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FIT FOR FAMILY PROGRAM EVALUATION 1

Implementation and Evaluation of Fit for Family:

A Family-based Community Education Program

Joseph Kalscheur

University of Wisconsin – Stout

December 18th, 2013


Abstract

In November, 2013, a family-based community education program titled Fit for Family

joined the growling battle against obesity in America. In Dunn County Wisconsin, obesity rates

and low income levels both exceed the state averages. With an above average obesity rate and

low income level, Dunn County Wisconsin was seen as a prime location for Fit for Family to

administer curricula focused on increasing the acceptance of and knowledge about the health

benefits of a healthful diet and physically active lifestyle. The goal of the implementation of Fit

for Family was to bring families together in a fun and interactive environment that fosters

healthy lifestyle choices in wake of an obesity epidemic. Fit for Family involved three 90-minute

sessions that meet once a week. Each session was broken up into three main components: healthy

snack, nutrition education, and physical activity, where community volunteers from all around

the county came and lent a hand. Evaluation of this program was administered via pre-and-post

surveys. Results from these surveys indicate that this program was in deed effective in improving

participant’s knowledge and acceptance towards making healthy lifestyle choices. Due to

relatively small sample size, and many lurking variable with this kind of study, further research

is needed to generate more conclusive evidence on the effectively of this program.


Introduction

There is a great need for the programs that are centered on healthy eating and physical

activity throughout the state of Wisconsin, particularly in Dunn County. According to the

Wisconsin Nutrition Education Program (WNEP), in 2011, 53% of all deaths in Wisconsin were

due to heart disease, cancer, and diseases clearly linked to diet (An Investment in Wisconsin,

2013). WNEP data from 2009 show that only 23% of Wisconsin adults eat the recommended

serving of fruit and vegetables. (An Investment In Wisconsin, 2013). According to the Wisconsin

Diabetes and Prevention Control Program, Division of Public Health, and Department of Health

Services, the burden of food and nutrition-related diseases in the area is substantial and reflects

the rates of overweight and obese people around the nation, with 63% of adults being classified

as either overweight or obese and roughly 26% being classified as obese. In Dunn County,

approximately 24% of the adult population is identified as having high blood pressure, a disease

linked to excess consumption of high sodium processed foods and low consumption of fruits and

vegetables (Wisconsin Diabetes and Prevention Control Program, Division of Public Health, and

Department of Health Services, 2011). The fact of the matter is that poor eating habits are highly

associated to poor health.

Low-income families are particularly susceptible, with inadequate diets and less

knowledge about nutrition recommendations than families with more financial resources

(Wisconsin Nutrition Education Program: An Investment in Wisconsin, 2013). The poverty level

in Dunn County is higher than the average in the state of Wisconsin, with 15.5% of the

population in Dunn County below the poverty level, compared to the state rate of 12% (U.S.

Census Bureau, 2011). This trend in having higher than average poverty rates in Dunn County

transcends to having a significant percentage of students enrolled in the Menomonie School


District who participate in the free and reduced lunch program. In Dunn County, the percentage

of students participating in the free and reduced lunch program ranges from 25.9% in Oaklawn

Elementary School to 65.8% in River Heights Elementary School. Fit for Family aims to address

this population by forming a strong partnership with River Heights Elementary school coinciding

with it being designated as the host site for which Fit for Family will be instituted.

Purpose & Objectives

The goal of the implementation of Fit for Family was to bring families together in a fun

and interactive environment that fosters healthy lifestyle choices in wake of an obesity epidemic.

The intended outcomes for this program were to engage, educate, and empower families to make

healthier lifestyle choices that can eventually turn into habits. As a pilot study, this project was

not designed with the intent to uncover any earth-shattering findings that; nevertheless, this

project was developed to act as a firm stepping stone for future community health education

projects to learn from and expand upon our efforts. Specifically, the evaluation of Fit for Family

aimed to accomplish the following objectives:

1. Assess the effectiveness of the Fit for Family program on increasing the knowledge about

the health benefits of eating nutritiously (e.g. building a healthier plate, or balancing

sugar, fat, and salt within diet).

