Planning a Nutritional Education Program

 

1. Nutrition Education Needs

Majority of female prisoners have the thought of whether they will have enough food for themselves or for their families due to their incarceration. Half of them were incarnated most of their life and did not know what had happened outside those walls, so they might not be knowing how to shop and where to get food, lacking the skills to cook a meal, and do not know anything about food assistance programs (1). They were so used of having people to cook for them and because of restricted time they were not able to have much physical activity. The usage of literacy sources such as nutritional pamphlets and recipes could enable the prisoners to cultivate a healthy diet with regular physical activities. Preventing them from any nutrition-related chronic disease and help them to maintain a healthy lifestyle. “Implementing and developing intervention that focuses on skill building and developing healthy lifestyle that incorporate good nutritional practices and physical activity” (1).  In addition, implementing education program on portion sizes and calorie estimation, healthy food purchasing with budget, cooking classes and even food sanitation classes, as well as focusing on healthy eating with a balance diet helps decrease the risk of chronic disease. In summary, a curriculum for this target population should include lessons on nutrition and childhood nutrition (portion sizes, nutritional balance and choice of food), skill in relation to cooking, budgeting, purchasing, and preparing (safe food handling practices and procedures), and physical activity habits.

2. Social Cognitive Theory

The major focus of this nutrition intervention is to apply and develop food management skill and making healthy food choices that include meal planning, shopping, and with limiting budget. By providing this skill to the female inmates allow and ensure them the skills they need by following the Social Cognitive Theory (SCT) for behavior change. The implementation of this theory was used by the Healthy Cents curriculum that will be followed for this nutrition intervention (2). SCT is based on the idea of having a comfortable learning environment, goal setting, providing opportunities to participate, and skill development to help foster behavior change (2). There are eight key concepts in SCT which consist of environment, reciprocal determinism, self-regulation, behavioral capability, expectations, self-efficacy, observational learning, and reinforcement (3). In Healthy Cents, this program stresses on using teaching lessons in a series to approach in influencing behavior change, providing a comfortable learning environment, dynamic interaction of the person, by knowing a person knowledge and skill, help individuals to apply with the knowledge, group work is encouraged, and goal setting using the information that are being introduced during the lesson (4). Participants are express to improve their nutrition and food shopping skills through this program.

The main issue with this target population is the lack of knowledge of how to shop and plan a meal with budget. When these female prison inmates are released and re-enter into the society, they will seek for jobs but with their limited education and low literacy levels the chances of getting employed are lower (5). Without a job, they will not have enough money to buy food. Therefore, with this program enabling them to plan and shop on budget yet having a healthy lifestyle.

This intervention started with addressing the reciprocal determinism of female inmates participating in Healthy Cents. In Lesson 1 discussed how to make healthy choices on a budget (2). The objectives about this lesson is to allow individual to practice choosing healthier alternatives familiar food and by teaching them the true meaning of healthy foods. The curriculum emphasis on lecturing, focusing on content, provides information, and asking recall questions, focusing on dialogue learning techniques to generate interest and excitement about the topic lesson (2). Each lesson content activities for the participation to apply, they will be divided into a small group setting to do some group activities such as practicing with the information they learn, food tasting, and goal setting for individual. At the end of the class, the participation get to take home tips or message handouts and recipe they tried in the lesson.

