Evaluation of Statewide Nutrition Education Networks 

Prepared by:

Research Triangle Institute

Washington, DC

and

Health Systems Research, Inc.

Washington, DC

Prepared for:

Office of Analysis, Nutrition and Evaluation

Food and Nutrition Services

U.S. Department of Agriculture

Alexandria, VA

Contract No. FCS-53-3198-5-038

Patricia McKinney, Project Officer

August 1999
Health Systems Research, Inc. Acknowledgements

ACKNOWLEDGMENTS

This report was prepared by James Hersey, Lauren Harris-Kojetin, Jennifer Matheson, and

Leeann Shiveley of Research Triangle Institute and Sheryl Anderson, Loren Bell, and Mary

Harkins of Health Services Research, Inc. under contract to the Food and Nutrition Service

(Contract No. FCS-53-3198-5-038). Other staff contributing to this project included Elissa

Adair, and Cynthia Woodsong of RTI and Jean Anliker, Hillary Bellamy, Synod Boyd, Naomi

Eisen, Vivian Gabor, Donna Oberg, and Beth Zimmerman of HSR. 

We wish to acknowledge the support and assistance we received from Patricia McKinney and

from Carol Olander who served as our Project Officers for this study. Valuable guidance and

thoughtful reviews were provided by Steven Carlson and Ted Macaluso of FNS.

Special thanks go to all the individuals in state nutrition education networks who contributed

their time to the interviews that provided much of the information for this project, and who are

making important contributions to the nutrition of low income Americans. 
Health Systems Research, Inc. Table of Contents Page iii

Table of Contents

Executive Summary ........................................................ iii

Chapter I. Background and Purpose ........................................ 1

A. Study Background ....................................... 1

B. Purpose of the Evaluation .................................. 7

Chapter II. Study Approach .............................................. 10

A. Data Collection Approach ................................. 10

B. Data Analysis Approach .................................. 11

C. Study Limitations ....................................... 12

Chapter III. Network Development ......................................... 14

A. Network Participation .................................... 14

B. Network Recruitment and Expansion ........................ 18

C. Organizational Structure and Governance ..................... 23

D. Contributors to Effective Collaboration ....................... 28

Chapter IV. Planning and Needs Assessment .................................. 31

A. Conducting the Needs Assessment .......................... 32
Health Systems Research, Inc. Table of Contents Page iv

B. Data Sources .......................................... 34

C. Uses Made of the Needs Assessments ........................ 37

D. Additional Benefits ...................................... 42

Chapter V. Network Nutrition Education and Social Marketing ................... 43

A. Social Marketing Activities ................................ 44

B. Individual and Small Group Nutrition Education

Network Activities ...................................... 51

C. System, Policy, and Environmental Change .................... 56

D. Impact of Network Activities on Statewide Nutrition Education .... 57

Chapter VI. Lessons and Conclusions ....................................... 62

A. Accomplishments ....................................... 63

B. Challenges ............................................ 76

C. Lessons About Success ................................... 79

D. Conclusion ............................................ 85

References

Glossary
Health Systems Research, Inc. Executive Summary Page iii 

Executive Summary

I. Background and Approach

A. Background and Purpose

This report describes the progress and accomplishments of 22 Statewide nutrition education

networks funded through cooperative agreements awarded in September 1995 and in

September 1996 by the Food and Nutrition Service (FNS). The demonstration sought to

establish, in each participating State, a self-sustaining, collaborative Statewide nutrition

education network of public and private organizations that would use social marketing concepts

to provide nutrition education to adults and children who were participating in or eligible for the

Food Stamp Program. 

B. Study Approach

Under contract to FNS, Health Systems Research, Inc. (HSR) and its subcontractor, Research

Triangle Institute (RTI), conducted a process evaluation that sought to examine those elements

that foster the development of nutrition networks. The study team conducted baseline and

follow-up site visits, telephone interviews and reviews of written materials produced by the

networks. The networks were assessed in terms of their progress as of the fall of 1998.
Health Systems Research, Inc. Executive Summary Page iv 

II. Findings and Conclusions

A. Accomplishments

Sixty percent of the networks had achieved the objectives of their cooperative agreements by

the fall of 1998:

# Establishment of Broad Statewide Networks. More than 80 percent of

States that were awarded cooperative agreements had established broad

networks of public and private organizations supporting nutrition education for

low-income audiences.

# Receipt of Nutrition Education Plans. Seventy-five percent of Round One

networks and one-half of Round Two networks submitted and received approval

of a nutrition education plan (NEP) as part of the State Food Stamp Program. 

# Leveraging of Resources. In total, USDA provided roughly $4 million in

funding for the two rounds of cooperative agreements (including the technical

assistance associated with the initiative). In 1998, these networks attained more

than $20 million in non-federal funding and identified additional in-kind

contributions from non-governmental organizations that further leveraged the

resources that networks were able to devote to nutrition education. One

network obtained more than $8 million in new non-federal funding for nutrition

education; other smaller networks saw comparable or greater rates of growth. 

# Planning and Development of Social Marketing Activities. Nearly all

networks were able to conduct planning and needs assessment for social

marketing activities. As a result, networks are initiating new social marketing

activities to reach low-income populations via mass media, targeted newsletters, 

nutrition education in schools serving low-income populations, and reminders

among food retailers and community activities. 

Evaluations conducted by the networks themselves indicate the value of these

efforts. An evaluation of a pilot campaign in Michigan found that a social

marketing effort that included broadcast and print messages was effective in

reaching low-income populations. An evaluation in Washington state found that

food stamp participants read and used nutrition information sent to them in

newsletters. An evaluation in California found that kiosks in supermarkets

serving low-income populations increased the purchase of fruits and vegetables.
Health Systems Research, Inc. Executive Summary Page v 

B. Lessons about Success

Progress has not always been easy and networks faced formidable challenges in forging strong

partnerships, in identifying and documenting resources under FSP matching requirements, and

in developing social marketing efforts. While the majority of networks succeeded in addressing

these challenges, a common feature of the networks that failed was their inability to successfully

resolve inter-organizational issues regarding resources. 

Important factors that contribute to the success of nutrition networks include: (1) experienced

leadership teams, (2) support of senior management, (3) attention to partnership issues, (4)

attention to resource management issues, (5) emphasis on complementary modes of social

marketing, and (6) emphasis on development and enhancement of community nutrition

education programs.
Health Systems Research, Inc. Chapter I Page 1 

CHAPTER I

Background and Purpose

This report describes the progress and accomplishments of 22 Statewide

nutrition education networks funded through cooperative agreements awarded

by the Food and Nutrition Service (FNS) as part of a demonstration project in

October 1995 and October 1996. These networks were intended to expand the

reach and approach of nutrition education for participants in the Food Stamp

Program (FSP) through the development of self-sustaining, collaborative

Statewide networks of public and private organizations to plan and conduct 

nutrition education and social marketing to promote the Dietary Guidelines for

Americans. 

This chapter describes the background of the Statewide nutrition education network

cooperative agreement demonstration and the purpose of this study.

A. Study Background

1. USDA Nutrition Programs

The nutrition assistance programs administered by the U.S. Department of Agriculture’s

(USDA’s) Food and Nutrition Service (FNS) have long been the cornerstone of this country’s

effort to ensure adequate nutrition for the disadvantaged. In recognition of this responsibility,

FNS has undertaken efforts to make high-quality nutrition education available to the largest

possible number of individuals and families participating in nutrition assistance programs, while

at the same time striving to assure that limited resources are used in a cost-effective manner. 

Historically, FNS has supported nutrition education through individual programs and standalone grant initiatives. For example, client education is integrated in the Special Supplemental

Nutrition Program for Women, Infants and Children (WIC). Some grant programs have
Health Systems Research, Inc. Chapter I Page 2 

provided seed money targeted to special audiences (e.g., teenagers) or to certain topics (e.g.,

breastfeeding). However, nutrition education is not required in most food assistance programs,

including the largest of these: USDA’s Food Stamp Program which provides food benefits to

low income households.

To expand nutrition education efforts to reach Food Stamp participants, the Food Stamp

Program, through optional Nutrition Education Plans, works in partnerships with States. State

agencies may receive 50-50 Federal matching funds to conduct nutrition education. State Food

Stamp Agencies may claim nutrition education activities as a reimbursable administrative

expenses, along with certification, benefit issuance, and other administrative tasks. 

Administrative activities are funded equally by States and the Federal government. State Food

Stamp Agencies build these expenses into their annual State plans and budget projections. The

commitment of these funds is contingent on FNS’ approval of the plan and budget. If approved,

funds which reflect costs to administer the plan are disbursed from FNS to the State Food

Stamp Agency. The State Agency then has the authority to distribute funds in a manner

consistent with Agency requirements and the approved plan. The approach used by most State

Food Stamp Agencies is to subcontract nutrition education activities to Cooperative Extension

programs located within their States.

2. The Nutrition Education Cooperative Agreement Demonstration

In order to increase the scope of nutrition education activities and expand the number of

participants receiving nutrition education, FNS undertook a demonstration project which

awarded two rounds of Nutrition Education Network Cooperative Agreements to 22 States to

develop or expand Statewide nutrition education networks.

Aims of the Demonstration. The cooperative agreements were intended to foster the

development of integrated, multi-partner State-level nutrition education networks which could

bring together State and local government agencies, nonprofit organizations, and

representatives of private industry, in order to coordinate the delivery of innovative nutrition
Health Systems Research, Inc. Chapter I Page 3 

education messages designed specifically for persons receiving or potentially eligible for food

stamp benefits. FNS expected that the networks would help:

# Maximize the amount and efficient use of private and public resources;

# Identify specific client information needs and relevant ways of addressing them;

and

# Effectively recruit and leverage community organizations to deliver appropriate

messages.

Specifically, the objectives of the cooperative agreements were to:

# Support the planning and development of a collaborative nutrition

education/promotion campaign for food stamp recipients and eligibles by

building a network of public and private organizations that includes the State

Food Stamp Agency;

# Promote the Dietary Guidelines for Americans by planning to integrate key

messages into State nutrition education/promotion for the target audience;

# Expand the reach and approach of current State nutrition education efforts by

incorporating the use of social marketing principles and tools in planning

activities; and

# Result in self-sustaining nutrition education efforts by creating State funding

packages that include contributions approved for inclusion as allowable costs for

reimbursement by the Food Stamp Program.

Social Marketing. The networks were charged with incorporating the principles and tools of

social marketing in their planning for nutrition education and promotion efforts. Social

marketing is an audience-centered approach that features multiple and reinforcing channels of

communication along with public policy and environmental changes to influence behavior. 

Although social marketing efforts often make use of television, radio ads, videos, and

brochures, these materials by themselves do not constitute social marketing. Rather, social

marketing entails a comprehensive program in which these materials are employed as part of the

tactics to reach a target audience. Social marketing emphasizes the importance of keeping the

target audience and network partners involved in needs assessment, message development, and

refinement of messages and delivery strategies (Lefebvre and Flora, 1988; Andreason, 1995).
Health Systems Research, Inc. Chapter I Page 4 

Social marketing techniques include analysis and segmentation of audience needs that influence

message development and delivery, use of the media to reach large numbers of people, and an

emphasis on ultimately changing behavior. In the context of this effort, social marketing

emphasized audience analysis to develop and deliver messages that:

# Promote food choices among program participants consistent with the Dietary

Guidelines for Americans;

# Are positive and action-oriented;

# Reach audiences through multiple communication channels in culturally

appropriate ways;

# Can be consistently reinforced by families, communities, and the media; and

# Are periodically subjected to evaluations of their effectiveness.

The cooperative agreements provided seed money to hire network coordinators who could

devote full time to establishing the network organization and goals, coordinate the preparation

of a consumer-centered nutrition education plan (NEP) and recruit partners to contribute

resources for implementing the plan. By the end of the cooperative agreements, State nutrition

networks were expected to shift their focus to implementing the NEP and become selfsustaining. Table I-1 summarizes the key differences between the cooperative agreements and

the network’s Food Stamp NEPs.
Health Systems Research, Inc. Chapter I Page 5 

Table I-1.

Key Features of Cooperative Agreements and Nutrition Education Plans

Features Cooperative Agreements Nutrition Education Plans

Purpose Set up self-sustaining networks and Implement integrated, Statewide

nutrition plans. nutrition plans approved by FNS.

Major Steps Hire network coordinators. Support and coordinate delivery of

Recruit network members and set up local vehicles.

appropriate organization structures.

Identify educational and resource needs.

Create nutrition plans that reflect network needed.

collaboration and integrate current

education efforts. Updated FSP NEP amendments

Pursue needed resources.

Submit Statewide nutrition education and

financial plan to FNS.

Participate in FNS study of nutrition

networks.

nutrition education through State and

Assess nutrition efforts.

Modify nutrition education plans, as

annually.

Duration 30 months. Ongoing.

Funding Amount One-time, up to $200,000. Proposed by networks and reviewed as

part of FSP nutrition education plans.

Funding Source Food Stamp research and demonstration Contributions from network partners,

funds. along with FSP reimbursement at the

50% rate.

 

Implementation of the Cooperative Agreements. The first round of cooperative

agreements were issued to 12 States in October 1995 (referred to as Round One cooperators). 

The primary grantees in each of the 12 States included a mix of seven State public health

agencies, four Cooperative Extension programs, and one State Department of Education (as

shown in Table I-2). The cooperative agreements were initially intended to run for 18 months,

with the expectation that by the end of that time the sponsoring agency would be able to

organize the network, conduct its needs assessment, and develop an initial plan of action to

apply for Food Stamp administrative funds. The final step in the process would be to actually

submit their proposal to the State Food Stamp Program, which would then incorporate the

nutrition education activities into the State’s Food Stamp Program Plan of Operations.
Health Systems Research, Inc. Chapter I Page 6 

Table I-2.

Types of Primary Grantees for the Statewide Nutrition Education Network

Cooperative Agreements

Type of Primary 1995 Cooperative Agreements 1996 Cooperative Agreements

Grantee (Round One States) (Round Two States)

Cooperative Extension

Service

Alabama, Minnesota, Colorado, Kansas, Michigan, Nevada,

Virginia, Washington New Jersey, North Carolina,

Pennsylvania, South Dakota, Wisconsin

Public Health Agency Arizona, California, Georgia, Iowa, Oklahoma

Maine, Missouri, Vermont

Department of Education Indiana

Towards the end of the first year, due to network start-up delays combined with unanticipated

time to get regulatory clarifications from FNS regarding matching requirements, additional time

was required to complete the objectives of the cooperative agreement. Therefore, Round One

cooperators were given the opportunity to apply for an additional 12 months of funding to

complete their needs assessment and develop their plans. At the same time as these extensions

were being offered, cooperative agreements were awarded in an additional 10 States (Round

Two cooperators). Primary grantees in Round Two States included one State public health

agency and nine Cooperative Extension agencies. The Round Two agreements were 30 months

in duration in order to allow sufficient time for network development and progress toward

sustainability.

Technical Assistance. To support the development of nutrition education networks, FNS

also provided technical assistance (TA) to cooperators both directly and via a contract that they

issued to HSR. In addition, to providing technical assistance, FNS convened training meetings

with all of the cooperators to provide information and facilitate communication among network

participants in various States. Each of the cooperative agreement States were provided the

opportunity for technical assistance in a number of areas relative to the development of the

networks. Round One States were provided with an initial site visit and up to 80 hours of TA,

which could also include up to two additional site visits. Round Two States were provided with

an initial site visit and up to 80 hours of TA with one additional site visit as their limit. States

requiring more than 80 hours were accommodated by shifting hours from States not needing
The evaluation team, while including staff from both RTI and HSR, was led by RTI and 1

constructed to be independent of HSR’s technical assistance team. While members of the TA

team reviewed this report for accuracy, the conclusions were drawn solely by the evaluation team.

Health Systems Research, Inc. Chapter I Page 7 

their full 80 hours. Technical assistance provided to the Round One States focused mostly on

organizational development, strategic planning, needs assessment, and developing the Food

Stamp NEP. Technical assistance to the Round Two States focused more on social marketing

practices, needs assessment, and organizational communications (Table I-3). 

Table I-3.

Summary of Technical Assistance Provided

Type of TA Provided Round One States Round Two States

Communications Georgia, Indiana, Minnesota, Kansas, Pennsylvania, Wisconsin 

Vermont

FSNEP Development Georgia, California, Maine, Kansas, Nevada, Oklahoma,

Missouri, Vermont, Virginia Pennsylvania, Wisconsin.

Needs Assessment California, Iowa, Maine, Missouri. Colorado, Kansas, Oklahoma,

Nevada, South Dakota

Organizational Development Arizona, Indiana, Iowa, Maine, Colorado, Kansas, Nevada, North

Minnesota, Vermont, Virginia, Carolina, Oklahoma, Pennsylvania

Washington 

Social Marketing None* Colorado, Kansas, North Carolina,

South Dakota, Wisconsin

Strategic Planning California, Maine, Minnesota, Nevada, North Carolina

Washington

Did Not Request TA Alabama Michigan, New Jersey

* The Technical Assistance contract did not allow for provision of assistance in social marketing during

the initial year of the contract.

