FOOD SKILLS for FAMILIES

Transcription

1 FOOD SKILLS for FAMILIES Aboriginal Diabetes Initiative Evaluation Report October 2012

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3 TABLE OF CONTENTS EXECUTIVE SUMMARY INTRODUCTION PROGRAM DELIVERY Program Overview Program Delivery EVALUATION METHODOLOGY PROGRAM IMPACT ON PARTICIPANTS Participant Demographic Data Participant Healthy Eating Behaviour Participant Confidence Biggest Changes as a Result of Taking the Food Skills for Families Program. 4.5 Program Satisfaction Other Program Impacts Barriers to Healthy Eating SUMMARY AND FUTURE CONSIDERATIONS Summary Highlights Future Considerations i

4 This Food Skills for Families Program Evaluation Report is available from the Canadian Diabetes Association, Pacific Area. Phone: Web: foodskillsforfamilies.ca

5 Executive Summary T he Canadian Diabetes Association Food Skills for Families program teaches healthy eating and cooking skills with a focus on reaching Aboriginal, new immigrant, Punjabi and low income families throughout BC. It was one of five initiatives of the British Columbia Healthy Living Alliance 1, funded by ActNow BC, designed to promote wellness and prevent chronic disease. Currently, the Canadian Diabetes Association Food Skills for Families program is funded by the BC Ministry of Health for delivery throughout BC. Program delivery on reserves in BC was funded by the Aboriginal Diabetes Initiative, Pacific Region, First Nations & Inuit Health, Health Canada (ADI). This Evaluation Report covers information gathered from participants, Community Facilitators and Bands involved in thirty-one (31) ADI-funded Food Skills for Families programs delivered on reserves throughout BC from April 2011 to March At the conclusion of the Food Skills for Families 6-week programs, some improvement in the frequency of fruits and vegetables or salad consumption was reported. There were a number of barriers reported by participants that prevented healthy choices from being easy choices, in particular, the ability to access and/or to afford fresh fruits and vegetables. However, approximately two-thirds of the participants stated they definitely intend to eat more fruits and vegetables over the next year. With regard to salt and sugary drinks, the Food Skills for Families program appears to have had the most impact on participants who initially reported adding salt to their food twice a day or more or those who drank sugary drinks on a daily basis. The percentage change in these two groups was the most significant. There was a positive change related to eating less fried foods and in the confidence levels participants reported with preparing and cooking new foods and reading facts on food labels. The biggest changes in behavior reported by participants include eating healthier, trying new foods and reading food labels. These changes were also reported by the Community Facilitators as the biggest changes observed in the participants. The written and verbal reports from participants and Community Facilitators attest to the program s ability to positively influence participants healthy eating, cooking and nutrition knowledge, skills, attitudes and confidence. The ADI-funded Food Skills for Families program has built community capacity by training Community Facilitators from on reserve communities across the province and demonstrated the positive influence of the Food Skills for Families program throughout the Band. The program is highly regarded by all stakeholders involved and there is a keen interest from on reserve communities to participate. 1 BC Healthy Living Alliance is a group of not-for-profit organizations working collaboratively to support British Columbians to eat healthier, get active and live tobacco free. OCTOBER 2012 EVALUATION REPORT i

6 Future Considerations B ased on the evaluation consultation and questionnaire results, a number of considerations are presented to optimize the future potential of the ADI-funded Food Skills for Families program. Program Delivery Link the ADI-funded Food Skills for Families program with other food skills and food security initiatives to improve the accessibility and affordability of healthy food, in particular, fruits and vegetables for vulnerable populations. For example, food preservation/canning programs, community gardens and community kitchens. Continue to reinforce key messages and identify additional strategies within the program that would assist participants to make healthier beverage choices, decrease their sugar sweetened beverage intake, reduce sodium/salt intake and eat more fruits and vegetables. Foster opportunities for Community Facilitators to share their knowledge, experiences, successes and lessons learned with each other. Emphasize the value of the certificate of completion and consider offering incentives to participants, when feasible, to encourage participation in all six sessions. Encourage Band members who have responsibility for preparing food for community events on reserve to complete the Food Skills for Families program. ii EVALUATION REPORT OCTOBER 2012