Concept	Need for Nutrition Education	Strategies for Change in Lesson
Environment	Female inmates may not have access to healthy and nutritious foods because of where they live, lack of knowledge of what foods are considered healthy, and do not have enough money to buy foods.	Provide information on what foods that are healthy, provide resources (MyPlate) and handouts that are consider healthy foods, and display ways to shop with budget (L1 -L6)
Reciprocal Determinism	Majority of the female inmates that are being release are from low socioeconomic with limited access to food, limited nutrition education, low literacy which might cause this population’s ability to change.	Teach about smart shopping for fruits and vegetables (L1), having healthy snacks that they can afford (L2), developing a food budget (L3-L4), educate in planning a meal (L5), and food shopping on a budget (L6). Discuss the importance of these helps them to change the idea that they able to have a healthy lifestyle with a limited budget.
Self-Regulation	Many inmates who got release currently not practicing healthy eating habits, may need assistance in selecting appropriate goals, problem solving, monitoring, and even decision making.	Aid with goal setting, problem solving, and decision making by encouraging the participants to take home handouts and recipes (L1-L6). Also, encourage participants to use what they learned and participate in the discussion concerning their goals and decision (L1-L6).
Behavioral Capability	Prisoners need the knowledge and skill to manage their food after they are release, so they need assistance and education on how to prepare healthy meals with alternatively cheap healthy food options.	Provide information and demonstration on how to shop and plan healthy meals and snacks in way that is easy to follow (L1, L2, L4-L6).
Expectations	While many female inmates may know that fruits, vegetables, whole grains are healthy for them, they may not believe that is impossible for them to purchase healthy items with low budget.	Introduce new ways to purchase healthy food options and encourage participants to try new recipes. Handouts and recipe sheets will be provided additional information and ideas to try after the lessons (L1-L6).
Self-Efficacy	The target population may not live at the area where they are easily access to grocery store, therefore, they may not try before some of the foods.	Promote and motivate the participants in trying new foods and make some changes with their diets. Handouts and recipe provided with additional recipe of trying other food options. (L1-L6)
Observational Learning	Inmates are being confined with other prisoner in the cells so they often talked and learned from each other.	Lessons are taught through observational learning that involved group problem-solving discussion, listening, seeing, hearing and even asking can engage in and to promote understanding to participants (L1-L6)
Reinforcements	The target populations may not implement on healthy meals option because after they are released the chances of them getting employed are low (5) therefore lack of financial resources which lead to limited access to healthy food.	Having low-income which eligible them to participate in food assistance programs. Inform the participants about food assistance programs can help them to access and choose foods with higher nutritional quality (L3).

3. Curriculum

The Healthy Cents program in an extension of Food Supplement Nutrition Education (FSNE) by University of Maryland. It is published in the year 2015 and is funded by United States Department of Agriculture’s SNAP-Ed. This curriculum is designed for adults, parents/fathers/mothers with low-income individuals and families who have limited food resources, limited budget to purchase and prepare healthy food at home. This program combines nutrition education and food resource management principles to encourage limited resource families to make healthy food choices that include making healthy choices on a budget, decreasing food expenses, developing a food budget, planning a meal, and food shopping on a budget (6). The curriculum links tools and methods for improved food resource management with USDA nutrition messages to stretch food dollars and encourage healthy food choices using MyPlate (6). These lessons were developed using the Social-Cognitive Theory. The program was created to last for 60 minutes per lesson and with the total of 12 lessons. The lesson will be started off with the whole group then will be divided into smaller group of 4 participants each for discussion and activities.

Educators able to easily follow along with the lesson plans because it is well-organized format. In the curriculum, there are handouts for the educators about materials that they need and things that are require for each lesson. There is a free downloadable file called Healthy Cents from the USDA website with all the complete information needed to facilitate the lessons. The lesson will inform about who, why, lesson length, where, and what about each topic, materials and supplies that are needed for the class, things to say and side notes for the educators, discussion questions for the participants, activities that will be doing for each lesson, new recipe to try, as well as handouts for the learners.

After taking a sample handout from the take home tips, the handout was found to be a 4.3 Flesch-Kincaid Grade Level on Microsoft Word. However, not all handout contains the same literacy level. One of the handout has a grade level of 8.9. Some of the handouts are appropriate yet some is not appropriate for the target population, because with their limited education and low literacy levels (5) and about 68% did not receive high school diploma (7), it will be hard for them to comprehend the harder and higher literacy information on their own.

It is important to point out that Healthy Cents contain total of 12 lessons in the curriculum. In this assignment, it will be shorten to 6 lessons that are relevance to this target populations’ needs. Everyone is provided with a copy of handout about the lesson and recipe to bring home with them.

Lesson 1: Making Healthy Choices on a Budget. The first lesson stresses the importance about what is healthy food using MyPlate poster and how to afford and shop smartly for fresh produces. The major goal is to able to choose healthier alternatives to familiar foods and able to identify different ways to buy fresh produce using coupons and with limited budget.