2. Assess the effectiveness of the Fit for Family on empowering families to make a healthy

lifestyle change in their personal lives (e.g. cook more home-cooked meals, be more

physically active, etc.).

3. Identify particular instructional methods that prove to be more effective than others.


The purpose of this research project was to evaluate the effectiveness of the Fit for Family

program in Menomonie, Wisconsin. Fit for Family focused on increasing the acceptance of and

knowledge about the health benefits of a healthful diet and physically active lifestyle. Initial

hypothesis for this project is as follows: if families actively participate in three 90-minute

community education sessions centered on nutrition and physical activity, then they will increase

their acceptance of and knowledge about making healthy life-style choices.

Review of Literature

One of the first seminal studies related to health and fitness in America was coauthored

by Dr. Hans Kraus and Bonnie Prudden in December 1953. The article “Muscular Fitness and

Health” sounded an alarm about the poor state of youth fitness in America (President’s Council

on Fitness, Sports and Nutrition, 2013). In the years that followed, growing concerns reached the

national level as President Eisenhower created the President’s Council on Youth Fitness in June

1956. From that point on, the Presidents Council has continued to grow and adapt as the needs of

the American people also grow and change over time. As the Council stands today, with

President Obama as their leader, the mission of the Presidents Council is to “engage, educate,

and empower all Americans to adopt a healthy lifestyle that includes regular physical activity

and good nutrition” (President’s Council on Fitness, Sports & Nutrition). Thereby, the program

outcomes and objective of Fit for Family augments the efforts supported by the current President

of the United States of America, Barrack Obama, and his affiliates.

Methodologies

A mixed methods research approach was used to assess the effectiveness of Fit for

Family. A quantitative evaluation measuring the effectiveness of Fit for Family was conducted


using pre-and post-surveys, modeled after pre-and-post surveys developed by the Department of

Agriculture, Trade and Consumer Protection (DATCP) (see appendix for sample surveys). The

time efficient surveys allowed us to collect the data we were interested in, while also exploiting

the limited amount of time we had to cover all the content and activities of each session. We

used the DATCP surveys as a model for the development of our own pre-and post-surveys

because; we knew they had been successfully used by other community outreach program

planners.

The qualitative assessment was collected from the post survey, where respondents were

asked to answer five open-ended questions. A benefit of including this qualitative component

into our data collection was that it allowed us to develop a more clear understanding of what the

participant’s thoughts and feelings were of this program by hearing it directly from the source.

The use of mixed methods research in this study was supported by Susan Foxwell, Director of

Research Services at the University of Wisconsin – Stout. During an in-person interview with

Foxwell, she explained that the mixed methods approach is always the most preferred method

because it provides an assessment of treatment from more than one perspective (S. Foxwell.

2013).

The program outline for Fit for Family did not follow any one particular community

health outreach program, but it was the product of collaborate brainstorming and strategic

planning between invested students, school administrators, community partners, school

educators, campus leaders, and local businessman.

Program Implementation


Fit for Family meet once a week for three weeks on Thursdays from 6:00 pm to 7:30 pm

at the River Heights Elementary School between the dates of November 7th, 2013 and November

21st, 2013. The Fit for Family program was featured in the Fall 2013 Community Education

Guidebook for the School District of Menomonie. This Guidebook is disseminated to each family

enrolled in the School District of the Menomonie Area on a quarterly basis by Kale Proksch,

District Facilities Community Education Coordinator for the Menomonie Area School District.

Registration forms, along with the promotional fliers (see appendix for both) were original

documents made specifically for Fit for Family and were disseminated to each of the five

elementary schools within the Menomonie Area School District, separate to the Fall 2013

Community Education Guidebooks. These registration forms, along with a five dollar registration

fee were mandatory for each family to fill out and turn in before they could be accepted into the

Fit for Family program. The deadline to which families had to turn this form in was November

5th, 2013 (two days before the program started). Completed registration forms and fees were

either turned into Kale Proksch, Sarah Place (Grant Coordinator for the River Heights

Elementary School), or myself. Once registered, families (no matter the size) could expect to

participate in the programs three 90-minute sessions that were centered on nutrition and physical

activity. Each session was broken up into three main components: healthy eating, nutrition

education, and physical activity.

