food skills for families adi evaluation report 10-30-2012 · web: foodskillsforfamilies.ca ....

Aboriginal Diabetes Initiative

Evaluation Report

2 0 1 1 — 2 0 1 2

FOOD SKILLS

for FAMILIES

October 2012

TABLE OF CONTENTS

EXECUTIVE SUMMARY ……………………………..…………………………………….…………..….

1.0 INTRODUCTION ………………...…………………………………………………………..…........

2.0 PROGRAM DELIVERY ……………………………………………………………….………….…..

2.1 Program Overview ……………………………………..…….……..…...……………..….

2.2 Program Delivery ……………………………..………………………………………...….

3.0 EVALUATION METHODOLOGY ……………………………………..………………………..…..

4.0 PROGRAM IMPACT ON PARTICIPANTS ………………………………….…….…...……….....

4.1 Participant Demographic Data ……………………………………………………....….

4.2 Participant Healthy Eating Behaviour ………………………………….…………….….

4.3 Participant Confidence ………………………………………...……………………..…..

4.4 Biggest Changes as a Result of Taking the Food Skills for Families Program ……….…

4.5 Program Satisfaction ………………………………………………………………..…......

4.6 Other Program Impacts ………………………………………………………............…..

4.7 Barriers to Healthy Eating ……………………………………………………………….....

5.0 SUMMARY AND FUTURE CONSIDERATIONS ……………………...………………………….…

5.1 Summary Highlights ………………………...………………………………..…...........….

5.2 Future Considerations …………………...………………………..…….……………...….

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This Food Skills for Families Program

Evaluation Report is available from the

Canadian Diabetes Association, Pacific Area.

Email: [email protected]

Phone: 604-732-1331

Web: foodskillsforfamilies.ca

Executive Summary

T he Canadian Diabetes Association Food Skills

for Families program teaches healthy eating

and cooking skills with a focus on reaching

Aboriginal, new immigrant, Punjabi and low

income families throughout BC. It was one of five

initiatives of the British Columbia Healthy Living

Alliance1, funded by ActNow BC, designed to promote

wellness and prevent chronic disease. Currently, the

Canadian Diabetes Association Food Skills for Families

program is funded by the BC Ministry of Health for

delivery throughout BC. Program delivery on reserves

in BC was funded by the Aboriginal Diabetes Initiative,

Pacific Region, First Nations & Inuit Health, Health

Canada (ADI).

This Evaluation Report covers information gathered

from participants, Community Facilitators and Bands

involved in thirty-one (31) ADI-funded Food Skills for

Families programs delivered on reserves throughout BC

from April 2011 to March 2012.

At the conclusion of the Food Skills for Families 6-week

programs, some improvement in the frequency of

fruits and vegetables or salad consumption was

reported. There were a number of barriers reported by

participants that prevented healthy choices from being

easy choices, in particular, the ability to access and/or

to afford fresh fruits and vegetables. However,

approximately two-thirds of the participants stated

they definitely intend to eat more fruits and vegetables

over the next year.

With regard to salt and sugary drinks, the Food Skills

for Families program appears to have had the most

impact on participants who initially reported adding

salt to their food twice a day or more or those who

drank sugary drinks on a daily basis. The percentage

change in these two groups was the most significant.

There was a positive change related to eating less fried

foods and in the confidence levels participants

reported with preparing and cooking new foods and

reading facts on food labels.

The biggest changes in behavior reported by

participants include eating healthier, trying new foods

and reading food labels. These changes were also

reported by the Community Facilitators as the biggest

changes observed in the participants.

The written and verbal reports from participants and

Community Facilitators attest to the program’s ability

to positively influence participants’ healthy eating,

cooking and nutrition knowledge, skills, attitudes and

confidence.

The ADI-funded Food Skills for Families program has

built community capacity by training Community

Facilitators from on reserve communities across the

province and demonstrated the positive influence of

the Food Skills for Families program throughout the

Band. The program is highly regarded by all

stakeholders involved and there is a keen interest from

on reserve communities to participate.

1BC Healthy Living Alliance is a group of not-for-profit organizations working

collaboratively to support British Columbians to eat healthier, get active and live

tobacco free.

EVALUATION REPORT OCTOBER 2012 i

CANADIAN DIABETES ASSOCIATION: FOOD SKILLS FOR FAMILIES

Future Considerations

B ased on the evaluation consultation and questionnaire results, a number of

considerations are presented to optimize the future potential of the ADI-funded

Food Skills for Families program.

Program Delivery

• Link the ADI-funded Food Skills for Families program with other food skills and

food security initiatives to improve the accessibility and affordability of healthy

food, in particular, fruits and vegetables for vulnerable populations. For

example, food preservation/canning programs, community gardens and

community kitchens.

• Continue to reinforce key messages and identify additional strategies within the

program that would assist participants to make healthier beverage choices,

decrease their sugar sweetened beverage intake, reduce sodium/salt intake and

eat more fruits and vegetables.

