A Mixed-Method Evaluation of Local Community Health Education on Food Intake and Behavior Change

Principal Investigator:  Kim Tippens, ND, MSAOM, MPH
Student Investigator: Bob Graybill


Introduction: Cooking nutritious meals is an important part of maintaining health.  With levels of obesity, diabetes, and other preventable diseases rising, public health programs that focus on nutrition and cooking education are becoming more common.  It is important to understand the motivations and barriers of participants in these programs to support behavior change.

Methods: This study offers a mixed methods analysis of participants’ experiences with the Food as Medicine Everyday (FAME) classes taught in northwest Oregon from 2013-2015.  Surveys including the FAME Assessment Survey (FAS), designed for this class and the Patient Activation Measure (PAM) were collected at the beginning and the end of the 12-week class.  Semi-structured interviews were conducted with a sub-group of participants and analyzed using thematic analysis by the research team.

Results: Thirty-Four individuals completed the surveys.  Participants reported a significant decrease in eating at restaurants and an increase in cooking at home as well as an increase in total whole grain consumption.  Non-significant trends showed an increase in total vegetable consumption and decrease in refined grain consumption. There was also a small but significant increase in patient activation level, studied by the Patient Activation Measure survey (PAM).  Eight individuals completed the semi-structured interviews which gave insight into each participant’s motivations for health and food behavior changes and the barriers impeding these changes.  Primary motivators for food behavior change and taking the FAME class were health concerns and a desire to change food choices.  Chief barriers to behavior change included time management, organization, a lack of knowledge and self-reporting oneself as a poor cook.  These barriers can be mitigated and changes facilitated by the structure of the class and the importance of family, friends and peer participation.

Conclusions: According to the limited survey responses and the interviews, participants in the FAME classes successfully implement some targeted food behavior changes including cooking more at home, reducing meals out at restaurants and changing food choices  Further research is needed to determine exactly which food behaviors change.  Our findings underscore the importance of nutrition education and cooking programs that encourage partnering and family involvement and focus on not only food preparation but food selection and shopping.