Healthy eating. This segment was offered during the first 15-20 minutes of the program.

This timeframe was chosen to allow families enough time to check-in at the registration table

upon arrival, grab a bite to eat, and then find a place to sit and eat comfortably together as a

family without being pressed for time. We were also informed by Sarah Place, who lead similar

community education events in the past, that it is common to have families arrive 10-15 minutes


late (which turned out to be absolutely true). Ultimately, offering the snacks at that time seemed

effective in insuring families had enough time to cozy-in before the actual didactic learning

began. The snacks were funded in part by the five dollar registration fee each family was

required to pay before participating. The vast majority of the snacks, however, were supplied by

community supporters such as UW-Extension, the Menomonie Area School District Food

Service Department, and the Menomonie Food Market Co-op.

Nutrition education. Immediately following the healthy eating time, families were taken

through a series of nutrition-focused presentations, demonstrations, games, and group

discussions. Each session was focused on a specific area of nutrition as shown below in Table 1.

The nutrition education sessions were led by Kara Helget, an AmeriCorps Farm to School

Nutrition Educator in the Menomonie Area School District. We also partnered with UW-

Extension, Mayo – Menomonie’s Education Center, and the Menomonie Food Market Co-op.

UW-Stout student volunteers also helped with the planning and delivery of the nutrition

education lessons. The goal of these lessons was not to lecture the families via PowerPoint.

Instead, we aimed to cover the material in a more informal, fun, and interactive way. This

presentation style allowed us to be more appealing for participants of any age. To help make

these lessons more kid friendly, we approved our plan with two UW-Stout students enrolled in

the Early Childhood Education program. While we still used PowerPoints at each of the three

sessions, we designed them to serve a secondary supportive roll to that of visual demonstrations,

group discussions, and games. Handouts were also created to highlight the main teaching or take-

a-way points that Kara covered at each session so that the families would have the information

on-hand for future reference. The SmartBoard technology was also used to deliver nutrition

education lessons to the youth population.


Physical activity. Following the nutrition education lessons, the remainder of each

session was devoted to bring families closer together through play and physical activity. Again,

each session focused on a separate avenue of movement-driven activities such as (1) Football

Training Camps with the UW-Stout Football team, (2) team building with University Recreation

– Stout Adventures, (3) Laughter Yoga with Sue Halama and Medic ball (Dodge ball) with help

from Mrs. Munoz, who is the physical education teacher at River Heights. Below you will find

the basic program outline for each of the three Fit for Family sessions, including the key

stakeholders who were held responsible for each particular activity.

Table 1: This table shows the major themes and activities for each of the three Fit for Family sessions.

Data Collection Procedures

There were two different methods of data collection used to assess the effectiveness of Fit

for Family: (1) registration forms and attendance records and (2) surveys.


Registration forms and attendance record. By the November 5th deadline, we received

18 completed family registration forms (Note: we did accept one unregistered family of five who

showed up the day of the event). The information included on these documents allowed us to

gain great perspective on the demographic of people who plan to participate during Fit for

Family. Such information included the name, age, grade level in school (if child), and special

needs of each family member planning to attend. Once all the forms were collected, information

from each form was compiled using Excel Software and then reviewed to identify any particular

patterns, trends, or special needs that should to be accounted for in program planning. From this

listing of participants, an attendance roster was generated that was later used to check-in each

participant before each session.

Pre-and-post surveys. The pre-and-post surveys used in this study served as the primary

data source in the assessment of Fit for Family. The pre-survey was disseminated at the

beginning of the 1st session while the families ate their healthy snack and before any nutrition

education content was covered. The post-survey was disseminated just before the families were

dismissed on the 3rd and final session. We neglected to survey the youth participants due to the

fact that we only had a limited amount of time to collect survey data without taking time away

from the programs scheduled activities. For our purposes, we classified any participant in 7th

grade or below as being a “youth”. The sample sizes for the pre-and-post surveys were 14 adults

and 11 adults, respectively. After all the anonymous surveys were collected, data from these