B. Purpose of the Evaluation

This evaluation report was produced under a contract between FNS and HSR and its

subcontractor, the Research Triangle Institute (RTI). Under this contract, HSR provided

technical assistance to the 22 networks and RTI led an evaluation of the networks ability to

meet the cooperative agreement goals. The goal of this evaluation was to assess the progress 1

made by networks in developing organizational structures, recruiting members, conducting a
Health Systems Research, Inc. Chapter I Page 8 

needs assessment for nutrition education efforts, and preparing a plan to obtain continued

support for the network as part of the FSP State NEP. 

A number of networks successfully completed the original goals, and have moved onto the

delivery of nutrition education. In cases where networks are actively engaged in the provision

of nutrition education, this report describes these activities in addition to accomplishments

associated with planning and network development. As a basis for evaluation, RTI and HSR

built upon the conceptual framework shown in Figure 1.1, which illustrates the interchange

between grant receipt, staff acquisition, network recruitment, and network maintenance. The

networks were expected to continue planning and acquiring resources to deliver nutrition

education and to sustain the network. 

Specifically, the evaluation was designed to answer the following four study questions:

Question 1. What processes did the networks use to develop Statewide nutrition

education networks?

Question 2. How effective were the processes employed by networks in the

following:

# Building a network of public and private organizations to support

collaborative nutrition education and promotion for food stamp

recipients and eligibles? 

# Integrating messages promoting the Dietary Guidelines for

Americans into State nutrition education and promotion for food

stamp eligible audiences? 

# Expanding the reach and approach of State efforts by

incorporating the principles and tools of social marketing? and

# Developing self-sustaining nutrition education efforts as part of a

State’s nutrition education plan? 

Question 3. What can FNS do to foster development of Statewide nutrition education

networks?

Question 4. What lessons can be learned about the development of effective

Statewide nutrition education networks?
Health Systems Research, Inc. Chapter I Page 9 

This document reports on the progress made by the nutrition education networks in developing

nutrition education programs through the fall of 1998. The interviews for this evaluation were

conducted approximately three years after the funding of the Round One cooperators; at that

time most of the original cooperative agreements had expired and many of the networks had

begun to receive support for their activities as part of an approved nutrition education plan

(NEP) funds. The interviews with Round Two cooperators were conducted approximately two

years after their award of a cooperative agreement.

It is difficult to assess the ultimate effectiveness of planning without knowing how well

networks were able to translate these plans into action. As of this writing, many of the Round

Two networks were just beginning to engage in nutrition education that derived from network

efforts. Also, many of the networks which had implemented nutrition education activities are

likely to expand their activities in coming years. Hence, this report is not able to provide

definitive answers to these questions. Rather, this report describes the process of implementing

the cooperative agreements, and the progress and challenges the networks faced during the

initial years of the demonstration project.
Health Systems Research, Inc. Chapter II Page 10 

CHAPTER II

Study Approach

The basic approach to this process evaluation was to build on baseline data collected

early in the network developmental process, follow-up site visits, telephone interviews

with key network members, and review of written materials. The evaluation sought to

identify the factors that fostered the development of networks and to describe the

barriers to network development experienced by some networks.

This chapter describes (1) the approach used for data collection, (2) the approach to data

analysis, and (3) the limitations of the study.

A. Data Collection Approach

Data were collected through a series of steps, including a review of grant applications,

interviews with project staff and network staff members, site visits to States, discussions with

technical assistance staff, review of quarterly reports and documents, and a set of follow-up

calls with States during the fall of 1997 plus follow-up interviews in the fall of 1998. The

information that was collected is summarized in Table II-1.
Health Systems Research, Inc. Chapter II Page 11 

Table II-1.

Summary of Data Sources for the Evaluation

Data Source Time Periods Type of Information Sought

Baseline Interim Follow-up

Jan. 1996/ Fall 1997 Fall 1998

Feb. 1997

Interviews with project director x x x Description of history, strategy,

and accomplishments

Interviews with network x x x Description of plans,

coordinator information requests

Interviews with State FSP x x Description of current nutrition

network representative education and role with

network.

Other network interviews: Network member experience

 Major private sector partners x x and accomplishments

 Other major partners x x

Review of Applications and x x x Planning, strategies, and

Nutrition Education Plans resources for nutrition

education 

Review of nutrition education x Changes in quantity, focus,

materials targeting, cultural relevance

Minutes, reports, newspaper x Activities and participation of

articles, media materials network partners

Technical assistance logs ongoing Nature of technical assistance 

Progress reports Quarterly Progress and accomplishments

B. Data Analysis Approach

This study gathered both factual information and personal opinions of individual network

partners. The analysis was completed by assessing information from multiple interviews and

written documentation which described the developmental status of each individual network and

members’ perceptions of the factors that contributed to success and posed challenges. The

study sought to identify lessons that were applicable across a number of networks. To do so,
Health Systems Research, Inc. Chapter II Page 12 

the evaluation focused on factors that appeared to hold true in three or more network settings. 

Because this study sought to identify best practices that networks could share directly with

others, this report includes examples of exemplary practices associated with specific networks

(since this will facilitate the ability of networks to be an ongoing resource to one another). 

No network was equally effective in all areas. A balanced assessment of the cooperative

agreement demonstration must describe the limitations as well as the strengths of the program. 

Accordingly, the findings section discusses the challenges that networks faced, and the

strategies networks used to meet those challenges.

C. Study Limitations

This report characterizes the accomplishments of networks as of the fall of 1998. It is important

to recognize that these networks are still developing, and that progress is not necessarily linear

(e.g., several networks that appeared inactive earlier developed new energy once staff vacancies

were filled). The network development is an evolving process, and it would be unfair to

characterize a shortcoming (or an accomplishment) in some area at a particular point in time as

a definitive assessment. It is also likely that many of the social marketing activities that have

been planned by the networks will be implemented in coming years. Hence, a later look may

clarify the picture of networks’ contributions toward the social marketing and delivery of

nutrition education. 

This report seeks to describe the process by which networks developed. Wherever possible, the

analysis sought to corroborate findings through several sources and a review of written

documents. Nonetheless, the information in this report ultimately was based on the perceptions

of the individuals interviewed. Memories fade, perceptions by definition are limited, and

participants often have their own idiosyncratic institutional and personal viewpoints. Thus, the

interpretations of external evaluators inevitably will be incomplete. 

Finally, the study sought to identify best practices that account for the relationship between

activities and outcomes. In doing this, the report sought to use examples of best practices that

occurred in several networks and in a variety of circumstances. However, correlation does not
Health Systems Research, Inc. Chapter II Page 13 

necessarily imply causality. Hence, the conclusions the report draws regarding best practices

may be viewed more appropriately as useful in generating hypotheses that deserve to be further

investigated in more rigorous studies. 
Health Systems Research, Inc. Chapter III Page 14 

CHAPTER III

Network Development

The cooperative agreements enabled the development of Statewide nutrition education

networks. The typical network had more than 20 partners, of which more than half

were from the private sector. The networks faced challenges in engaging large

numbers of for-profit private partners, such as food retailers, though when they did

participate, the for-profit partners made important contributions to network activities. 

Network members were actively involved in the development of network activities, they

utilized a consensus model of decision making, and they structured themselves into

committees which typically met monthly between quarterly meetings of the entire

network.

This chapter describes network development in terms of (1) network participation, (2) network

recruitment and expansion, (3) organization structure and governance, and (4) contributors to

effective collaboration.

A. Network Participation

Networks had an average of 21 members, roughly half of which were members of the private

sector. The number of State-level partners ranged from less than ten to more than 60. Table

III-1 lists the organizations most commonly represented in the State networks and shows how

many States had representation in their network from those organizations. About half of

network members were governmental organizations. In addition to the State Food Stamp

Agency that was involved with all networks, the networks most frequently included State

Departments of Health (91 percent of networks) and the Cooperative Extension Service (82

percent of networks). 
Health Systems Research, Inc. Chapter III Page 15 

Table III-1.

Number of State Networks with Active Representation from Various Types of

Organizations

Type of Organization

Networks (n = 22)

Number Percent

Public Sector Organizations:

State Food Stamp Agency 22 100%

State Department of Health 20 91%

Cooperative Extension Service 18 82%

Department of Education 15 68%

University or Medical School Department (other 15 68%

than extension)

WIC 15 68%

Aging Services/Departments on Aging 9 41%

Other Public Sector Organizations: (e.g., State 7 32%

Dept. of Agriculture, Dept. of Labor, Head Start)

Private Sector Organizations:

Commodity Boards and Councils* 13 59%

Professional and Voluntary Association (e.g., 12 55%

American Cancer Society, American Diabetes

Association)

Food Banks 10 45%

Other Non-profit Organizations (e.g., churches) 9 41%

For-profit Organizations (e.g., supermarkets and 9 41%

food retailers)

*In some States, Agricultural Commodity Boards have been legislatively chartered in such a way that they could

be viewed as public organizations.

About two-thirds of networks included the WIC program, the State Departments of Education,

and a University or Medical School Department (other than extension). Other public

organizations included the Area Agencies on Aging, State Departments of Agriculture, State

Departments of Labor, public schools, Head Start programs, and Indian Tribal Councils. 
In some States, agricultural commodity boards were legislatively established in a way that might 2

allow them to be viewed as public sector organizations.

Health Systems Research, Inc. Chapter III Page 16 

Roughly half of network members were private, non-profit organizations. These included food

banks, voluntary organizations (such as the American Cancer Society, or the American Diabetes

Association), and agricultural commodity councils such as the Dairy Council. Other private, 2

non-profit organizations included public schools, health plans and hospitals, and churches or

ministries. Nearly all networks included private sector partners, and more than half of networks

had 10 or more non-profit organizations participating in the network. 

Forty percent of Statewide networks included for-profit organizations, such as supermarket

chains, but these were usually limited to a relatively small number of members. The perception

of many Network Coordinators is that food retailers were willing to support the nutrition

education networks, but they preferred to do so in concrete ways (e.g., in-kind support for

social marketing), rather than through participation of staff in network meetings. When they

could be involved, these for-profit organizations made important contributions to nutrition

education efforts, particularly in support of the development and distribution of nutrition

education materials (e.g., CA, GA, MI). Hence, efforts to involve for-profit organizations will

continue to receive attention on the part of networks.

In general, organizations represented in the networks were active participants who maintained

their involvement during the course of the study. In only a couple of States did the major

contributors to the network’s activities consist entirely of governmental agencies. In most

cases, there was a mixture of involvement from government agencies, local community

agencies, private non-profit organizations, and other nutrition-oriented members. This blend

indicates that States saw the value of having a variety of organizations represented by the

overall membership.

While some networks intentionally decided to start small before expanding, this study found that

the networks that started more ambitiously tended to be more successful. For example, there

were three networks with less than 10 partners, and none of them received approval for an

NEP. In contrast, nearly a quarter of networks had between 30 and 60 partners, and all of
Health Systems Research, Inc. Chapter III Page 17 

these larger networks developed NEPs that were approved. Similarly, having a large number of

cooperating members in the network appeared to contribute to success in identifying matching

funds to support the continued operation of the network activities. In almost all cases, the

States that raised over $1 million using NEP and other funds were those with the higher number

of active members. Only one State had a comparatively low number of members (n = 12) but a

high amount of funding ($3 million). It may be that the more members who are actively

involved in the network, the more opportunities there are to gain funding through a variety of

sources. In other words, the more people who are involved in the network, the more likely it is

that new and innovative sources of funding will be identified and secured. It could also be the

case that Network Coordinators who are well-connected to other nutrition-interested

professionals in the State, who are highly enthusiastic, and who have experience with marketing

and coalition-building are better equipped to achieve high levels of membership. The same

qualities of those Coordinators could also account for the success in securing high levels of

funding.

With such a varied group of members represented in the networks, it is not surprising that the

contributions of network members is varied as well. Two contributions were relatively constant

across all members: the sharing of ideas on network issues, and general participation in

activities and meetings. Other contributions included:

# membership on subcommittees;

# holding of leadership positions on the network;

# in-kind donations for activities;

# dissemination of information to other organizations and professionals in the

State;

# expertise for marketing and fund-raising;

# development of social marketing materials;

# outreach to the target population;

# assistance with formative research such as focus groups or surveys; and
Health Systems Research, Inc. Chapter III Page 18 

# language translation of nutrition education or social marketing materials.

B. Network Recruitment and Expansion

1. Prior Collaboration Among Network Members

All States experienced some level of collaboration among network members surrounding

nutrition or food issues prior to the Nutrition Education Networks. Many of these were formal

collaborative relationships based on interagency agreements. In general, network members who

had worked together in the past continued to build on those prior relationships while welcoming

new partners. Other collaborations were informal working relationships with individuals who

knew each other through professional interests and activities. For example, in New Jersey, the

Network Coordinator had extensive prior experience collaborating with other organizations on

issues relevant to vulnerable populations. Some of those other agencies included municipalities,

federations, and foundations. Because of this connection, the Coordinator was aware of the

various “agendas” of network partners from the outset, enabling a tight collaboration through

understanding. Another State’s Extension and Department of Public Health staff had

collaborated together for many years prior to the network formation. They had collaborated on

in-service training, training sessions, curriculum evaluations, and WIC initiatives. Their longstanding history of collaboration was cited by a key network member as one reason why the two

departments were so capable of working together effectively on the network project.

Although the mission of the Nutrition Education Network was somewhat different from the

missions of the other coalitions or groups, many of the same agencies and individuals were

represented in both. In some cases, a formal, active, and well-represented nutrition-related

coalition had been in place from which the network emerged. For instance, in Maine and

California, the network was able to build on the relationships developed by a prior 5-A-Day

coalition. In other States, prior collaboration of network members on other nutrition initiatives

helped facilitate the development of network partnerships. Members in the Nevada network, for

example, had earlier participated in a task force to address hunger issues in their State. In

Colorado, the University of Colorado and Colorado State University had formed a coalition in

1988 to foster collaboration in teaching, research, and outreach focused on nutrition. In
Health Systems Research, Inc. Chapter III Page 19 

addition, the Denver Metro area had a Food Assistance and Nutrition Education Interagency

Committee that had been in operation for years prior to the Nutrition Education Network. 

Some of the members of this group included WIC, Food Stamps, EFNEP, FSNEP, Dairy

Council, School Lunch Program, food banks, Head Start, and the Hunger and Food Policy

Coalition. Many of the current network members knew each other through their work on this

prior committee and were accustomed to convening for meetings, making decisions together,

and building strategies for solving problems surrounding the topic of nutrition. 

2. Network Expansion

Regardless of whether there were many collaborative relationships among network members in

the State prior to the network and whether those relationships were formal or informal, the

networks were able to expand in two important ways. The first was by incorporating new and

more diverse partners into the already existing set of people who may have worked together in

the past. All networks brought in new partners, whether it was through personal contacts or

formal marketing. Secondly, more formalized relationships among members and much-needed

coordination developed among nutrition educators, food retailers, and State and local agencies. 

An important benefit of having a wide and diverse range of network members is the more

extensive or expanded recruitment of organizations to participate in network activities. 

Network members can actively refer people in their own communities to take part in the

network nutrition education activities. This study found that this happened quite often among

the 22 States. Referrals also resulted from less direct means, such as when network members

promoted network activities. An FSNEP Coordinator in one State, for example, invited the

Network Coordinator to FSNEP agent meetings periodically to talk about network activities. 

These discussions provided information to a wider body of people who had direct and

consistent contact with the target population. Whether one-on-one or indirectly, it is certain

that network members helped spread the word about the network, thereby raising the number of

people receiving the message or education.

The network became a vehicle through which States could work toward a common, well-
Health Systems Research, Inc. Chapter III Page 20 

defined, coordinated goal. Even though it took some States longer to develop and coordinate

their networks, all benefitted from the formalized structure that it afforded.

3. Organizational Affiliation

The following section outlines the ways organizations and agencies worked with and under the

network structure. The initial discussion begins with the primary grantee (the organization

charged to head the Cooperative Agreement by the State Food Stamp Program), then moves to

issues of how new networks fit into a State structure with an existing FSNEP.

Organizational Affiliation of the Primary Grantee. Thirteen of the primary grantees who

served as the organizational home for the cooperative agreements were State Cooperative

Extension agencies; eight were affiliated with State Health Departments; and one was a State

Department of Education. The location of an organization as a primary grantee in a

Cooperative Extension agency or as a public health organization turned out not to be associated

with success or failure of the networks. Both types of organizations appeared to have

respective strengths and weaknesses. The public health organizations often had limited

experience with USDA reimbursement procedures and therefore needed to learn how to

develop budgets under this type of matching program. Conversely, public health organizations

often contributed experience with social marketing activities that proved to be an asset to the

network. Cooperative Extension programs often had experience with USDA reimbursement

procedures that made budget development easier. In addition, Cooperative Extension brought

experience working with Food Stamp participants through the EFNEP program as well as

experience operating a FSNEP. However, in some of the States in which the Extension Service

had an existing FSNEP and was not the primary grantee, there seemed to be less incentive to

promote further expansion through the network. 