7 Partnership and Collaboration Continue the partnership between the Aboriginal Diabetes Initiative and Canadian Diabetes Association to help sustain and extend the reach of the Food Skills for Families program so that it becomes a readily available healthy eating and chronic disease prevention strategy for on reserve Aboriginal families. Continue to fund training of new on reserve Food Skills for Families Community Facilitators to further build community capacity. Continue to support existing on reserve Community Facilitators to maintain their knowledge and skills, and provide updated resources to deliver the Food Skills for Families program. Encourage Bands to leverage Community Facilitator and program participant knowledge of healthy eating and cooking to extend the impact more broadly within their communities (knowledge transfer/exchange). Encourage/advocate for Bands, government and other stakeholders to reduce barriers to healthy eating for vulnerable populations and to make the healthy choice the easier choice. Data Management Strengthen Community Facilitators understanding and adherence to data management protocols, specifically the completion of pre and post questionnaires by all participants, and ensure Community Facilitators correctly and consistently label the questionnaires with the participant s unique confidential identifier. Work toward simplifying the coding procedures in the pre and post questionnaires to maximize availability of matched data for greater reliability. Future Evaluation Continue to collect participant data (pre and post program) to build evidence of the impact of the program on healthy eating and to communicate evaluation results broadly. Conduct periodic follow up evaluations, such as telephone surveys and focus groups with Community Facilitators and participants, to determine the impact of the program in the longer term. OCTOBER 2012 EVALUATION REPORT iii

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9 1.0 INTRODUCTION T he Canadian Diabetes Association (CDA) Food Skills for Families program teaches healthy eating and cooking skills with a focus on reaching Aboriginal, new immigrant, Punjabi and low income families throughout BC. It was one of five Healthy Eating Strategy initiatives, representing one of four pillar strategies implemented by the BC Healthy Living Alliance 2 with funding from ActNow BC 3, designed to promote wellness and prevent chronic disease. The Canadian Diabetes Association, Pacific Area, is pleased to present the second evaluation of the ADIfunded Food Skills for Families program. This Evaluation Report covers information gathered from participants, Community Facilitators and Bands involved in thirty-one (31) ADI-funded Food Skills for Families programs delivered on reserves throughout BC from April 2011 to March The first evaluation report for the ADI-funded Food Skills for Families program covered programs delivered on reserve from January to March There are two overall evaluation reports for the Food Skills for Families program: the first report covered programs delivered September 2008 to June 2009 and the second covered programs delivered September 2009 to December These reports can be found at The third evaluation report covering program delivery from January 2011 to June 2012 will be released in October The purpose of this evaluation is to determine: Whether the Food Skills for Families program is achieving its program goals to: - Build cooking skills and nutritional knowledge in the targeted at risk populations: on reserve Aboriginal families. - Increase capacity within on reserve Aboriginal communities by training Community Facilitators to reach out to and improve food and nutrition knowledge and skills in their communities. Whether the Food Skills for Families program is achieving the positive outcomes identified in previous evaluations of the overall program, such as participants: - Are eating more fruits and vegetables every day as a result of taking this course, and are more likely to meet the recommended 5-7 servings per day (Canada Food Guide 4 ) than previously. - Have a significantly higher level of knowledge about what foods are healthy. - Are cooking more meals from scratch, e.g., not using convenience or packaged meals and including raw or fresh ingredients. - Have a significantly higher level of confidence about preparing and cooking healthy foods, trying new foods, applying food safety procedures and understanding nutrition facts on food labels. Whether ADI on reserve participants face similar or different barriers to healthier eating and cooking than participants in the Food Skills for Families program overall. 2 BC Healthy Living Alliance is a group of not-for-profit organizations working collaboratively to support British Columbians to eat healthier, get active and live tobacco free OCTOBER 2012 EVALUATION REPORT 1

