Abstract
This report describes the protocol guiding the design and evaluation of a theory-driven, web-based lesson to promote farmers’ market fruit and vegetable (FV) purchases and 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. 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) and pretesting the resulting content (N = 52), 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 (2 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. Theory-driven, web-based nutrition education expressly designed for WIC to promote farmers’ market use is lacking. The WIC Fresh Start program addresses the paucity of programs of this type. Findings will advance understanding of effective approaches for promoting farmers’ market FV purchases and consumption among WIC participants. NCT02565706 (registered September 30, 2015)
Highlights
This report describes the protocol guiding the design and evaluation of a theory-driven, web-based lesson to promote farmers’ market fruit and vegetable (FV) purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
Dose-response effects Positing that receipt of more of the lesson will foster more positive outcomes, hypothesis 7 tests doseresponse relationships. This hypothesis will be examined in a series of analysis of covariance (ANCOVA) and linear mixed-effects (LME) models with posttest and follow-up measures of FV intake, voucher redemption, knowledge, attitudes and skills as outcomes, lesson dose as the fixed factor, and receipt of Farmers’ Market Nutrition Program (FMNP) vouchers, socio-demographic variables and pretest measures of each outcome as covariates
The present investigation addresses low FV intake, an issue of public health concern, among WIC participants, a population at increased risk of inadequate intake, and leverages vouchers provided by WIC to improve FV access in this population
Summary
The present investigation addresses low FV intake, an issue of public health concern, among WIC participants, a population at increased risk of inadequate intake, and leverages vouchers provided by WIC to improve FV access in this population. Methodological strengths of the study include the randomized design, use of an active control group, validated measures of both the frequency and quantity of FV intake, objective measures of FMNP voucher and CVV redemption, and repeated measurements, which will permit examination of the sustainability of lesson effects over time. The lesson will reach other WIC participants similar to those engaged in the research. The study sample and location limit transferability to diverse WIC audiences in other parts of the country, the lesson may serve as a model for the development of similar resources tailored to local needs. KWC provided methodological guidance on the design and implementation of the study. All authors contributed to drafting and revising the manuscript and approved the final manuscript
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