It turned out, however, that the organization affiliation of the primary grantee was not

significantly associated with the success of networks in obtaining funding for a Nutrition

Education Plan as there were both successes and failures among Cooperative Extension and

Public Health Programs.
Health Systems Research, Inc. Chapter III Page 21 

Rather, it appeared that the determining factor for success of the networks was the manner in

which network members built on their respective strengths and faced the challenges of

collaboration. In States in which the primary grantee for the cooperative agreement was

affiliated with a health department, success was associated with the attention of the network to

financial management issues. For example, 80 percent of networks which succeeded in

receiving approval for a NEP had developed procedure manuals to help partners address

matching issues and had staff dedicated to handling accounting issues associated with

reimbursement. In contrast, of the public health agencies which have failed to receive an

approved NEP none had devoted this level of attention to financial management issues. 

Relationship with Existing FSNEPs. About three-fourths of the cooperative agreements

were awarded to States that had already funded a FSNEP through the Cooperative Extension

Service. There was considerable variability in how this operated (as summarized in Table III-2).

# In one State, Colorado, the Cooperative Agreement was administered by the

Cooperative Extension Service and the network developed a single Statewide

plan which sought to coordinate both the extension component and the network

components under the leadership of the Statewide network.

# In nine States, the Cooperative Agreement was awarded to the Cooperative

Extension Service and the network was operated as a separate component of the

FSNEP.

# In one State, Alabama, the Cooperative Agreement was awarded to the

Cooperative Extension Service and the network decided to receive continuing

funding as part of the FSNEP previously awarded to the Cooperative Extension

Service.

# In seven States, the Cooperative Agreement was awarded jointly to an agency

associated with the Department of Health or Department of Education and the

Cooperative Extension Program. In these cases, the Cooperative Extension

Service was operating their own FSNEP but also participated as a member of the

Statewide nutrition education network.

# In four cases, Cooperative Agreements were awarded to States that did not have

existing FSNEPs (three of these awards were to Cooperative Extension Services

and one was to a public health program).
Health Systems Research, Inc. Chapter III Page 22 

Table III-2.

Relationship Between Statewide Network and Prior FSNEP 

Coordination with Prior FSNEP Primary Grantee Total

Public Health or Cooperative

Education Extension

Prior FSNEP:

 Network coordinates all FSNEP components 1 1

 Network is [or plans to be] one component of FSNEP 7 9 16

 Network is integrated into the Extension FSNEP 1 1

No existing FSNEP 2 2 4

Total 9 13 22

Again, it turned out, however, that prior FSNEP funding was not itself a significant predictor of

success or failure in receiving an approved network NEP. Rather, in States that already had an

FSNEP, the factor significantly associated with success in receiving an approved NEP was the

extent of collaboration among network partners, as evidenced by the development of network

activities that involved a collaboration across different types of organizations. In States who

had prior FSNEP funding, 92 percent who received an approved network-related NEP (and

none who did not) also developed network-related collaboration that involved multiple State

partners. While this is not necessarily a causal sequence, it suggests that the willingness of

network members to collaborate across common social marketing activities is an important

contributor to the success of networks.

C. Organizational Structure and Governance

3. Overall Network Governance

The network committees typically met monthly or every other month. A common pattern was

to have monthly committee meetings (often via conference calls) and to convene as an entire

network several times a year. 
Health Systems Research, Inc. Chapter III Page 23 

In general, the networks were dependent on the Network Coordinator or the Project Director to

provide overall direction and advice. However, most networks did try to establish a decisionmaking structure to guide the overall activities of the network. The network organizational and

decision-making structures fell into three general categories: a steering committee with

subcommittees; staff-directed governance and support; and a "committee of the whole."

# Steering Committee with Subcommittees. Many of the networks developed

a steering committee to provide overall direction to the network and to propose

network activities. Most of the steering committees were composed of the

Project Director, the Network Coordinator, and chairs of various

subcommittees. In some cases, the founding members of the network served as

the steering committee. The steering committees were supported by smaller

subcommittees, usually built around a specific strategic function, such as

message development or fund raising. The steering committees met more

frequently than subcommittees on the whole and were often responsible for

reviewing subcommittee reports, developing the agendas for the network-wide

meetings, and presenting activities for final decisions. The steering committee

model was the most common form of governance. Fourteen of the networks had

steering committees.

# Staff-Directed Governance and Support. In some cases, the Network

Coordinator, Project Director, and other paid staff ran day-to-day network

activities and made many of the decisions necessary to implement network

activities. The network staff would then present issues to the network

membership as a whole for discussion and approval. Subcommittees were only

formed when needed for short term assignments. The New Jersey and

Pennsylvania networks are examples of this governance structure. A total of six

networks utilized this staff-directed form of governance.

# Committee of the Whole. In a few cases, the network was small enough for

the members to meet as a single governing committee and provide direction to

paid staff. In theses cases, core members of the network would meet on a

regular basis to make decisions and provide assignments to staff or volunteers. 

Networks using this model often formed “workgroups” composed of volunteers

to undertake short term assignments. In addition, States that used this model

often called upon consultants to implement network activities, such as needs

assessment. Two networks used this method of governance.

Regardless of their overall style of governance, most of the networks depended on the

leadership skills of the Network Coordinator or the Project Director to maintain their direction

and focus. These leadership skills were particularly important in those States governed by a
Health Systems Research, Inc. Chapter III Page 24 

steering committee composed of representatives from different agencies and interest groups. 

For example, it was usually the role of the Project Director to communicate network decisions

to the leadership of the sponsoring agency. In some cases, conflicts arose between the

sponsoring agency leadership and the decisions made by the network, and the Project Director

would act as a mediator to resolve the issues. The degree to which the Project Director could

act as a bridge between the two often made the difference in whether the network was able to

accomplish its objectives. Conflicts between the network governance structure and the upper

management of the sponsoring agency lead to one network becoming inactive and two others

searching for new sponsoring agencies.

2. Committee Structures

In addition to a structure for network governance, many of the networks formally structured

their committees to help with development of the network activities. In some States, the

committee structures were very formal and included long-term activities and responsibilities. In

other States, the committee structures were less formal and often time limited. The committee

structures usually fell into two categories: function committees and topic committees.

# Function Committees. These committees were organized to carry out a

necessary function of the network. They usually had responsibility for fund

raising, social marketing campaign development, needs assessment and planning,

or other ongoing activities. 

# Topic Committees. These committees were usually charged with developing

recommendations for nutrition topics for the social marketing campaign or

developing activities directed at target populations. These committees were

often time-limited. 

In most cases the networks used a combination of the two types of committees described above. 

For example, the Maine network has developed function committees, including a “Health

Promotion” committee and a Funding committee, to conduct ongoing activities. They have also

developed several topic committees to promote network activities. One such topic committee is

the “Agriculture Committee,” developed to promote a specific program designed to increase use

of farmer's markets by food stamp recipients. In addition, those networks using a staff-directed
Health Systems Research, Inc. Chapter III Page 25 

or "committee of the whole" approach to network structure were more likely to use time-limited

“workgroups” than formal committees.

Of those networks with committee structures, 41 percent had four committees. Another 18

percent had five or more committees, 14 percent had three committees, and 27 percent operated

without a permanent committee structure. Where committees existed, they typically met

monthly or every other month. A common pattern was to have monthly committee meetings

(often via conference calls), and then to convene as a network several times a year. While no

two networks have developed the exact same committee structure or function, there were a

number of common elements among some of the committees (as shown in Table III-3).

Table III-3.

Typical Committee Structure of Networks

Number and Type of Committees Networks (n = 22)

Number Percent

Number of Committees:

5 or more committees 4 18%

4 committees 9 41%

3 committees 3 14%

No permanent committee structure 6 27%

Type of Committee:

Steering committee 13 59%

Social marketing/Media committee 15 68%

Resource development committee 15 68%

Needs assessment/Research and evaluation committee 9 41%

School programs committee 4 18%

Nutrition Education Plan committee 13 59%

Specific target audience committees: i.e., aging, newsletter, 13 59%

partnership, food security, 5-A-Day

Network development and coordination committees: i.e., 12 55%

partnership, academy, planning, vision, new voices
Health Systems Research, Inc. Chapter III Page 26 

Below are examples of the types of committees formed by the network and their general

functions.

# Funding and Resource Development Committees. Responsibility for

developing funds for Federal match usually fell to a resource or funding

committee. These committees often were responsible for identifying potential

grants, government in-kind contributions, and contacting local nutrition

programs regarding their participation in network activities. In some cases, the

resource committees also were responsible for identifying volunteers for working

on network activities. Thirteen networks developed funding or resource

development committees.

# Needs Assessment Committees. These committees were responsible for

examining secondary data related to the needs of food stamp clients and

developing or conducting primary research to identify needs of special

populations. The needs assessment committees usually were responsible for

developing focus groups, conducting key informant interviews, and collecting

community-based data. Twelve networks used needs assessment committees. 

# Social Marketing Committees. Social marketing committees generally

worked to develop a social marketing strategy for the network. They were often

charged with converting the needs assessment information into a strategic plan

for developing messages, identifying methods of delivering messages, making

media contacts, and developing materials. Twelve networks used social

marketing committees.

# Message Development Committees. Message development committees

were responsible for identifying the topic areas for the nutrition education

messages, and then developing the content for the social marketing campaign. 

Eleven networks used message development committees.

# Target Population Committees. Target population committees were usually

used to identify the special needs of different target populations. Some of the

committees focused on non-English speaking populations, while others focused

on mothers, children, or the elderly. Twelve networks used target population

committees.

# Topic Committees. Eight networks developed committees around nutrition

topics. These committees usually functioned as combination social

marketing/message development/target population committees. Some of the

topics the committees addressed included 5-A-Day promotions for low-income

audiences, eat more fruits and vegetables, eat more low-fat foods, and nutrition

topics for school-aged children.
Health Systems Research, Inc. Chapter III Page 27 

Three networks did not use any committee structure at all. In two of the three States, special

workgroups were established to work on time-limited topics but were disbanded once their job

was complete. In the third State, local networks were established and much of the planning and

implementation work was shifted to these programs.

Organizational theory (Francisco, et al., 1993, Goodman, et al., 1993) suggests that the

operation of active committee structures is a predictor of the strength of networks. The results

of this current study provide support for this prediction; 93 percent of networks that succeeded

in receiving an approved NEP had four or more active committees on their network compared

to only 44 percent of the networks who failed to receive funding through an approved NEP

(Chi-square = 6.5, p < 0.01).

D. Contributors to Effective Collaboration

In general, network members reported that network partners worked well together. By learning

from those States whose networks had worked effectively (in part due to the collaborative

relationships among members), this study attempted to identify some of the more salient

contributing factors. The following are factors reported by network members as contributing to

the smooth-running collaborations of networks, and Table III-4 summarizes the benefits

associated with these factors.

# One factor leading to an effective network is the promise of reciprocal benefits

to all parties. If the network can offer the members something in return for their

time, effort, and money, members are more likely to join and remain members. 

The return may be low and difficult to define from an outsider’s point of view,

but the most effective networks had partners who reaped some benefit for their

contributions, whether they be personal or professional benefits. For example, in

Oklahoma, the Social Marketing Campaign message will target families with

small children, though one of the most active members of the network represents

the Aging population. When asked why she put so much time and energy into

the network, she commented that she knew that if the efforts to provide nutrition

education to this initial population were successful, soon the elderly would be

targeted by the network. She also felt it was important to be a key member of

the network so that she could be a constant witness to other members of the

needs of the elderly in the State. 
Health Systems Research, Inc. Chapter III Page 28 

Table III-4.

Benefits Attributed to Certain Network Characteristics

Characteristic Benefit

Emphasis on reciprocal benefits Ability to minimize turf concerns

Active Committees High member contributions and involvement

Members more likely to effectively communicate network mission and

activities to non-network individuals

Positive prior collaborations Reduced tension, fewer turf problems

More effective decision making

Higher likelihood of recruiting more members through networking

Frequent self-assessment and Perception of responsiveness among members

evaluations

Understanding of what aspects need to be changed

Feedback on what is working well

Recognition of accomplishments Renewed motivation for continued efforts

Modeling of positive behavior

# Committee structures offered in a way for individual members to make visible

contributions to the network, and breaking work into units that could be handled

by committees help to further progress toward each goal. Another factor that

contributes to an effective network is having active committees.

# Positive experience with prior collaborations among network members was also

cited as a factor for successful networks. In Maine, for example, most of the

members had worked collaboratively prior to the Maine Nutrition Education

Network’s inception. Most of them knew each other from professional

meetings, prior efforts, meetings of the Maine Nutrition Council, and the 5-ADay Coalition. These prior collegial relationships certainly worked in the

network’s favor in terms of reducing tension, preventing turf battles, and

increasing the effectiveness of decision making.

# One way to foster communication among network members and those who

manage or administer the network is periodically to have formal conversations to

ensure all network members are having their voices heard. The network staff

(such as the Project Director, the Network Coordinator, or the Steering

Committee members) could set up brief meetings annually to discuss with other

members how the network can better serve each member’s own target

population, how the network can work more effectively with the member’s
Health Systems Research, Inc. Chapter III Page 29 

agency, and how the member can be used most effectively to be an integral part

of the network. Not only does that approach generate important and innovative

ideas, it also improves morale, shows members that the network staff take their

contributions seriously, and allows for a formal venue for grievances and

feedback.

# Building in regularly scheduled self-assessment (annually, semiannually) of all

network members was described as one way to ensure members’ concerns were

heard and addressed. By proactively evaluating the satisfaction of the members,

networks were more likely to retain members and promote stronger and more

collegial relationships. A survey to evaluate the satisfaction of the members

allows the network to identify views, opinions, and suggestions, while findings

can be used to strengthen collaborations, activities, and meetings.

# Reminders to members about frequent dissemination of the network's message

was perceived as important. For instance, the network in New Jersey showed

how important it is to formalize networking among network members and the

non-members with whom they are in contact. In order to facilitate “intentional

trickle-down” of the network mission and message to people outside of the

network, each member was asked during meetings to report on how they

disseminated the message to others since the last meeting. This helped ensure

members would discuss network activities with others across agencies and

throughout the State.

# Finally, network members were clear about the importance of recognition of the

contributions and accomplishments of network members. This included awards,

newsletter articles featuring a particular partner each month, and seeking

opportunities to say “thank you.”
Health Systems Research, Inc. Chapter IV Page 30 

CHAPTER IV

Planning and Needs Assessment

All the Statewide nutrition education networks engaged in a needs

assessment and planning process to inform the development of nutrition

education initiatives to reach particular target audiences. These planning

efforts involved a combination of review of secondary data (such as State

survey data on dietary practices), and focus groups with members of the

target audience. This information was used to select the target audience,

identify the nutrition behavior to be addressed, develop messages, and

decide on the channels to deliver information.

A key objective of the cooperative agreements was to “expand the reach and approach of

current State nutrition education efforts by incorporating the use of social marketing principles

and tools in planning activities.” A basic tenant of social marketing approaches is their use of a

variety of needs assessment tools to understand the needs and interests of the target audience. 

The planning term “needs assessment” is used commonly in a public health context to refer to a

set of activities associated with planning and implementing systems of care. The focus is on

identifying the need for specific services in order to develop a system of services that is

responsive to a population’s needs and can help bring about positive changes in the population’s

behavior. Analysis of data gathered through needs assessments were used to chose target

audience, target behavior, message, mode, and delivery. This section describes the needs

assessment and planning process undertaken by State nutrition education networks.
Health Systems Research, Inc. Chapter IV Page 31 

A. Conducting the Needs Assessment

All the nutrition education networks conducted some form of needs assessment. Two-thirds of

networks designated a specific committee of the network to oversee or conduct the needs

assessment while the remaining networks conducted the needs assessment using a committeeof-the-whole. About half the networks conducted the needs assessments using network

members and volunteers and about half the networks contracted for assistance in conducting the

needs assessments. The length of the planning and needs assessment process ranged from 6 to

18 months. Resources and member’s opinions and preferences influenced whether the network

chose to hire a contractor or to conduct the needs assessment themselves. About half of the

networks conducted the social marketing activities themselves. For instance:

# Kansas nutrition network members conducted focus groups and gathered

information at community organization functions, such as A Head Start

open house, as part of a needs assessment.

# Network members of the Minnesota nutrition network used the help of a team of

graduate students to conduct a neighborhood needs assessment.

About half of networks contracted for help for all or part of their needs assessment activities.

# The Missouri nutrition network hired a consultant to develop the social

marketing campaign. The contractor conducted focus groups and interviews

with the target population and with Health, Nutrition and Social Service

professionals. Results were presented in a report. The contractor recommended

slogans, message concepts, core printed materials, print and broadcast media,

community events, and professional activities. The Nutrition Education

Campaign and Evaluation Committee of the network reviewed the consultant’s

recommendations and proposed target audiences, needs of the target audience,

and ways to motivate the target audience. 

# The Georgia nutrition network hired a marketing contractor, to plan a campaign

based on the tenets of social marketing, particularly using members of the target

audience to guide the development of the campaign and provide feedback on all

campaign materials. The network devoted 18 months to conducting formative

research and evaluation of draft materials with members of the target audience. 

In general, networks that were able to draw on contract specialists were able to conduct a more
Health Systems Research, Inc. Chapter IV Page 32 

thorough needs assessment and complete activities more quickly, than networks which relied

solely on their members for all these activities.