10 2.0 PROGRAM DELIVERY 2.1 Program Overview F ood Skills for Families is a consumer-based skills building program with a standardized, best practice curriculum developed by expert community-based dietitians to teach healthy cooking skills. A standardized Train-the Trainer Mentorship program was also developed to train lay personnel. The curriculum and Train-the Trainer Mentorship program are based on Canada s Food Guide, current nutrition evidence and adult education principles for provincial and national applicability. Curriculum Outline The curriculum has a consistent core knowledge and skill foundation that was specifically adapted to meet the needs of each target population: Aboriginal, new immigrant, Punjabi and low income families, and most recently, seniors. Community Facilitator Manuals and Participant Handbooks have been developed for each of these target populations. The curriculum is built around six sessions, with each session addressing a different topic based on the Canada Food Guide and its key messages. Information and recipes for these sessions are adapted to the needs of each of the target populations. Session 1 Variety for Healthy Eating Session 2 Fabulous Fruits, Vegetable and Whole Grain Goodness Session 3 Meat & Alternatives, Milk & Alternatives & Healthy Fats Session 4 Planning Healthy Meals, Snacks and Beverages Session 5 Savvy Shopping (Grocery Store Tour) Session 6 Celebrations! The curriculum is designed to be readily adapted to new target populations and has demonstrated the potential to meet the needs of young families, older adults and those with diabetes and other chronic diseases. A Sodium Addendum has been developed to provide guidelines for Community Facilitators and participants on recommended maximum daily sodium intake and tips to help lower sodium consumption. The Canadian Diabetes Association s Just the Basics 5 handout is also provided to all participants as a Diabetes Addendum. This resource has been developed specifically for the Aboriginal community and provides tips for healthy eating and diabetes prevention and management. Both addendums are part of ongoing curriculum updates for Community Facilitators and participants. Train-the-Trainer Mentorship Program M aster Trainers, with representation from each health region of the province, train Community Facilitators across the province. The Community Facilitators deliver the Food Skills for Families program in host organizations throughout BC. Community Facilitators delivering the ADI-funded Food Skills for Families program are members of on reserve communities. Host Organizations H ost organizations include schools, community recreations centers, Aboriginal groups, First Nations Bands, early childhood development services, community kitchens, faith-based organizations, food banks, friendship centers, and multicultural service agencies among others. Host organizations who expressed an interest are selected based on criteria including: appropriate kitchen facilities, ability to recruit participants from the target populations, and availability of a Food Skills for Families Community Facilitator. 5 Canadian Diabetes Association has produced Just the Basics: Tips for Healthy Eating, Diabetes Prevention and Management for the general public (available in English, Punjabi, Chinese and Spanish) and the Aboriginal community. 2 EVALUATION REPORT OCTOBER 2012

11 2.2 Program Delivery Number of Programs Delivered A total of 31 ADI-funded Food Skills for Families programs were delivered to 242 on reserve participants from April 2011 to March The Aboriginal Diabetes Initiative provided the CDA Food Skills for Families program with on reserve communities and contacts. These communities were approached to explore their interest in the program and the availability of a suitable kitchen facility and community member suitable to be trained as a Community Facilitator. Where program criteria were met, Community Facilitator training and program delivery were scheduled. Number of ADI-Funded Programs by Health Authority REGION NUMBER OF PROGRAMS Fraser 2 Interior 8 Northern 9 Vancouver Coastal 6 Vancouver Island 6 TOTAL 31 COMMUNITY Chilliwack, Pitt Meadows Ashcroft, Barriere, Keremeos, Lillooet, Lytton, Merritt (2), Oliver Aiyansh (2), Burns Lake, Dease Lake, Greenville, Hazleton, Quesnel, Skidegate, Terrace North Vancouver (3), Squamish (3) Alert Bay, Chemainus, Duncan, Nanaimo, Port Alberni (2) Host Organizations and Number of Participants in ADI-Funded Programs HOST ORGANIZATION NAME PARTICIPANTS Ashcroft Indian Band Health Center 7 Burns Lake Band 6 Gitxsan Health Society 8 Hiiye'yu Lelum Society 8 H'ulh-etun Health Society (Penelakut) 9 Hupacasath First Nation 9 Katzie First Nation 8 Kitsumkalem Band 4 Lhoosk'uz Dene Nation 8 Lower Similkameen Indian Band 4 Namgis First Nation 6 Nanaimo Community Kitchens Society 5 Nisga'a Valley Health Authority 11 Nisga'a Valley Health Authority 7 Nisga'a Valley Health Authority 7 Nzeman Child and Family Development 8 Osoyoos Indian Band 8 Scw'exme Community Health Services 14 Scw'exmx Community Health Services 5 Simpcw First Nation 12 Skidegate Indian Band 7 Squamish Nation (North Vancouver) 10 Squamish Nation (Squamish) 8 Squamish Nation (Squamish) 7 Squamish Nation (Squamish) 8 Sto:lo Nation 9 Tahltan Health and Social Services Authority 6 Tseshaht First Nations 9 Tsleil-Waututh Nation 12 Tsleil-Waututh Nation 5 Xaxli'p First Nation 8 TOTAL 242 OCTOBER 2012 EVALUATION REPORT 3

