The Create Better Health (CBH) Curriculum is a direct education intervention designed to improve the nutrition and physical activity-related knowledge, skills, and self-efficacy of SNAP-Ed eligible adults to lead an active and healthy lifestyle with limited resources. CBH has a unique emphasis on improving food resource management through the use of "Create" concepts. "Create" concepts teach participants how to use foods they already have in their kitchen to create a variety of nourishing meals. CBH includes 8 lessons that are to be offered in a series of 6-8 classes. Nutrition educators are trained regularly to teach CBH classes all of which include a nutrition topic, physical activity discussion, and a hands-on (ideally) cooking demonstration that utilizes a "Create" concept. CBH addresses and evaluates individual level changes including short term readiness and capacity and medium-term changes over the course of a series, as well as long-term changes 6 months after participation in the areas of healthy eating, physical activity, and food resource management. CBH also includes a 1-year follow-up survey to evaluate long-term behavior changes.
Intervention Target Behavior: Healthy Eating, Physical Activity and Reducing Screen Time
SNAP-Ed Strategies: Direct Education
CBH targets adults at a variety of locations where SNAP-eligible participants congregate, including in the community, faith-based organizations, and worksites.
Settings: Community-wide, Faith-based centers, Worksites
Age/Population Group: Parents/Caregivers, Adults, Older Adults, Unhoused
Race All
Ethnicity: All
CBH includes a curriculum booklet, handouts including the "Create" concepts, evaluation tools, and a class observation tool. These components provide participants the knowledge, skills, and self-efficacy to improve nutrition and physical activity related behaviors, and food resource management. They also provide the implementing agency the tools to utilize CBH as intended, as well as evaluate its impact on target behaviors. CBH includes 8 detailed lesson plans. Classes are ideally taught as an 8-lesson series over 4-8 weeks, but can be also be taught as a 6-7 class series. There are 3 required core classes that emphasize key SNAP-Ed concepts. Other lessons included in a series can be selected by the educator based on series length and needs of the specific audience. 'Create' handouts are the cornerstone of CBH and should not be eliminated. Other handouts are optional. Use of the CBH evaluation tools is highly encouraged, and the class observation tool can help maintain program fidelity.
Create Better Health (CBH) Curriculum includes:
- CBH Participant Handouts
- Create Concept Handouts x 12 (English and Spanish)
- Nutrition/Food Budgeting Handouts x 15 (English and Spanish)
- Physical Activity/Active Lifestyle Handouts x 5 (English only)
- CBH Participant Evaluation
- CBH Class Observation Checklist
Formative research was conducted using a 30-item survey to assess nutrition and physical activity-related knowledge and behavioral intentions. The 108 survey participants were from 6 counties (3 rural and 3 urban). Key findings include 80% planned to change their diet, 79% planned to be more active, and 89% agreed they could prepare a healthy meal at home after participating in a CBH class. Additional results from the pilot study can be found in the following manuscript: Create Better Health: A Practical Approach to Improving Cooking Skills and Food Security.
Outcome evaluation was conducted using a retrospective post-pre survey distributed in every CBH class. Results suggest that the majority of participants had strong intent to change nutrition and physical activity related behaviors. The survey has been completed by 3,368 participants. Additionally, impact evaluation data was collected through an online survey offered to participants 6-months after completing CBH classes. A total of 220 participants completed the survey. Detailed results from these evaluations include the following:
- 74% reported an intent to eat a variety of fruits and vegetables daily.
- 67% reported an intent to choose a variety of foods based on MyPlate recommendations.
- 67% reported an intent to stretch food dollars to last the month.
- 63% of participants reported an intent to be physically active for at least 30 minutes 5 days per week.
- 66% reported an increase in using MyPlate to make food choices.
- 61% reported an increase in consuming at least 2 1/2 - 3 cups of vegetables daily.
- 62% reported an increase in eating at least 2 cups of fruit per day.
- 61% reported an increase in choosing and preparing healthy food for their families on a budget.
- 68% reported an increase in reading the nutrition facts label.
- 61% reported an increase in shopping with a grocery list.
- 55% reported an increase in choosing to be active at least 30 minutes 5 days per week.
- 55% reported an increase in physical activity to make muscles stronger.
Evidence Base: Research-tested
Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.
| Readiness and Capacity - Short Term (ST) | Changes - Medium Term (MT) | Effectiveness and Maintenance - Long Term (LT) | Population Results (R) | |
| Individual | ST1, ST2 | MT1, MT2, MT3 | LT1, LT2, LT3 | |
| Environmental Settings | ||||
| Sectors of Influence |
After participating in a Create Better Health series, adult participants reported:
- MT1a: 54% reported usually/always consuming at least 2 ½-3 cups of vegetables daily.
- MT1b: 57% reported usually/always consuming at least 2 cups of fruit daily.
- MT1f: 64% reported usually/always using MyPlate to make food choices.
- MT2g: 64% reported usually/always stretching food dollars to last the month.
- MT3: 60% reported usually/always being physically active for at least 30 minutes, 5 times per week.
At least 6-months after participating in a Create Better Health series, adult participants reported:
- LT1f: 66% reported an increase in using MyPlate to make food choices.
- LT1l: 61% reported an increase in consuming at least 2 1/2 - 3 cups of vegetables daily.
- LT1m: 62% reported an increase in eating at least 2 cups of fruit per day.
- LT2a: 61% reported an increase in choosing and preparing healthy food for their families on a budget.
- LT2b: 68% reported an increase in reading the nutrition facts label.
- LT2m: 61% reported an increase in shopping with a grocery list.
- LT3: 55% reported an increase in choosing to be active at least 30 minutes 5 days per week,
- LT3c: 55% reported an increase in physical activity to make muscles stronger.
A pre-post survey is used for the CBH class series. Participants complete the same survey during the first and last class in the series. During mid-series classes, participants complete a brief qualitative survey about behavior changes made since the previous class. Participants can choose to be contacted 6 months and 1 year after completing a series for a follow-up survey. An intent to change survey is also available for participants in a one-time CBH recruitment class. All surveys are available in English and Spanish.
Website: The Create Better Health Curriculum website includes curriculum lessons, handouts, surveys and recipes.
Contact Person(s):
Lea Palmer, MPH, RDN
Assistant Director, USU Create Better Health
Phone: 408-343-0247
Email: lea.palmer@usu.edu
Kristi Strongo, MPH, CHES
Direct Education Coordinator, USU Create Better Health
Phone: 801-669-1654
Email: Kristi.strongo@usu.edu
Heidi LeBlanc, MS
Program Director, USU Create Better Health
Phone: 435-797-3923
Email: heidi.leblanc@usu.edu
*Updated as of August 23, 2023