Process Evaluation of a Farm-to-WIC Intervention.
Process Evaluation of a Farm-to-WIC Intervention.
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DOI：
10.1016/j.jand.2021.05.014
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发表时间：
2021-10
影响因子：
4.8
通讯作者：
Sikorskii A
中科院分区：
文献类型：
--
作者：
Di Noia J;Monica D;Sikorskii A
尽管农场到机构的干预措施有望解决有限的蔬菜获取作为摄入障碍的问题，但为妇女、婴儿和儿童特别补充营养计划(WIC)设计的计划仍然缺乏。因此，人们对农场到WIC干预措施的实施和行动机制知之甚少，这些干预措施通过这些措施影响蔬菜摄入量和参与者对此类计划的满意度。为了检验促进蔬菜摄入量的从农场到WIC的干预措施是否按预期实施，接受干预的参与者与普通护理对照组的参与者在蔬菜相关知识、态度和行为的中间结果以及体力活动和体重状况的次要结果方面的差异；以及参与者对干预的满意度。对作为试点研究一部分收集的执行忠诚度日志和调查数据进行了描述性和比较分析，对此进行了进程评估。背景是一家总部位于新泽西州的大型城市WIC机构。在2019年6月3日至8月1日期间招募的该机构17个地点中的3个(一个干预地点和两个对照地点)，参与者是297名主要是西班牙裔成年人(160人在干预地点登记，137人在对照地点登记)。干预措施将注重行为的指导和讲义与引入基于WIC的农贸市场、实地考察一个地区的农贸市场、电话培训和支持以及食谱演示和品尝结合在一起。主要结果是蔬菜摄入量(通过自我报告衡量，客观上使用真皮类胡萝卜素作为摄入量的生物标记物)和兑换WIC提供的在农贸市场购买水果和蔬菜的代金券(使用WIC提供的数据客观衡量)。在过程评估中，使用日志来记录计划活动。采用参与式问卷调查方法，对蔬菜相关知识、态度、行为、体力活动及干预满意度进行评估。体重状况通过直接测量身高和体重来评估。在基线、干预中期和干预后(分别为基线后3个月和6个月)收集数据。描述性统计被用来描述执行的忠诚度。中间和次要结果与蔬菜摄入量之间的关系在基线时用皮尔逊相关性进行了检验。基线值和协变量调整后的线性混合效应模型检验了基线后组间结果的差异。通过推论和主题分析评估干预的满意度。干预后，干预组蔬菜摄入量明显高于对照组。接受干预也与兑换代金券的可能性更大有关。几乎所有参与者(≥94%)都接受了意向的干预；较小比例的人完成了一次或多次计划的前往该地区农贸市场的旅行(28%)以及电话辅导和支持电话(88%)。虽然大多数中间和次要结果与基线、干预后蔬菜摄入量的测量有关，但变量在研究组之间没有差异。平均满意度评分为≥6.8，满分为7分。最受欢迎的是食谱演示、学习蔬菜、实地考察以及与工作人员的融洽关系。尽管有人建议增加实地考察的天数和时间，但有限的市场天数和营业时间限制了这样做的能力。初步数据突显了这一广受欢迎的干预措施的前景。中期结果研究结果表明，在该计划未来的大规模试验中，应考虑其他潜在的干预作用机制。需要采取广泛的举措，改善服务不足社区进入农贸市场的机会。
Despite the promise of farm-to-institution interventions for addressing limited vegetable access as a barrier to intake, programs designed for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are lacking. As such, little is known about the implementation of and mechanisms of action through which farm-to-WIC interventions affect vegetable intake and participant satisfaction with such programs. To examine whether a farm-to-WIC intervention to promote vegetable intake was implemented as intended, differences between participants who received the intervention relative to those in a usual-care control group in intermediate outcomes of vegetable-related knowledge, attitudes, and behaviors, and secondary outcomes of physical activity and weight status; and participant satisfaction with the intervention. A process evaluation encompassing descriptive and comparative analyses of implementation fidelity logs and survey data collected as part of a pilot study was conducted. The setting was a large, New Jersey-based, urban WIC agency. Recruited between June 3, and August 1, 2019 through 3 of the agency’s 17 sites (one intervention and two control sites), participants were 297 primarily Hispanic adults (160 enrolled at the intervention site and 137 at control sites). The intervention combined behaviorally focused instruction and handouts with the introduction of a WIC-based farmers’ market, field trips to an area farmers’ market, telephone coaching and support, and recipe demonstrations and tastings. Primary outcomes were vegetable intake (measured via self-report and objectively using dermal carotenoids as a biomarker of intake) and the redemption of vouchers provided by WIC for fruit and vegetable purchases at farmers’ markets (measured objectively using data provided by WIC). For the process evaluation, logs were used to document program activities. Vegetable-related knowledge, attitudes, and behaviors, physical activity, and satisfaction with the intervention were assessed with participant questionnaires. Weight status was assessed with direct measures of height and weight. Data were collected at baseline and at mid- and post-intervention (3 and 6 months post-baseline, respectively). Descriptive statistics were used to characterize implementation fidelity. Associations between intermediate and secondary outcomes and vegetable intake were examined at baseline with Pearson correlations. Post-baseline between-group differences in the outcomes were examined with linear mixed-effects models adjusted for baseline values and covariates. Satisfaction with the intervention was assessed with inferential and thematic analyses. Post-intervention, measures of vegetable intake were higher in the intervention relative to the control study group. Receipt of the intervention was also associated with a greater likelihood of voucher redemption. Nearly all participants (≥ 94%) received the intervention as intended at the WIC-based farmers’ market; smaller percentages completed one or more planned trips to the area farmers’ market (28%) and telephone coaching and support calls (88%). Although most intermediate and secondary outcomes were associated with measures of vegetable intake at baseline, post-intervention, the variables did not differ between study groups. Mean satisfaction ratings were ≥ 6.8 on a 7-point scale. Recipe demonstrations, learning about vegetables, field trips, and the rapport with staff were liked most about the program. Although adding days and times for field trips was suggested, limited market days and hours of operation limited the ability to do so. Preliminary data highlight the promise of this well-received intervention. Intermediate outcome findings suggest that other potential intervention mechanisms of action should be considered in future large-scale trials of this program. Broad-scale initiatives are needed to improve access to farmers’ markets in underserved communities.
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