Diabetes Canada Process, Outcomes + Evaluation Prepared by: The Food Skills for Families Team July 2018

Transcription

1 Diabetes Canada PRENATAL FOOD SKILLS FOR FAMILIES Process, Outcomes + Evaluation Prepared by: The Food Skills for Families Team July P a g e

2 INTRODUCTION Food Skills for Families is a hands-on curriculum based program that makes healthy eating, shopping and cooking easy, quick and fun. It has a proven impact for ten years in British Columbia (B.C). Currently, the program reaches the following priority populations: seniors, newcomers, low income families and people of Punjabi and Indigenous descent. The early years setting is a provincial priority that could benefit from the Food Skills for Families (FSF) program. A prenatal pilot program was offered at select sites across B.C. in 2017 with partner agencies and health authorities. This report summarizes the process for developing this prenatal curriculum, presents highlights from the evaluation conducted with participants, host organizations and community facilitators, and outlines next steps for consideration. Collaboration and partnership were fundamental throughout with one comment undeniably highlighting the need and benefit; Without the Diabetes Canada program, we are not able to offer this hugely valuable component to our prenatal education. The funding to cover at least some food costs for the lunch is a significant boost to our food budget which has not seen an increase in almost 15 years. PILOT PATHWAY The idea and interest in offering a prenatal program first originated in 2014 during conversations with health authority contacts. This pilot curriculum was born out of collaboration and a desire to reach groups that could benefit from hands-on skills programming, with the goal of making it a permanent curriculum accessible to other areas in B.C. if successful. In order to meet the needs of the prenatal demographic, the Food Skills for Families program was integrated into the already established weekly pregnancy outreach program. 2 P a g e

3 As a first step, two staff from Island Health s Parksville Family Services attended a Food Skills for Families Train-the-Trainer program in February 2015 and became certified as Food Skills for Families Community Facilitators. The traditional Food Skills curriculum was then reformatted into 18 weekly segments consisting of one hour of Food Skills curriculum and one hour of prenatal learning based on the competencies from the Perinatal Services B.C. perinatal pathway. A pilot curriculum addendum was developed in collaboration with the Food Skills team, the Parksville staff and an Island Health Community Dietitian. Additional recipes were selected and the curriculum adjusted to support easy flow of material across the 18 week time span. Core Food Skills learning activities and outcomes were maintained throughout. The pilot period began on April 16 th, 2015 and ended on August 20 th, Small edits and changes were made as required, based on feedback from the Parksville team. Food Skills program staff and the B.C. Ministry of Health project lead visited the program in July 2015 to observe a session in action and meet with the Parksville team and participants. A debrief session occurred in August 2015 with all involved to discuss obstacles, successes and share feedback on the entire pilot project. Highlights of this discussion were shared in the October 2015 evaluation outcome document. Additional changes were made to the layout of the initial pilot program, including adjusting recipe placement in the 18-week program to ease timing and flow of program and allowing for flexibility in moving prenatal learnings. Parksville Family Place ran a second prenatal Food Skills program using the adjusted prenatal curriculum from August 27 th, 2015 to January 14 th, Since then, the pilot has been embedded directly into Parksville Family Place rotation of programs and offered six more times to the end of Building off the success of the initial testing in Parksville, the goal for 2017 was to offer the pilot to additional communities across B.C. An invitation to partner was circulated to stakeholders across the province in August of P a g e