• Foster opportunities for Community Facilitators to share their knowledge,

experiences, successes and lessons learned with each other.

• Emphasize the value of the certificate of completion and consider offering

incentives to participants, when feasible, to encourage participation in all six

sessions.

• Encourage Band members who have responsibility for preparing food for

community events on reserve to complete the Food Skills for Families program.

EVALUATION REPORT OCTOBER 2012 ii

Partnership and Collaboration

• Continue the partnership between the Aboriginal

Diabetes Initiative and Canadian Diabetes Association

to help sustain and extend the reach of the Food Skills

for Families program so that it becomes a readily

available healthy eating and chronic disease

prevention strategy for on reserve Aboriginal families.

• Continue to fund training of new on reserve Food Skills

for Families Community Facilitators to further build

community capacity.

• Continue to support existing on reserve Community

Facilitators to maintain their knowledge and skills, and

provide updated resources to deliver the Food Skills

for Families program.

• Encourage Bands to leverage Community Facilitator

and program participant knowledge of healthy eating

and cooking to extend the impact more broadly within

their communities (knowledge transfer/exchange).

• Encourage/advocate for Bands, government and other

stakeholders to reduce barriers to healthy eating for

vulnerable populations and to make the healthy

choice the easier choice.

Data Management

• Strengthen Community Facilitators’ understanding and

adherence to data management protocols, specifically

the completion of pre and post questionnaires by all

participants, and ensure Community Facilitators

correctly and consistently label the questionnaires

with the participant’s unique confidential identifier.

• Work toward simplifying the coding procedures in the

pre and post questionnaires to maximize availability of

matched data for greater reliability.

Future Evaluation

• Continue to collect participant data (pre and post

program) to build evidence of the impact of the

program on healthy eating and to communicate

evaluation results broadly.

• Conduct periodic follow up evaluations, such as

telephone surveys and focus groups with Community

Facilitators and participants, to determine the impact

of the program in the longer term.


EVALUATION REPORT OCTOBER 2012 iii

1.0 INTRODUCTION

T he Canadian Diabetes Association (CDA) Food Skills

for Families program teaches healthy eating and

cooking skills with a focus on reaching Aboriginal, new

immigrant, Punjabi and low income families throughout

BC. It was one of five Healthy Eating Strategy initiatives,

representing one of four pillar strategies implemented by

the BC Healthy Living Alliance2 with funding from ActNow

BC3, designed to promote wellness and prevent chronic

disease.

The Canadian Diabetes Association, Pacific Area, is

pleased to present the second evaluation of the ADI-

funded Food Skills for Families program. This Evaluation

Report covers information gathered from participants,

Community Facilitators and Bands involved in thirty-one

(31) ADI-funded Food Skills for Families programs

delivered on reserves throughout BC from April 2011 to

March 2012.

The first evaluation report for the ADI-funded Food Skills

for Families program covered programs delivered on

reserve from January to March 2011.

There are two overall evaluation reports for the Food

Skills for Families program: the first report covered

programs delivered September 2008 to June 2009 and the

second covered programs delivered September 2009 to

December 2010. These reports can be found at

www.foodskillsforfamilies.ca. The third evaluation report

covering program delivery from January 2011 to June

2012 will be released in October 2012.

The purpose of this evaluation is to determine:

• Whether the Food Skills for Families program is

achieving its program goals to:

- Build cooking skills and nutritional knowledge in

the targeted at risk populations: on reserve

Aboriginal families.

- Increase capacity within on reserve Aboriginal

communities by training Community Facilitators

to reach out to and improve food and nutrition

knowledge and skills in their communities.

• Whether the Food Skills for Families program is

achieving the positive outcomes identified in

previous evaluations of the overall program, such as

participants:

- Are eating more fruits and vegetables every day

as a result of taking this course, and are more

likely to meet the recommended 5-7 servings per

day (Canada Food Guide4) than previously.

- Have a significantly higher level of knowledge

about what foods are healthy.

- Are cooking more meals from ‘scratch,’ e.g., not

using convenience or packaged meals and

including raw or fresh ingredients.

- Have a significantly higher level of confidence

about preparing and cooking healthy foods,

trying new foods, applying food safety

procedures and understanding nutrition facts on

food labels.

• Whether ADI on reserve participants face similar or

different barriers to healthier eating and cooking

than participants in the Food Skills for Families

program overall.

2 BC Healthy Living Alliance is a group of not-for-profit organizations working collaboratively to support British Columbians to eat healthier, get active and live tobacco free.

3 http://www.phac-aspc.gc.ca/publicat/2009/ActNowBC/index-eng.php

4 http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/basics-base/quantit-eng.php

EVALUATION REPORT OCTOBER 2012 1

Train-the-Trainer Mentorship Program

M aster Trainers, with representation from each

health region of the province, train Community

Facilitators across the province. The Community

Facilitators deliver the Food Skills for Families program

in host organizations throughout BC. Community

Facilitators delivering the ADI-funded Food Skills for

Families program are members of on reserve

communities.

