WIC NE State & Local - Phase II

Appendix PPP.2:
Nutrition Educator PAper Survey

OMB Control Number: 0584-XXXX
Expiration date: XX/XX/XXXX

WIC Nutrition Education Study

Phase II Survey of Nutrition Educators

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it ‎displays a valid OMB number. The valid OMB control number for this information collection is 0584-XXXX. The time required to ‎complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, ‎searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of ‎information.

Thank you for completing this survey for the WIC Nutrition Education Study (NEST). This survey is being conducted for the USDA, Food and Nutrition Service (FNS) to collect information for a study to evaluate the impact of nutrition education on the eating and physical activity behaviors of participants. Your responses will provide important information about how you conduct nutrition education and about your experience working with WIC participants.

Responses for individual sites or respondents will not be identified in any study reports or publications. Although survey responses will be identifiable to FNS, the responses will not be used for compliance or monitoring activities.

The information you provide will help strengthen and enhance WIC nutrition education efforts and highlight the efforts across the country to promote healthy eating and physical activity practices among WIC participants.

Please complete the survey by MM/DD/YYYY.

Most questions include a box  for you to check response(s). Some questions require you to enter numbers or text responses. Please use blue or black ink to complete the survey. We recommend that you review the questions before beginning the survey so that you can obtain any information needed to respond. The survey will take about 20 minutes to complete.

Nutrition Education Survey Help Desk

If you have any problems completing the survey, please contact:

[Toll-free phone number]
[Email address]

Nutrition Education Contacts

For all questions, nutrition education includes breastfeeding education.

1. How often do you use the following methods to provide nutrition education? (Check one response for each method.)

   Method	Never	Rarely (<10%)	Occasionally (11–39%)	Some-times (40–59%)	Often (60–89%)	Almost Always (≥90%)
   One-on-one counseling: Face to face (in WIC site)						
   One-on-one counseling: Telephone						
   One-on-one counseling: Video conferencing						
   Group education sessions						
   Other nutrition education activities (e.g., monthly topic, worksheets, videos, self-study modules)						

2. How often do you assist participants with technology-based nutrition education methods? Assistance could take the form of explaining the process, helping participants complete the education, or following up on their experience using these methods. (Check one response for each method.)

Method	Never	Rarely (<10%)	Occasionally (11–39%)	Some-times (40–59%)	Often (60–89%)	Almost Always (≥90%)
Technology-based nutrition education used by participants at site (e.g., computer, kiosk, tablet)						
Technology-based nutrition education used by participants offsite via Internet (e.g., web-based nutrition education modules)						

3. How do you provide nutrition education to participants who do not speak English? (Check all that apply.)

• Not applicable—all participants that I work with speak English.  GO TO QUESTION 5

• I speak the same language as most of our non-English speaking participants.  GO TO QUESTION 5

• I ask a bilingual WIC staff member to interpret or translate.

• I use an interpreter or translator available at the site.

• I use a language line/phone interpreter service.

• I use a translation program on the computer.

• Participants bring family member or friend to interpret.

• Other (describe):

4. How confident are you in your ability to provide nutrition education to participants whose primary language is different from yours?

• Very confident

• Somewhat confident

• Not at all confident

Training

The next three questions ask about training you have received from the WIC Program during the past 12 months.

5. During the past 12 months, how did you receive training on nutrition topics and nutrition education skills? (Check all that apply.)

• I did not receive any training.  GO TO QUESTION 8

• National/State/regional conferences or workshops

• Training sessions/courses at a State training center

• In-person training sessions (e.g., conferences, workshops) provided by your local agency

• In-person training sessions (e.g., conferences, workshops) provided by other local agencies or programs

• State or local agency webinars

• Online training modules or courses

• Training provided during local agency or site staff meetings

• Individual staff mentoring/coaching

• Other (describe):

6. In the first column, check “Yes” or “No” to indicate if you received training on the topic during the past 12 months. In the second column, for each topic that you check “Yes,” estimate the number of hours of training on that topic you received during the past 12 months.