4 Twenty-eight organizations expressed interest and after numerous rounds of conversations, the four below were able to secure approval from senior staff and resources to offer the program in their community: Host Healthiest Babies Possible Sara for Women Society Community Connections Society of Southeast BC Comox Valley Family Services Association Vancouver/Richmond Mission/Abbotsford Cranbrook Courtenay Location A total of nine pre-natal programs were completed by end of 2017: Host Location Dates Indigenous Reach Parksville Family Place Parksville Family Place Parksville Family Place Parksville Family Place Parksville Family Place Community Connections Society of Southeast BC Community Connections Society of Southeast BC Comox Valley Family Services Healthiest Babies Possible Parksville Parksville Parksville Parksville Parksville Cranbrook Cranbrook Courtenay Jan 21 st to May 19 th, 2016 May 26 th to Sept 22 nd, 2016 Sept 29 th to Feb 2 nd, 2017 Feb 9 th to Jun 8 th, 2017 Jun 29 th to Oct 26 th, 2017 Feb 8 th to Jun 7 th, 2017 Jun 15 th to Oct 19 th, 2017 May 9 th to Sept 26 th, 2017 Qualicum First Nations Qualicum First Nations Qualicum First Nations Qualicum First Nations Qualicum First Nations Ktunaxa First Nation Ktunaxa First Nation Komoks First Nation Vancouver Jul 4 th to Oct 31 st, 2017 Connection through Indigenous Learning Lodge Group FMNCP Recipient Yes Yes Yes No Yes No Yes Yes Yes 4 P a g e

5 Although solicitation for new partners ended in 2017, the Food Skills team continues to support partners who offered the pilot if they choose to offer the program in Programs continuing into 2018 are as follows: Host Location Dates Indigenous Reach Parksville Family Place Parksville Family Place Parksville Family Place Comox Valley Family Services Parksville Parksville Parksville Courtenay Nov 2 nd, 2017 to Mar 8 th, 2018 Mar 22 nd to Jul 19 th, 2018 Jul 26 th to Nov 22 nd, 2018 Jun 12 th to Oct 9 th, 2018 Qualicum First Nations Qualicum First Nations Qualicum First Nations Komoks First Nation FMNCP Recipient No No No No Community Connections Society of Southeast B.C. Cranbrook Dates to be determined Ktunaxa First Nation No PILOT EVALUATION EVALUATION PURPOSE Historically Food Skills for Families curriculum has not been edited and modified to the extent required for this pilot. It was important to assess if this new curriculum met its objectives, identify areas for improvement and options to offer the program in all of the regional health authorities. EVALUATION QUESTIONS, DESIGN + METHOD Participants were asked to complete a questionnaire similar to the standard Food Skills for Families evaluation, with the addition of 16 questions related to prenatal topics and the confidence level of the participants: before starting the pilot during the intake meeting or during Session One after completing the program. 5 P a g e

6 Due to the fact that this prenatal program allowed participants to enter at any time during the 18-week pilot, responses collected covered a variety of sessions attended, from 6 to 15. Data was not collected if less than six sessions were attended. See Appendix A for pre-program questionnaire and Appendix B for post program questionnaire. A total of 63 participants completed a pre, post or both pre and post questionnaire. Results presented are from matched pre and post evaluations (n=24). Health Authority Island Health 15 Vancouver Coastal 6 Interior Health 3 Fraser Health 0 # of Matched Questionnaires Community facilitators and host organizations also completed a survey to provide feedback on the pilot program. FINDINGS + CONCLUSIONS Participant Demographics 75% of participants identified as female. The remaining 25% did not respond to the question. 75% of the questionnaires were from participants ages 20-34, with the vast majority in this age group under 25. The remaining 25% of participants were between 35-54, with the vast majority under % of participants prepared meals for one or more ADULTS. 29% of participants prepared meals for one or more CHILDREN. Experience with Diabetes 46% of participants (11 participants) reported that Diabetes has impacted their life, while 54% of participants indicated that Diabetes is not part of their life. 6 P a g e

7 Of the 11 participants who indicated that Diabetes is a part of their life: Statement I have Pre-diabetes. 0% I am living with Type 1 Diabetes. 0% I am living with Type 2 Diabetes. 0% I had Gestational Diabetes when I was pregnant. 0% I am a caregiver of a person living with Diabetes. 9% I live with a family member(s) living with 27% Diabetes. I think I am at risk for developing Diabetes. 9% Other. Participants exclusively mentioned having 55% family members with Diabetes. *Note: Respondents may have selected more than one category. % Agree IMPACT Percentage Increase in Food Consumption Eating fruits two or more times per day increased by 17% Eating vegetables or salad two or more times per day increased by 11% Knowledge of the recommended daily servings of fruits and vegetables increased by 53% At the end of the program participants were asked about their fruit + vegetable consumption 71% reported eating fruit each day 63% reported eating vegetables or salad every day 88% intended to increase the amount of fruits and vegetables they ate over the next 6-12 months 7 P a g e

