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Online WIC Nutrition Education to Promote Farmers' Market Fruit and Vegetable Purchases and Consumption

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ClinicalTrials.gov Identifier: NCT02565706
Recruitment Status : Completed
First Posted : October 1, 2015
Results First Posted : October 30, 2019
Last Update Posted : October 30, 2019
Sponsor:
Collaborator:
USDA Food and Nutrition Service
Information provided by (Responsible Party):
Jennifer Di Noia, William Paterson University of New Jersey

Brief Summary:
This study is evaluating the WIC Fresh Start program, a theory-driven, web-based nutrition education lesson to promote farmers' market fruit and vegetable purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).

Condition or disease Intervention/treatment Phase
Cardiovascular Diseases Cancer Type 2 Diabetes Obesity Behavioral: WIC Fresh Start Program Behavioral: Existing Online Health Education Not Applicable

Detailed Description:
This study is evaluating the WIC Fresh Start program, a theory-driven, web-based nutrition education lesson to promote fruit and vegetable (FV) consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Designed to leverage vouchers provided to WIC participants for FV purchases through the Farmers' Market Nutrition Program (FMNP) and monthly cash value vouchers (CVVs) redeemable at farmers' markets, the lesson is conceptually grounded in formative research on knowledge, attitudes and skills influencing farmers' market FV purchases and consumption and theoretical understanding of approaches for modifying them. Lesson content delivery is primarily through short video segments and audio output to increase accessibility for low-literate learners. Informed by a community-based participatory research approach, WIC participants are engaged as full partners in the development of the lesson and the delivery of content (videos feature WIC participants). The setting is a large WIC agency serving three New Jersey counties. Separate samples of women were recruited to participate in 1) focus groups for guiding lesson content development (N = 56 participants) and pretesting the resulting content (N = 52 participants), 2) cognitive testing to assess the clarity and interpretability of items and response formats in measures of knowledge, attitudes and skills developed for the study (N = 15), 3) one-on-one sessions to assess reactions to initial versions of video segments developed for the lesson (N = 20), and 4) the outcome evaluation (N = 744). Stratified based on FMNP voucher receipt, participants are randomized to receive the lesson or existing online health education. Outcome measures (administered orally to reduce literacy demands of the response task) are completed at pretest (immediately before the lesson), posttest (two weeks after the lesson), and 3 and 6 months after posttesting. Short- and long-term lesson effects on FV intake, FMNP voucher redemption and the redemption of CVVs at farmers' markets will be evaluated. Evidence for mediation by knowledge, attitudes, and skills of lesson effects on FV intake and voucher redemption, dose-response relationships, and user satisfaction with the lesson also will be examined.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 744 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Online WIC Nutrition Education to Promote Farmers' Market Fruit and Vegetable Purchases and Consumption
Study Start Date : July 2014
Actual Primary Completion Date : June 2016
Actual Study Completion Date : June 2016

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: WIC Fresh Start Program
Participants in this arm receive the Fresh Start program.
Behavioral: WIC Fresh Start Program
The intervention is an online lesson to promote farmers' market FV purchases and consumption. The lesson comprises three modules, each consisting of 1) behavior change content presented through a video segment featuring WIC participants, and 2) an interactive activity to build targeted knowledge, attitudes, and skills.

Active Comparator: Existing Online Health Education
Participants in this arm receive existing online WIC health education.
Behavioral: Existing Online Health Education
Any of seven existing online WIC health education lessons (lessons are available on breastfeeding, being active, fruits and vegetables, calcium, cholesterol, oral health and iron). The lessons consist of an introductory segment presented with online text and graphics. After reading this material, viewers have the option to complete one of four lesson activities. The activities provide opportunities for viewers to read further on the topic and are designed to reinforce key points of the lesson.

Experimental: WIC Fresh Start Program (FMNP)
Participants in this arm receive the Fresh Start program and WIC Farmers' Market Nutrition Program (FMNP) vouchers redeemable at farmers' markets.
Behavioral: WIC Fresh Start Program
The intervention is an online lesson to promote farmers' market FV purchases and consumption. The lesson comprises three modules, each consisting of 1) behavior change content presented through a video segment featuring WIC participants, and 2) an interactive activity to build targeted knowledge, attitudes, and skills.