Topic	Included in Training in Past 12 Months?	If Yes, Estimated Number of Hours
Breastfeeding	 Yes  No
Prenatal nutrition	 Yes  No
Infant nutrition	 Yes  No
Child nutrition	 Yes  No
Value Enhanced Nutrition Assessment (VENA) skills	 Yes  No
Participant or learner-centered education	 Yes  No
Motivational interviewing	 Yes  No
Emotion-based counseling	 Yes  No
Group facilitation skills (e.g., facilitated group discussion)	 Yes  No
Weight and growth issues (prenatal weight gain, infant/child growth, and weight gain)	 Yes  No
Other nutrition topics	 Yes  No

7. Which, if any, of the topic(s) you’ve received training on over the past 12 months have been most useful to you in providing nutrition education?

______________________________________________________________

______________________________________________________________

______________________________________________________________

If you do not provide one-on-one counseling, GO TO QUESTION 21.

8. How are discussion topics determined for most of your one-on-one counseling sessions? (Choose up to three responses. Write “1” for the process used most often, “2” for the process used next most often, and “3” for the process used next most often.)

____ I choose the most appropriate topic(s).

____ The participant chooses the topic(s) she wants to talk about.

____ The participant and I choose the topic(s) together.

____ Other (describe):

9. For each category of women participants, which topics do you discuss most often? (Check up to seven topics for each category.)

   Topic	Pregnant	Postpartum	Breastfeeding
   Breastfeeding			
   Calcium intake			
   Cooking/meal preparation			
   Dental care			
   Diabetes			
   Folic acid			
   Food safety/Foods to avoid			
   Fruit and vegetables			
   Having enough to eat			
   Healthy snacking			
   High blood pressure/hypertension			
   Infant feeding			
   Iron/anemia			
   Milk (lower fat choices/consumption)			
   Nausea, vomiting, or constipation			
   Physical activity			
   Pica (eating non-food items)			
   Postpartum depression/self-care			
   Postpartum weight loss			
   Prenatal nutrition/diet			
   Preparing for a healthy pregnancy			
   Protein intake			
   Shopping for and preparing healthy foods			
   Sugar-sweetened beverages			
   Vitamin and mineral supplements			
   Water consumption			
   Weight gain during pregnancy			
   Whole grains			
   Other (describe):_____________			

10. Which topics do you discuss most often with parents/caregivers of infants? (Check up to seven topics.)

• Breastfeeding

• Colic

• Constipation, diarrhea, or vomiting

• Food intolerances/allergies

• Formula preparation/feeding

• Infant feeding practices

• Infant growth and development

• Introduction of cow’s milk

• Introduction of solid foods

• Inappropriate foods (e.g., high-fat foods, fast foods, honey)

• Iron/anemia

• Overfeeding

• Parenting

• Physical activity

• Propping the bottle (leaving infant unattended with bottle)

• Sugar-sweetened beverages

• Water consumption

• Weaning from the bottle

• Other (describe):

11. Which topics do you discuss most often with parents/caregivers of children? (Check up to seven topics.)

• Child growth and development

• Child feeding practices

• Constipation, diarrhea, or vomiting

• Cooking/meal preparation

• Dental health

• Family meals

• Fruit and vegetables

• Healthy snacks

• Healthy weight for child

• Inappropriate/sometimes foods (e.g., fast foods, high-fat foods)

• Iron/anemia

• Milk (lower fat choices/consumption)

• Parenting

• Physical activity

• Pica (eating non-food items)

• Picky eaters

• Portion sizes

• Screen time

• Shopping for and preparing healthy foods

• Sugar-sweetened beverages

• Water consumption

• Weaning from the bottle

• Whole grains

• Other (describe):

12. During your one-on-one counseling sessions, how often are participant behavioral goals (e.g., nutrition or physical activity) set?

• Goal setting is not part of one-on-one counseling sessions.  GO TO QUESTION 21.

• Rarely

• Occasionally

• Sometimes

• Often

• Almost always

13. How are participant goals selected for most of your one-on-one counseling sessions? (Choose up to three responses. Write “1” for the process used most often, “2” for the process used the next most often, and “3” for the process used next most often.)

____ The participant usually identifies the goal(s).  GO TO QUESTION 15.

____ I usually suggest the goal(s).

____ The participant and I usually select the goal(s) together.

____ Other (describe):

14. How much input do participants have in setting their goal(s)?

• A little

• Some

• A lot

15. In your one-on-one counseling sessions with women participants, what three goals are set most often? (Write “1” for the goal set most often, “2” for the goal set next most often, and “3” for the goal set next most often.)