8 Cooking from Scratch There were no changes in the proportion of participants (92%) who indicated that they prepared a main meal from scratch once a day or more at the end of the program in comparison to the beginning of the program. Use of Salt Slightly more participants reported adding salt to their meals 2-4 times per week or less at the end of the program compared to the start (54% vs. 58%). Fewer participants reported adding salt to their meals twice a day or more at the end of the program as compared to the beginning of the program (33% vs. 17%). Sugary Drinks At the end of the program, fewer participants reported drinking sugar sweetened beverages twice a day or more (33% vs. 17%). There was no change from pre to post- program in the proportion of participants who reported consuming sugar sweetened beverages 2-4 times per week or less (54%). Fried Foods, Fats + Oils There was an increase in the number of participants who reported consuming fried foods 2-3 times per week or less postprogram (83% vs. 92%). At both pre- and post-program, 0% of participants reported consuming fried foods twice a day or more. Percentage Increase in Cooking + Nutrition Confidence Confidence in preparing new food increased by 31%. Confidence in reading nutrition facts on food labels increased by 100%. Confidence in following basic food safety procedures increased by 15%. Percentage Decrease or Increase in Factors that Stopped Participants from Buying, Preparing + Eating More Healthy Foods Barriers Pre- Program Post- Program Change I don t know which foods are healthy 4% 0% e 100% I don t know which methods of cooking are healthy 12.5% 0% 100% I don t have healthy recipes 25% 8% 68% 8 P a g e

9 I cannot buy fresh fruits and vegetables locally 0% 0% 0% Healthy foods cost too much 46% 42% 9% I don t have the right kitchen equipment or utensil 25% 8% 68% I don t like the taste of healthy foods 12.5% 4% 68% Other 29% 21% 28% None of the above no barriers 17% 42% 59% *The Other category included barriers of time, food preferences of family members, living conditions, and pregnancy challenges which impeded their ability to buy, prepare, and eat more healthy foods. *Consistent with previous evaluations, the high cost of healthy foods continues to be a perceived persistent barrier after the program. PROGRAM DELIVERY 83% percent of participants reported that they would use the Participant Handbook at home. 96% of participants reported that they were very satisfied or satisfied with the facilitator. WHAT PARTICIPANTS ARE SAYING Program Comments She [the instructor] is great very informative, friendly, great at accommodating everyone with a job to do to fit in. Definitely I'm satisfied with this class. I've learned a lot of healthy recipes and shared the feeling with friends. Looked forward to this group every week. What did you like most Cooking with people and feeling more confident about the Food Skills for Learning new recipes, cooking with others Families program? The food and the socializing, working together to make it all happen All the friendly people in the group Meeting and interacting with other moms, learning new ways to cook Trying new foods, a time/space to ask questions, considering the social/cultural value of food 9 P a g e

10 What is the biggest change you made as a result of taking this program? Is there anything that should be improved when the program is run again? The way I eat It has helped me stop eating as much fast food and eating more salads Trying to eat healthier, trying new foods and recipes Incorporating more veggies to diet Eating a lot of salad Prepare my own food and eat healthy I waste less food at home I made some friends Hot food in the winter and cold food in summer. More recipes. Less exotic foods, more easy stuff to make for low income families too. Would love more groups like this offered or possibly for it to just keep going. WHAT HOST + COMMUNITY FACILITATORS ARE SAYING Were there challenges with participation? What were the strengths of the pilot program? Fluctuated due to illness, employment, doctor s appts, forgetfulness, apathy, birth of baby High at beginning and leveled off to 6 9 mid way Consistent core group, Potential for someone to attend all sessions is low and after baby is born they have to miss many sessions Average of about 8 per session Excellent program to have peer support in both pregnancy, nutrition, parenting and cooking Education in bite sized pieces Great opportunity to ask experts questions with scheduling appts or seeking them out Boosted nutrition Program put nutrition back on the front burner in our pregnancy outreach program. We have wanted to do a program like this in our prenatal group, we did not have the staffing resources to hire and train a dedicated staff person. The Food Skills facilitator is so well prepared by Diabetes Canada to facilitate because of nutrition/food prep knowledge, and knowledge and experience in working with marginalized families and pregnant women. She is a perfect fit in our prenatal outreach program and an essential component of the success Our pregnancy outreach program did not have the education resources or curriculum (or the time to develop a curriculum) for a cooking program despite wanting to do this for many 10 P a g e

