Research Brief
Evaluation and Lessons Learned From the Development and Implementation of an Online Prenatal Nutrition Training for EFNEP Paraprofessionals

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Abstract

Objective

Design, implement, and evaluate the effectiveness of a video-based online training addressing prenatal nutrition for paraprofessional peer educators.

Methods

Quasi-experimental pre-posttest study with 2 groups of paraprofessionals working for the Expanded Food and Nutrition Education Program in 17 states and US territories: intervention (n = 67) and delayed intervention comparison group (n = 64). An online training was systematically developed using Smith and Ragan's instructional design model, the Cognitive Theory of Multimedia Learning, principles of adult learning, and selected constructs of the Social Cognitive Theory. Changes in knowledge, identification of inappropriate teaching practices, and self-efficacy, were assessed. Within- and between-group comparisons were done using ANCOVA.

Results

The intervention group scored significantly higher (P < .05) in all evaluations compared with preassessments and the comparison group. After delayed intervention, the comparison group scored significantly higher (P < .05) than in preassessments. Paraprofessionals reacted positively to future online trainings and were interested in them.

Conclusions and Implications

A video-based online training is an effective method to complement in-person trainings to prepare paraprofessionals to teach nutrition lessons.

Introduction

For almost 50 years, the Expanded Food and Nutrition Education Program (EFNEP) has hired and trained paraprofessionals (peer educators).1 The purpose of training people indigenous to the vulnerable communities EFNEP serves has been twofold: to facilitate rapport with program participants and give paraprofessionals skills to improve their health and income status.2 In EFNEP, nutrition education professionals train and supervise the paraprofessional educators,1 a process used in other community nutrition education programs including the Special Supplemental Nutrition Program for Women, Infants, and Children.3

Training paraprofessionals is a continuous responsibility with many challenges requiring significant commitments of time and program resources. During the 2014 annual conference of the Society for Nutrition Education and Behavior, EFNEP coordinators expressed concerns about the quality of paraprofessional supervision. In 2015, an EFNEP paraprofessional supervision committee was formed. This committee delineated paraprofessional supervisors’ responsibilities, as well as traits and skills needed to accomplish those responsibilities.4

In addition to managing day-to-day program implementation, supervisors face the challenge of providing comprehensive initial trainings to newly hired paraprofessionals. Initial training for EFNEP paraprofessionals typically addresses program policies, paperwork, recruitment strategies, nutrition content, and curriculum training.5 Because paraprofessionals work in geographically dispersed communities, it is difficult to schedule trainings and manage costs.5, 6 Additional challenges include the need to tailor in-person ongoing training to a heterogeneous group of paraprofessionals. Previous studies reported wide variations in paraprofessional age, race/ethnicity, and formal education.7, 8, 9 The lessons that EFNEP delivers are revised and updated to reflect changes in the Dietary Guidelines for Americans.10 Paraprofessionals must be retrained as curricula are revised.

Furthermore, the training of paraprofessionals is inconsistent nationally,5 even among states using the same curriculum.11 In EFNEP no specific curriculum is required, but a few curricula are used widely across the country.10 However, curricula rarely include instructions on how to train paraprofessionals.10 When aggregated national program data are used, as is done in EFNEP,1 a lack of consistency in training threatens the fidelity of lesson delivery and undermines confidence in program evaluation data.

Online trainings could mitigate many training challenges while being tailored for heterogeneous users. Geographically dispersed employees can access online trainings from their local offices. Online trainings are easier to update and faster to disseminate, and although initial developmental costs can be high, development costs can be quickly offset as larger numbers of employees complete that training.12 Curricula developers could also offer online trainings nationwide to supervisors buying their curricula to facilitate the consistent training of paraprofessional educators.

Identification of best practices is needed for the development, implementation, and evaluation of the effectiveness of online trainings before widespread online trainings are adopted for paraprofessionals within national nutrition education programs. One report showed significant improvements between pre- and post-evaluations and determined that the online training was less costly than in-person training.6 However, that study included only 22 newly hired paraprofessionals and no comparison group.6 Studies with larger samples and inclusion of a comparison group are needed to provide data to better inform the design of online trainings. Furthermore, interviews with paraprofessionals and their supervisors indicated that an online training would enhance teaching self-efficacy; thus, evaluations of this construct might be considered.11 Christofferson et al6 included 1 question addressing self-efficacy. Moreover, the evaluated training was an online certification program to train paraprofessionals on basic nutrition knowledge (important for staff development), but paraprofessionals were not trained on how to teach a curriculum.6 Also, an action step the EFNEP paraprofessional supervision committee identified was that supervisors should provide training virtually and record training programs for future use.4

The objective of this research was to develop, implement, and evaluate a theory-based online training for EFNEP paraprofessionals to prepare them to teach a prenatal nutrition lesson. This investigation is beneficial because, to the authors' knowledge, published information does not exist on evaluations of video-based online trainings for EFNEP paraprofessionals that train them how to teach nutrition lessons. Lessons learned from developing and implementing this online training are included as supplementary information to help EFNEP professionals develop effective online trainings for paraprofessionals. Furthermore, other nutrition education programs using paraprofessionals, such as the Special Supplemental Nutrition Program for Women, Infants, and Children, may benefit from this evaluation guiding supervisors in adopting or creating online trainings for paraprofessionals.

Section snippets

Methods

This was a quasiexperimental pre-posttest research design involving a convenience sample of EFNEP paraprofessionals in multiple states assigned to intervention or delayed intervention (comparison) groups. Paraprofessionals completed an online training addressing the Eating Smart and Being Active During Pregnancy lesson; the training included multiple assessments. This study was approved by the Colorado State University Institutional Review Board.

Results

Table 1 displays paraprofessionals’ demographic characteristics; these did not differ by group. There was a wide range of years of EFNEP experience (<1 to >11 years) and ages; most paraprofessionals were aged ≥42 years. Most paraprofessionals had at least some college education (94%) and indicated that English was their primary language (80%). Most educators had taught at least 1 lesson from the ESBA curriculum (85%) but the large majority had not received training on the Eating Smart and Being

Discussion

This investigation confirmed that paraprofessionals can be trained on how to teach a nutrition lesson using a video-based online training. A previous report included a limited number of paraprofessionals (22) from a single state,6 in contrast to this more representative sample (>100 paraprofessionals from 17 states and US territories). However, supporting Christofferson and collaborators’ findings,6 the current researchers also observed significant improvements in paraprofessionals’ knowledge

Implications for Research and Practice

Results from this study provide practitioners with information they can use to take the action step the paraprofessional supervision committee suggested (provide online training and archive it for later reviews).4 The lessons learned (Table 4) provide practical information to address challenges in developing and implementing online trainings. This information is relevant to developers of video-based online trainings beyond EFNEP and independent of the content delivered, because many of the

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Conflict of Interest Disclosure: The authors have not stated any conflicts of interest.

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