Research to support the development and evaluation of a new EFNEP curriculum for high school aged adolescents: Rev It Up!
Creators: name: Bastian, Graham Eric
Publisher: name: No Publisher Supplied
Year: 2022

description: U.S. high schoolers exhibit poor nutrition-related behaviors. They have the lowest diet quality of any age group (Healthy Eating Index = 51/100) and three-quarters do not meet physical activity guidelines. Poor nutrition-related behaviors are typically more prevalent in high schoolers from low income households. Despite low-income high schoolers being an ideal target audience for nutrition education, they are currently underserved by the Expanded Food and Nutrition Education Program (EFNEP). Nationwide, only 4% of youth who complete an EFNEP lesson series each year are in grades 9-12. To address the need to reach more low-income high schoolers through EFNEP education, the Rev It Up! curriculum was developed by Dr. Palmer-Keenan and her research group at Rutgers University, starting in 2014. Rev It Up! is a 10-lesson curriculum informed by the Theory of Planned Behavior that employs gamification to introduce and reinforce nutrition and physical activity concepts. Although Rev It Up! had previously undergone extensive field testing, several development and evaluation needs still existed. The purpose of this dissertation project was to address these needs through 3 distinct research projects that were each summarized as distinct chapters that appear in journal manuscript format. First, a narrative literature review was conducted from March to September 2021 to identify ways sustainable diet education could be incorporated into nutrition education, with the purpose of informing such a lesson for Rev It Up! The review resulted in 5 recommendations for nutrition educators: 1) shift towards a plant-based diet, 2) mitigate food waste, 3) limit consumption of ultra-processed foods, 4) engage in local food systems, and 5) choose sustainable seafood. Each recommendation is discussed in detail within the dissertation. Second, a revised EFNEP evaluation questionnaire for participants in 6th-12th grade was developed and research-tested for use in curriculum assessment. The research necessary to complete it used a previously identified 5-step process: 1) domain concept prioritization, 2) question generation, 3) question pretesting, 4) reliability testing, and 5) criterion validity testing. Steps 1 and 2 were conducted by an EFNEP workgroup, in which the author participated. Step 3 was conducted by the author via cognitive interviews with low-income 6th-12th graders (N=14). Steps 4 and 5 were conducted by the author via a secondary analysis of NJ EFNEP program data from 9th-12th grade participants (N=164). Exploratory factor analysis, inter-item correlations, and Cronbach’s α were used for reliability analysis and Spearman correlations and Bland-Altman plots were used for criterion validity analysis. The research resulted in a 13-item scale with 4 factors. Cronbach α values (0.53-0.75) and Spearman ρ values (0.30-0.55) were deemed acceptable, and results were corroborated by the inter-item correlations and Bland-Altman plots. Finally, an impact evaluation of Rev It Up! was conducted using a secondary analysis of NJ EFNEP program data with 9th-12th graders who completed a lesson series (n=190). Paired t-tests with the entire sample indicated significant improvements in reported decreased sugar-sweetened beverage (SSB) consumption (mean change = -0.42±1.23, p &lt;0.001), but no improvements in reported vegetable consumption or moderate-to-vigorous physical activity (MVPA). Yet, when subgroup analyses were conducted with only youth who could improve their self-reports from pre- to post-test (vegetable N=161, SSB N=168, MVPA N=173), significant improvements were found for all 3 behaviors (vegetable mean change = 0.22±0.95, p&lt;0.01; SSB mean change = -0.56±1.20, p&lt;0.001; MVPA mean change = 0.29±1.95, p=0.05). Overall, the project resulted in 3 outputs. First, the research base for a sustainability-focused Rev It Up! lesson was enhanced. Second, the EFNEP 6th-12th grade questionnaire was revised, and evidenced acceptable validity and reliability for use in assessing the curriculum, as well as by the program nationally. Finally, the evidence base for Rev It Up! was evaluated using a subgroup analysis which may be more reflective of the curriculum’s “true” impact than previous evaluations. Further discussion is included on future research needs and overall evaluation needs in nutrition education and behavior.