Plans for extensive needs assessments were sometimes revised to be less ambitious. For

instance, one State network had originally planned to conduct six focus groups in each of the

counties in the State. The network held a two-day training session in focus group facilitation,

which 24 people attended, piloted focus groups, and conducted focus groups in three counties. 

After speaking with representatives from other States at the All-Cooperators Meeting in July

1998, the network decided to redirect their focus group research. The population of food

stamp recipients in the State is highly concentrated in a small number of urban areas in the State

and recipients in outlying areas have difficulty coming together as a group for nutrition

education. Instead of focus groups throughout the State, the network decided to conduct

interviews that oversample in urban areas with high Food Stamp populations.

Other States ran into some difficulty with completing their needs assessment. For example, the

social marketing committee in one nutrition network was chaired by the network member with

the most expertise in media. Unfortunately this member’s time commitments changed and she

was unable to facilitate this project. Fortunately, as part of the network development process,

the Network Coordinator discovered another initiative having similar social marketing interests

as the nutrition network and who were also struggling with inadequate resources. The groups

agreed to combine resources, both personnel and financial, in order to develop and conduct a

social marketing campaign. 

Some States use their technical assistance hours to assist with the needs assessment. For

example California requested the technical assistance provider to conduct key informant

interviews with network partners. This request was made because California network officials

were concerned that an objective party would be more likely to receive honest and frank

information than would network staff conducting the same interviews. Oklahoma officials

collected focus group data, and requested the technical assistance provider to analyze the data

and prepare a report with recommendations. 
Health Systems Research, Inc. Chapter IV Page 33 

Whether or not the networks drew on specialized consultant or contract expertise, it appeared

that the involvement of network members in the design and interpretation of their needs

assessment activities was critical in determining that the needs assessment information was

utilized in the development of nutrition education initiatives.

B. Data Sources

Needs assessment is a data driven process. Two types of data are used in the needs assessment

process: primary data, which are collected for a particular needs assessment initiative; and

secondary data, which already exist. State nutrition education networks collected secondary

data, primary data, or a combination of both in conducting needs assessments. 

It is often advantageous to use secondary data when conducting, or at least initially conducting,

a needs assessment. Collecting secondary data, most often, is substantially less time consuming

and consumes less resources (personnel and financial) than collecting primary data. However,

secondary data may not provide the specificity needed (e.g., data may be available on food

stamp recipients in New Jersey, but it may not be broken down by county). Primary data

collection can provide researchers with specific data to answer particular research questions. 

Often primary data collection can provide detailed information on a population not available

through secondary data. Ideally, if resources are available, a secondary data collection can be

conducted to gather general data, and then a primary data collection can provide data to fill the

gaps identified during the review of secondary data. 

For their needs assessment, many of the State networks collected secondary data (see Table IV1). States reviewed the literature and reviewed county-level and State-level health data.
Health Systems Research, Inc. Chapter IV Page 34 

Table IV-1. 

Types of Data Used to Conduct Needs Assessment

Type of Data Networks mentioning (n) States

Primary Data Collection 

- focus groups 16 AL, CA, CO, IA, ME, MI, MN,

- interviews 4 ME, MO, NJ, PA

- survey of target population 2 ME, WI

- survey of service providers 2 GA, SD

- discussion among network members/survey 2 CA, MI

 of network members

- neighborhood needs assessment 1 MN

MO, NV, NJ, OK, SD, VA, VT,

WA, WI

Secondary Data Analysis

Literature review, epidemiologic information, 11 AL, CA, CO, GA, ME, NC,

federal consumption data, Food Stamp NV, PA, SD, VT, WI

statistics, Department of Education statistics,

national, State, and local data, CDC’s

Behavior Risk Factor Surveillance System

(BRFSS)

Primary and Secondary Data 10 AL, CA, CO, GA, ME, NV, PA,

SD, VT, WI

# The Georgia Nutrition Education Network did a comprehensive literature

review and reviewed existing data from the Centers for Disease Control’s

Behavior Risk Factor Surveillance System (BRFSS). 

# The Colorado network conducted in-depth analysis of county data,

epidemiological information, and federal consumption data.

# In North Carolina, the nutrition network reviewed the extensive needs

assessment conducted by the Cardiovascular Disease Task Force. The

information was taken from a biannual Carolina Poll, Spring of 1998 that

surveyed a random sample of 700 adult North Carolinians.

# Networks in Arizona utilized State survey data on dietary practices by

different population groups to identify target audiences for nutrition

education efforts—namely, low-income Hispanic women who consumed

relatively low amounts of fruits and vegetables.
Health Systems Research, Inc. Chapter IV Page 35 

State networks used a variety of primary data collection methods. Focus groups were by far the

most common method mentioned by networks. Other primary data collection methods

employed include interviews and surveys.

# A needs assessment for the Virginia nutrition network included 16 focus groups

with Food Stamp Program families in different regions of the State.

# For the Michigan nutrition network, five focus groups were conducted with 45

low-income residents of Kent County, the site of the pilot campaign. The

questions explored current sources of nutrition information, preferences for new

information, and reactions to campaign concepts.

# A committee of the Nevada nutrition network wrote guidelines for focus groups

and professional facilitators were contracted to lead the focus groups. Seven

focus groups, broken out by gender, were conducted with middle school

students.

# The Network Coordinator for the New Jersey nutrition network is conducting

interviews face to face or over the telephone with food stamp recipients in the

four counties where the social marketing campaign will be piloted. The goal of

the interviews is to address what will make a person open up their “junk” mail.

# Interviews were conducted with representatives from each member of the

Pennsylvania nutrition network organization. Information collected during the

interviews included the mission and goals of the organization, areas not being

addressed, and what would be needed to fill the identified gaps. The network

also utilized secondary data: demographic information and statistics from

Pennsylvania State University, the Office of Rural Health, the Department of

Aging, and Second Harvest; and primary data: interviews. 

# A survey on fruit and vegetable consumption and focus groups regarding

nutrition education preferences were conducted among low-income mothers for

the Wisconsin nutrition network. In addition, the network reviewed secondary

data using local and national sources to compile an extensive summary of the

nutritional status and nutrition education needs of low-income populations. The

Wisconsin network collected primary data from low-income mothers via a

survey on fruit and vegetable consumption and focus groups regarding nutrition

education preferences.

# For the Minnesota nutrition network, a team of graduate students did a

neighborhood needs assessment of the organizations (institutions and businesses)

that serve the target population within or close to the neighborhood boundaries. 

Interviews were conducted with key informants and snowball sampling was used

to choose other interviewees. The graduate students described the network,
Health Systems Research, Inc. Chapter IV Page 36 

sought the key informants advice on how to approach neighborhood residents

and reassured interviewees of the intent of the social marketing campaign. Ten

State nutrition networks mentioned that they conducted both primary and

secondary data collections for their needs assessments. The South Dakota

network collected both primary and secondary data. In their needs assessment,

the South Dakota network reviewed data from the survey, focus groups, and

State demographic studies of the population. The network developed and

distributed Statewide a survey to organizations serving the food stamp

population. South Dakota also conducted focus groups with male and female

adults who have children under 18 years old.

# The California network analyzed biennial State survey data on dietary practices

to determine the target audiences for campaign activities. They then conducted

20 focus groups with Food Stamp Program families in different regions of the

State to make decisions about the way to convey messages. 

In general, networks which made use of both secondary and primary data tended to produce

more detailed assessment reports, and this combination had the advantage of grounding the indepth findings from focus group discussions within the broader context of dietary patterns

within a State. The analysis of secondary data could also help shape and make better use of

focus group data (which was a more labor intensive process).

C. Uses Made of the Needs Assessments

The needs assessments were used in a number of ways: (1) to select the target audience, and

target behavior, for nutrition education efforts, (2) to learn more about the target audience’s

perceptions, knowledge, and barriers to change, (3) to develop a campaign logo, (4) to develop

and/or test messages, and (5) to select the channels of communication (see Table IV-2). 
Health Systems Research, Inc. Chapter IV Page 37 

Table IV-2. 

Uses Made of Needs Assessments 

Purpose Networks Mentioning States

Select target audience 7 CO, KS, MO, NV, PA, SD, WI

Identify health problem or needs of target audience/ 8 GA, MI, MN, MO, NC, NV,

target audience’s readiness to change health VT, WI

behaviors/ identify barriers to nutritious eating

Develop theme and logo 8 CA, MI, MN, MO, NV, OK,

SD, VA

Develop messages 5 GA, ME, MO, VT, WA

Determine mode and medium to reach audiences 6 GA, IA. MI, MO NJ, WA

Other

Target outreach to other potential member PA

organizations and agencies that may be

interested in the Network’s activities

Post results on State NEP web site and WI

summary sheet of data produced

A number of networks mentioned using the results of the needs assessment to select a target

audience. 

# The Colorado nutrition network initially planned on targeting either families with

young children or the elderly, but after reviewing focus group and other needs

assessment data, the steering committee of the network chose to target low

income families with children between the ages of three and five. Their needs

assessment demonstrated that many organizations in Colorado target the elderly,

but there is a lack of programs in Colorado for families. 

# The Kansas nutrition network applied the results of needs assessment activities,

including focus groups and county-level secondary data, to select the target

population: preschool children and their caretakers.

# The South Dakota nutrition network applied the results of surveys, focus groups,

and State demographic studies to select the target population: parents with

children under 18 years old and teen parents. 

# Based on a needs assessment, the Wisconsin network will focus on increased

consumption of fruits at breakfast.
Health Systems Research, Inc. Chapter IV Page 38 

# A committee of the Nevada nutrition network reviewed national data and

selected girls ages eleven through fourteen as the target audience. Girls were

chosen because a high proportion of girls have low consumption of calcium. The

network also mentioned that they do not have the resources to target a larger

audience, however they anticipate that boys will follow the actions of girls.

The most common use made of the needs assessment was learning about an audience’s interest

in and perceptions about nutrition and nutrition education. This includes identifying the target

audience’s readiness to change health behaviors and identifying barriers to changing behaviors.

# In the first phase of planning by the Georgia nutrition network, information was

obtained from 3 sources: original data was collected from Georgia’s public

health nutritionists; a comprehensive literature review was conducted; and

existing data from CDC’s Behavior Risk Factor Surveillance System (BRFSS)

was reviewed. This data was analyzed to provide background information and

evidence for identifying specific health problems related to nutrition and physical

activity.

# The focus groups conducted for the Michigan nutrition networks’s needs

assessment revealed that the respondents had a good general understanding of

healthy eating habits and the health benefits associated with a healthy diet. 

However, respondents identified significant barriers to food consumption,

including food costs, difficulties with methods of food preparation, lack of

preparation time, and family preferences. The campaign was altered so that

these barriers were addressed through tangible forms of assistance, such as

recipes, meal planners, coupons, in-store demonstrations, and neighborhood

cooking classes.

# After conducting focus groups, the Missouri nutrition network chose three

action steps/objectives which they believe are behaviors people would be willing

to change. The action steps developed are increasing intake of fruits and

vegetables; teaching low-fat methods of meat preparation; and increasing intake

of grains and beans.

Eight State nutrition networks mentioned that the results of a needs assessment were considered

when developing a theme and logo for a social marketing campaign.

# Based on findings from focus groups, the Michigan Nutrition Network adapted

their logo, nutrition information, and delivery of their campaign. The slogan of

the logo was favorably evaluated and participants expressed a strong preference

for a smiling mouth on the logo.
Health Systems Research, Inc. Chapter IV Page 39 

# Needs assessment activities conducted by Oklahoma included market testing

slogans and logos. Two different slogans with accompanying logos were

developed for market testing among target population members in 1998: 1)

Feed Your Family for Fitness, and 2) Eat Well, Live Well...It’s Within Your

Reach. The slogans and logos were market tested in focus groups. The steering

committee reviewed the feedback from the focus groups and determined that the

slogan would be Eat Well, Live Well...It’s Within Your Reach.

Developing the message for a social marketing campaign was mentioned by five States as an

outcome of a needs assessment.

# The Missouri Nutrition Network, chose three action steps/objectives for the

social marketing campaign based on results of focus groups. The social

marketing committee then developed messages and chose themes around these

action steps. The messages and themes were pretested with focus groups. 

Findings from the focus groups revealed that the target audience prefers themes

that rhyme, mention family, and emphasize eating for health. 

# The Vermont nutrition network applied what they learned from a needs

assessment, which included discussion with network partners, review of

literature, and focus group findings, in choosing to focus on variety of foods and

the messages: choose a variety of foods; reduce total fat, saturated fat, and

cholesterol; eat 5 or more servings of fruits and vegetables; and balance the food

you eat with physical activity to maintain healthy weight.

# The Georgia nutrition network applied the results of a needs assessment to

develop concepts based on the attitudes and behaviors of the target audience.

The concepts were consuming five fruits and vegetables per day, eating a low-fat

diet, and encouraging more physical activity. Concepts were pretested with six

different focus groups made up of food stamp recipients throughout Georgia. 

Then the concepts were refined and tested in interviews in WIC clinics with

members of the target audience. 

Six networks mentioned that the needs assessment was used to determine the mode or select the

medium to be used in reaching a target audience.

# Iowa conducted focus groups to determine the best way to get information to

the elderly.

# The Michigan nutrition network tailored the campaign’s delivery of information

via the media based on the results of focus groups. Television, in-store
Health Systems Research, Inc. Chapter IV Page 40 

programs, and local newspaper features were preferred over radio and the

Internet. Billboards and magazines were also judged to be effective means of

communications. These findings were incorporated into the delivery methods of

the campaign. 

# The contractor for the Georgia nutrition network developed suggestions for

disseminating the message based on findings from the needs assessment.

# Since there is no Statewide television, radio, or newspaper market in New Jersey

(residents in southern New Jersey receive media stations from Philadelphia while

residents in northern New Jersey receive New York media stations), the New

Jersey nutrition network has decided to do a mass mailing. The network

mentioned that the interviews they are conducting as part of their needs

assessment will be used to determine how to get people to open up their mail.

# Based on the findings from focus groups, the Washington State nutrition

education network chose newsletters and direct mail as their medium.

Besides gathering information to use in developing the social marketing campaign, some of the

networks had a secondary use for the needs assessment.

# The Wisconsin nutrition network posted findings from the needs assessment on

the Wisconsin NEP web site. A summary sheet from the data was produced as

well.

# In addition to using the findings from the needs assessment to develop a social

marketing plan, the Pennsylvania nutrition network used their research/needs

assessment data to target outreach to other potential member organizations and

agencies that may be interested in the Network’s activities. 

# Along with developing a social marketing campaign based on the findings of the

needs assessment, the Minnesota nutrition network provided the Department of

Health in St. Paul Ramsey County, a network member, with needs assessment

and focus group results. The Department of Health reviewed the needs

assessment and focus group results and developed classes to meet the needs of

the community.

D. Additional Benefits

Nutrition networks mentioned that they often learned valuable lessons from the needs

assessments and were provided with unanticipated benefits. 
Health Systems Research, Inc. Chapter IV Page 41 

# The South Dakota nutrition network mentioned that they learned that even

agencies and organizations that have served a specific population for many years

must not rely solely on their own perceptions of the needs of the target

population. The target population must be included as a partner in the planning

process; their input and feedback is invaluable. For example, when designing a

Network logo and theme, South Dakota network members discovered that their

perceptions of what would be appealing to the target audience were not

accurate, despite the fact that many of the network members have worked with

limited resource populations in various programs. In pretests, the

representatives of the target population chose very different images and wording

than the network members had as being most appealing. This difference reveals

the importance of providing an opportunity for the input of the target population

during the planning process. 

# Members of the Wisconsin nutrition network said that the needs assessment and

the local level data collection was a great benefit to the network. Network

member’s involvement in the needs assessment process fostered the development

and growth of inter-organizational relationships within the Network. Movement

along the continuum of organizational relationships was evident. Organizations

moved from just being network members, to being partners, to being

collaborators through their involvement in the needs assessment. 
Health Systems Research, Inc. Chapter V Page 42 

CHAPTER V

Network Nutrition Education and Social Marketing

The Statewide nutrition education networks were actively engaged in

development of nutrition messages that were targeted to specific lowincome audiences and were delivered via a range of social marketing

channels. In a number of States, partners collaborated in the

dissemination of messages and the development of complimentary

nutrition education efforts. 

A central goal of the Statewide nutrition education network cooperative agreements was to

foster the development of innovative sustainable approaches to nutrition education for lowincome families and particularly for food stamp recipients and eligibles. The previous section

discussed the needs assessment and other planning activities of the 22 networks, which is the

foundation for developing appropriate and effective nutrition education messages. This section

presents aggregate information regarding the scope of the network activities by the fall of 1998. 

The information provided is based on interviews with Network Coordinators, Project Directors

and network members. This section describes major activities of each of the networks. 

Because of the evolving nature of network activities and the number of partners, this section

does not provide a comprehensive description of all nutrition education activities. Nonetheless,

the information on the major network activities provides a sense of the scope and breadth of

nutrition education and social marketing resulting from network activities. 

The section starts by describing the activities stemming from networks’ social marketing efforts. 