12 Number of Community Facilitators Trained T wenty-nine (29) Community Facilitators were trained from within the on reserve Aboriginal community by a Food Skills for Families Master Trainer. Six of the 31 programs were co facilitated by two Community Facilitators. This option was effective for a number of Bands who had more than one person interested in training and to ensure consistent program delivery. The following table captures the locations of trained Community Facilitators. On Reserve Aboriginal Communities with a Trained Community Facilitator NAME HEALTH AUTHORITY COMMUNITY FACILITATORS Ashcroft Band IHA 2 Burns Lake Band NHA 1 Fraser Canyon Indian Administration (FCTA) IHA 1 Gitxsan Health Society NHA 1 Iskut Band NHA 2 Katzie First Nation FHA 2 Kitsumkalum Band NHA 1 Lytton First Nation IHA 1 Nisga'a (Gingotx/NewAiyansh/Gitwinksihlkw/Laxgalt'sap) NHA 2 Nuuchahnulth Tribal Council VIHA 2 Nuxalk Nation VCHA 2 Penticton Indian Band IHA 2 Saulteau First Nation (Moberly Lake East) NHA 1 Scw'exme IHA 1 Sechelt Indian Band VCHA 1 Seton Lake Indian Band IHA 2 Simpcw First Nation (North Thompson Indian Band) IHA 1 Skidegate Indian Band NHA 1 Sts ailes Indian Band (formally known as Chehalis) FHA 1 Tahltan NHA 1 T'Souke First Nation VIHA 1 TOTAL 29 4 EVALUATION REPORT OCTOBER 2012

13 3.0 Evaluation Methodology P articipants complete a pre questionnaire at the start of each program and a post questionnaire at the final session of the six week program. For a variety of reasons, not all participants complete both a pre and post questionnaire. Recognizing that not all participants complete both questionnaires, a unique confidential identifier for each participant was introduced to ensure the results from their pre and post questionnaires could be attributable to the same group of participants. Evaluation data includes: Results from the matched pre and post participant questionnaires. Feedback from Community Facilitators, in particular the Community Facilitator Summary Reports submitted at the conclusion of each Food Skills for Families Program. Limitations of the Data W ith many individuals involved in collecting program data, consistent adherence to data management protocols remains a challenge, specifically to ensure the following: a record of each participant is kept and reported to measure level of participation; a pre and post questionnaire is filled out by each participant; and a unique confidential identifier is assigned to each participant and accurately and consistently recorded on both the pre and post questionnaires to allow appropriate matching of pre program to post program information. It is recognized that completion of written questionnaires by vulnerable populations can be subject to literacy issues and other limitations. Community Facilitators also reported challenges ensuring sufficient time to complete the post questionnaire given the fullness of the last session and the celebration that followed often with other community members. OCTOBER 2012 EVALUATION REPORT 5

14 4.0 Program Impact on Participants This section provides an overview of the results from the participant pre and post questionnaires. 4.1 Participant Demographic Data O f the 242 participants, 155 completed a pre questionnaire and 111 completed a post questionnaire, with 61 matched pre and post questionnaires. Results reported for this evaluation are based on this matched sample of 61 participants. Demographic data from the participant questionnaires indicated that: 75% were female and 25% were male. 16% were under 20 years of age, 34% were years, 28% were years and 22% were 55 years and older. 6 EVALUATION REPORT OCTOBER 2012

15 4.2 Participant Healthy Eating Behaviour A t the conclusion of the Food Skills for Families 6- week programs, there was some improvement in the frequency of eating fruits and vegetables or salad. Very few participants would meet the recommended 5-7 serving per day based on the post questionnaire data. However, at the end of the program, substantially more participants stated that they definitely intend to eat more fruits and vegetables over the next year. The percentage of participants who reported eating fruit five to six times per week or more increased from 48% at the start of the program to 59% at the end. At the end of the program, fewer participants reported eating vegetables or salad once a week or less (8% in the post questionnaire versus 22% in the pre questionnaire) and increased numbers of participants reported eating vegetables or salad more than once a week specifically, 2-6 times per week (42% in the pre questionnaire, 58% in the post questionnaire). Participants who were knowledgeable about the recommended daily servings of fruit and vegetables increased by 11% (55% pre; 66% post). 89% of participants said they intended yes probably (28%); yes definitely (61%) to increase the amount of fruit and vegetables they eat over the next 6-12 months. The proportion of participants selecting yes definitely increase by 33% at the end of the program. C omments from participants and Community Facilitators indicated an awareness of the importance of eating more fruit and vegetables. I never knew how important it was to put a variety of fruits and vegetables into the diet besides meat and potatoes or meat and rice. When asked, What is the biggest change you made as a result of taking the program? many participants indicated they are eating and cooking more vegetables, for example: I started cooking/using more vegetables when I cook. Using veggies more. Cooking meals from scratch and using more vegetables. Mindful eating - including more veggies. I eat more veggies and fruit and prepare more home meals. I use more green and red peppers and more vegetables. Community Facilitators also reported their observations about the participants. I heard mothers talking about what to try with their children when it comes to veggies. Community Facilitators reported that participants indicated that they want to eat more fruit and vegetables but which are not always readily accessible. Cannot buy fruits and vegetables locally. Too expensive. The store is too far away and there is no transportation. OCTOBER 2012 EVALUATION REPORT 7

