Adoption, Implementation and Maintenance of the Food and Physical Activity Questionnaire for National Nutrition Education Program Evaluation

Abstract

Abstract Objectives The Expanded Food and Nutrition Education Program (EFNEP) is a national nutrition education program aimed to improve the health of low-income families in the areas of diet quality, physical activity, food safety, food resource management, and food security. Although EFNEP funds may not be used for research, the program provides an opportunity to disseminate and implement research-based tools and interventions. This study examines the nationwide adoption, implementation, and continual use of the research-tested Food and Physical Activity Questionnaire (FPAQ) for EFNEP adult evaluation. Methods Transition from the Adult Behavior Checklist to the FPAQ was assessed following the RE-AIM dissemination and implementation framework. Specifically, the three factors of Adoption, Implementation, and Maintenance. Adoption was measured by the proportion of total EFNEP institutions using the FPAQ. Implementation measures included consistency and modifications made by EFNEP institutions. Lastly, maintenance was assessed via national program outcomes. Results Adoption was 100%. All 76 land-grant universities that deliver EFNEP used FPAQ starting October 1, 2018. On average, FPAQ was used annually by 384 professionals, 1456 paraprofessionals, and 15,705 volunteers. Implementation fidelity was supported through Spanish and English language formatted questionnaires, facilitation guides, and online training. All institutions used the same web-based system to enter participant responses pre and post nutrition education intervention. Modifications included grayscale questionnaires and translation into Chinese, Hmong, Arabic, Somali, and Karen. Averages of 2018 and 2019 FPAQ results show that after completing EFNEP, adults improved behaviors in the areas of diet quality (93%), physical activity (78%), food safety (80%), food resource management (80%), and food security (48%). Conclusions Overall, the FPAQ was successfully adopted and implemented by all 76 universities that deliver EFNEP across the country. As use continues, additional measures of efficacy at the university-level and the national-level may strengthen the assessment of maintenance and public health impact of national nutrition education programs. Funding Sources USDA National institute of Food and Agriculture (NIFA), Expanded Food and Nutrition Education Program (EFNEP).