Host Organizations

H ost organizations include schools, community

recreations centers, Aboriginal groups, First

Nations Bands, early childhood development services,

community kitchens, faith-based organizations, food

banks, friendship centers, and multicultural service

agencies among others.

Host organizations who expressed an interest are

selected based on criteria including: appropriate

kitchen facilities, ability to recruit participants from the

target populations, and availability of a Food Skills for

Families Community Facilitator.

2.0 PROGRAM DELIVERY

2.1 Program Overview

F ood Skills for Families is a consumer-based skills

building program with a standardized, best practice

curriculum developed by expert community-based

dietitians to teach healthy cooking skills. A standardized

Train-the Trainer Mentorship program was also

developed to train lay personnel. The curriculum and

Train-the Trainer Mentorship program are based on

Canada’s Food Guide, current nutrition evidence and

adult education principles for provincial and national

applicability.

Curriculum Outline

The curriculum has a consistent core knowledge and skill

foundation that was specifically adapted to meet the

needs of each target population: Aboriginal, new

immigrant, Punjabi and low income families, and most

recently, seniors. Community Facilitator Manuals and

Participant Handbooks have been developed for each of

these target populations.

The curriculum is built around six sessions, with each

session addressing a different topic based on the Canada

Food Guide and its key messages. Information and

recipes for these sessions are adapted to the needs of

each of the target populations.

The curriculum is designed to be readily adapted to new

target populations and has demonstrated the potential

to meet the needs of young families, older adults and

those with diabetes and other chronic diseases.

Session 1 Variety for Healthy Eating

Session 2 Fabulous Fruits, Vegetable and Whole Grain Goodness

Session 3 Meat & Alternatives, Milk & Alternatives & Healthy Fats

Session 4 Planning Healthy Meals, Snacks and Beverages

Session 5 Savvy Shopping (Grocery Store Tour)

Session 6 Celebrations!

A Sodium Addendum has been developed to provide

guidelines for Community Facilitators and participants

on recommended maximum daily sodium intake and

tips to help lower sodium consumption. The Canadian

Diabetes Association’s “Just the Basics”5 handout is also

provided to all participants as a Diabetes Addendum.

This resource has been developed specifically for the

Aboriginal community and provides tips for healthy

eating and diabetes prevention and management. Both

addendums are part of ongoing curriculum updates for

Community Facilitators and participants.


5 Canadian Diabetes Association has produced Just the Basics: Tips for Healthy Eating, Diabetes Prevention and

Management for the general public (available in English, Punjabi, Chinese and Spanish) and the Aboriginal community.

2.2 Program Delivery

Number of Programs Delivered

A total of 31 ADI-funded Food Skills for

Families programs were delivered to 242 on

reserve participants from April 2011 to March

2012.

The Aboriginal Diabetes Initiative provided the

CDA Food Skills for Families program with on

reserve communities and contacts. These

communities were approached to explore their

interest in the program and the availability of a

suitable kitchen facility and community member

suitable to be trained as a Community

Facilitator. Where program criteria were met,

Community Facilitator training and program

delivery were scheduled.


REGION NUMBER OF

PROGRAMS COMMUNITY

Fraser 2 Chilliwack, Pitt

Meadows

Interior 8

Ashcroft, Barriere,

Keremeos, Lillooet,

Lytton, Merritt (2),

Oliver

Northern 9

Aiyansh (2), Burns Lake,

Dease Lake, Greenville,

Hazleton, Quesnel,

Skidegate, Terrace

Vancouver Coastal 6 North Vancouver (3),

Squamish (3)

Vancouver Island 6

Alert Bay, Chemainus,

Duncan, Nanaimo, Port

Alberni (2)

TOTAL 31

Number of ADI-Funded Programs

by Health Authority

Host Organizations and Number of

Participants in ADI-Funded Programs

HOST ORGANIZATION NAME PARTICIPANTS

Ashcroft Indian Band Health Center 7

Burns Lake Band 6

Gitxsan Health Society 8

Hiiye'yu Lelum Society 8

H'ulh-etun Health Society (Penelakut) 9

Hupacasath First Nation 9

Katzie First Nation 8

Kitsumkalem Band 4

Lhoosk'uz Dene Nation 8

Lower Similkameen Indian Band 4

Namgis First Nation 6

Nanaimo Community Kitchens Society 5

Nisga'a Valley Health Authority 11



Nzeman Child and Family Development 8

Osoyoos Indian Band 8

Scw'exme Community Health Services 14

Scw'exmx Community Health Services 5

Simpcw First Nation 12

Skidegate Indian Band 7

Squamish Nation (North Vancouver) 10

Squamish Nation (Squamish) 8



Sto:lo Nation 9

Tahltan Health and Social Services Authority 6

Tseshaht First Nations 9

Tsleil-Waututh Nation 12

Tsleil-Waututh Nation 5

Xaxli'p First Nation 8

TOTAL 242


T wenty-nine (29) Community Facilitators were

trained from within the on reserve Aboriginal

community by a Food Skills for Families Master Trainer.

