Development and Implementation of Food Literacy Workshops in the Community

Study Overview
=================
Brief Summary
-----------------
Nutritional factors are responsible for 10% of the global health burden. In Israel, 31% of Jewish women and 52% of Arab women are obese. It is predicted that this generation will see increased cardiovascular disease (CVD) and decreased life expectancy. Sustained lifestyle changes including small changes in nutrition behavior, can substantially reduce the risk of CVD. Eating habits are affected by different abilities, circumstances, and skill sets, however, most nutrition programs focus on nutrition facts, and less on skills that can help translate knowledge to positive health behaviors and health outcomes. In the last decade a new field has emerged, Food literacy (FL), which acknowledges the importance of addressing skills such as nutrition knowledge, competencies, self-efficacy, literacy and health literacy, so as to enable positive change in nutrition behaviors. Food literacy, in summary, is the capability to make healthy food choices in different contexts, settings and situations. The proposed program seeks to improve nutrition behaviors in disadvantaged communities via a train-the-trainers program, that will provide community leaders with the tools necessary to disseminate FL skills through the framework of existing community social-structures.

Detailed Description
-----------------
Nutritional factors are responsible for 10% of the global health burden. In Israel, 31% of Jewish women and 52% of Arab women are obese. Diabetes rates are rising in accordance with the rise in obesity. Because of these factors, it is predicted that this generation will see increased cardiovascular disease (CVD) and decreased life expectancy. Sustained lifestyle changes including small changes in nutrition behavior, can substantially reduce the risk of CVD. Eating habits are affected by different abilities, circumstances, and skill sets, however, most nutrition programs focus on nutrition facts, and less on skills that can help translate knowledge to positive health behaviors and health outcomes. In the last decade a new field has emerged, Food literacy (FL), which acknowledges the importance of addressing skills such as nutrition knowledge, competencies, self-efficacy, literacy and health literacy, so as to enable positive change in nutrition behaviors. FL, in summary, is the capability to make healthy food choices in different contexts, settings and situations. The proposed program seeks to improve nutrition behaviors in disadvantaged communities via a train-the-trainers program, that will provide community leaders with the tools necessary to disseminate food literacy skills through the framework of existing community social-structures. In stage I of the study, community lay leaders from pre-existing community frameworks of Belz Hasidic Haredi community and Arab lay leaders from East Jerusalem will undergo training in a manualized program that enables lay leaders to effectively disseminate FL skills through engaging visual and game-based tools.In stage II the lay leaders will implement the program in their communities.

Official Title
-----------------
Development and Implementation of Food Literacy Workshops in the Community

Conditions
-----------------
Lifestyle Risk Reduction, Health Behavior, Food Habits

Intervention / Treatment
-----------------
* Behavioral: FL lay leader training and workshop implementation


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Women who are recognized leaders in the community Participants for the Arab training program must speak and read Arabic Participants for the Belz training program must speak and read Hebrew Exclusion Criteria: Arab women from East Jerusalem who do not meet leadership criteria Belz women who are not established community group leaders

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Interventional Model Description: This study includes a pre/post study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lay leader training in FL intervention<br>Community lay leaders from pre-existing community frameworks will undergo training in a manualized program that enables lay leaders to effectively disseminate food literacy skills through engaging visual and game-based tools in a food literacy workshop. Post training, lay leaders will implement the food literacy workshop in their communities. | Behavioral: FL lay leader training and workshop implementation<br>* Intervention components will include a training course for community lay leaders, enabling them to acquire the skills to lead food literacy workshops. This includes raising their knowledge about nutrition recommendations and food labels, raisin self efficacy, and improving nutrition related organization and preparation skills.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Mediterranean Diet adherence | Women complete self report survey reporting on their eating habits, including consumption of sweets, sweet beverages, fruits and vegetables, whole grains, and legumes. | At baseline and three months after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the level of food literacy | Level of food literacy will be assessed by using a food literacy self report scale based on Poelman's Self-Perceived Food Literacy (SPFL) questionnaire (Poelman et al, 2018). | At baseline and three months after intervention | 
| Change in lay leaders' Self Efficacy: self report questionnaire | Self Efficacy will be assessed through self report questionnaires, assessing participants self-efficacy in facilitating the food literacy material to target populations among trainers. | At baseline and three months after intervention | 
| FL workshops in the community | Each lay leader will have implemented a FL workshop in their community, within a year of graduating the FL-lay leader training course. This will be assessed through phone interviews with the participants and research staff supervision. | One year post intervention | 
| Change in Attitude to diet | Attitude to diet will be assessed by using a self report scale based on C.Pettinger's Attitude to Diet questionnaire (Pettinger, Holdsworth, Gerber, 2004). | At baseline and three months after intervention |