Next, the section discusses network activities involving small group and individual nutrition

education. The third section describes the effects of networks in terms of system and policy

change. A fourth section describes the effects of networks on nutrition education in some
Health Systems Research, Inc. Chapter V Page 43 

States, and a final section describes lessons that can be learned from the networks’ experiences.

A. Social Marketing Activities

The cooperative agreements provided States with resources to recruit network members,

develop organizational structures, and create NEPs that include a social marketing initiative. It

was intended that the networks’ nutrition education activities would be developed through

social marketing principles and processes. Although all networks utilized some social marketing

processes, nutrition education approaches differed greatly from State to State. Some networks

engaged primarily in social marketing interventions, while others utilized a combination of

innovative and more traditional nutrition education techniques.

The State networks are in varying stages of the social marketing process. At the time of the

final report interviews, 15 States were actively engaged in social marketing-driven nutrition

education activities, and the majority of the remaining States were engaged in the planning

process. As might be expected, the nutrition education activities of the twelve States who

entered into cooperative agreements with FNS in 1995 were more firmly established than the

ten States who entered into agreements during 1996. Many of the Round Two States had been,

up to this point, engaged in network development and planning activities. Five of the Round

Two States (and one Round One State) were still in the planning phase at the time of these

interviews and had not yet implemented nutrition education activities. The majority of the

networks that are still in the planning process have identified a target audience and developed a

logo, slogans and, in some cases, messages even if they have not finalized their method of

delivery.

The following four critical aspects of the networks’ nutrition education efforts will be discussed

in the following sections: target audience, nutrition education message/topic, mode of delivery,

and scope of dissemination.

1. Target Audience
Health Systems Research, Inc. Chapter V Page 44 

One of the most basic and consequential decisions that networks have had to make is deciding

on their target audience. Every other decision regarding their social marketing initiative

depends on what target audience has been chosen. Not surprising given the diversity of the

network States, most networks have identified more than one target audience (see Table V-1). 

All networks identified food stamp recipients or a broader low-income population as their target

audience. Most networks have further segmented their target audience by age group or other

identifying factor. Ten networks identified children as their target audience (seven targeted

teens specifically), seven have targeted parents or caretakers of children, and three States have

chosen the elderly as their target audience. 

Table V-1.

Target Audiences for Network Nutrition Education Activities

Population Networks States

Number of

Low-income Populations 22 AL, AZ, CA, CO, GA, IN, IA, KS, ME, MN, MI, MO,

NC, NJ, NV, OK, PA, SD, VA, VT, WA, WI

Adults Food Stamp Participants 8 AL, CO, ME, NC, NJ, OK, PA, VA, WA 

Food Stamp Parents with Children 4 CA, ME, VA, WA 

Low-income Parents with Children 7 CA, ME, MN, MO, SD, VA, WI

Infants and/or Preschool Children 4 GA, IA, KS, ME

Elementary School Children 9 CA, CO, GA, IA, IN, ME, MI, MO, NV, VT

Junior High and High School Students 7 CA, GA, IA, IN, ME, NV, VT 

Low-income Senior Citizens 3 AL, IA, PA

Staff serving Low-income Populations 3 ME, MN, WI

Note: This table is limited to the largest of the major social marketing and nutrition education

activities that can be attributed to Statewide nutrition education networks. It does not include

activities of individual partners that were underway prior to the establishment of the network. 

2. Message Content

The networks are in various stages of developing their nutrition education messages. Some

networks have developed messages and begun implementing nutrition education activities, while

others have only agreed upon a topic area or central network slogan from which the messages
Health Systems Research, Inc. Chapter V Page 45

will be developed. As Table V-2 indicates, the most common nutrition education topics were

eating fruits and vegetables (ten networks) and general healthy eating/nutrition (eight

networks). One-third of the networks focused on lower fat consumption, 20 percent included a

specific messages encouraging physical activity, and 20 percent focused on eating a variety of

foods. Some less commonly mentioned topics were thrifty shopping, food safety, and calcium

intake.

Table V-2. 

Topics of Nutrition Education Messages

Topic Networks States

Number of

Eat fruits and vegetables 10 CA, GA, IA, IN, ME, MN, NC, NV, WI, VT

General nutrition/Healthy eating 9 AL, IA, ME, MI, MO, NJ, OK, SD, VA 

Lower fat/Cholesterol intake 7 AL, CA, GA, IN, ME, MN, VT

Thrifty shopping 6 AL, CA ME MN, VA, WA

Eat a variety of foods 5 CA, IA, IN, ME, VT

Physical activity/Balancing intake 5 CA, GA, IN, ME, VT

Food safety 2 MN, VA

Calcium intake 2 MN, NV

Pregnancy related nutrition 1 AL

Note: This table is limited to the largest of the major social marketing and nutrition education activities that

can be attributed to Statewide nutrition education networks. It does not include activities of individual

network members that were underway prior to the establishment of the network.

Table V-3 lists the specific nutrition education messages utilized or planned to be utilized by

each network. As indicated in the table, 11 of the 22 networks have mentioned multiple

messages of varying specificity. The messages range from very specific behavior changes such

as the Wisconsin theme regarding increased consumption of fruit at breakfast, to more general

nutrition Statements such as Michigan’s “Eat healthy, your kids are watching” message.
Health Systems Research, Inc. Chapter V Page 46

Table V-3.

Network Nutrition Education Messages

State Messages or Themes

AL General nutrition; budgeting food dollars; nutrition during pregnancy; reducing fat.

CA Eat more fruits and vegetables & grains, and lower fat: It’s “easy, affordable, tasty.” 

CO Try new foods.

GA Take charge of your health; Take 5-A-Day; Take down fat— It’s all in the choices, portions and

preparation; Take action— walk, plan, dance . . . 

IN Choose a variety of foods; Balance diet with physical activity.

IA Eat a variety of foods. Make healthy food choices.

KS Kansas Nutrition Network . . . Your connection to healthy food resources.

ME “Eat Smart -- It’s a Healthy Start.” Choose a variety of foods; Eat more fruits and vegetables. 

MI Eat Healthy— Your Kids Are Watching.

MN Theme: The Power of Eating: Learning, Energy & Growth. 

MO Theme: Eat for Health: It’s about you and your family too. Messages: Preparing healthful dinners

and snacks is convenient, affordable and a first step to improving a family’s overall health.

NJ Encouragement to participate in nutrition education.

NC Eating fruits and vegetables can save your life! Specific messages vary for target populations.

NV Increase grain, fruits and vegetables, increase calcium intake.

OK Feed Your Family for Fitness; Eat Well, Live Well . . . It’s Within Your Reach.

PA None at State level.

SD Eating Healthy, You and Your Family Are Worth It. 

VA Logo: Smart Choices, Healthy Families It’s Your Choice. Topics: Preparing delicious safe food;

healthy choices for the whole family; Making money and food stamps go further.

VT Topics: Choose a variety of foods; Reduce fat and cholesterol. 

WA Eat at least one meal together; Making money and foods stamps go further.

WI Increased consumption of fruits at breakfast.

Note: This table is limited to the largest of the social marketing activities in each network. 

3. Channels of Delivery

The diversity of the networks and the populations they have chosen to target is also reflected in

the variety of channels through which the network’s social marketing efforts have been directed. 
Health Systems Research, Inc. Chapter V Page 47

The most common modes of delivery utilized by the networks were public service

announcements (PSAs); radio and TV advertisement; and forums, conferences, booths and

speaker’s bureaus. 

Many networks utilized both innovative nutrition education efforts informed by social marketing

approaches and more traditional nutrition education techniques such as one-on-one and

classroom nutrition education activities. The networks’ more traditional nutrition education

efforts will be discussed in Section B. As indicated in Table V-4, the majority of the networks

(19 of 22) utilized multiple methods for delivering their messages. Some examples include:

# Alabama utilized 30 second television spots, a 1- 800 hotline, magnets,

brochures to promote their message;

# The Maine Nutrition Network utilized paid TV advertisement, a radio PSA, a

hotline, newsletters, and individual sessions/home visits; and

# Wisconsin plans to develop an Internet-based resource for nutrition education

information.
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Table V-4.

Modes of Delivery for Network Nutrition Education Initiatives

Message Mode/Channel Networks

Number of Stage of Implementation (Fall 1998)

Planned Conducting/Complete

Ads and PSAs; Radio, Newspaper, TV 8 KS, NC AL, CA, GA, ME, MI, MO

Forum, Conference, Speaker’s Bureau, Booth 9 CA, IN, ME, MI, MN, MO, NC, NJ,

WI

Newsletters, Bulletin 8 OK, SD AL, GA, ME, PA, WA, WI

Brochures, Posters, Magnets 7 OK, SD AL, CA, GA, MI, VA

Manual/Curriculum for Professionals Serving 5

Low-Income Populations

AL, GA, ME, MN, MO

Direct Mail Information 4 NJ ME, VA, WA

Hotline 5 NJ AL, MI, ME, VA 

Kiosk 4 SD CA, CO, GA 

Group Classes (6 sessions or more) 5 OK CA, IA, ME, MN, PA

Individual Sessions 3 NJ CA, IA, ME

Billboard, Outdoor Advertising 3 MN GA, MI

Demonstrations 4 SD GA, IN, MI

Video 2 AL, IN

Internet 1 WI

Transit Message 1 GA

Special Educational Activities: Great Food 3

Guide Pyramid Adventure, Grocery Store

Tours, Walk-a-thon. 

AL, GA, MI

Note: This table is limited to the largest of the major social marketing and nutrition education activities that

can be attributed to Statewide nutrition education networks. It does not include activities of individual

partners that were underway prior to the establishment of the network.

4. Scope of Dissemination

An important factor of consideration in assessing the nutrition education efforts of the networks

is the scope of activities conducted: geographic reach—were the activities conducted

Statewide, in a number of counties, or in a specific region of the State; number of sites involved

in the activity; and number of contacts or individuals participating in the activities. The scope of
Health Systems Research, Inc. Chapter V Page 49

dissemination varied significantly, not only from State to State, but also from activity to activity. 

Some networks conducted nutrition education activities on a Statewide basis such as Georgia

and California. In States where local health infrastructure has historically been strong, counties

were often the focal point of the network nutrition education efforts:

# In Michigan, where the Public Health Department has a strong county presence

with offices operating in each county throughout the State, the low-income

population of one county was the target of the network’s social marketing

campaign. The campaign included media-based awareness building activities as

well as partnership building for the development of special nutrition education

programs during the campaign.

The majority of States engaged in both county and State level nutrition education efforts, such

as the following:

# In California, a subset of counties that were not being served by EFNEP were

targeted for the network’s nutrition education efforts and, a Statewide social

marketing initiative was simultaneously implemented.

# Both Statewide and county-specific efforts were conducted in Maine, a State in

which county Cooperative Extension Programs have historically had greater

presence than local health departments. The “Eat Smart, It’s a Healthy Start”

PSA initiative reached 20,000 food stamp households Statewide while

individual- and group-based nutrition education classes were conducted in

specific counties.

Not surprisingly, networks that engaged in mass-media social marketing efforts often cited the

highest numbers of persons reached. States such as California, in which nearly one fifth of the

Federal match is retained by the network for the development of Statewide social marketing

efforts emphasizing broadcast advertising, have been successful in reaching broad audiences

Statewide. Networks have reached large numbers of their target audience through mailing of

newsletters and fact sheets as well as distribution of resource manuals/brochures at agencies and

locations frequented by the target population. The following illustrates this:

# The Virginia Nutrition Network utilized a food stamp mailing to distribute

nutrition education brochures to 200,000 food stamp households Statewide,

which encompassed all food stamp recipients in Virginia.
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Networks have also had success in generating thousands of contacts through county-based

initiatives, such as hosting the Great Food Guide Pyramid Adventure, which generated over

5,000 contacts in one Alabama county. Traditional nutrition education methods such as

classroom and one-on-one encounters have generally reached fewer audience members due to

the nature of the activity and limitations in staff, space and participation. The scope of these

activities are discussed in Section B.

5. Adaptation for Low-Income Audiences

As a part of their planning process, most networks utilized focus groups and pretests in the

development of nutrition education messages and channels of delivery. The messages and

activities reflect information gleaned from the target audience during the planning process and

were developed to meet the needs and requests expressed in the focus groups and pretests. Few

States engaged in additional adaptations for low-income audiences outside of the initial

assessment process. Some network members, however, reported that adaptations took place in

their own organizations as a result of their involvement in the network, due to increased

awareness of the need for nutrition education activities, and for materials specifically targeting

low-income populations.

B. Individual and Small Group Nutrition Education Network Activities

In addition to innovative social marketing efforts, at least six networks developed and

implemented more traditional nutrition education activities such as individual and small group

education and counseling (in addition to activities already being implemented by the

Cooperative Extension component of the FSNEP in their State). Four networks conducted

nutrition education classes and counseling sessions. As noted earlier, several States had not yet

implemented their social marketing campaign or other nutrition education activities. Several of

these networks, however, were engaged in nutrition education-related activities as they planned

and developed their nutrition education campaigns. Four networks developed educational and

resource materials such as curricula, resource guides, and newsletters during their planning

phase. These network activities are discussed below, organized by their four key components: 
Health Systems Research, Inc. Chapter V Page 51

target audience, message, mode of delivery, and scope of dissemination.

1. Target Audience

Although the target audiences of the more traditional nutrition education activities varied, as did

the social marketing target audiences, all networks chose to focus on low-income caretakers of

children for at least one of their activities. Two networks focused on Temporary Assistance to

Needy Families (TANF) recipients and other low-income adults. Nutritional needs and

nutrition education of seniors and pregnant women was an additional focus for several

networks. A few networks focused on professionals serving low-income populations and

seniors. As described below, the target audiences were as varied as the activities themselves:

# In Alabama, the target audience was Food Stamp Program recipients and

eligibles and low-income parents and children in grades K-12.

# The activities of the Kansas Nutrition Network have focused on children 0-5

years of age and their caretakers. Maine had projects that focused their activities

on children K-12, on parents from pregnancy until the child is three years old,

and on adult food stamp participants with children under age 18. 

# The target audiences of the Minnesota activities were junior high teachers, food

stamp participants, and parents of young children.

# In Pennsylvania, Supercupboard activities (e.g., a program of nutrition education

provided in conjunction with food banks) have been expanded by the network to

target the nutrition education needs of seniors, teen parents, and TANF

recipients (particularly women).

# Wisconsin targeted low-income caretakers of children, particularly mothers;

practitioners serving low-income populations; and low-income children and their

caretakers. 

# New Jersey has focused some of its education efforts on staff of the multiple

agencies and programs that serve food stamp participants. 

2. Message Content 

Nutrition education messages disseminated through the networks’ individual and group

activities spanned a variety of topics similar to those utilized in the social marketing activities. 
Health Systems Research, Inc. Chapter V Page 52

The most common message was ‘eating a variety of foods.’ As indicated below, the networks

utilized multiple messages in their individual and group activities.

# Alabama focused on 5-A-Day; the food pyramid; children’s nutrition needs; 

healthy snacking for children; food purchasing; meal preparation; and food

safety.

# Maine’s messages included: choose a variety of foods; eat more fruits,

vegetables and grains; eat 5-A-Day; construct a diet lower in fat; and balance

diet with physical activity. Their pregnant and parenting classes addressed infant

feeding, exposing infants to a variety of foods, and managing feeding problems.

# In Minnesota, educational workshops for professionals focused on nutrition

information resources; food handling and food safety; and vitamin, mineral, and

weight guidelines for children.

# In Pennsylvania, healthful eating, eating a variety of foods, lower fat

consumption, thrifty shopping, and food safety were among the nutrition

education messages for the senior, TANF recipient, and pregnant/parenting teen

nutrition education classes.

# Wisconsin focused on nutritional needs of the elderly and nutrition information

resources for practitioners.

3. Modes of Delivery

The networks utilized a variety of channels to deliver their nutrition education messages,

including structured group classes, individual sessions, one-time workshops, and resource

materials/curricula for practitioners. Three networks are utilizing weekly group classes to

deliver nutrition education:

# In Alabama, one local nutrition network developed a series of six weekly parent

nutrition education classes which were conducted through local religious

organizations. Another Alabama county developed a 10-week series of weekly

classes covering topics such as nutrition for pregnant moms, infant feeding, and

breast feeding utilizing peer educators.

# The Maine network has developed a curricula for six weekly classes taught in

elementary, junior high, and high school led by Family and Consumer Life

teachers and other teachers within the schools.

# Through a network-sponsored expansion of the Pennsylvania Supercupboard
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program, weekly nutrition education classes are conducted in a 6-8 week series.

One network utilized individual counseling and home visiting sessions to deliver nutrition

education:

# One county program in Maine provided individual nutrition education sessions

and home visits to low-income parents from pregnancy until the child is age three

as part of a network-initiated expansion of an existing program for children at

risk.

Nutrition education group and individual classes were not the only activities of the networks. 

They also engaged in a variety of nutrition-related activities designed to meet specific needs of

the counties and populations being served, such as:

# A local Alabama nutrition network produced a one-page guide describing

nutrition education materials, resources, and contacts for nutrition education

services available for low-income residents.

# The Kansas Nutrition Network provided nutrition education messages for

inclusion in the Kansas Community Action Program’s Annual calendar for lowincome families.

