This research was designed to investigate how the Expanded Food and
Nutrition Education Program (EFNEP) adapted to keep services for low-income
participants relevant, accessible, and effective during the period of
welfare reform. EFNEP’s adaptation strategies were examined using qualitative
assessment of the experiences of EFNEP personnel and quantitative
analysis using program monitoring data on implementation and outcomes.
To gather the study data, indepth interviews were conducted with State
EFNEP coordinators and selected county or regional EFNEP supervisors in
three States. Six focus group discussions with EFNEP paraprofessional
Community Nutrition Educators (CNEs) and two interviews with key
informants were conducted in one State. Verbatim transcripts were analyzed
qualitatively. A national dataset of selected program variables for the period
of 1997-2003 was created from State-level data excerpted from the national
EFNEP monitoring system. Regression analysis was used to examine trends
over time in program implementation and outcomes at the national and State
levels. The study also examined the characteristics of a subsample of 10
States with the strongest trends (5 positive, 5 negative) in behavior change
score, and the proportion of program graduates reporting an improvement in
dietary practices between program entry and completion.
EFNEP personnel reported that families transitioning to work continued to
need EFNEP, but had little time to attend nutrition education classes. Low-income
working parents who have less time for food preparation and acquisition
reportedly need information on managing food resources, preparing
quick healthy meals for home and work, and making good choices when
eating away from home. To reach these participants, EFNEP collaborated
with other agencies to deliver services to groups formed for other purposes,
offered programs on weekends or evenings, and identified new audiences.
Collaborating agencies included adult education and English language
programs, residential programs addressing various needs (e.g., domestic
abuse, homelessness, mental disabilities, and drug rehabilitation), welfare-to-work training programs, and occupational groups (e.g., daycare
providers). CNEs now teach more groups, reach more diverse audiences,
and address mandated audiences who must attend an agency’s program to
avoid sanctions (such as loss of Temporary Assistance for Needy Families
(TANF) benefits). Sustained collaboration with agencies serving similar
populations and interested in providing nutrition education to their clients
was critical to successful adaptation. This collaboration was difficult in
some rural areas where few agencies were available to collaborate with
EFNEP and where low population density and lack of transportation limited
attendance at group educational sessions.
Most EFNEP personnel felt that EFNEP was adapting successfully to serve
potential participants. The challenges posed by interagency collaboration
included constraints on the number and length of lessons, resulting in less
time for education and hands-on activities. Some personnel were concerned
that shorter program duration and group methods could reduce impact. To
preserve program quality, some sites established standards for minimum
length and frequency of lessons and provided extra individual or homestudy
lessons for people seeking more information and support. Training
CNEs to work with new audiences, revising curricula to focus on priority
topics, and subdividing large groups were other strategies to maintain effective
teaching. Such strategies required resources and were not practiced
equally in all sites. Program impact may depend on whether a supervisor is
primarily concerned with program survival and maintenance of large caseloads,
or employs strategies to sustain both high participation rates and
program quality.
Analysis of national EFNEP monitoring data confirmed many of the qualitative
findings. The proportion of participants reached by group (rather than
individual) methods increased from under 60 percent in 1997 to almost 72
percent in 2002-03. Characteristics of EFNEP participants also changed.
From 1997 to 2003, there was a reduction in the proportion of participants
living in rural areas or small towns, an increase in the proportion of
Hispanics, and a decrease in the proportion of African Americans.
Nationally, the percent of graduates reporting an improvement in dietary
behavior between program entry and completion remained relatively
constant, although trends in individual states varied widely. The rate of
program completion increased, probably due to inclusion of more mandated
participants and changes in graduation criteria associated with group
methods. The size of the Federal funding allocation to a State was the
program characteristic that best distinguished programs whose participants
improved their dietary behavior (from inadequate to adequate by program
graduation) from those state programs whose participants did not demonstrate
improvement in dietary behavior.
EFNEP has developed innovative strategies to adapt to welfare reform and
to contribute to its success by helping families practice healthy nutrition and
resource management as they transition to work. While the trends identified
in this study occurred during the era of welfare reform, EFNEP was also
influenced by other socioeconomic and policy conditions. Continued
funding constraints have implications for program access, quality, intensity,
and duration.
These analyses illustrate how data from EFNEP’s extensive program monitoring
system can be used to assess changes in program implementation and
behavior change outcomes. Research would be enhanced if program monitoring
data were complemented by an external EFNEP evaluation of
contrasting program approaches and multiple outcomes among participants
and nonparticipants.