16 Use of Salt, Fried Foods and Sugar Sweetened Beverages Adding salt to food Close to half of participants at the start and at the end of the program indicated that they added salt to their food once a week or less or never (44% pre and 47% post). About one third of the participants reported that they added salt to their food once a day or more (37% pre and 34% post). Fewer participants reported adding salt to their food twice per day or more at the end of the program (25% pre vs. 17% post). Comments from participants and Community Facilitators indicated an awareness of the importance of using less salt. A sample of participant comments about changes in their consumption of salt as a result of participating in the program, include: Using less salt, reading labels and avoiding salt and saturated fat foods. I am cutting out salt. Am being more conscious of salt. Use of sugar and sugar sweetened beverages Approximately one third of the participants reported drinking sugar sweetened beverages infrequently once a week or less (34% pre and 37% post). Fewer participants reported having a sugar sweetened beverage once a day or more at the end of the program than at the beginning (pre 43% vs. post 32%). However, the questionnaire data show that 25% of participants reported having 2-4 sugar sweetened beverages once a day or more. At the start of the Food Skills for Families program, 66% of participants reported drinking sugar sweetened beverages at least 2-4 times per week, with 43% having such beverages at least once per day. At the end of the program, these percentages were reduced to 63% and 32%, respectively. This reflects better program success for those who drink sugar sweetened beverages most regularly. Community Facilitators indicated that a key benefit of the program is the increased participant awareness of their sodium and sugar intake, and learning recommended daily sodium amounts and how to limit sugar intake. Knowing how much sugar was in their daily drinks was helpful to them. Fried foods, fats and oils Participant pre vs. post questionnaire data show a significant trend toward eating less fried food. Sixtyseven per cent (67%) of participants reported having fried foods once a week or less or never at the end of the course compared to 39% of participants at the beginning of the program, indicating a 28% positive shift. 8 of salt I am being more conscious EVALUATION REPORT OCTOBER 2012 Cooking from scratch Approximately 50% of participants reported cooking a main meal from scratch once a day or more at the start and at the end of the program. However, there was more of a positive shift at the extremes. The percentage of participants cooking from scratch once a week or less declined from 22% to 15%, and the percentage cooking from scratch twice a day or more increased from 15% to 22%.

17 4.3 Participant Confidence P articipants reported their level of confidence as very good or extremely confident at the conclusion of the course with: Following basic food safety (9% increase). Preparing and cooking new foods (34% increase). Reading facts on food labels (17% increase). The following chart shows the increase in confidence from pre to post program in the above skill areas reported by participants that attended ADI-funded Food Skills for Families programs. O verall, participants that attended ADI-funded Food Skills for Families programs reported being most confident about cooking and trying new foods as reinforced in their comments. Cooking was always confusing for me but now with the help of the program I feel more confident putting meals together. I enjoyed learning about new ways to add healthier foods into my daily life and trying new foods that I haven t tried before. I have confidence in cooking for a bunch of people. Community Facilitators also commented that the program helped to increase the confidence of participants in their cooking skills and their ability to feed their families. Increase in Confidence from Pre Program to Post Program Very good or extreme confidence following basic food s afety procedures 68.0% 77.0% Very good or extreme confidence preparing/cooking new foods 43.0% 77.0% Very good or extreme confidence reading nutrition facts on food labels 42.0% 59.0% Percent of Participants Pre Program Percent of Participants Post Program OCTOBER 2012 EVALUATION REPORT 9

18 CANADIAN DIABETES ASSOCIATION: FOOD SKILLS FOR FAMILIES 4.4 Biggest Changes as a Result of Program Participation P articipants and Community Facilitators of the ADI-funded programs report that the biggest change as a result of taking the Food Skills for Families program was eating and cooking healthier food, trying new foods and reading food labels. About eating healthier Participants said: Facilitators said: It made me more aware of the healthy content of foods I buy. Their views on healthy eating have changed, and eating healthier did not mean you need to change your diet drastically. Learned about portion control. They have more energy from eating healthier. Learning how to eat healthier, becoming more aware. I am eating more healthy foods and buying more healthy foods. I know how to cook healthier now and more educated with the amount and what is good for you. Participants learn enough that they begin to think about how they can make healthier choices in their diets. Participants learned to shop for healthy foods in the grocery store. I will now eat healthier. About reading labels Participants said: I am reading the ingredients of all the foods I buy. When out shopping I look at labels. Reading food labels before buying products. Reading food labels, less fruit juice and looking for healthier recipes. Using new ingredients and paying attention to labels. Not drinking anything or eating anything without knowing what s in it. 10 EVALUATION REPORT OCTOBER 2012