Six of the 31 programs were co–facilitated by two

Community Facilitators. This option was effective for a

number of Bands who had more than one person

interested in training and to ensure consistent program

delivery.

The following table captures the locations of trained

Community Facilitators.


http://www.health.gov.bc.ca/socsec/provmap.html

Number of Community Facilitators Trained

On Reserve Aboriginal Communities with a

Trained Community Facilitator

NAME HEALTH

AUTHORITY

COMMUNITY

FACILITATORS

Ashcroft Band IHA 2

Burns Lake Band NHA 1

Fraser Canyon Indian Administration (FCTA) IHA 1

Gitxsan Health Society NHA 1

Iskut Band NHA 2

Katzie First Nation FHA 2

Kitsumkalum Band NHA 1

Lytton First Nation IHA 1

Nisga'a (Gingotx/NewAiyansh/Gitwinksihlkw/Laxgalt'sap) NHA 2

Nuuchahnulth Tribal Council VIHA 2

Nuxalk Nation VCHA 2

Penticton Indian Band IHA 2

Saulteau First Nation (Moberly Lake East) NHA 1

Scw'exme IHA 1

Sechelt Indian Band VCHA 1

Seton Lake Indian Band IHA 2

Simpcw First Nation (North Thompson Indian Band) IHA 1

Skidegate Indian Band NHA 1

Sts’ailes Indian Band (formally known as Chehalis) FHA 1

Tahltan NHA 1

T'Souke First Nation VIHA 1

TOTAL 29


3.0 Evaluation Methodology

P articipants complete a pre questionnaire at the start

of each program and a post questionnaire at the final

session of the six week program. For a variety of reasons,

not all participants complete both a pre and post

questionnaire.

Recognizing that not all participants complete both

questionnaires, a unique confidential identifier for each

participant was introduced to ensure the results from their

pre and post questionnaires could be attributable to the

same group of participants.

Evaluation data includes:

• Results from the matched pre and post participant

questionnaires.

• Feedback from Community Facilitators, in particular

the Community Facilitator Summary Reports

submitted at the conclusion of each Food Skills for

Families Program.

Limitations of the Data

W ith many individuals involved in collecting program

data, consistent adherence to data management

protocols remains a challenge, specifically to ensure the

following: a record of each participant is kept and reported

to measure level of participation; a pre and post

questionnaire is filled out by each participant; and a

unique confidential identifier is assigned to each

participant and accurately and consistently recorded on

both the pre and post questionnaires to allow appropriate

matching of pre program to post program information. It

is recognized that completion of written questionnaires by

vulnerable populations can be subject to literacy issues

and other limitations.

Community Facilitators also reported challenges ensuring

sufficient time to complete the post questionnaire given

the fullness of the last session and the celebration that

followed often with other community members.


4.0 Program Impact on Participants

O f the 242 participants, 155 completed a pre

questionnaire and 111 completed a post

questionnaire, with 61 ‘matched’ pre and post

questionnaires. Results reported for this evaluation are

based on this matched sample of 61 participants.

Demographic data from the participant questionnaires

indicated that:

• 75% were female and 25% were male.

• 16% were under 20 years of age, 34% were 20-34

years, 28% were 35-54 years and 22% were 55

years and older.

4.1 Participant Demographic Data

This section provides an overview of the results from the participant pre and post questionnaires.


A t the conclusion of the Food Skills for Families 6-

week programs, there was some improvement in

the frequency of eating fruits and vegetables or salad.

Very few participants would meet the recommended 5-7

serving per day based on the post questionnaire data.

However, at the end of the program, substantially more

participants stated that they definitely intend to eat

more fruits and vegetables over the next year.

• The percentage of participants who reported

eating fruit five to six times per week or more

increased from 48% at the start of the program to

59% at the end.

• At the end of the program, fewer participants

reported eating vegetables or salad once a week

or less (8% in the post questionnaire versus 22% in

the pre questionnaire) and increased numbers of

participants reported eating vegetables or salad

more than once a week – specifically, 2-6 times

per week (42% in the pre questionnaire, 58% in

the post questionnaire).

• Participants who were knowledgeable about the

recommended daily servings of fruit and

vegetables increased by 11% (55% pre; 66% post).

• 89% of participants said they intended—yes

probably (28%); yes definitely (61%)—to increase

the amount of fruit and vegetables they eat over

the next 6-12 months. The proportion of

participants selecting yes definitely increase by

33% at the end of the program.

4.2 Participant Healthy Eating Behaviour

C omments from participants and Community

Facilitators indicated an awareness of the

importance of eating more fruit and vegetables.