# In Minnesota, nutrition education workshops were conducted for junior high

school teachers in two cities.

# New Jersey facilitated coordination between WIC, EFNEP, NEP, Summer Food

Service Program, the School Lunch Program, Head Start, and SHARE-NJ

through the development of the “Empowering Food Stamp Families for the 21st

Century” Conference. This conference included sessions focused on the

nutrition issues of food stamp participants.

# The Pennsylvania Nutrition Network delivered nutrition education presentations

at the annual WIC State meeting, a USDA Roundtable, and Annual Agriculture

Day at a local university.

4. Adaptation for Low-income Audiences

The networks utilized focus groups, concept testing, and pretesting during the planning stage in

order to develop materials and activities that were appropriate for limited-income audiences. 
Health Systems Research, Inc. Chapter V Page 54

Modifying the visual layout and adjusting the literacy level of written information are examples

of adaptations made by networks during the development of materials. The Alabama network,

for example, utilized large print menus that were designed to be easy to read from a literacy

stand point as well as visually non-intimidating.

5. Scope of Dissemination

Generally, the individual and group nutrition education efforts of the networks have been

conducted in limited areas within the States and have reached smaller audiences than the mediabased activities described in the social marketing section. Among the more traditional nutrition

education initiatives, food demonstrations and school-based group education programs have

yielded the largest number of participants/individuals reached, exceeded only by the distribution

of written materials featuring nutrition education information. Some examples are:

# In Alabama, nutrition education efforts were developed and conducted at the

county level in 41 of 67 counties, and their scope ranged greatly from parent

nutrition education classes in which 36 parents participated, to school-based

nutrition education which reached over 5,600 children.

# Nutrition education Statements developed by the Kansas Nutrition Network

were distributed to 7,500 low-income families Statewide last year within the

Kansas Community Action Program’s Annual calendar. 

# In Maine, group nutrition education activities reached 4,800 students and 217

teachers in 50 schools in more than 10 counties, and their individual nutrition

counseling reached 219 parents in one county.

# A workshop conducted for teachers in the Minnesota twin cities area reached 18

teachers from the two cities. Ten limited income parents participated in each of

two series of county-based nutrition education classes targeting parents.

# In Pennsylvania, food demonstrations were conducted at local sites for 16,000

participants per month Statewide last year. Weekly Supercupboard nutrition

education classes were conducted for 6-8 week series in three counties with a

total of over 500 participants (teens: 100 participants in one county; elderly: 250

participants in one county; TANF recipients: 170 participants in one county).

C. System, Policy, and Environmental Change
Health Systems Research, Inc. Chapter V Page 55

The nutrition education networks are often engaged in system and policy changes to increase

access to nutritious foods or access to nutrition education. USDA did not expect that all

programs would undertake activities to affect changes in this area, but when system, policy or

environmental changes do occur, they can make ongoing contributions to facilitate healthy

dietary behavior. For instance, several networks have affected system or environmental changes

that have increased the access to nutritious foods. Some examples include:

# The Maine Nutrition Network has been working with local Farmer’s Markets to

allow redemption of food stamps. This has had measurable effects in increasing

access to fresh fruits and vegetables. An assessment of food stamp redemption

data indicates that there was an increase of 15 percent in the dollar value of

redemption of food stamps from Farmer’s Markets or roadside stands.

# A local California program has been working with local teenagers to advocate

education to allow delivery of nutritious foods in schools. This can include use

of yogurt and low-fat foods in school cafeterias. 

# In Georgia, as a result of the involvement of one private partner, bottled water

has been allowed to be sold in addition to soda in several schools districts. 

Students have also been allowed to bring water to class. Network staff report

that drinking water has now become a socially-acceptable beverage to consume

instead of soda beverages.

Networks can also affect policy changes that lead to increased access to nutrition education. 

For instance, in New Jersey, as a result of the network, the Department of Labor changed its

policy to allow the FSNEP to be part of the Employment Services’ (ES) Job Skills/Life Skills

workshops. A memorandum documenting this change in policy was sent to all ES Regional

Managers and ES Local Office Managers. It is likely that such actions will increase in the future

as networks become more firmly established and gain greater experience in advocacy activities

to encourage nutrition changes.

D. Impact of Network Activities on Statewide Nutrition Education

The cooperative agreements and the resulting networks have served to: 1) increase the capacity

of programs to provide nutrition education, and 2) help develop collaborative partnerships that

improve nutrition education delivery to food stamp participants through social marketing and
Health Systems Research, Inc. Chapter V Page 56

individually directed activities. This has been accomplished through a series of steps which are

first outlined, then further discussed below:

# The cooperative agreements encouraged collaboration among public and private

partners with the aim of increasing the capacity and improving the coordination

and reinforcement of multiple channels of delivering nutrition education. 

# The networks planned increased delivery of nutrition education to low-income

populations, especially through innovative mechanisms such as social marketing.

# Statewide nutrition education efforts are better coordinated, and programs have

been expanded and modified to better meet the nutrition education needs of lowincome populations.

1. Increased Capacity and Partnerships

The NEPs have had an important role in developing the capacity for networks to deliver

effective nutrition education. Seventeen networks have at least two full-time equivalent (FTE)

staff who are dedicated to promoting nutrition education, and in some networks this number is

considerably higher. These resources have helped the networks to develop collaborative

relationships with the variety of State, local, and private organizations who were engaged in or

support nutrition education. In general, the networks have done a commendable job in

developing broad-based State coalitions to support nutrition education. Eighty percent of the

networks had 15 or more partners, and half of the network members were from the private

sector. If there was a shortcoming, it is that the number of for-profit partners was limited. 

Nonetheless, where for-profit partners were involved, they made important contributions to

nutrition education efforts, and network staff are hopeful that the involvement of for-profit

partners will increase as the networks move from planning to implementation of nutrition

education activities.

2. Expanded Nutrition Education

It is still early to make conclusions regarding the reach of the social marking activities stemming

from the Statewide nutrition education networks initiative. However, observations can be made

about network plans for nutrition education initiatives and the messages developed to convey
Health Systems Research, Inc. Chapter V Page 57

them. By the fall of 1998, nearly all networks were completing their planning stage or had

begun to implement social marketing plans to promote nutrition education efforts. (The only

exceptions to this were the three networks that were temporarily inactive while they sought to

fill staff vacancies.) 

All the networks planned to or were targeting a low-income or a food stamp population. There

was, however, considerable recognition of the need for market segmentation within this broader

group, and networks had developed more targeted messages and delivery strategies for: (1)

adult food stamp participants, (2) low-income parents of pre-school and elementary school

children, and (3) programs directed at children and adolescents in schools serving low-income

students. 

The messages covered different or multiple aspects of messages consistent with USDA Dietary

Guidelines for Americans. The most common nutrition education message addressed one or

more of the following five topics: (1) increasing consumption of fruits and vegetables, (2)

eating a variety of foods, (3) reducing fat intake, (4) teaching thrifty shopping, and (5)

balancing intake and physical activity. The messages were being tailored in content and style to

be appropriate for low-income populations based on feedback from the target audience.

The messages were designed to be communicated through a variety of social marketing

channels including radio and television ads, newsletters, brochures, and public relations efforts

in addition to nutrition education sessions. The networks were attentive to targeting the

delivery of messages through methods and distribution channels to reach low-income audiences. 

As a result, networks indicated that existing nutrition education programs have been expanded

and new programs have been developed as a result of network involvement. For example:

# In North Carolina there was a significant increase in the number of nutrition

education programs being conducted. North Carolina went from having a single

nutrition education program (Out for Lunch) to implementing 11 programs with

four additional programs in the planning stage. More counties than ever are now

receiving nutrition education throughout the State. 

# Four new programs have been implemented in Pennsylvania due to the influence
Health Systems Research, Inc. Chapter V Page 58

of the network. Those include: 1) a farmer’s market on-site nutrition counseling

program and monthly newsletter; 2) a nutrition education program for the elderly

delivered at congregate meal sites; 3) food demonstrations at local food banks;

and 4) a school nutrition awareness campaign.

# In Maine, new middle and high school nutrition programs, a summer nutrition

program and parent nutrition programs have been funded because of the

involvement of the network. The program is currently being delivered in 50

schools covering nearly half of the school districts in the States that offer free or

reduced school lunch to 50 percent or more of their students. 

Also, the establishment of Statewide nutrition education networks has increased awareness of

the need for nutrition education programs, specifically those targeting limited-income

populations. As a result of the activities and the awareness-building campaigns of the networks,

other organizations and agencies have begun to adapt existing nutrition education programs for

low-income populations. Some examples are:

# The South Dakota network has spent much of its early grant time educating

organizations and agencies throughout the State about appropriate nutrition

education activities for low-income populations. This is particularly relevant

since many of the organizations serve a broader population and have not

previously focused on low-income individuals. Organizations such as the Pork

Producers Council that previously only developed nutrition messages for the

general population are now considering adaptations for low-income populations.

# In Pennsylvania, newsletters distributed through a collaborative effort between

the Hunger Action Center, the County Commissioners, and the Rural Health

Office historically have been developed for the general adult population. As a

result of network involvement, they now include low-income-appropriate

nutrition education related information. The network is planning to bring an

intern on board to further expand this activity.

# California indicated that many of the local nutrition networks who were not

previously targeting low-income populations have now incorporated activities

that target this group.

3. Collaboration in Social Marketing and Nutrition Education

The majority of networks developed new materials to reach a specific target audience or to

provide a more general "umbrella" set of nutrition education resources. Network members
Health Systems Research, Inc. Chapter V Page 59

typically used materials developed by the network to supplement existing nutrition education

materials from their programs. There were a number of instances in which nutrition education

materials were shared across programs or the ideas for materials (such as newsletters for food

stamp participants) were shared among the networks in different States. Such sharing typically

arose from informal contacts of network members and sharing at conferences.

Various organization and agencies in the cooperative agreement States have also begun or

increased collaborative efforts related to nutrition education for low-income populations as a

result of their involvement with the Statewide nutrition education networks. Examples include:

# Through coordination with the State FNP, the Alabama network has been able to

develop a new program (Glow Germ) utilizing nutrition education materials

previously purchased through FNP but that were not being utilized.

# The Maine network has facilitated increased collaboration between the

Department of Health and Extension which resulted in those organizations using

the network needs assessment to develop a new program, “5-A-Day Power

Plus,” which provides a nutrition education curriculum for 4 grade teachers and th

students. As a result of networking and information sharing regarding the

nutrition education needs of the limited income populations during the New

Jersey network meetings, the State Food Stamp and NEP programs have made

their nutrition education materials/programs available to the Division of

Employment and Training to be included in their Life Skills workshops.

There were also examples in which different partners collaborated in a particular social

marketing initiative to a defined audience. For instance, in Maine, Virginia, and Washington

State, the Food Stamp Program provided labels to send newsletters to food stamp families with

children (or provided mailing inserts allowing food stamp participants to request this type of

newsletter). In Virginia, a number of Food Banks used materials developed by the network to

support nutrition education of families.
Health Systems Research, Inc. Chapter VI Page 60 

CHAPTER VI

Lessons and Conclusions

Cooperative agreements awarded by FNS contributed to the

development of Statewide nutrition education networks. Those

networks are now making important contributions to the delivery

of nutrition education to low-income populations through a variety

of social marketing efforts. However, this progress has not always

been easy, and there is much that can be learned about effective

network practices that can be shared among programs.

Factors that contributed to the success of nutrition networks included: 

(1) experienced leadership teams, (2) support of senior management, 

(3) attention to partnership issues, (4) attention to resource management

issues, (5) emphasis on complementary modes of social marketing, and 

(6) emphasis on development and enhancement of community nutrition

education programs. 

Earlier chapters of this report described the progress resulting from the cooperative agreement

demonstration in terms of network development (Chapter III), needs assessment and planning

(Chapter IV), and nutrition education and social marketing (Chapter V). This chapter provides

a more integrative assessment. The chapter describes (1) network accomplishments, (2)

challenges faced by networks and strategies to address the challenges, (3) lessons about success,

and (4) overall conclusions of the study.
Three of the Round One networks and two Round Two networks decided to pursue ongoing 3

funding as part of the FSNEP awarded to the Cooperative Extension Service in their State. 

By July 1999, three additional networks had received approval for their NEP, bringing the rate of 4

Round Two networks receiving an approved NEP to 80 percent.

Health Systems Research, Inc. Chapter VI Page 61 

A. Accomplishments

The results of this evaluation suggested that most of the States who were awarded cooperative

agreements made considerable progress in meeting the goals of the cooperative agreement. 

This report assessed network accomplishments in terms of the following outcomes:

# Preparation, submission, and approval of a Food Stamp Nutrition Education Plan

(FSNEP) or addition of network activities to an existing FSNEP;

# The social marketing and nutrition education activities resulting from the

networks;

# The resources leveraged (considering the size of food stamp population in the

State); and 

# Attainment of the objectives for the cooperative agreements (fully met,

substantially met, partially met, or failed to meet).

These outcomes are discussed at length in the following four sub-sections of Section A.

1. Approval of Network-Related Nutrition Education Plans

One measure of the success of the overall demonstration program was the proportion of

networks that went on to develop an NEP that was approved by the State and Regional Food

Stamp Program. By the Fall of 1998, 75 percent (9 of 12) of Round One networks and 50 3

percent of Round Two networks (5 of 10) had submitted and received approval for network

activities through an NEP (Table VI-1). This study considered networks to be successful in 4

terms of sustainability if they received funding as: (1) the sole or umbrella NEP in the State (2

networks); (2) a distinct component of a States’s NEP (7 networks) or; (3) part of an existing

NEP who operated under the auspices of the Cooperative Extension Service (5 networks). 
Even though three more Round Two networks had received approval for an NEP by July 1999, 5

our analysis of factors associated with success focuses on receipt of approval by the Fall of 1998,

because that is when interviews about network processes and activities took place.

Health Systems Research, Inc. Chapter VI Page 62 

Table VI-1.

Approval of Network-Related Nutrition Education Plans: Fall, 1998

NEP Approval Round One Round Two Total

NEP was submitted and approved 9 75% 5 50% 14 63%

NEP was not submitted (or not yet 3 25% 5 50% 8 36%

approved)

Total 12 100% 10 100% 22 100%

Note: This table shows column percentages.

Of the eight networks that had not received approval for an NEP, by the Fall of 1998, only two

had given up on efforts to submit a plan. One network was responding to request for revisions

to their plan, and other networks were still working on their submissions, though their progress

had been slowed by difficulty in identifying match or temporary inactivity as the networks

sought to recruit key network staff. By July 1999, three of these networks had an NEP

approved, bringing the percentage of Round Two networks that received approval of a NEP up

to 80 percent. 

All eight of the networks that did not submit and/or did not receive approval for their NEP by

the fall of 1998, encountered difficulties in identifying sources of matching funds . In addition, 5

six of these eight networks encountered inter-organizational issues regarding competition for

match funds that proved difficult to resolve (the problems involved a different set of

organizations in each State.) 

Also in four of the networks, turnover of a Project Director contributed to the networks’

difficulty in preparing an NEP. Four of the networks also confronted turnover in senior

management (such as the manager to whom the network Project Director reported). This

turnover could create difficulties if the new senior manager decided that the burden associated
Level of activity was rated by having the evaluation team and the technical assistance team 6

independently classify each network into one of the following categories: 

# Inactive—no longer functioning or temporarily inactive (e.g., several networks that had

been active were temporarily inactive as they engaged in filling a staff vacancy);

# Planning (e.g., several Round Two networks were still engaged in planning for the

submission of an NEP);

# Active (i.e., the network was actively engaged in nutrition education activities initiated

by the network as a result of completion of needs assessment activities); and

# Very active (i.e., the network was engaged in three or more major nutrition education

activities that were implemented with the support of the network). 

There was a 91 percent agreement between the two sets of initial ratings, and discrepancies were

quickly resolved through discussion. Nonetheless, these ratings were somewhat subjective, and 

reflect network activity at one point in time (Fall, 1998). A different set of ratings in terms of

level of activity might well apply in coming years.

Health Systems Research, Inc. Chapter VI Page 63 

with managing the reimbursement system was not justified by the amount of matching funds that

they were able to identify.

In two instances, State-specific political circumstances proved problematic. The first State was

recovering from a scandal involving misappropriation of funds for a different social marketing

campaign being conducted in a different State agency. Another State decided not to seek

additional USDA funds during an election year when candidates were opposing new State

programs.

2. Level of Social Marketing Activities

Networks also were assessed in terms of the level of social marketing activity in which they

engaged by the Fall of 1998. This assessment, summarized in Table VI-2, indicated that two- 6

thirds (67 percent) of Round One networks and one-half (50 percent) of Round Two networks

were very active or active when it came to developing and implementing social marketing

activities. The fact that levels of activity were higher among the Round One networks is likely

to be a reflection of the greater amount of time those networks were operational. It suggests

that levels of network social marketing activity will further increase in coming years. The

sections that follow describe social marketing efforts that resulted from network activities.
Health Systems Research, Inc. Chapter VI Page 64 

Table VI-2.