Active Comparator: Existing Online Health Education (FMNP)
Participants in this arm receive existing online WIC health education and WIC Farmers' Market Nutrition Program (FMNP) vouchers redeemable at farmers' markets.
Behavioral: Existing Online Health Education
Any of seven existing online WIC health education lessons (lessons are available on breastfeeding, being active, fruits and vegetables, calcium, cholesterol, oral health and iron). The lessons consist of an introductory segment presented with online text and graphics. After reading this material, viewers have the option to complete one of four lesson activities. The activities provide opportunities for viewers to read further on the topic and are designed to reinforce key points of the lesson.




Primary Outcome Measures :
  1. Number of Participants Who Redeemed FMNP Vouchers [ Time Frame: 6 months (2015 farmers' market season [June to November 2015]) ]
    The state WIC agency is providing data on FMNP voucher redemption.

  2. Frequency of Fruit and Vegetable Intake [ Time Frame: Pretest, posttest (2 weeks after pretest), and 3- and 6-month follow-up ]
    Times per day fruits and vegetable are consumed as assessed by a validated food frequency questionnaire.

  3. Quantity of Fruit and Vegetable Intake [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Cups per day consumed of fruits and vegetables as assessed by a validated fruit and vegetable screener.


Secondary Outcome Measures :
  1. Number of Participants Who Redeemed Cash Value Vouchers at Farmers' Markets [ Time Frame: 6 months (2015 farmers' market season [June to November 2015]) ]
    The state WIC agency is providing data on cash value voucher redemption.

  2. Response to Survey Items Assessing Knowledge of the WIC Farmers' Market Nutrition Program Using a True/False Format. [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Index of Knowledge of the FMNP Score range: 0-6 Higher scores indicates greater knowledge

  3. Response to an Item Assessing Knowledge of WIC-authorized Farmers' Markets Using a Yes/no Format. [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Knowledge of a farmers' market with farmers approved by WIC to accept WIC farmers' Market Nutrition Program and Cash Value vouchers Scores: No (0) and yes (1). Higher scores (yes responses) indicate that the respondent knows of a farmers' market with farmers approved by WIC to accept WIC farmers' Market Nutrition Program and Cash Value vouchers. Odds ratios and 95% confidence intervals indicate the likelihood of the outcome (knowledge of such markets) among those in the WIC Fresh Start (FMNP) arm relative to the comparator arm.

  4. Response to Survey Items Assessing Attitudes Towards Farmers' Market Fruits and Vegetables Using 7-point Likert Rating Scales. [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Attitudes towards Farmers' Market Fruits and Vegetables Score range: 6-42 Higher scores indicate more favorable attitudes

  5. Response to Survey Items Assessing Awareness of Locally Grown, Seasonal Fruits and Vegetables Using a Yes/no Format. [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Familiarity with Locally Grown Seasonal Items Score range: 0-3 Higher scores indicate greater familiarity

  6. Response to Survey Items Assessing Fruit and Vegetable Food Safety Skills Using 7-point Likert Rating Scales. [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Fruit and Vegetable Food Safety Skills Score range: 19-85 Higher scores indicate greater skills

  7. Response to Survey Items Assessing Farmers' Market Asking Skills Using a Yes/no Format. [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Farmers' Market Asking Skills Score range: 0-3 Higher scores indicate greater skills

  8. Response to Survey Items Assessing Positive Outcome Expectations for Consuming Locally Grown Fruits and Vegetables Using a Yes/no Format. [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Positive Outcome Expectations for Consuming Locally Grown Fruit and Vegetables Score range:0-3 Higher scores indicate more favorable ratings

  9. Response to an Item Assessing Whether the Participant Ever Purchased Fruits and Vegetables at a Farmers' Market Using a Yes/no Format. [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Lifetime Farmers' Market Fruit and Vegetable Purchases Scores: No (0), Yes (1). Higher scores (yes responses) indicate indicate that the respondent has ever purchased fruits and vegetables at a farmers' market. Odds ratios and 95% confidence intervals indicate the likelihood of the outcome (having ever purchased fruits and vegetables at a farmers' market) among those in the WIC Fresh Start (FMNP) arm relative to the comparator arm.

