Introduction
The base level of the framework represents the foundation of SNAP-Ed: individual, group, and family nutrition education and physical activity promotion and related interventions. All state SNAP-Ed Plans must include individual-level activities (identified as Approach 1 within the Food and Nutrition Act). Individual and group-based activities are designed to change goals and intentions toward behavioral changes among SNAP-Ed participants. The overarching evaluation question in this chapter is: To what extent does SNAP‐Ed programming improve and sustain participants’ healthy eating and physical activity behaviors?
The outcomes at this level are measured through validated and reliable questionnaires, such as the Food Behavior Checklist or the International Physical Activity Questionnaire, designed for low-income and low-literacy populations to self-report their behaviors. The indicators at this level focus on improving nutrition, stretching food dollars, and increasing physical activity through free or low-cost exercise or leisure-time sports. Short-term (ST) indicators illustrate goals and intentions that motivate or demonstrate readiness for behavior changes but fall short of action. ST indicators may result from low-dose, brief SNAP-Ed interventions, such as one-time workshops or the beginning lessons of an educational series. Many of the surveys associated with short-term indicators reflect the Transtheoretical (Stages of Change) Model, a theory that emphasizes individual readiness for health behavior change and associated progress in making and maintaining behavior change (Prochaska and Velicer, 1997).
Medium-term (MT) indicators are behavioral changes resulting upon completion of a series of evidence-based direct nutrition education and physical activity lessons. Sessions can include face-to-face instruction with a live instructor or via digital or interactive media. MT indicators represent changes in actions or behaviors as measured by pre- and post-questionnaires before and after individual, group, and family-based education and health promotion programs. Additionally, there are options for 24-hour dietary recalls, some of which use images and visual cues to estimate portion sizes. Certain physical activity behaviors can also be measured directly using pedometers, for instance, or parental observation of child behaviors.
The MT indicators are actionable for ongoing program evaluation and continuous program improvement. A sample of participants who begin and complete a SNAP-Ed program should have their targeted behaviors assessed at baseline (entry) and again at program completion (exit). Please see Appendix C for more information on sampling. For each indicator, a list of preferred questionnaires, sample questions, and data collection methodologies are suggested. The medium-term indicators are actionable for ongoing program evaluation and continuous program improvement. Evaluators should measure, analyze, and report changes in either mean (average) scores, where appropriate, or the distribution of participant responses or self-reported behaviors before and after the series. These summary statistics should be based on the number of participants who complete both the baseline and the program exit questionnaire. The reporting of means and/or the distribution of responses or behaviors should include the number of participants who responded to the survey question. Statistical testing is encouraged to rule out that the observed changes are due to chance. More information is available in Appendix C. Step-by-step guidance for SNAP-Ed program evaluation is available in Addressing the Challenges of Conducting Effective Supplemental Nutrition Assistance Program Education (SNAP-Ed) Evaluations. Some questionnaires may be proprietary, have specific requirements for use, or items of cost; please contact the survey developer before initial implementation.
While there is no time period or required number of SNAP-Ed program sessions for tracking MT indicators, states are expected to use principles from Best Practices for Nutrition Education for Low-Income Audiences. These principles include delivering a program fully and as intended, based on behavioral theory, and with an appropriate number of educational sessions and contacts.
At the individual level, the distinction between medium-term and long-term is that medium-term represents immediate outcomes following program completion, and long-term is at a minimum of 6 months post-intervention. The maintenance stage of the Transtheoretical (Stages of Change) Model lasts from 6 months to 5 years. Long-term indicators reveal whether SNAP-Ed participants continue to demonstrate targeted behavioral changes even after graduating from a direct education program. The University of Wyoming’s Cent$ible Nutrition Program has successfully evaluated long-term behaviors (Wardlow and Baker, 2012).