surveys was plotted using Microsoft Excel software. For objective I, we compared the difference

between the pre-and-post mean response values of two different survey questions: (Q1) “Rate

your level of knowledge on building a healthy plate.” and (Q2) “Rate you level of knowledge on

balancing sugar, fat, and salt in your diet.” Responses for these questions were based on a 1 to 5


scale with one being “none” and five being “extensive”. The mean value of the pre-and-post

survey responses for each question was then plotted and compared, as shown in Figure 4. For

objective II, this same process was repeated except for two different survey questions were

assessed: (Q3) “Rate your level of comfort on preparing healthy meals with your family.” (Q4)

“How motivated are you to make healthy lifestyle changes in your life?” These four scale-rated

questions served to provide quantitative data used in the assessment of objectives I and II. For

objective III, we looked at the variation in responses to the following open-ended questions as

they appeared on the post-survey: (1) “What was your favorite part of this program?” (2) “What

recommendations would you make to help us improve future programing? Additional questions

were added to the pre-and-post surveys for the purposes of uncovering useful information that

could also help guild future programs.

Results

The data collected from our attendance record showed that of the 67 registered

participants (19 registered families), 61 participants (17 families) attended session one, 45

participants (12 families) attended session two, and 32 participants (11 families) attended session

three. Thereby, the attendance rate of participants decreased in a somewhat linear fashion with

each offered session. The number of families also decreased, though at lesser rate. See figure 2

for a visual representation of this data.


Session 1 Session 2 Session 30

20

40

60

Participant vs. Family Attendance

FamiliesParticipants

Duration of Program Re

cod

of A

tten

danc

e

Figure 2: This graph shows attendance pattern of families and participants throughout Fit for Family.

Surveys

The pre-and-post mean response ratings to the four scale-rated questions used to test

objectives I and II are shown in Figure 4. As the results show, the mean scale-rated response

increased went up in value at the time of increased from pre-to-post, suggesting that Fit for

Family was effective on improving participant’s knowledge about eating nutritiously, while also

empowering them to make a healthy lifestyle change. Given that there are many lingering

variables that are likely to be at play with these results, more extensive evaluations need to be

conducted before these results can have merit.

01.5

34.5

3.867 3.625 3.4674.334 3.909 4.273 4.364

Pre-and-Post Survey Scale-Rated Responces

Pre-SurveyPost-Survey

Responce Categories

Ratin

g Sc

ale¹


Figure 4: This graph shows relationship between the pre-and-post mean response ratings to each of the

four featured researches questions.

To identify what instructional methods participants liked the best we asked the post-

survey sample subjects to provide narrative feedback responses to the following focus areas:

(1)“What was your favorite part of this program?” and (2)”Please list at least one

recommendation or suggestion to help us improve future programming.” Each response was

recorded as they were written. If sample subjects provided more than one answer (e.g. favorite

part was physical activity and meal suggestions) then each part would be counted individually at

the same weight. Duplicate responses were added together. The data sets from these two

response narratives can be seen below in Figure 5 and 6.

Physical

activit

yies

Games

Healthy e

ating

Food

Medic B

all

Kids acti

vities

Meal Su

ggesti

ons

Laugh

ter Yo

ga All 0

1

2

3

4

5

Favorite part of the program?

Program Favorits

Num

ber o

f Res

onde

nts

Figure 5: This graph shows the program “favorites” as seen by the post-survey sample subjects.

As shown in Figure 5, nine of the 14 responses are linked to the physical activity

component of Fit for Family (e.g. physical activities, games, Medic-ball, Laughter Yoga), while


the other five responses were shared between the food and nutrition education components. This

sufficient trend strongly suggests that the physical activity component of Fit for Family was

among, if not the “favorite part of the program”. Although the lack of an adequate sampling size

is apparent in Figure 6, an interesting relation between “more games” and “less lecture” can be

drawn out from this data. Furthermore, because the vast majority of the lecturing was

administered during the nutrition education lessons, one could speculate that even though we

tried reducing the “lecture” time given throughout this program, there is still room for

improvement in this area and should consider more creative content delivery methods in the

future.

Don't turn fami-lies away at the

door.