“I never knew how important it was to put a variety of

fruits and vegetables into the diet besides meat and

potatoes or meat and rice.”

When asked, “What is the biggest change you made as a

result of taking the program?” many participants

indicated they are eating and cooking more vegetables,

for example:

• “I started cooking/using more vegetables when I cook.”

• “Using veggies more.”

• “Cooking meals from scratch and using more

vegetables.”

• “Mindful eating - including more veggies.”

• I eat more veggies and fruit and prepare more home

meals.”

• “I use more green and red peppers and more

vegetables.”

Community Facilitators also reported their observations

about the participants.

• “I heard mothers talking about what to try with their

children when it comes to veggies.”

Community Facilitators reported that participants

indicated that they want to eat more fruit and

vegetables but which are not always readily accessible.

• “Cannot buy fruits and vegetables locally.”

• “Too expensive.”

• “The store is too far away and there is no

transportation.”



Use of Salt, Fried Foods and Sugar Sweetened Beverages

Adding salt to food

Close to half of participants at the start and at the end of

the program indicated that they added salt to their food

once a week or less or never (44% pre and 47% post).

About one third of the participants reported that they

added salt to their food once a day or more (37% pre and

34% post). Fewer participants reported adding salt to their

food twice per day or more at the end of the program (25%

pre vs. 17% post).

Comments from participants and Community Facilitators

indicated an awareness of the importance of using less salt.

A sample of participant comments about changes in their

consumption of salt as a result of participating in the

program, include:

• “Using less salt, reading labels and avoiding salt and

saturated fat foods.”

• “I am cutting out salt.”

• “Am being more conscious of salt.”

Use of sugar and sugar sweetened beverages

Approximately one third of the participants reported

drinking sugar sweetened beverages infrequently — once a

week or less (34% pre and 37% post).

Fewer participants reported having a sugar sweetened

beverage once a day or more at the end of the program

than at the beginning (pre 43% vs. post 32%). However, the

questionnaire data show that 25% of participants reported

having 2-4 sugar sweetened beverages once a day or more.

At the start of the Food Skills for Families program, 66% of

participants reported drinking sugar sweetened beverages

at least 2-4 times per week, with 43% having such

beverages at least once per day. At the end of the program,

these percentages were reduced to 63% and 32%,

respectively. This reflects better program success for those

who drink sugar sweetened beverages most regularly.

Community Facilitators indicated that a key benefit of the

program is the increased participant awareness of their

sodium and sugar intake, and learning recommended

daily sodium amounts and how to limit sugar intake.

• “Knowing how much sugar was in their daily drinks

was helpful to them.”

Fried foods, fats and oils

Participant pre vs. post questionnaire data show a

significant trend toward eating less fried food. Sixty-

seven per cent (67%) of participants reported having

fried foods once a week or less or never at the end of

the course compared to 39% of participants at the

beginning of the program, indicating a 28% positive

shift.

Cooking from scratch

Approximately 50% of participants reported cooking a

main meal from “scratch” once a day or more at the

start and at the end of the program. However, there

was more of a positive shift at the extremes. The

percentage of participants cooking from scratch once a

week or less declined from 22% to 15%, and the percentage

cooking from scratch twice a day or more increased from

15% to 22%.

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4.3 Participant Confidence

P articipants reported their level of confidence as

very good or extremely confident at the conclusion

of the course with:

• Following basic food safety (9% increase).

• Preparing and cooking new foods (34% increase).

• Reading facts on food labels (17% increase).

The following chart shows the increase in confidence

from pre to post program in the above skill areas

reported by participants that attended ADI-funded

Food Skills for Families programs.

O verall, participants that attended ADI-funded

Food Skills for Families programs reported being

most confident about cooking and trying new foods as

reinforced in their comments.

• “Cooking was always confusing for me but now

with the help of the program I feel more

confident putting meals together.”

• “I enjoyed learning about new ways to add

healthier foods into my daily life and trying new

foods that I haven’t tried before.”

• “I have confidence in cooking for a bunch of

people.”

Community Facilitators also commented that the

program helped to “increase the confidence of

participants in their cooking skills and their ability to

feed their families.”



Increase in Confidence from Pre Program to Post Program

59.0%

77.0%

77.0%

42.0%

43.0%

68.0%

Very good or extreme

confidence reading nutri tion

facts on food labels


confidence

preparing/cooking new

foods


confidence fol lowing bas ic

food s afety procedures

Percent of Participants Pre Program

Percent of Participants Post Program

P articipants and Community Facilitators of the ADI-funded programs report that the biggest change as a

result of taking the Food Skills for Families program was eating and cooking healthier food, trying new

foods and reading food labels.

4.4 Biggest Changes as a Result of Program

Participation

About reading labels

Participants said:

“I am reading the ingredients of all the foods I buy.”

“When out shopping I look at labels.”