19 Specific changes as reported by participants I am cooking more often and doing it without much money. Added more fiber to my diet. I have cut down on my salt and sugar. Laying off the fatty foods. Eating more fruits and veggies. My portions are different. Learning how to shop for healthy foods in a grocery store. Cooking more from scratch. (Many of the participants mentioned that they are doing more cooking at home from scratch). Meal planning was new to many and this was an important change. (Community Facilitator) About trying new foods Participants said: I m cooking with spices now. Adding different ingredients to my cooking. Going to start using whole wheat flour. Cooking different foods. Introducing new foods. Facilitators said: The biggest change is that they are willing to try new things and that is a very important in an Aboriginal community. Use of different foods and variety of color in their cooking. Trying new recipes was an important change. Meal planning was new to many and this was an important change. OCTOBER 2012 EVALUATION REPORT 11

20 4.5 Program Satisfaction Participant Feedback P articipants were provided the opportunity to comment about their satisfaction with the Community Facilitator, Participants Handbook, what they liked most about the program and any program improvements they recommend. Community Facilitator N inety-six percent of participants were very satisfied (81%) or satisfied (15%) with the Food Skills for Families Community Facilitator. They described the Community Facilitators as very helpful, informative, knowledgeable, easy going and well organized. Comments included: Awesome teacher. Explains well. A lot of information presented clearly. Excellent instructor. Very good and clear messages. Did a wonderful job at helping us learn. Made sure our questions were answered. Flexible, made us feel welcome. Program W hen participants were asked what they liked most about the program, the hands-on experience and preparing the food together rated high. I liked how we got together and shared our knowledge and skill of cooking through the food we prepared. I enjoyed the hands on experience and learning new techniques. Many participants enjoyed the new recipes. Love the recipes and how they include traditional food. I enjoyed learning new recipes, cooking in a group and getting tips and ideas from individual people. Participants very much liked trying new foods and new ways of cooking, for example: I liked making food that I have previously only had in restaurants. I liked learning about new ways to add healthier foods into my daily life and trying new foods I haven t tried before. I learned a lot of different ways to cook vegetables and learned about different ways to prepare meats and fish. The foods prepared were easy to make and very yummy. Many participants liked the entire program. Everything. The skills I learned, the people that came and the instructor that held the program. Having a taste of everyone s cooking, meeting different people, especially working with different partners, learning how to cook new vegetables, and after eating having a full tummy. 12 EVALUATION REPORT OCTOBER 2012

21 Participant Handbook P articipants of the ADI-funded programs found the handbook to be very useful, similar to participants in the program overall, with 93% indicating that they intend to use the Participant Handbook at home. Many participants mentioned that they liked the recipes and found them easy to follow. A lot of information that I was not aware of. It is simple to follow which made healthy food easy and tasty. Suggested Program Improvements P articipants had few suggestions for program improvement. The main request related to the desire for more sessions or the opportunity to return for a follow-up program. I wish the program could have been two to three times a week. There were a number of comments regarding the need for better equipment in the kitchen, e.g., better stove and utensils for cooking. SEPTEMBER OCTOBER 2012 EVALUATION REPORT 13 ii

22 Community Facilitator Feedback C ommunity Facilitators reported receiving very positive feedback from participants about the program. Participants commented how helpful they found the program; that recipes were easy and tasty; and that they are eating healthier, trying new ingredients and recipes, cooking from scratch, reading food labels, and feeling more confident about choosing and cooking healthy foods. Eating nutritious food does not have to taste bland. Community Facilitators reported many benefits of the program, including: Learning enough that participants can begin to think about how they can make healthier choices in their diets. Healthy food can taste good and be filling. Learning how to change recipes to make them healthier, opening our minds to new foods and new ways of cooking, i.e. to talk about ways to change the diet of the community as a whole. There was enthusiasm for cooking at home and trying new things, open to herbs and spices and trying other beverages. Eating healthy for less money. The hands on experience and sharing experiences with others are critical. You can have fun in the kitchen while cooking healthy. 14 EVALUATION REPORT OCTOBER 2012