____ Achieving or maintaining healthy weight

____ Breastfeeding initiation or duration

____ Changing beverage intake (e.g., more water, less sugar-sweetened beverages)

____ Eating less fast food

____ Having family meals

____ Increasing fruit and vegetable intake

____ Increasing physical activity

____ Increasing whole grain intake

____ Switching from whole milk to lower fat milk

____ Other (describe):

16. In your one-on-one counseling sessions with parents/caregivers of infants, what three goals are set most often? (Write “1” for the goal set most often, “2” for the goal set next most often, and “3” for the goal set next most often.)

____ Achieving or maintaining healthy growth/weight

____ Breastfeeding duration

____ Feeding appropriate amount of formula

____ Introducing solid foods

____ Increasing physical activity

____ Transitioning to table foods

____ Weaning from the bottle

____ Other (describe):

17. In your one-on-one counseling sessions with parents/caregivers of children, what three goals are set most often? (Write “1” for the goal set most often, “2” for the goal set next most often, and “3” for the goal set next most often.)

____ Achieving or maintaining healthy growth/weight

____ Changing beverage intake (e.g., more water, less sugar-sweetened beverages)

____ Choosing healthy snacks

____ Having family meals

____ Increasing fruit and vegetable intake

____ Increasing physical activity

____ Increasing whole grain intake

____ Switching from whole milk to lower fat milk

____ Other (describe):

18. In your opinion, which WIC-related factors present the greatest challenge to helping participants achieve their goals? (Choose up to three factors. Write “1” for the most significant factor, “2” for the next most significant factor, and “3” for the next most significant factor.)

____ Participants do not usually meet with the same WIC staff member at each visit for consistent follow-up on goals.

____ Goals are usually not discussed or reinforced at subsequent WIC visits.

____ Time limits on WIC appointments make effective goal-setting or follow-up difficult.

____ WIC staff members lack the knowledge or resources to help participants achieve their goals.

____ The time between WIC appointments is too long for effective follow-up on goals.

____ Other (describe):

____ There are no WIC-related factors that make it difficult to help participants achieve their goals.

19. In your opinion, what societal or environmental factors make it difficult for participants to achieve their goals? (Choose up to three factors. Write “1” for the most significant factor, “2” for the next most significant factor, and “3” for the next most significant factor.)

____ Financial constraints make it difficult for participants to achieve goals (e.g., cannot afford to buy healthy foods).

____ Participants do not have access to nonfinancial resources needed to achieve goals (e.g., stores that sell healthy foods or safe place for physical activity).

____ Participants do not have support from their family/friends/community for achieving their goals.

____ Lack of services or programs to support goals make it difficult for participants to achieve behavior changes.

____ Participants are not motivated to make nutrition- or health-related behavioral changes.

____ Participants receive conflicting or mixed messages about nutrition from several sources (e.g., media, health care provider).

____ Advertising for unhealthy foods makes it difficult for participants to follow through on goals.

____ Other (describe):

20. In your opinion, what are the three most important factors in helping participants set and achieve their goals? (Write “1” for the most important factor, “2” for the next most important factor, and “3” for the next most important factor.)

____ Allowing participants to identify their own goals

____ Asking participants to verbalize their motivations for making the change

____ Breaking larger goals into small achievable steps

____ Expressing confidence in participants’ ability to make the change

____ Planning for challenges and obstacles that may arise

____ Planning rewards for achieving goals

____ Setting measurable goals with defined time frames

____ Follow-up on progress or challenges in achieving goals

____ Other (describe):

If you do not provide group education sessions, GO TO QUESTION 24.

Group Education Sessions

21. How often do you use the following activities or resources during your group education sessions? (Check one response for each activity or resource.)

    Activity or Resource	Never	Rarely (<10%)	Occasionally (11–39%)	Some-times (40–59%)	Often (60–89%)	Almost Always (≥90%)
    Icebreakers/warm up activities						
    Discussions between pairs of WIC participants						
    Educational props (e.g., breastfeeding dolls, food containers)						
    Informational charts or displays						
    Food sampling/ demonstrations						
    Hands-on activity or game						
    Physical activity						
    PowerPoint presentation						
    Video/DVD						

22. How are the topics for your group education sessions determined? (Check all that apply.)

• Each day, week, month, or quarter has a specific topic.

• There are specific topics for participant categories (e.g., breastfeeding class, prenatal class, infant class).

• Participants select from a menu of topics when they schedule their appointments.

