Identifying Barriers and Facilitators of the Expanded Food and Nutrition Education Program Participation

Identifying Barriers and Facilitators of the Expanded Food and Nutrition Education Program Participation Identifying Barriers and Facilitators of the Expanded Food and Nutrition Education Program Participation Approximately fifty percent of cardiovascular disease-related morbidity and mortality have been attributed to nutrition insecurity. Nutrition insecurity is characterized by sub-optimal diet quality and unsafe food practices and often co-occurs with food insecurity. In 2016, about 40% of adults with income above 130% of the federal poverty level had poor diet quality compared to approximately 60% of adults with income at or below 130% of the federal poverty level. The high prevalence of poor nutrition among low-income individuals highlights the need for interventions that aim to improve diet quality such as nutrition education interventions. Food pantries provide emergency food assistance to community members and are uniquely positioned to address poor diet quality among vulnerable populations. Food pantries can target poor diet quality by providing access to healthy food options. Food pantries can also equip clients with nutrition education that aims to increase their willingness to choose healthy food options when available, as well as management of limited food resources. Increasing access to nutrition education is critical given the documented evidence of improved nutrition outcomes, such as diet quality, safe food practices, and food resource management, among individuals who participate in nutrition education. Further food pantries occasionally employ community health workers (CHWs) to assist clients with addressing other social or health needs through navigation to other community resources. Training CHWs to deliver evidence-based nutrition education or navigate clients to such programs has the potential to improve diet quality among food pantry clients. The USDAs Expanded Food and Nutrition Education Program (EFNEP) is an evidence-based nutrition education program that targets low-income community members. EFNEP can be delivered by professionals and paraprofessionals. EFNEP aims to address nutrition insecurity by providing interactive nutrition and physical activity education to low-income populations. About 93% of EFNEP participants report improved dietary quality. EFNEP participation has been associated with a seven-point increase in adjusted Health Eating Index-an index that assesses adherence to dietary guidelines. EFNEP participation has also been shown to improve food security, physical activity, and resource management. Despite the demonstrated positive effect of EFNEP, the program reach remains sub-optimal. In 2021, EFNEP reached about 200,000 low-income adults and 450,000 low-income youth which is less than three percent of the 25.6 million adults living in poverty. There is inadequate information regarding barriers and facilitators to EFNEP delivery or referral by agencies that work with low-income community members such as food pantries. There is also limited information regarding barriers and facilitators of EFNEP participation among low-income community members. My long-term goal is to increase participation in evidence-based nutrition education programs by food pantry clients while leveraging community resources and partnerships to increase the availability of healthy and nutritious food at local food pantries. This small research project (SRP) will build upon my current research that seeks to identify determinants of healthcare use and health outcomes among food pantry clients and to implement nutrition interventions to improve health behavior and health outcomes among food pantry clients. This SRP will advance this area of research inquiry using the following aims: Specific Aim 1: To identify barriers and facilitators to EFNEP delivery or referral by food pantry personnel. We will conduct semi-structured interviews with 5-10 food pantry and EFNEP personnel using an interview guide informed by the Capability, Opportunity, Motivation, Behavior (COM-B) framework. Specific Aim 2: To identify barriers and facilitators to EFNEP participation by food pantry clients. We will conduct semi-structured in-depth interviews with 10 food pantry clients. The interview guide will also be developed using the COM-B framework.