  10. Response to Survey Items Assessing Farmers' Market Fruit and Vegetable Preparation Skills Using 7-point Likert Rating Scales. [ Time Frame: 2 weeks ]
    Farmers' Market Fruit and Vegetable Preparation Skills Score range:12-84 Higher scores indicate greater skills

  11. Response to an Item Assessing Whether the Participant Purchased Fruits and Vegetables at a Farmers' Market in the Past Two Weeks Using a Yes/no Format. [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Recent Farmers' Market Fruit and Vegetable Purchases Scores: No (0), Yes (1). Higher scores (yes responses) indicate that the respondent purchased fruits and vegetables at a farmers' market in the past two weeks. Odds ratios and 95% confidence intervals indicate the likelihood of the outcome (having purchased fruits and vegetables at a farmers' market in the past two weeks) among those in the WIC Fresh Start (FMNP) arm relative to the comparator arm.

  12. Response to an Item Assessing Behavioral Intentions to Purchase Fruits and Vegetables at a Farmers' Market in the Next Two Weeks Using a Yes/no Format. [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Intentions to Purchase Fruits and Vegetables at a Farmers' Market Scores: no (0), Yes (1). Higher scores (yes responses) indicate that the respondent intends to purchase fruits and vegetables at a farmers' market in the next two weeks. Odds ratios and 95% confidence intervals indicate the likelihood of the outcome (intending to purchase fruits and vegetables at a farmers' market in the next two weeks) among those in the WIC Fresh Start (FMNP) arm relative to the comparator arm.

  13. Response to Survey Items Assessing Knowledge of Locally Grown Seasonal Fruits and Vegetables Found at Farmers' Markets in July Using a Yes/no Format. [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Knowledge of Locally Grown Seasonal Fruits and Vegetables found at Farmers' Markets in July Score range:0-9 Higher scores indicate greater knowledge

  14. Response to Survey Items Assessing Food-specific Knowledge Using a True/False Format [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Food-specific Knowledge Score range: 2-13 Higher scores indicate greater knowledge

  15. Response to Survey Items Assessing Knowledge of Area Farmers' Markets [ Time Frame: Pretest, posttest, and 3- and 6-month follow-up ]
    Farmers' Market-specific Knowledge Score range:0-2 Higher scores indicate greater knowledge



Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Pregnant or postpartum WIC participant
  • Female caregiver of infant/child WIC participant

Exclusion Criteria:

  • Restrictions on food intake
  • Classified by WIC as high risk/requiring an individualized nutrition care plan

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02565706


Locations
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United States, New Jersey
Saint Joseph's WIC Program
Paterson, New Jersey, United States, 07524
Sponsors and Collaborators
William Paterson University of New Jersey
USDA Food and Nutrition Service
Investigators
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Principal Investigator: Jennifer Di Noia, PhD Professor, Department of Sociology, William Paterson University

Publications of Results:
Di Noia, J., Monica, D., Sikorskii, A., & Cullen, K. W. (2017). Outcomes of a randomized controlled trial of nutrition education to promote farmers' market fruit and vegetable purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). BMC Nutrition, 3, 48. doi:10.1186/s40795-017-0172-0

Other Publications:
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Responsible Party: Jennifer Di Noia, Professor, William Paterson University of New Jersey
ClinicalTrials.gov Identifier: NCT02565706     History of Changes
Other Study ID Numbers: WIC NEI-12-TX
First Posted: October 1, 2015    Key Record Dates
Results First Posted: October 30, 2019
Last Update Posted: October 30, 2019
Last Verified: October 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: The data sets used and/or analyzed during this study are available from the corresponding author on reasonable request.
Time Frame: Data are available for sharing.
Access Criteria: Contact the PI with requests (dinoiaj@wpunj.edu).
Keywords provided by Jennifer Di Noia, William Paterson University of New Jersey:
Fruit, vegetables, income, WIC program, farmers' market
Additional relevant MeSH terms:
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Cardiovascular Diseases