23 Community Facilitator Feedback The following stories were reported by Community Facilitators. Older youth mentored the younger ones. We had drop-in guests. A teacher came to see what was going on when we were about to eat so we invited her to join us. She raved about the food. A janitor came at the right time to eat one day and joined us and he thought the food was great. This enhanced the youths self-esteem and confidence in their ability to cook especially since these adults are people they see every day. B grew up with 16 siblings. She is keen to try healthy recipes and is sharing them with her friends and family. She wants to continue with a cooking program. She has added more vegetables to her family s dinner. After several weeks, her family is eating more vegetables. She herself has given up drinking pop and drinks more water. We had the community kitchen model where participants make food and take it home. However, most often the participants did not prepare the whole recipe. They did a small part since large volumes were necessary. With the Food Skills for Families program, the participants work with one other partner or in a small group and prepared the entire recipe by themselves, and had to read and follow the instructions. They were proud of their accomplishments especially when the group raved about the recipe. I gave one of the women all the ingredients to do the lentil soup at home because she missed that session. The woman took it all home and made the soup and all the people she cooked for loved it. She had to make a double batch because so many people wanted to try it. She was so proud. A success story is G who has made significant changes to his lifestyle. He now walks 3-4 times per week for minutes even in the rain. He reads labels and watches for salt and saturated fat. He loves Puritan Stew and it was on sale so he went to buy some. At the store he looked at the sodium content which was very high and didn t buy it. He is a single parent trying to make changes for his son s health as well. They now sit at the table for dinner. In the past his son would eat while playing a computer/video game. OCTOBER 2012 EVALUATION REPORT 15

24 4.6 Other Program Impacts B ased on comments received from Community Facilitators, a number of important program impacts include: The development of friendships and social networks, such as: single parents bonding ; bringing moms and teens closer together. The sharing of knowledge, for example: older participants sharing their knowledge with younger couples and grandchildren; sharing the recipes with other family members; and older groups mentoring younger groups. A number of the Band caterers have taken the Food Skills for Families program or are supervised by people who have participated. As a result, caterers have changed menus to reflect healthier choices for community functions. 16 EVALUATION REPORT OCTOBER 2012

25 4.7 Barriers to Healthy Eating P articipants were asked in both pre and post questionnaire, What stops you from buying, preparing and eating more healthy foods? Of those participants who reported at least one barrier, the three most frequently mentioned barriers are: Healthy food costs too much (50%); I don t have healthy recipes (48%); and I don t know which methods of cooking are healthy (39%). At the end of the program, knowledge about methods of cooking healthy was substantially reduced as a barrier with only 9% reporting this as a barrier. Cost of food remained a barrier at the end of the program but for a smaller percentage of participants (pre 50% and post 35%). A Community Facilitator indicated that, some participants were pleasantly surprised that meal planning for a week saved them money. Not having healthy recipes also remained a barrier at the end of the program but for a slightly smaller percentage of participants (pre 48% and post 40%). Not being able to buy fruits and vegetables locally was a barrier at the start and end of the program (pre 29.5% and post 28.3%). When barriers to healthy eating reported by participants in the ADI-funded programs were compared to barriers reported by participants in the March 2011 Food Skills for Families Evaluation Report (off reserve Aboriginal, new immigrant, Punjabi and low income combined), it is worth noting that participants in the ADI-funded programs reported having less local access to fruit and vegetables. This was a barrier for 29.5% of on reserve participants, compared to 12.6% of the combined populations. Cost, healthy recipes and healthy cooking methods were reported as the top three barriers for both groups. Local access to fruit and vegetables ranked as the sixth most significant barrier for the other populations, compared to fourth for the ADI-funded participants. Comments from Community Facilitators reinforced the challenges of cost and limited access to fruit and vegetables because of cost, lack of availability in the local community, long distances to retail stores and lack of readily available transportation. Participants would need to drive an hour to get to a store and often they do not have the transportation. What Stops You From Buying, Preparing and Eating More Healthy Foods Matched Participants I don't know which foods are healthy. 6.5% 11.4% I don't know which methods of cooking are healthy. 8.7% 38.6% I don't have healthy recipes. 39.1% 47.7% I cannot buy fresh fruits and vegtables locally 29.5% 28.3% Healthy foods cost too much. 34.8% 50.0% I don't have the right kitchen equipment or utensils. 18.2% 17.4% I don t like the taste of healthy foods. 4.5% 10.0% Percent of Participants Pre Program Percent of Participants Post Program OCTOBER 2012 EVALUATION REPORT 17