“Reading food labels before buying products.”

“Reading food labels, less fruit juice and looking for healthier recipes.”

“Using new ingredients and paying attention to labels.”

“Not drinking anything or eating anything without knowing what’s in it.”

About eating healthier

Participants said:

“It made me more aware of the healthy

content of foods I buy.”

“Learning how to eat healthier, becoming

more aware.”

“I am eating more healthy foods and buying

more healthy foods.”

“I know how to cook healthier now and more

educated with the amount and what is good

for you.”

“I will now eat healthier.”

Facilitators said:

“Their views on healthy eating have changed,

and eating healthier did not mean you need to

change your diet drastically. Learned about

portion control. They have more energy from

eating healthier.”

“Participants learn enough that they begin to

think about how they can make healthier

choices in their diets.”

“Participants learned to shop for healthy foods

in the grocery store.”



Specific changes as reported by

participants

“I am cooking more often and doing it without much

money.”

“Added more fiber to my diet.”

“I have cut down on my salt and sugar.”

“Laying off the fatty foods.”

“Eating more fruits and veggies.”

“My portions are different.”

“Learning how to shop for healthy foods in a grocery

store.”

“Cooking more from scratch.” (Many of the participants

mentioned that they are doing more cooking at home

from scratch).

“Meal planning was new to many and this was an

important change.” (Community Facilitator)


About trying new foods

Participants said:

“I’m cooking with spices now.”

“Adding different ingredients to my cooking.”

“Going to start using whole wheat flour.”

“Cooking different foods.”

“Introducing new foods.”

Facilitators said:

“The biggest change is that they are willing to try

new things and that is a very important in an

Aboriginal community.”

“Use of different foods and variety of color in their

cooking.”

“Trying new recipes was an important change.”

“Meal planning was new to many and this was an

important change.”


Program

W hen participants were asked what they liked most

about the program, the hands-on experience and

preparing the food together rated high.

• “I liked how we got together and shared our

knowledge and skill of cooking through the food we

prepared.”

• “I enjoyed the hands on experience and learning

new techniques.”

Many participants enjoyed the new recipes.

• “Love the recipes and how they include traditional

food.”

• “I enjoyed learning new recipes, cooking in a group

and getting tips and ideas from individual people.”

Participants very much liked trying new foods and new

ways of cooking, for example:

• “I liked making food that I have previously only had

in restaurants.”

• “I liked learning about new ways to add healthier

foods into my daily life and trying new foods I

haven’t tried before.”

• “I learned a lot of different ways to cook vegetables

and learned about different ways to prepare meats

and fish.”

• “The foods prepared were easy to make and very

yummy.”

Many participants liked the entire program.

• “Everything. The skills I learned, the people that

came and the instructor that held the program.”

• “Having a taste of everyone’s cooking, meeting

different people, especially working with different

partners, learning how to cook new vegetables,

and after eating having a full tummy.”

4.5 Program Satisfaction

Community Facilitator

N inety-six percent of participants were very satisfied

(81%) or satisfied (15%) with the Food Skills for

Families Community Facilitator. They described the

Community Facilitators as very helpful, informative,

knowledgeable, easy going and well organized.

Comments included:

• “Awesome teacher.”

• “Explains well.”

• “A lot of information presented clearly.”

• “Excellent instructor.”

• “Very good and clear messages.”

• “Did a wonderful job at helping us learn.”

• “Made sure our questions were answered.”

• “Flexible, made us feel welcome.”



Participant Feedback

P articipants were provided the opportunity to comment about their satisfaction with the Community Facilitator,

Participants Handbook, what they liked most about the program and any program improvements they

recommend.

Participant Handbook

P articipants of the ADI-funded programs found the

handbook to be very useful, similar to participants in

the program overall, with 93% indicating that they

intend to use the Participant Handbook at home. Many

participants mentioned that they liked the recipes and

found them easy to follow.

• “A lot of information that I was not aware of.”

• “It is simple to follow which made healthy food

easy and tasty.”

Suggested Program Improvements

P articipants had few suggestions for program

improvement. The main request related to the

desire for more sessions or the opportunity to return for

a follow-up program.

• “I wish the program could have been two to three

times a week.”

There were a number of comments regarding the need

for better equipment in the kitchen, e.g., better stove

and utensils for cooking.


EVALUATION REPORT SEPTEMBER 2012 ii EVALUATION REPORT OCTOBER 2012 13

Community Facilitator Feedback

C ommunity Facilitators reported receiving very positive feedback from

participants about the program. Participants commented how helpful they

found the program; that recipes were easy and tasty; and that they are eating

healthier, trying new ingredients and recipes, cooking from scratch, reading

food labels, and feeling more confident about choosing and cooking healthy

foods.

• “Eating nutritious food does not have to taste bland.”

Community Facilitators reported many benefits of the

program, including:

• “Learning enough that participants can begin to think about how they

can make healthier choices in their diets.”

