NutriBee Intervention Improves Diet and Psychosocial Outcomes by Engaging Early Adolescents from Diverse and Disadvantaged Communities

Abstract

Objective: NutriBee was the first clinical nutrition intervention designed to bring the Institute of Medicine recommendations for 20 hours of experiential nutrition-themed learning to grades 4–7 into club and camp settings. We piloted NutriBee to assess acceptability and impact among early adolescents in diverse and disadvantaged communities in order to evaluate its future potential as a group medical nutrition intervention.

Methods: Nine communities across Guam, Maryland, Michigan, and New Mexico representing South Pacific Island, American Indian, urban African American, recently immigrated Hispanic, and rural Caucasian ethnic groups piloted NutriBee in nonclinical settings (clubs, schools, camps). The 6 club and camp pilots administered consenting NutriBee participants a 41-question pre–post survey assessing impact on food selection and the psychosocial parameters of intentions, outcome expectations, self-efficacy, and knowledge. Process measures included dose, fidelity, and acceptability questions.

Results: Pre- and postsurveys were completed by 170 of 179 (95%) consenting, eligible participants. Impact scores increased significantly (p < 0.001): Food selection behavior (+9.3%), intentions (+19.1%), outcome expectations (+15.1%), self-efficacy (+7.4%), and knowledge (+17.6%). Each pilot (n = 6) demonstrated significant (p < 0.001) impact, a mean dose delivered of 80% (16 hours) or higher, and an acceptability score of at least 74%. Girls participating in girl-only programs (n = 72) shared greater impact than girls in coed programs (n = 41; 13.6% vs. 10.4% mean score increase, p = 0.05).

Conclusions: NutriBee successfully extended the impact of an IOM-aligned intervention to club and camp settings to which clinicians can refer at-risk early adolescents.

Key words:

• early adolescence
• collaborative
• inquiry-based
• hands-on and experiential learning
• games-based learning
• food safety
• nutrition education
• Institute of Medicine
• community-based participatory research
• preventive medicine

ACKNOWLEDGMENTS

We thank Katherine Nelson, Valerie Montague, and Rachael Leon Guerrero, PhD, for their careful data collection. Dedicated efforts of Vickie Fish, EdD, executive director of Guam Girl Scouts International, and Wonha Kim, MD, MPH, made the Guam pilot possible. We thank the OPREVENT team for their valuable input in the learning materials and NutriBee implementation. Liane M. Summerfield, PhD, Elizabeth Anderson Steeves, Preety Gadhoke, PhD, MPH, and Este de Fossard-Nelson, MED, MA, contributed their insights in nutrition education and behavior change relevant to NutriBee's design and implementation. Claire Welsh assisted with the JHSPH IRB.

CONFLICT OF INTEREST

Ingrid Kohlstadt is the founder and Executive Director of the nonprofit organization (501c3) NutriBee National Nutrition Competition, a component of whose intervention was evaluated in this research. Joel Gittelsohn and Yu Fang have no competing interests.

AUTHOR CONTRIBUTIONS

I.K. developed the intervention materials and designed and implemented the study. J.G. designed the questionnaire (instrument), analyzed the data, and directed the implementation of the OPREVENT study, which included NutriBee Sites A–C. Y. F. completed the data entry and worked with J.G. on data analysis.

Funding

We thank the MetLife Foundation for the generous grants that supported the design, implementation, and evaluation of this research study.