Less lecture More sessions More games 0

1

2

3

Recommendations/Suggestions for improvement?

Recieved Recommendations/Suggestions

Num

ber o

f Res

pond

ents

Figure 6: This chart shows that recommendations for improvement, provided by the five of the 11 post-

survey subjects.

In a different section of the post-survey, participants were asked to circle the number on

the rating scale that best describes them with 1 being “not at all” and 5 being “extremely”. After

reviewing all the responses to the question: “How well were your expectations met?”, four out of

the 11 respondents said their expectations were “very” met and the remaining respondents said


their expectations were “extremely” met. In a similar manner, the participants were asked the

question: “Would you attend another event with this focus?”. To our surprise, all the respondents

claimed that they would.

Limitations

The limitations of this project are extensive. First, the sample size for this study was

small and potentially skewed (14 pre-survey responses and 11 post-survey responses). With such

a small sample size it is harder to prove that our results did not persist through chance.

Generalizability is also a great limitation for this project being that all the participating families

lived within the Menomonie, Wisconsin area. Additionally, the data this study will generate is

likely to have some inclusion of lurking bias due to the fact that voluntary response sampling

(i.e. sampled participants choose to get involved) had to be used rather than random sampling.

As a result, the data collection for the study is susceptible to being biased because people are

motivated to respond or not. The validity of this research also depended on the clients’ honesty

in reporting.

Discussion

The results of this study gives inconclusive but supportive data in favor of the initial

hypothesis of this study, which claimed: if families actively participate in three 90-minute

community education sessions centered on nutrition and physical activity, then they will increase

their acceptance of and knowledge about making healthy life-style choices. Partial to the success

of this program, we can pay tribute to the challenges, moreover, the lessons learned from those

challenges. As a first-time program, the majority of the challenges we faced took place in the

pre-event and planning stage. To help minimize these particular challenges in the future the


registration deadline will be set one to two weeks before the start of the program, instead of just

two days before, leaving more time to properly plan for the exact number of participants.

Given the need for community education programs, such as Fit for Family, will remain

high for quite some time, our future plans for this winter will include making a plan for

developing a model that will help make community education programs more sustainable in the

long run. Although program development is challenging, it also is a lot of fun and satisfying

seeing people enjoy themselves and their family while participating in one of your events. Seeing

moments such as those unfold and hearing side comments such as: “that was awesome!”, “we

looked forward to this all week”, “do we have to leave already?”, reminded us (volunteers) that

even thought this was a short-term “pilot study” program, our efforts in this program have a real

and lasting effect on the life’s of the families we serve in their pursuit to a healthier lifestyle. My

hope is that through this program and the objectives we assessed more extensive family-based

community education programs can unfold in furthering obesity prevention and research in

America.


References

President’s Council on Fitness, Sports & Nutrition.

http://www.fitness.gov/about-pcfsn/

School District of Menomonie. (2013). Fall 2013 Community Education Guidebook.

S. Foxwell, personal communication, October 10th, 2013

Wisconsin Department of Agriculture, Trade and Consumer Protection. (2013). Buy local, buy

Wisconsin. Retrieved from

http://datcp.wi.gov/Business/Buy_Local_Buy_Wisconsin/Farm_to_School_Program

/index.aspx?AspxAutoDetectCookieSupport=1

Wisconsin Department of Public Instruction. (website)

http://fns.dpi.wi.gov/fns_progstat

Wisconsin Diabetes and Prevention Control Program (DPCP), Division of Public Health, and

Department of Health Services. (2011). The 2011 burden of diabetes in Wisconsin.

Retrieved from http://www.dhs.wisconsin.gov/publications/P0/P00284.pdf

Wisconsin Nutrition Education Program. (2013). An Investment in Wisconsin.


Appendix

App. 1: Promotional Flier - Drafted by Joe Kalscheur


App. 2: Registration Form – Drafted by Joe Kalscheur


App. 3: Pre-survey (page 1 of 2)


App. 4: Pre-Survey (page 2 of 2)


App.5: Post-survey (page 1 of 2)


App. 5: Post-survey (page 2 of 2)

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