35 years. For the “Before EFNEP” questions, participants mentioned “any time before the past two months” or provided the particular month before EFNEP lessons took place. Regarding the “Now” questions, emerging themes were relevant to the past weeks or past month. Some participants indicated that additional descriptions such as “in the week before EFNEP” were helpful in pinpointing the intended timeframe. Most (18/23) of the participants could correctly differentiate the time periods between the “Before” and “Now” questions. Most participants preferred the “side-by-side” (vs “separate page”) format.


      A retrospective AQ, especially in a side-by-side format, may be an appropriate alternative to the prospective surveys to evaluate behavioral outcomes of adult EFNEP participants. Next steps include piloting the retrospective survey to examine its criterion validity and feasibility with a larger sample.


      Agricultural Experiment Station, NC3169 Multistate Project


      Supplementary data related to this article can be found at