Level of Network Social Marketing Activity: Fall, 1998

Level of Network Social Marketing Activity Round One* Round Two* Total

Very Active (approved NEP, 3 or more major social

marketing activities attributable to the network)

3 25% 0 0% 3 14%

Active (approved NEP, new social marketing activities

attributable to the network)

 5 42% 5 50% 10 46%

Planning (working on submission of NEP and

marketing plan)

1 8% 3 30% 4 18%

Inactive (3 networks were temporarily inactive as they

sought to replace key network staff; 2 networks had

largely ceased functioning) 

3 25% 2 20% 5 22%

Total 12 100% 10 100% 22 100%

* Percents represent column percents.

As noted previously, one of the key goals of the cooperative agreements was to develop

networks that incorporated social marketing approaches to nutrition education. This goal was

beginning to be realized, although it was still too early to assess the full impact of social

marketing activities. All the networks undertook a needs assessment process to develop

nutrition education activities targeted toward food stamp populations. Networks engaged in the

following four broad types of social marketing activities.

# Television and radio broadcast materials. The majority of nutrition

networks actively had been working on the development of TV and/or radio

materials to support nutrition education. In 1998, a major Statewide media

campaign was launched in California and media campaigns were pilot tested in

counties in Michigan and Missouri. A separate evaluation of the Michigan pilot

project (described below) found that the social marketing effectively reached a

low-income population and conveyed messages likely to influence their behavior. 

Social marketing campaigns were scheduled to be launched during 1999 in 12

more States.

# Direct mailing to food stamp participants. Three networks (Maine, Virginia,

and Washington State) developed mailings and newsletters that were sent to

more than 100,000 food stamp participants. An evaluation in Washington State

found that a substantial proportion of food stamp families read the mailings and

reported that they tried some of the suggestions in the newsletters.
Health Systems Research, Inc. Chapter VI Page 65 

# School-based programs. About half of the networks were working with

children in schools in which 50 percent or more of the children received free- or

reduced-price school lunch (one indicator of a low-income population). These

programs typically worked with classroom teachers to integrate well-tested

nutrition educational materials into their classroom instruction. 

# Development of community activities. One of the important contributions of

networks was the development or enhancement of community-based nutrition

programs. Given the matching structure of the NEP, this usually involved

identifying existing local government programs that could provide in-kind

resources to serve as matching funds. Depending on the proportion of these

funds devoted to network activities, resources were increased by 50 to 100

percent. In addition, a number of networks made efforts to develop new

community-based networks and to work with diverse groups such as faith

communities and emergency food providers. 

About half of State networks are developing strong local community-based

nutrition programs. For instance, a county program in Maine was providing

nutrition education as part of a comprehensive-services program for parents of

preschool children who are judged to be at risk for abuse and neglect. California

had issued local incentive awards to more than 30 communities, and the North

Carolina network was working with 15 community programs covering more than

60 counties of the State (as shown on the map in Figure 2).

# Private Partnerships. Although strong public-private partnerships were still

emerging, the examples we saw of partnerships suggest that these relationships

could be very effective. For instance, local supermarket chains in Michigan and

Georgia provided in-kind services to support the development of media

materials. Supermarket chains in Arizona and California tested the use of

interactive kiosks to increase purchases of fruits and vegetables. An evaluation

of the kiosks found that their use influenced modest yet statistically significant

increases in the purchase of fruits and vegetables in supermarkets serving lowincome communities.
Health Systems Research, Inc. Chapter VI Page 66 
Since January 1995, the National Fluid Milk Processor Promotion Board has spent approximately 7

$80 million a year on television and print ads featuring athletes and celebrities sporting a white

milk mustache. 

Health Systems Research, Inc. Chapter VI Page 67 

One question sometimes raised about social marketing is whether use of mass media can

effectively target a food stamp population. Findings from the Kent County pilot test (Holaday,

1999) indicated that the campaign there reached a low-income audience. The pilot test

employed a television ad (which ran 394 times on cable channels (USA, TNN, BET,

Nickelodeon, and Lifetime), along with billboards in 20 locations, 200 bus posters, newsletters,

and take-home information on school lunch menus in schools in low-income neighborhoods. 

A random-digit-dialing telephone survey of 800 adults found that the campaign had achieved a

high level of awareness, particularly among low-income adults. The campaign message was

recalled by 52 percent of adults with income below $20,000 (combining measures of unaided

and aided recall). This was significantly higher than the rate of recall (42 percent) among adults

with higher income levels. 

The unaided or “top-of-mind” awareness of the campaign message “Eat healthy, your kids are

watching” was recalled by more than twice as many low-income adults (7 percent) and all adults

(5 percent) than the national “Got Milk” campaign which had run for more than a year (recalled 7

by about 2 percent of low-income and higher-income adults). Further analysis indicated that

school lunch menus were a particularly cost-effective way to reach low-income adults. 

Newsletters, billboards, newspapers, and TV ads were about equal in cost-effectiveness. 

Posters and bus signs were the least cost-effective medium.

The evaluation yielded evidence that the campaign messages could affect the attitudes of adults

(Table VI-3). The study found that low-income adults (the target for the campaign) were more

likely than higher-income adults to report being persuaded by the message, “Eat healthy, your

kids are watching.” When asked what they thought about that message, low-income adults

were more likely to respond, “I didn’t know my kids watch what I eat. I’ll try to set a good

example now.” The study also found a higher percentage of reported persuasion among

African-Americans (34 percent among men and 21 percent among women) than among other
Health Systems Research, Inc. Chapter VI Page 68 

ethnic groups, and among individuals without college experience (22 percent) than among those

who were better educated.

Table VI-3.

 Attitudes Toward Campaign Message: Pilot Study in Kent County, Michigan

Group Low-income Higher-income Total

Old Acceptors 65 66% 545 78% 610 76%

New Acceptors 20 20% 85 12% 105 13%

Resisters 13 13% 72 10% 85 11%

Total 98 100% 702 100% 800 100%

Note: Percentages show column percentages. Respondents were asked: “Which Statement best describes

what you think about when you read or hear the message, “Eat healthy, your kids are watching?” 

Would you say:

(Old Acceptors) “I know my kids are watching and I try to set a good example.”

(New Acceptors) “I didn’t know my kids watch what I eat. I’ll try to set a good example now” 

(Resisters) “It doesn’t matter to my kids what I eat.” 

Source: Adapted from Holaday, R.M. “Evaluation of the Michigan Nutrition Support Network: Network

Building and ‘Eat Healthy’ Campaign.” Final Report to Michigan State University Extension. 

Report by Holaday Research and Consulting. Lansing, MI: March 1999.

In summary, the Michigan pilot study demonstrated that a social marketing campaign can target

low-income adults who are likely to be food stamp participants. The Michigan experience also

offered evidence of the benefits that a social marketing campaign can have on coalition

development at the community level. One long time nutrition educator commented (Holaday,

1999):

Even though we’ve had FNP for five years, some . . . don’t get it. 

Apparently, it’s the message of the Eat Healthy campaign that makes the

difference, and being part of a team. It leads to referrals from one agency

to another that just didn’t happen before . . . The campaign focused

everybody. 

3. Leveraging of Resources
Health Systems Research, Inc. Chapter VI Page 69 

In total, USDA provided roughly $4 million in funding for the two rounds of cooperative

agreements (including the technical assistance associated with the initiative). In 1998, these

networks obtained more than $20 million in non-Federal funding (about 95 percent of these

resources came from in-kind resources.) In addition, the networks identified a significant

amount of in-kind services from non-governmental agencies that added considerably to the

resources that networks were able to devote to nutrition education. The value of nongovernmental in-kind was difficult to assess (programs did not have a reason to keep track of

these figures since they did not count as match). However, there were enough examples to

suggest that these leveraged resources were substantial. For instance, the Virginia network was

able to enlist the assistance of volunteers in food banks across the State to provide information

about nutritious ways to prepare foods, and the California nutrition network’s publicity

regarding decreases in State consumption of fruits and vegetables resulted in several hundred

hours of air time that translated into more than $500,000 in value.

Although it usually took considerable effort on the part of networks to put the matching

mechanisms into place and to identify sources of matching funds, this work was beginning to

bear fruit by 1994 and it appeared that the leveraging of resources would continue to grow in

coming years. In States whose networks received support as part of the approved NEP for

successive years, the average amount of proposed funding for network activities had increased

by more than 20 percent a year. During their initial year, a number of networks had difficulty

spending all their approved funds largely due to delays in hiring. However, during the second

year, actual expenditures tended to be much closer to the approved amounts.

The cooperative agreements were not the only cause of growth in expenditures for the FSNEP. 

The network-related NEPs accounted for only about a third of the total $74 million a year in

federal funding associated with the FSNEP program in 43 States. The majority of FSNEP funds

went to Cooperative Extension programs, and in most States the extension-related FSNEPs

started prior to the implementation of the nutrition education networks. Nonetheless, several

findings suggested that the cooperative agreements contributed in important ways to the

leveraging of funds for nutrition education. First, the cooperative agreements helped to broaden

the network of agencies that participated in FSNEP; more than half of network-related FSNEP
Health Systems Research, Inc. Chapter VI Page 70 

funding in 1998 supported nutrition activities of organizations beyond Cooperative Extension. 

Second, in most of the instances where the primary grantee was Cooperative Extension, the

cooperative agreements were used to help plan for multi-agency coordination and for

development of new social marketing activities. 

The effect of the nutrition network on resources available to support nutrition education is

illustrated by California’s program. As the largest of the network programs, it best illustrates

the range of changes in nutrition education programs that could be influenced by the nutrition

networks (see Table VI-4). For example, non-Federal funding for the extension component of

California’s FSNEP grew from $2.6 to $3.2 million, while non-federal funding for the networkrelated nutrition education component increased from $200,000 to $8.3 million. The network

started a number of new programs such as Latino 5-A-Day, and added a social marketing

emphasis, that magnified the potential effect of the program on low-income populations.

The increased resources in the California nutrition network—accounting for about two-thirds of

the growth—came primarily from a concerted effort to identify State, county, and local

governmental programs that were willing to allow the resources they were spending on nutrition

education to be counted as match for the network, with the expectation that 50 percent of the

additional resources obtained would be returned to the local program to increase its own

nutrition education efforts. The remaining 50 percent would be retained by the network to

support Statewide social marketing campaign and outreach to special populations, as well as

financial infrastructure to track the matching funds. 
Health Systems Research, Inc. Chapter VI Page 71 

Table VI-4.

The Growth in Non-Federal Resources for Nutrition Education for Food Stamp

Participants in California

Organization 1995 1998 Impact of Network

Staff Resources Staff Resources

CA Nutrition Network 3 $200,000 29 $8.3 million

 Program development 2 6 Additional capability

 Administration and 1 16 New services

 support 

 Media and marketing 0 4 New component

 Evaluation 0 3 New component

Project LEAN 1 $300,000 2 $600,000 50% expansion

5-A-Day 2 $300,000 4 $300,000 New media component

Latino 5-A-Day 0 0 3 $300,000 New Program

Dept. of Education 4 $600,000 4 $300,000 Network preserved staff after

NET program ended

 FSNEP (Extension) $2.5 million $3.6 million FSNEP was started in 1994

 EFNEP $3.2 million $3.2 million Funding for EFNEP stayed flat

Total: $6.3 million $16 million

Note: Column totals are less than the sum of rows because of adjustments to eliminate double

counting.

A third of the growth is attributable to the network’s ability to identify foundation funding that

could be devoted to nutrition education. While part of this new funding was fortuitous, (a

major new source of support, The California Endowment, was established by Blue Cross/Blue

Shield during the process of health care reform), the fact that the network was in place as a

result of the cooperative agreement enabled the network to take advantage of this opportunity. 

The California Endowment was interested in coalitions that were engaged in efforts to improve

the health of underserved populations. The fact that the network was already established as a

program to meet these requirements gave network partners an advantage in submitting grant

applications; and senior network personnel alerted network partners to submit grant applications

to the foundation. 
Health Systems Research, Inc. Chapter VI Page 72 

Other smaller networks have shown comparable or even greater rates of growth. For instance,

in Maine, the non-federal resources expended on network activities increased eightfold from less

than $50,000 to more than $400,000. In addition, the experience developed through the

nutrition education networks also contributed to the ability of States to secure funding for other

prevention programs. For instance, the experience of the network was instrumental in the

ability of the Georgia health department in obtaining a major grant for a network-based

approach to prevention of cardiovascular disease in minority communities. 

One of the issues the study investigated was displacement. In some national programs,

displacement can occur when States reclassify clients or move programs from one funding

source to another in a way that maximizes the share of the program cost that is paid by the

Federal government. The study did not find evidence that displacement was occurring in any of

the States that were evaluated. Rather, it appears that before the network, the funding for

nutrition education in many States had been decreasing. In many States, funding for 5-A-Day

had been cut back; the EFNEP program had been flat-funded for nearly a decade (resulting in an

effective decrease in resources for nutrition education); and USDA NET grants to provide

nutrition training to school food service personnel had ended. Given this context, the Food

Stamp nutrition education program was extraordinarily timely. The cooperative agreements

were able to build on existing networks and provide the resources needed to continue nutrition

education to low-income populations.

4. Achievement of Objectives for the Cooperative Agreements

Earlier sections of this chapter have described the success of the cooperative agreement

demonstration project in terms of specific outcomes such as obtaining approval for an NEP,

developing social marketing activities, and leveraging resources for nutrition education. This

section describes the success of the networks in four of the specific objectives associated with

the cooperative agreements:

# Building an active Statewide Nutrition Education Network of public and private

organizations to support nutrition education and promotion to food stamp

recipients and eligibles;
The ratings were independent made by the evaluation team and by the technical assistance team. 8

There was 91 percent agreement in ratings then the discrepancies were resolved in discussion. 

While these ratings are somewhat subjective , nonetheless, they may serve a useful tool in

helping to identify lessons associated to the success of the demonstration program. 

Health Systems Research, Inc. Chapter VI Page 73 

# Integrating messages promoting the Dietary Guidelines for Americans into State

nutrition education/promotion for the target audiences;

# Incorporating social marketing approaches to expand the reach and approach of

current State nutrition education; and

# Submitting and receiving approval for a nutrition education plan under the State

Food Stamp Program.

Using these criteria, networks were classified in terms of how fully they had attained those

objectives by the fall 1998. Each network was classified into one of four categories: (1) failed

to meet objectives of the cooperative agreement (i.e., networks that failed to submit or receive

approval for an NEP); (2) partially met objectives (i.e., one network submitted a plan that was

approved as part of the States FSNEP but, at the State-level, it was essentially a single-agency

program); (3) substantially met the objectives (these networks submitted a NEP that was

approved but major activities were primarily limited to a small number of organizations); (4)

fully met the objectives (these networks were judged by the fall of 1998 to have attained all of

the objectives of the cooperative agreements). An assessment of the progress of networks in 8

meeting these objectives is shown in Table VI-5. Characteristics associated with failure and

success in terms of this outcome is discussed in the sections that follow. 
Health Systems Research, Inc. Chapter VI Page 74 

Table VI-5.

Progress Toward Attainment of Objectives for Cooperative Agreements: Fall 1998

Attainment of Objectives Round One Round Two Total

Fully met objectives 6 50% 2 20% 8 36%

Substantially met objectives 2 17% 3 30% 5 23%

Partially met objectives 1 8% 0 0% 1 5%

Failed to meet objectives 3 25% 5 50% 8 36%

Total 12 100% 10 100% 22 100% 

Note: Percentages indicate column percentages.

B. Challenges

Cooperators faced a number of challenges. Chief among them were:

# Lack of experience with the FSP reimbursement mechanism. One of the

barriers to the networks’ submitting approved NEPs was the primary grantee’s

unfamiliarity with the reimbursement mechanism. In two-thirds of the networks

that failed to attain the objectives of the cooperative agreement, the network

staff had no prior experience with the Food Stamp Program reimbursement

mechanism. Many primary grantees were more familiar with grants which did

not have matching requirements. This situation was complicated by new

questions about reimbursable expenses that were raised as social marketing

efforts were being planned in a wide number of States. Questions ranged from

“What constitutes a governmental entity?” to “What criteria should be applied to

assure that a social marketing program is reaching a food stamp audience?” 

Because FNS staff sometimes needed to seek legal guidance to make sure that

rules were consistently applied, it often appeared to grantees that the matching

requirements were an evolving process. 

Unfamiliarity with the funding mechanism did not necessarily make it impossible

for a network to succeed, however. Nearly half (47 percent) of the networks

that achieved the objectives of the cooperative agreement had a primary grantee

that was unfamiliar with the reimbursement mechanism. Indeed, the largest

network in the country (receiving more than $8 million a year) faced similar

conditions. The difference was that this network had strong leadership and high

level support from senior management, made a concerted effort to address the

matching issues, and developed effective procedures to achieve match among

partners.
Health Systems Research, Inc. Chapter VI Page 75 

# Difficulty in obtaining matching funds. The Food Stamp Program requires

State FSNEPs to identify a 1:1 match for every dollar of FSP administrative

funds they receive under an approved nutrition education plan. Match can come

from State and local governmental cash and in-kind contributions devoted to

nutrition education for low-income populations and/or from private cash

contributions. However, as mentioned earlier, in-kind match from private

organizations (whether nonprofit agencies such as food banks, or for-profit

organizations such as supermarket chains) does not count as matching funds. 

