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MT5: Nutrition Supports*

Framework Component

Changes - Adoption and promotion of nutrition-related supports in sites and organizations

Indicator Description

Sites and organizations that adopt PSE changes and complementary promotion often including favorable procurement, meal preparation activities, or other interventions that expand access and promote healthy eating; associated potential audience reached.

*SNAP-Ed Priority Outcome Indicator

Background and Context

Adoption takes place when sites or organizations make at least one change in policy or practice to expand access or improve appeal for healthy food and beverages. These may include, but are not limited to, those in the SNAP-Ed Library on SNAP-Ed Connection.

Measuring PSE adoption goes hand-in-hand with estimating reach. Reach is often based on estimation when actual counts are unavailable, considering the population that is potentially exposed to the intervention (UNC, 2013). Evaluators should also consider ways to maximize measures of reach by monitoring a policy or environmental change that can spread across sites or an entire organization. For instance, the reach of a local school wellness policy will be greater when the policy is adopted district-wide rather than one school at a time. We calculate total reach to demonstrate the broader exposure on the entire organization.

Many estimates of reach require accessing partner data, such as customers at a farmers' market, clients at a food pantry, or customer estimates for shopping for food if these data are not known or publicly available. Often data-sharing agreements across public and private sectors are necessary and may require letters of agreement. Institutional Review Board (IRB) other levels of approval that may be necessary.

Outcome Measures

Adoption

Takes place when SNAP-Ed sites or organizations put into effect an evidence-based PSE change, such as those included in the SNAP-Ed Library on SNAP-Ed Connection.

  • MT5a. Number and proportion of sites or organizations that make at least one change in writing or practice to expand access or improve appeal for healthy eating
  • MT5b. Total number of policy changes
  • MT5c. Total number of systems changes
  • MT5d. Total number of environmental changes
  • MT5e. Total number of promotional efforts for a PSE change

Potential Reach

  • MT5f. Reach: Total potential number of persons who encounter the improved environment or are affected by the policy change on a regular (typical) basis and are assumed to be influenced by it.

What to Measure

Adoption

The documentation of change(s) adopted in the SNAP-Ed qualified site or organization. Documentation (direct observation, photographic evidence, repeated self-assessments or surveys) or interviews with key informants to confirm the uptake of the PSE change in the site or organization. Nutrition-related changes can include one or more of the following PSE changes, often including favorable procurement or meal preparation activities or others that expand access and promote healthy eating. The following list is not exhaustive; other evidence-based or practice-based changes may arise.

  • Policy
    • A. Improvements in hours of operation/time allotted for meals or food service
    • B. Policies for working parents
    • C. Rules for foods served in meetings or in classrooms
    • D. Standards for healthier eating across the organization
    • E. School wellness or child care wellness policy
  • Systems
    • F. Change in menus (variety, quality, offering lighter fares)
    • G. Removing sugar-sweetened beverages from children's menus
    • H. Improvements in free water access, taste, quality, smell, or temperature
    • I. Restrictions on use of food as rewards or during celebrations
    • J. Change in food purchasing specification towards healthier food(s)
    • K. Change in vendor agreement towards healthier food(s)
    • L. Prioritizing farm-to-table/increase in fresh or local produce
    • M. Enhanced training on menu design and healthy cooking techniques
    • N. Use of standardized, healthy recipes
    • O. Collecting excess wholesome food to donate to charitable organizations
  • Environmental
    • P. Edible gardens (establish, reinvigorate or maintain food gardens)
    • Q. Lactation supports or dedicated lactation space
    • R. Healthier vending machine initiatives (e.g. access to healthier foods and beverages)
  • Promotion (Marketing)
    • S. Point-of-purchase and distribution prompts
    • T. Menu labeling with calorie, fat, sodium, added sugar counts
    • U. Vending machine labeling (e.g. calories, traffic light color coding)
    • V. Increased awareness of the changes by target audiences

It is important to document each change that occurs within a site. One change alone may not have enough magnitude to produce an impact. Thus, evaluators can document multiple changes that occur (e.g., signage, changes in layout and display of food and beverages). Measuring adoption may be labor-intensive; thus, it can be appropriate to choose a sample of sites for evaluation purposes (see Appendix C for details on sampling).

Measuring Reach

Reporting Reach Characteristics

When aggregating reach of PSE changes across sites and organizations, you are encouraged, but not required, to describe the characteristics of persons potentially reached. Because PSE activities are to be adopted only in SNAP-Ed qualified sites, we assume the majority of persons exposed to the change are low-income. However, reporting reach information by race/ethnicity, gender, languages spoken, household income levels, eligibility for free and reduced priced school meals, ZIP codes, or other factors will be important to address stakeholders’ concerns and questions. Reporting reach data by different socioeconomic, race, and Latino/Hispanic origin may explain to what extent PSE changes have the potential to benefit disparate populations.

Population

Persons in sites or organizations

Surveys and Data Collection Tools

See ST5 for a listing of the environmental and policy assessment tools.

Key Glossary Terms

Adoption, Environmental, Policy, Reach, Systems

Additional Resources or Supporting Citations

Food and Nutrition Service Local School Wellness Policy: https://www.fns.usda.gov/tn/local-school-wellness-policy

Institute of Child Nutrition: https://theicn.org/

University of North Carolina Center for Training and Research Translation: Evaluating Policy, Systems, and Environmental Changes.

National Farm to School Network: https://www.farmtoschool.org/