11 years. The food skills curriculum specific to the prenatal period is an amazing resource which was reinforced almost weekly with the comments from participants about how tasty, easy and healthy the recipes were and how helpful the book was in explaining questions they might have about prenatal nutrition. The program helps to build social connections. The kitchen is an environment that releases inhibitions and creates an equal playing ground (despite a wide range of skill levels that women came with to the group) for discussions on concerns that families experience. These discussions may begin related to nutrition, budgeting, trying new foods, tips & tricks in the kitchen but often quickly moved to all aspects of pregnancy and any of life s challenges especially those that under resourced families have in common. The shared cooking and lunch session often created a more relaxed feeling among participants and women were feeling less tense as they moved into the prenatal topic discussion component of the group. This in turn often led to richer discussions on the prenatal topic. The impact on our pregnancy outreach program budget is enormous. The introduction of the food skills program during pregnancy is also brilliant as the prenatal population is often open to eating better and increasing knowledge about food preparation in order to have a healthy pregnancy and increase the likelihood of having a healthy baby. Because the kitchen is a great environment for discussing a wide range of issues, once participants discuss making changes in nutrition they also begin to discuss behavior change in another area such as physical activity, smoking, self-care, etc. Discussions that started in the kitchen often carried on into our prenatal topic discussions and offered opportunities to engage women in making other health and behavior changes Reaching high risk clients Participants enjoyed interactive format Creating social connection Participants always felt they learned something new 11 P a g e

12 FUTURE CONSIDERATIONS Program Delivery Addressing attendance issues: incentives, childminding and transportation. Align the Farmer s Market Nutrition Coupon Program with prenatal programs to reduce the cost barrier of healthy foods to participants. Evaluation: restructure data collection method for prenatal group as barriers to accurate responses occur between 18 week pre and post timing. With varied due dates developing continuity with postpartum programs for ongoing support and sharing. Addressing needs of small and large agencies for planning and delivery of program. Addressing open versus closed program registration. Program Content Recipe adjustments and addressing food sensitivities. Rotation of prenatal topics. Adjustments to timing to adequately address needs of Food Skills and prenatal content. 12 P a g e

13 NEXT STEPS Collaborate with health authorities and communities to build formal and standardized prenatal Food Skills for Families curriculum. Create formal partnership with pre-natal curriculum with Farmers Market Nutrition Coupon Program to increase reach of pregnant women accessing coupons across B.C. Consider additional funding to overcome barriers for attendance such as transportation or child minding. Communities may have a variety of standards so aligning with suitable pregnancy outreach programs (POPs) programs that have the structure to support this model may be challenging. Models of delivery would need to be investigated to achieve some consistency and ensure similar evaluation measurements and outcomes across B.C. THANK YOU TO ALL OF THE SUPPORTERS AND CONTRIBUTORS TO THE ONGOING WORK FOR PRENATAL FOOD SKILLS FOR FAMILIES MINISTRY OF HEALTH & PHSA HEALTH AUTHORITIES PARKSVILLE FAMILY PLACE COMOX VALLEY FAMILY SERVICES SARA FOR WOMEN COMMUNITY CONNECTIONS VCH, HEALTHIEST BABIES POSSIBLE COMMUNITY FACILITATORS PARKSVILLE PROGRAM SUPPORT TEAM 13 P a g e

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15 APPENDIX A PRE-PROGRAM FORM 15 P a g e

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22 APPENDIX B POST-PROGRAM FORM 22 P a g e

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