Hence, networks had to devote considerable time and energy to identifying

resources that could be counted toward matching funds. Cooperative Extension

programs were often able to identify matching funds from State university or

local county programs. However, when extension programs tried to go outside

these sources, they often faced the same challenges as non-extension groups. 

Seven of the eight networks that failed to obtain the objectives of the

cooperative agreements reported significant difficulties in identifying sources of

matching funds. 

# Historical turf and cultural differences among organizations. Networks

often had to confront barriers to collaboration stemming from differences in

culture and background of organizations interested in nutrition education. In

part, this problem occurred because in some States, the organizations had not

worked together before. Sometimes organizations felt no incentive to participate

in a network, particularly if they already had an existing source of funding for

nutrition education or had a disincentive to growth such as difficulties in hiring

new staff. In addition, organizations often varied in their traditional emphasis

(e.g., extension programs have emphasized one-on-one or small group education

of low-cost meal preparation; public health programs have emphasized broadbased health; food banks have focused on food access issues; commodity

councils have an interest in promoting consumption of agricultural products). 

These differences sometimes proved a challenge to networks; nearly all (89

percent) of the networks that failed to meet the objectives of the cooperative

agreements, encountered inter-organizational issues about control and resources

that appeared to contribute to the failure of the networks. 

# Limited experience of network members with social marketing. Although 

USDA has a longstanding interest in nutrition education, historically it has

involved small group and individual education similar to that offered through

EFNEP. In many respects, social marketing was new to many network

members. At the beginning of the demonstration project, nearly half of the

primary grantees had relatively limited experience with integrated social

marketing campaigns. The cooperative agreements enabled the networks to

develop their capacity in this area.
Health Systems Research, Inc. Chapter VI Page 76 

# Staff turnover. Staff turnover was often a challenge to networks; although the

effect of turnover appeared to depend on the level of the person who left. 

About a third of Network Coordinators left and needed to be replaced between

the initial award of the cooperative agreements and the fall of 1998. Turnover of

Network Coordinators was about the same both for networks that met their

objectives and those that did not; thus, it appeared that networks were able to

adapt to this change in personnel.

On the other hand, the loss of a Project Director (even though that person may

only have worked on the network part time) posed a significant challenge to

fledgling networks. In four of the networks that failed to attain project

objectives, turnover of a Project Director contributed to difficulties in preparing

an NEP. This finding suggests the value of succession planning in the leadership

of networks.

This evaluation assessed the success of networks in confronting these challenges and attaining

the objectives of the cooperative agreements. Table VI-6 highlights the differences between

networks which by the fall of 1998 had met (fully or substantially) or had failed to meet the

objectives of the cooperative agreement. This outcome is reported here because it is the most

inclusive, but, in fact, similar findings were observed using criteria based on receipt of an NEP,

or level of activity, or level of resources, since these outcome were interrelated.

Eight of the nine networks that failed to meet (or only partially met) the objectives of the

cooperative agreements (on the part of the health department in resistance to accepting or

transferring matching funds) plus AL and WI which didn’t try to form a broader network]

encountered inter-organizational issues regarding leadership and resources that proved difficult

to resolve. (The problems involved a different set of organizations in each State.) This

association does not necessarily imply causality; but it does suggest that inter-organizational

issues deserve serious attention. In contrast, the lack of experience with FSP reimbursement

mechanisms was common among failed networks, but successful networks faced this problem as

well. This suggests that lack of experience in this area is something that can be addressed. 
Health Systems Research, Inc. Chapter VI Page 77 

Table VI-6.

Challenges Faced by Unsuccessful and Successful Networks

Challenge Unsuccessful Successful Networks Significance

Networks (n = 9) (n = 13)

n Percent n Percent Chi-sq. p

Significant difficulty identifying match 8 89% 3 23% 12.0 .001

Inter-organizational challenges 8 89% 3 23% 12.0 .001

Limited experience with social 8 89% 6 47% 6.2 .05

marketing

Primary grantee lacked experience with 6 67% 6 47% 1.9 n.s.

a reimbursement program 

Senior management turnover 4 50% 1 8% 6.9 .01

Turnover of Project Director 4 44% 2 15% 4.0 .05

Turnover of Network Coordinator 3 33% 4 31% 0.4 n.s.

Three or more challenges 6 67% 4 31% 4.4 .05

Four or more challenges 4 44% 2 15% 4.0 .05

Five or more challenges 4 44% 0 0.0 10.4 .001

Note: Unsuccessful networks were defined as networks that had not met, or had only partially achieved the

objectives of the cooperative agreements by the fall of 1998. Successful networks were defined as

networks that had substantially or fully achieved the objectives of the cooperative agreements. 

Networks were assessed in terms of attainment of the four objectives of the cooperative agreements. 

C. Lessons about Success

This evaluation identified a number of characteristics that contributed to the development of

effective nutrition education networks. For purposes of this analysis, the evaluation team

classified networks in terms of: (1) receipt of a nutrition education plan; (2) attainment of

objectives for the cooperative agreements (fully met, substantially met, partially met or failed to

meet); (3) the level of resources leveraged for network-related nutrition education activities

(controlling for the size of the food stamp population in the State); and (4) the level of nutrition

education activity resulting from the network. Although these criteria sound different, in
Health Systems Research, Inc. Chapter VI Page 78 

practice, they were highly interrelated; that is, networks that were successful in leveraging

resources were better able to support active social marketing efforts. 

The analysis of these findings, summarized in Table VI-7 and discussed in the sections that

follow, suggests that strengths in leadership, network approach, and resource management

contributed to the success of networks.

Table VI-7.

Characteristics Associated with Successful Networks

Characteristic (n = 13) (n = 9)

Successful Unsuccessful Significance

Networks Networks 

n Percent n Percent Chi-sq. p

Strengths of Leadership:

Experienced leadership team 10 77% 0 0% 9.8 .01

Support of senior management 6 46% 0 0% 3.6 .05.

Strengths of Approach:

Emphasis on partnerships 8 62% 0 0% 6.2 .05

Emphasis on complementary social 8 62% 0 0% 6.2 .05

marketing activities

Emphasis on local programs 9 69% 1 11% 5.1 .05

Strengths in Resource Management:

Multiple sources of match 6 46% 0 0% 3.6 .05

Resources for financial management 6 46% 0 0% 3.6 .05

Multiple Strengths:

Three or more strengths 10 77% 0 0% 9.8 .01

Six or more strengths 6 46% 0 0% 3.6 .05

4. Strength in Leadership

Experienced Leadership Teams. Active nutrition education networks uniformly benefitted

from experienced leadership teams. Leaders with prior experience with managing multi-agency
Health Systems Research, Inc. Chapter VI Page 79 

coalitions were able to forge strong relationships among network partners, to operate effectively

within governmental organizations, and to creatively identify sources of matching funding. 

Most (77 percent) of the successful networks, and all of the very active networks, were

characterized by experienced leadership teams. In contrast, none of the unsuccessful networks

had the benefit of an experienced leadership team for the duration of the demonstration project.

The operative term is leadership “teams.” In most networks, a Project Director and the

Network Coordinator worked closely together. It was common for one of those individuals to

be a “visionary” and for the other individual to bring operational expertise. It was not necessary

for both individuals to have both visionary and operational skills; but it did appear important

that the team encompass both types of expertise. The most active networks also included staff

with a variety of specialized skills in areas such as marketing, accounting, evaluation, and

organizational management.

As noted, one of the challenges that networks faced was succession planning. For instance,

about half of the networks had more than one person fill the role of network coordinator, and a

third of the networks had had more than one Project Director. Although most networks were

able to smoothly replace their network coordinators, those that lost a Project Director (to

retirement or transfer to another State), were at risk of becoming inactive, at least temporarily,

until someone was identified who could fill that role.

Strong Senior Management. The highly successful networks typically benefitted from strong

senior management support. Such support was manifest in enthusiasm for the program,

willingness to promote the program with other senior staff in State government and assistance,

if needed, in garnering the resources to support financial management associated with the

system. In some cases this was the person to whom the Project Director reported, in other

instances, it was a higher level senior manager within the government.
Health Systems Research, Inc. Chapter VI Page 80 

In contrast, inactive networks often encountered problems in maintaining senior management

support. In some States, support depended on a senior administrator who retired. In other

cases, it was difficult to convince senior managers to accept the challenges of obtaining

matching funds. The cooperative agreement mechanism provided a “honeymoon” period during

which the network could try to enlist the support of senior management. But if that support

was not evident by the time the cooperative agreement ended, then problems associated with

submitting an NEP proved difficult to resolve. 

Some networks were active even in the absence of senior management support. But in those

instances, the networks had strong support from managers of the State Food Stamp Program,

and network members worked to develop strong local linkages for ongoing support. 

Several networks also sought the support of a political patron such as the “Governor’s Wife.” 

This level person could serve as a useful spokesperson who could generate favorable publicity

for network activities and boost the morale of network participants. However, to have a major

effect on sustainability, this support needed to be coupled with the support of senior

management staff.

2. Strengths of Approach

Emphasis on Partnerships. One of the important elements of success was attention to

promoting activities across a variety of partners. Competition for match funds between

traditional food stamp nutrition education programs and the networks undermined several

networks’ ability to develop. This problem occurred in seven of the nine networks that failed or

only partially achieved the objectives of the cooperative agreements. Also, networks that have

primarily emphasized activities conducted by a single organization have not grown as rapidly in

terms of developing as many new nutrition education activities.

In contrast, the very active networks paid considerable attention to partnership issues. Seven of

the eight networks that fully achieved the objectives of the cooperative agreements were

characterized by the partners’ strong commitment to the network goals and objectives. These
Health Systems Research, Inc. Chapter VI Page 81 

networks worked to develop both common social marketing activities and to promote activities

to which each of various partners could contribute. For instance, the Colorado network used

the strengths of various partners in northern Colorado, in the Denver area, and in the San Luis

Valley area, working with Cooperative Extension, the health department, and the medical

school. The Maine nutrition network developed programs at the county level to support

collaboration between extension and local health services staff. The California nutrition

network used Project LEAN regional offices as locations from which to coordinate expanded

outreach to minority communities. The network had introduced major new programs originated

by the 5-A-Day coalition, by Project LEAN, and by the Department of Education, and was

looking to develop programs with the faith community. The North Carolina nutrition network

works with community programs covering more than 60 counties around the State.

Emphasis on complementary modes of nutrition education. Active networks had

developed innovative linkages with a variety of programs, tools, and channels to deliver

nutrition education messages. In theory, it would be possible for a network to be considered

very active if it had a major social marketing campaign even in only one program area. In

practice, however, active networks tended to engage in a variety of major programs to deliver

nutrition education. For instance, one network had a major initiative working with retail food

chains, special nutrition education targeted to minority populations, an active extension program

providing individually-directed education, and an overarching nutrition media and social

marketing campaign. Part of what made networks effective was that they not only helped

coordinate a number of programs, but also delivered common nutrition messages through

multiple channels in ways that reinforced each other. These programs recognized that social

marketing could compliment one-on-one and small group education efforts, and that an

integrated approach would be most effective in promoting behavior change. 

Emphasis on growth of community nutrition education programs. A key characteristic of

highly active networks was their effort to develop and expand local nutrition education

programs. For instance, the Maine Nutrition Network developed effective linkages at the

community level across extension, public health, and Area Agencies on Aging that were helping

to develop long term linkages to support community-based nutrition education. The North
Health Systems Research, Inc. Chapter VI Page 82 

Carolina network developed mini-grant procedures to encourage grant applications for

innovative nutrition education from community organizations throughout the State. Several

growing networks have found it helpful to commit development time to one new area each year. 

As one component is solidly in place, the network then made a concerted effort in another area

(for instance, launching a general series of community organization incentive grants, and then

once that effort was well underway, starting to develop more specialized outreach, such as work

with faith communities or with food banks). 

3. Strengths in Resource Management

Innovative Approaches to Identify Matching Funds. Highly active programs have been

creative in identifying sources of match. For instance, one State network developed procedures

to qualify teacher time in low-income school districts as matching funds. A Cooperative

Extension-led network developed a set of procedures and an internal technical assistance

manual to help county nutrition programs to identify sources of match to support local

programs. The key to one large network program was a strategy of offering county and local

government programs a 50/50 incentive to identify matching funds for nutrition education. 

Under this procedure, for each dollar that a local program identified as being countable for

matching funds, the local program received $0.50 back to increase its nutrition education

activities, while the other $0.50 went to the network for uses such as accounting, State level

initiatives (such as a media campaign), and further development (such as outreach to the faith

communities). This incentive encouraged county and local programs to participate in the

nutrition education process. Network partners were pleased that these incremental funds

allowed them to increase the resources they had to work with low-income populations.

Attention to Financial Management. Active and successful networks devoted considerable

attention and provided staff resources to respond to financial management. This proved a

particular challenge to agencies such as health departments that were not used to this funding

mechanism, (i.e., reimbursement for documented match) and so had to develop the accounting

systems to handle it. 
Health Systems Research, Inc. Chapter VI Page 83 

Several States offered useful examples of careful approaches to financial management. For

instance, the North Carolina Nutrition Network developed a manual to help local programs to

identify and document matching procedures. The Maine Nutrition Network developed

streamlined procedures to allow local schoolteachers to document training and classroom time

devoted to nutrition education. The California Nutrition Network hired an accounting manager

who had worked with reimbursement programs with another department. The network also

hired a consultant who had developed procedures for reimbursement programs and had him

adapt accounting software to document matching contributions. The accounting and the

contracts units of the health department met jointly with representatives of the State Food

Stamp Program to make sure all their accounting procedures were effective. The work of the

network in establishing what they considered to be an “audit-proof” accounting system proved

important in persuading State and Regional FSP staff to approve the network’s procedures for

documenting the matching contributions in their NEP. 

It appeared that a combination of these strengths, rather than any single factor, allowed

networks to meet the challenges that they faced and achieve the success that is encouraging the

continued growth of the program.

D. Conclusion

Sixty percent of networks were able to achieve the goals of the cooperative agreements in terms

of developing a Statewide nutrition education network, developing and implementing social

marketing efforts to increase delivery of nutrition education to low-income populations, and

submitting a nutrition education plan that was approved and resulted in ongoing funding of the

networks. The networks that met these objectives reported important accomplishments. The

networks succeeded in leveraging more that $20 million in non-Federal funding for nutrition

education during 1998; most of the networks conducted needs assessments and many had

launched multifaceted social marketing efforts. The efforts encompassed schools, broadcast and

print media, newsletters to food stamp participants, and outreach to minority, elderly, and

underserved populations.
Health Systems Research, Inc. Chapter VI Page 84 

The networks often faced challenges posed by limited experience with the reimbursement

mechanism, difficulty in finding matching funding, and lack of experience with social marketing. 

In some cases, these barriers—particularly if they were accompanied by turnover of a Project

Director—resulted in failure of the network to flourish. Networks also had to pay careful

attention to challenges of inter-organizational teamwork. These barriers were not

insurmountable, however. Experienced network leadership; strong senior management support;

attention to identifying sources of match and to financial management; and an emphasis on

partnership, complementary modes of social marketing, and development of community

programs provided strengths that helped the networks to achieve their objectives. Application

of these lessons could help to strengthen and increase the delivery of nutrition education to lowincome populations.
Health Systems Research, Inc. References

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Health Systems Research, Inc. Glossary

Glossary

Glossary of Terms

Abbreviation and/or Name Definition

Cooperative Agreements These were cooperative agreements awarded to States in 1995 and

1996 to support the development of Statewide nutrition education

networks

Cooperators This refers to the organizations supported by the award of a

cooperative agreement to the State Food Stamp Program to support

development of Statewide Nutrition Education Networks

Cooperative Extension The county and State university extension organization affiliated

with the Cooperative State Research Education and Extension

Service (CSREES)

Dietary Guidelines for Americans These are the guidelines illustrated in the USDA Food Pyramid

FNP Family Nutrition Program The term used by some States to refer to the Cooperative Extension

component of the State Food Stamp Nutrition Education Program.

FNS Food and Nutrition Service The organization that administers the Food Stamp Program

FSNEP Food Stamp Nutrition This term refers to nutrition education programs supported by the

Education Plan USDA School Lunch Program.

FSP Food Stamp Program The USDA organization that administers the Food Stamp Program.

NEP Nutrition Education Plan The nutrition education plan submitted to and approved by the Food

Stamp Program to support approved nutrition education activities

under the State’s Food Stamp Program Plan of Operations. 

NET Nutrition Education and This program provides training for nutrition education related to

Training Program USDA school lunch programs.

Primary Grantee This refers to the lead organization awarded funding by the State

Food Stamp Program under the cooperative agreements.

Social marketing A comprehensive, audience-centered approach involving multiple,

reinforcing channels of communication and environmental change

to promote healthy behavior. 

State’s Food Stamp Program Plan of This is the plan submitted by the State Food Stamp Program that

Operations. once approved by FNS becomes the basis for expenditure of

administrative funds by the State Food Stamp Program.

WIC Supplemental Nutrition Program for Women, Infants, and Children
Health Systems Research, Inc. Glossary