• “Healthy food can taste good and be filling.”

• “Learning how to change recipes to make them healthier, opening our

minds to new foods and new ways of cooking, i.e. to talk about ways to

change the diet of the community as a whole.”

• “There was enthusiasm for cooking at home and trying new things, open

to herbs and spices and trying other beverages.”

• “Eating healthy for less money.”

• “The hands on experience and sharing experiences with others are

critical.”

• “You can have fun in the kitchen while cooking healthy.”



Community Facilitator Feedback

The following stories were reported by Community Facilitators.


Older youth mentored the younger ones. We had

drop-in guests. A teacher came to see what was

going on when we were about to eat so we

invited her to join us. She raved about the food.

A janitor came at the right time to eat one day

and joined us and he thought the food was great.

This enhanced the youths’ self-esteem and

confidence in their ability to cook especially since

these adults are people they see every day.

I gave one of the women all the ingredients to do

the lentil soup at home because she missed that

session. The woman took it all home and made

the soup and all the people she cooked for loved it.

She had to make a double batch because so many

people wanted to try it. She was so proud.

B grew up with 16 siblings. She is keen to try

healthy recipes and is sharing them with her

friends and family. She wants to continue with a

cooking program. She has added more

vegetables to her family’s dinner. After several

weeks, her family is eating more vegetables. She

herself has given up drinking pop and drinks more

water.

A success story is G who has made significant

changes to his lifestyle. He now walks 3-4 times

per week for 20-40 minutes even in the rain. He

reads labels and watches for salt and saturated fat.

He loves Puritan Stew and it was on sale so he

went to buy some. At the store he looked at the

sodium content which was very high and didn’t

buy it. He is a single parent trying to make

changes for his son’s health as well. They now sit

at the table for dinner. In the past his son would

eat while playing a computer/video game.

We had the community kitchen model where

participants make food and take it home.

However, most often the participants did not

prepare the whole recipe. They did a small part

since large volumes were necessary. With the

Food Skills for Families program, the participants

work with one other partner or in a small group

and prepared the entire recipe by themselves,

and had to read and follow the instructions. They

were proud of their accomplishments especially

when the group raved about the recipe.



B ased on comments received from Community Facilitators, a number of important program impacts include:

4.6 Other Program Impacts

A number of the Band caterers have taken the Food Skills for Families program or

are supervised by people who have participated. As a result, caterers have

changed menus to reflect healthier choices for community functions.


• The development of friendships and social networks, such as: “single parents bonding”; “bringing moms and

teens closer together.”

• The sharing of knowledge, for example: older participants sharing their knowledge with younger couples and

grandchildren; sharing the recipes with other family members; and older groups mentoring younger groups.


P articipants were asked in both pre and post

questionnaire, “What stops you from buying,

preparing and eating more healthy foods?” Of those

participants who reported at least one barrier, the three

most frequently mentioned barriers are: Healthy food

costs too much (50%); I don’t have healthy recipes (48%);

and I don’t know which methods of cooking are healthy

(39%).

• At the end of the program, knowledge about

methods of cooking healthy was substantially

reduced as a barrier with only 9% reporting this as

a barrier.

• Cost of food remained a barrier at the end of the

program but for a smaller percentage of

participants (pre 50% and post 35%). A Community

Facilitator indicated that, “some participants were

pleasantly surprised that meal planning for a week

saved them money.”

• Not having healthy recipes also remained a barrier

at the end of the program but for a slightly smaller

percentage of participants (pre 48% and post 40%).

• Not being able to buy fruits and vegetables locally

was a barrier at the start and end of the program

(pre 29.5% and post 28.3%).

When barriers to healthy eating reported by participants

in the ADI-funded programs were compared to barriers

reported by participants in the March 2011 Food Skills for

Families Evaluation Report (off reserve Aboriginal, new

immigrant, Punjabi and low income combined), it is

worth noting that participants in the ADI-funded

programs reported having less local access to fruit and

vegetables. This was a barrier for 29.5% of on reserve

participants, compared to 12.6% of the combined

populations. Cost, healthy recipes and healthy cooking

methods were reported as the top three barriers for both

groups. Local access to fruit and vegetables ranked as

the sixth most significant barrier for the other

populations, compared to fourth for the ADI-funded

participants.

Comments from Community Facilitators reinforced the

challenges of cost and limited access to fruit and

vegetables because of cost, lack of availability in the local

community, long distances to retail stores and lack of

readily available transportation.

• “Participants would need to drive an hour to get to a

store and often they do not have the transportation.”

4.7 Barriers to Healthy Eating


10.0%

17.4%

34.8%

28.3%

39.1%

8.7%

6.5%

4.5%

18.2%

50.0%

29.5%

47.7%

38.6%

11.4%

I don’t l ike the taste of healthy foods.

I don't have the right kitchen equipment or utensils.

Healthy foods cost too much.