Lesson 2: Decreasing Food Expenses. The objective of this lesson is to help individual or families to buy healthy snacks that are affordable. Participants will compare the cost of buying individually packaged snacks to bulk package, make their own snacks and understand that snacks can be affordable to made at home and healthy. they will also practice to read nutrition facts labels to identify healthy foods.

Lesson 3: Developing a Food Budget. This lesson is intended to teach the participants to choose between food needs and food wants also developing a plan on estimation food expenses. The participants will learn the 5 food groups that made up of a healthy plate and learn to plan for monthly food budget. They will play a board game that related to the lesson and try some new food that they can make for themselves.

Lesson 4: Community Food Assistance Programs. Participants will have the opportunity to get resources and examine the food assistance programs that are available in the community. Practice saving money using coupons to purchase healthier items.

Lesson 5: Planning a Meal to Make Life Simpler. This lesson will allow the participants to know the benefits of meal planning and acquire skills needed for developing a weekly meal plan. The learners will taste a healthy recipe that is simple to prepare.

Lesson 6: Food Shopping on a Budget. Participants will learn about shopping strategies Practice using unit price compare to prices at the grocery store. Explore the layout of a grocery store and how to find lower cost items by looking at the products on shelves below eye level. Ask the participants to choose one new strategy to try for saving money at the grocery store.

This curriculum is quite complete, however there is a gap in the program. The involvement of others who have chronic disease in the program will face challenges. As we know, from the nutrition assessment that there are quite many of inmates have chronic disease due to the foods being served in the prison and lack of physical activities, therefore some might face the challenge of health-related nutrition concerns. They do not have the knowledge on what kind of food and nutrition that meet the needs of their body. Perhaps modifying the intervention to involve lesson on obesity, malnutrition, diabetes, and other chronic diseases that require certain kind of foods and provide alternative food options to help lower health risks that would make it more complete.

4. Other Program Components

As the target population focuses on female inmates, it is important to consider a wider age range. This intervention educates on budgeting and how to shop with limited resources. It educates and incorporation of knowledge for healthy food options. It shows about meal planning and budgeting shopping, however it did not educate about portion sizes. American food culture is well known for big portion; they might have calculated and plan their meal but without the proper portion sizes will cause them to over eat which will lead to overweight and obese. Other than portion size, providing hands-on approach and educating on how to prepare meals will have beneficial to the target population.

In addition, studies have showed that female inmates must overcome their unique social, mental, emotional, and physical challenges that prevent their ability to blend smoothly back into the society (8). Therefore, emphasis on discussing healthy lifestyle choices and habits for individual or families to create an environment that allows for positive behavior change (8) is extremely important to this population.

 

References

1. Decker, Jennifer and Dharod, Jigna. Nutrition Education Needs of Women Being Released from Prison. Maine Nutrition Network, USM. USDA, Food Stamp Nutrition Education, 2006. Website. Available at  . Accessed March 1, 2017.

3. Boyle Marie A. Community Nutrition in Action: An Entrepreneurial Approach 7^th ed. Boston, MA; pp 87. Textbook. Published 2016. Accessed March 25, 2017.
4. United States Department of Agriculture. Healthy Cents. 2015. Website. Available on . Accessed on March 26, 2017.
5. Astray-Caneda, Vivian, Busbee, Malika and Fanning, Markell. Social Learning Theory and Prison Work Release Programs. Florida International University, USA. 2013. Website. Available at . Accessed March 26, 2017
6. Learning to Shop Wisely for Nutritious Foods Makes Healthy Cents. Food Supplement Nutrition Program. University of Maryland Extension. 2017. Website. Available at . Accessed March 26, 2017.
7. Harlow, Caroline Wolf. Ph.D. BJS Statistician. Education and Correctional Populations. Bureau of Justice Statistics. Revised January 2003. Website. Available at . Accessed March 27, 2017.
8. Reentry Programs for Women Inmates. Washington, DC: U.S. Department of Justice, National Institute of Justice. Journal Issue No. 252. June 2003. Website. Available at . Accessed March 26, 2017.