26 5.0 Summary & Future Considerations 5.1 Summary Highlights A t the conclusion of the ADI-funded Food Skills for Families programs, some improvement in the frequency of eating fruit and vegetables or salad was reported. However, a number of barriers exist for participants that prevent healthy choices from being easy choices, in particular, the ability to access and/or afford fresh fruit and vegetables. Encouragingly, approximately two-thirds of participants stated they definitely intend to eat more fruit and vegetables over the next year. The Food Skills for Families program appears to have the most impact on participants who reported adding salt to their food twice a day or more or those who drank sugary drinks on a daily basis percentages in these categories had the largest change. Participants reported a positive change related to eating less fried foods and in their confidence levels to prepare and cook new foods and read facts on food labels. The biggest changes in behavior reported by participants as a result of taking the Food Skills for Families program include eating healthier, trying new foods and reading food labels. These changes are also reported by the Community Facilitators as being the biggest changes they observed in the participants. The written and verbal reports by participants and Community Facilitators attest to the program s ability to positively influence participants healthy eating, cooking and nutrition knowledge, skills, attitudes and confidence. The program is highly regarded by all stakeholders involved. 18 EVALUATION REPORT OCTOBER 2012

27 5.2 Future Considerations B ased on the evaluation consultation and questionnaire results, a number of considerations are presented to optimize the future potential of the ADI-funded Food Skills for Families programs. Program Delivery Link the ADI-funded Food Skills for Families programs with other food skills and food security initiatives to improve the accessibility and affordability of healthy food, in particular fruit and vegetables for vulnerable populations. For example, food preservation/canning programs, community gardens and community kitchens. Continue to reinforce key messages and identify additional strategies within the program that would assist participants to make healthier beverage choices, to decrease their sugar sweetened beverage intake, reduce sodium/salt intake, and eat more fruits and vegetables. Foster opportunities for Community Facilitators to share their knowledge, experiences, successes and lessons learned with each other. Emphasize the value of the certificate of completion and consider offering incentives to participants, when feasible, to encourage participation in all six sessions. Encourage Band members with the responsibility for preparing food for community events to complete the Food Skills for Families program. OCTOBER 2012 EVALUATION REPORT 19

28 CANADIAN DIABETES ASSOCIATION: FOOD SKILLS FOR FAMILIES Partnership and Collaboration Continue the partnership between the Aboriginal Diabetes Initiative and Canadian Diabetes Association to help sustain and extend the reach of the Food Skills for Families program to become a readily available healthy eating and chronic disease prevention strategy for on reserve Aboriginal families. Continue to fund training of new on reserve Food Skills for Families Community Facilitators to further build community capacity. Continue to support existing on reserve Community Facilitators to maintain their knowledge and skills, and provide updated resources to deliver the Food Skills for Families program. Encourage Bands to leverage Community Facilitator and program participant knowledge of healthy eating and cooking to extend the impact more broadly within their communities (knowledge transfer/exchange). Encourage/advocate for Bands, government and other stakeholders to reduce barriers to healthy eating for vulnerable populations and to make the healthy choice the easier choice. Data Management Future Evaluation Strengthen Community Facilitators understanding and adherence to data management protocols, specifically the completion of pre and post questionnaires by all participants, and ensure Community Facilitators correctly and consistently label the questionnaires with the participant s unique confidential identifier. Work toward simplifying the coding procedures in the pre and post questionnaires to maximize availability of matched data for greater reliability. 20 EVALUATION REPORT OCTOBER 2012 Continue to collect participant data (pre and post program) to build evidence of the impact of the program on healthy eating and to communicate evaluation results broadly. Conduct periodic follow up evaluations, such as telephone surveys and focus groups with Community Facilitators and participants, to determine the impact of the program in the longer term.

29 Recognition T he Food Skills for Families program would like to thank the Master Trainers, Community Facilitators, participants, staff, Bands and host organizations for their support of program delivery, participation in the evaluation process and notable efforts to ensure quality evaluation data was collected and reported. Zena Simces and Susan Ross, Evaluation Consultants, designed the evaluation, undertook the analysis and synthesis of the data, and prepared the evaluation report. Barry Forer, Statistical Consultant, analyzed the participant data and assisted in summarizing results. Samantha Bissonnette, Program Coordinator, and Barb Kemp, Program Manager and Master Trainer, assisted in the review of the data and final report. A special thank you to the Aboriginal Diabetes Initiative, Pacific Region, First Nations & Inuit Health, Health Canada for funding the Food Skills for Families program for on reserves communities across BC. OCTOBER 2012 EVALUATION REPORT 21

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