I cannot buy fresh fruits and vegtables locally

I don't have healthy recipes.

I don't know which methods of cooking are healthy.

I don't know which foods are healthy.

Percent of Participants Pre Program

Percent of Participants Post Program

What Stops You From Buying, Preparing and Eating More Healthy Foods Matched Participants

5.1 Summary Highlights

A t the conclusion of the ADI-funded Food Skills for Families programs, some improvement in the frequency of

eating fruit and vegetables or salad was reported. However, a number of barriers exist for participants that

prevent healthy choices from being easy choices, in particular, the ability to access and/or afford fresh fruit and

vegetables. Encouragingly, approximately two-thirds of participants stated they definitely intend to eat more fruit

and vegetables over the next year.

The Food Skills for Families program appears to have the most impact on participants who reported adding salt to

their food twice a day or more or those who drank sugary drinks on a daily basis – percentages in these categories

had the largest change.

Participants reported a positive change related to eating less fried foods and in their confidence levels to prepare and

cook new foods and read facts on food labels.

The biggest changes in behavior reported by

participants as a result of taking the Food Skills

for Families program include eating healthier,

trying new foods and reading food labels. These

changes are also reported by the Community

Facilitators as being the biggest changes they

observed in the participants.

The written and verbal reports by participants

and Community Facilitators attest to the

program’s ability to positively influence

participants’ healthy eating, cooking and

nutrition knowledge, skills, attitudes and

confidence. The program is highly regarded by

all stakeholders involved.

5.0 Summary & Future Considerations


5.2 Future Considerations

B ased on the evaluation consultation and questionnaire results, a number of

considerations are presented to optimize the future potential of the ADI-funded

Food Skills for Families programs.



Program Delivery

• Link the ADI-funded Food Skills for Families programs with other food skills and

food security initiatives to improve the accessibility and affordability of healthy

food, in particular fruit and vegetables for vulnerable populations. For example,

food preservation/canning programs, community gardens and community kitchens.

• Continue to reinforce key messages and identify additional strategies within the

program that would assist participants to make healthier beverage choices, to

decrease their sugar sweetened beverage intake, reduce sodium/salt intake, and

eat more fruits and vegetables.

• Foster opportunities for Community Facilitators to share their knowledge,

experiences, successes and lessons learned with each other.

• Emphasize the value of the certificate of completion and consider offering

incentives to participants, when feasible, to encourage participation in all six

sessions.

• Encourage Band members with the responsibility for preparing food for community

events to complete the Food Skills for Families program.



Partnership and Collaboration

• Continue the partnership between the Aboriginal

Diabetes Initiative and Canadian Diabetes

Association to help sustain and extend the reach of

the Food Skills for Families program to become a

readily available healthy eating and chronic disease

prevention strategy for on reserve Aboriginal

families.

• Continue to fund training of new on reserve Food

Skills for Families Community Facilitators to further

build community capacity.

• Continue to support existing on reserve Community

Facilitators to maintain their knowledge and skills,

and provide updated resources to deliver the Food

Skills for Families program.

• Encourage Bands to leverage Community Facilitator

and program participant knowledge of healthy

eating and cooking to extend the impact more

broadly within their communities (knowledge

transfer/exchange).

• Encourage/advocate for Bands, government and

other stakeholders to reduce barriers to healthy

eating for vulnerable populations and to make the

healthy choice the easier choice.

Data Management

• Strengthen Community Facilitators’ understanding

and adherence to data management protocols,

specifically the completion of pre and post

questionnaires by all participants, and ensure

Community Facilitators correctly and consistently

label the questionnaires with the participant’s

unique confidential identifier.

• Work toward simplifying the coding procedures in

the pre and post questionnaires to maximize

availability of matched data for greater reliability.

Future Evaluation

• Continue to collect participant data (pre and post

program) to build evidence of the impact of the

program on healthy eating and to communicate

evaluation results broadly.

• Conduct periodic follow up evaluations, such as

telephone surveys and focus groups with

Community Facilitators and participants, to

determine the impact of the program in the longer

term.

Recognition

T he Food Skills for Families program would like

to thank the Master Trainers, Community

Facilitators, participants, staff, Bands and host

organizations for their support of program

delivery, participation in the evaluation process

and notable efforts to ensure quality evaluation

data was collected and reported.

Zena Simces and Susan Ross, Evaluation

Consultants, designed the evaluation, undertook

the analysis and synthesis of the data, and

prepared the evaluation report. Barry Forer,

Statistical Consultant, analyzed the participant

data and assisted in summarizing results.

Samantha Bissonnette, Program Coordinator, and

Barb Kemp, Program Manager and Master Trainer,

assisted in the review of the data and final report.

A special thank you to the Aboriginal Diabetes

Initiative, Pacific Region, First Nations & Inuit

Health, Health Canada for funding the Food Skills

for Families program for on reserves communities

across BC.



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