• Topics are determined based on participants’ interest during each group session.

• Other (describe):

23. Thinking about the group sessions you have facilitated over the past 6 months, which topics were discussed most often? (Check all that apply.)

• Breastfeeding

• Child feeding practices

• Cooking/meal preparation

• Dental health

• Fruit and vegetables

• Healthy snacks

• Healthy weight for child

• Healthy weight for mother

• Infant feeding practices

• Infant/child growth and development

• Introduction of solid foods

• Inappropriate/sometimes foods (e.g., high-fat foods, fast foods)

• Iron/anemia

• Milk/choosing lower fat milk

• Parenting

• Physical activity

• Picky eaters

• Portion sizes

• Prenatal nutrition/diet

• Shopping for and preparing healthy foods

• Sugar-sweetened beverages

• Water consumption

• Whole grains

• Weaning from the bottle

• Other (describe):

Nutrition Education Resources

24. How much do you agree or disagree with each statement?

    Statement	Agree Strongly	Agree	Disagree	Disagree Strongly
    I have the educational materials necessary to assist participants with their nutrition, breastfeeding, physical activity, and other goals.				
    I have the necessary referral information for other programs and resources that are available to assist participants in their nutrition, breastfeeding, physical activity, and other behavioral goals.				

25. How often do you refer participants to other programs or resources for assistance with their nutrition, breastfeeding, physical activity, and other behavioral goals?

• Never

• Rarely

• Sometimes

• Often

About You

26. How much do you agree or disagree with each statement?

    Statement	Agree Strongly	Agree	Disagree	Disagree Strongly
    I serve as a role model for healthy eating and physical activity behaviors for the WIC participants at my site.				
    My own eating and physical activity habits influence the way I talk to WIC participants.				

27. Which job titles or roles do you have in the WIC Program? (Check all that apply.)

• WIC director/coordinator

• Site/clinic supervisor

• Registered dietitian (RD)

• Degreed nutritionist, not RD

• Trained nutrition paraprofessional (e.g., nutrition assistant, nutrition aid, competent paraprofessional authority, diet technician, social services technician)

• Nurse

• Nutrition educator coordinator

• Administrative/clerical/support staff

• Lactation consultant/WIC-designated breastfeeding expert

• Breastfeeding coordinator

• Breastfeeding peer counselor

• Other (describe):

If you checked only one option for Question 27, GO TO QUESTION 29.

28. Which best describes your primary role in the WIC Program? (Check one.)

• WIC director/coordinator

• Site/clinic supervisor

• Registered dietitian

• Degreed nutritionist, not RD

• Trained nutrition paraprofessional (e.g., nutrition assistant, nutrition aid, competent paraprofessional authority, diet technician, social services technician)

• Nurse

• Nutrition educator coordinator

• Administrative/clerical/support staff

• Lactation consultant/WIC-designated breastfeeding expert

• Breastfeeding coordinator

• Breastfeeding peer counselor

• Other (describe):

29. How many years have you worked for the WIC Program? (Include your time at this WIC site and other WIC experience.)

• Less than 1 year

• 1–3 years

• 4–6 years

• 7–10 years

• 11–20 years

• More than 20 years

30. During your time working for WIC, how many years have you provided nutrition education as part of your job?

• Less than 1 year

• 1–3 years

• 4–6 years

• 7–10 years

• 11–20 years

• More than 20 years

31. What is the highest degree you have completed?

• High school diploma or GED

• Associate’s degree

• Bachelor’s degree

• Graduate degree

32. Which, if any, of the following credentials do you have? (Check all that apply.)

• Registered Dietitian (RD)

• Licensed Dietitian/Nutritionist (LD/LN)

• Dietetic Technician, Registered (DTR)

• Certified Medical Assistant (MA/CMA)

• Registered Nurse (RN)

• Licensed Practical Nurse (LPN)

• International Board Certified Lactation Consultant (IBCLC)

• Certified Lactation Consultant/Certified Lactation Educator/Certified Lactation Educator & Counselor (CLC/CLE/CLEC)

• Other (describe):

• No credentials

33. What is your age?

• 24 or younger

• 25–34

• 35–44

• 45–54

• 55 or older

A Final Question

34. Please use the space below to share a brief description of any special nutrition education activities or approaches that you use with WIC participants.

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

You have completed all of the survey questions!

Thank you for contributing to the WIC Nutrition Education Study.