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Peer Nutrition Education Programs on College Campuses
REPORT
...............................................................................................
Peer Nutrition Education Programs on College Campuses TANYA M . H O R A C E KN , A N C YM . BETTS,A N D J O Y RUTAR University of Nebraska, Lincoln, Lincoln, Nebraska 68583-0806
INTRODUCTION Although college students have consistently consumed inadequate diets,'-* they are interested in nutrition.When comparing the importance of various health issues, nutrition was one of the most highly ranked by students,and 60% of a midwest student population indicated interest in receiving nutriCollege students' most tional information and assi~tance.~ used source for nutritional information is their family and peer group.l0.l1 In general, insufficient nutrition education resources are in place on most college campuses to really make a difference in the students' diets.A few of the sources of nutrition information include nutrition and health classes, health services, and campus dietitians. Seventy-nine percent of the responding 160 American College Health Association health centers provided some type of nutrition education.12Among those, 121 provided one-on-one counseling. Use of peer educators has been advocated as a way to enhance the scope of nutrition education services for college ~ t u d e n t s . l ~ J ~ ~ ' ~ Peer educators are cost effective because they will usually serve in a voluntary capacity in order to acquire experience.15 Peer educators can serve as effective role models for the college student populationlo and, as students are much more responsive to their peers,16 peer educators may be effective in encouraging behavioral changes.14Kessler et a l l 7 found 51 health centers (41% of those surveyed) that used student volunteers as nutrition peer educators.These students typically had completed a basic nutrition course and usually majored in nutrition or some other health field. Between 1 and 30 students served as peer educators per year, with an average of 6.6. Student volunteers were used most for outreach presentations (16.9%), weight management (16.5%), individual (7%),and cholesterol reduction (3%) counseling. Students majoring in dietetics or other allied health fields can act as peer educators. Doing so often provides an invaluable, practical experience for these student^'^^^^ that enhances the quality of their education and consequently their readiness to act as professionals. Upper-class dietetic majors have
Address for correspondence: Nancy M. Betts, Ph.D., R.D., University of Nebraska, Lincoln, 316 Ruth Leverton Hall, Lincoln, NE 68583-0806;Tel: (402) 472-1584; Fax: (402) 472-3716. O 1996 SOCIETY FOR NUTRITION EDUCATION
been shown to exhibit more positive eating behaviors than freshmen nutrition major^,'^.^^ in part due to their educational experiences. As peer educators, dietetic and healthrelated majors could be effective role models as well as sources of information. The purpose of this study was to determine the prevalence and scope of peer nutrition education programs on college campuses and to make recommendations for starting such a program.
METHODS Surveys were sent to all 234 directors for Didactic Programs in Dietetics (DPD).The directors' names and addresses were obtained from the 1994-1995 Directory of Dietetics Programs.The survey included items regarding the existence of peer nutrition education programs, how long such programs had been in place, how the programs were coordinated, peer educator demographics and training, program funding, services provided, program evaluation, and other areas of interest, such as problems experienced and advice for starting a program.The survey was developed based upon the literature and piloted with three nutrition science faculty. The DPD directors were asked to fill out the survey or to forward it for response to the most appropriate person on their campus. Descriptive statistics including mean, range, frequencies, and percentages were used to summarize the results.
RESULTS Forty-nine percent of the surveys (n = 115) were returned in the postage paid envelopes included with the mailing. Of the returns, 74 schools did not currently have a peer nutrition education program. Of these 74 schools, 5 had had a peer nutrition education program in the past but discontinued it and 5 were in the process of starting one. Forty-six schools explained why they did not currently have a program (or discontinued it).The four most common reasons were (1) such a program has never been considered (23%), (2) services already provided by another area (23%),(3) insufficient faculty exist to coordinate (13%),and (4) insufficient time available to organize (10%). Other reasons of interest included
354
Horacek et al./PEER NUTRITION EDUCATION
lack of financial resources, potential legal liability, and low student population. Fifteen schools reported that they did not have a formal peer nutrition education program but did list their informal nutrition education activities. A list of these activities is included in Table 1.
Peer nutrition education programs. Twenty-six of the respondents reported that their schools had peer nutrition education programs. The school populations ranged in size from less than 1000 to 48,000 students, with an average size of 15,000 students.The surveyed programs had been in place from 1 to 20 years, with an average duration of 7 years.The programs were most frequently coordinated by health services staff (36%),followed by nutrition professors (25%),DPD directors (14%),and graduate students (10%).Some schools indicated that two positions shared the responsibility for coordination of the program-for example, a registered dietitian (RD) and a health educator, the health services RD and a nutrition professor, and the peer wellness center nurse and the DPD director.Three examples of programs are outhed in Table 2. Peer nutrition educator demographics. Most of the programs (92%) used dietetic students as educators, with the number of peer educators participating in the programs ranging from 1 to 50, with an average of 14 per program. Some schools (19%)also used health education and/or exercise science majors as peer nutrition educators. Most schools used upper-class peer educators, with only one responhng school
Table 1. Informal peer nutrition education activities. Volunteer tutor system Via class assignments Dietary assessment of peers Workshops within the residence halls Counseling clients at the campus fitness center Field experience for community practicum Short-term practicums Undergraduate and graduate nutrition club Senior dietetic students team teaching with a nutrition science faculty member 3 weeks of a freshmen wellness course
Through the student health center One-on-one counseling Diabetes education Computer nutrient analysis Projects to promote National Nutrition Month Graduate assistant acting as a peer educator through the dining services Residence hall presentations
using freshmen and six (23%)using sophomores. Seven of the programs (27%) used graduate students as peer educators. One half of the respondmg schools had established course prerequisites as a condition to a student's serving as a peer educator, but only five had grade point average requirements. Fifteen of the programs (57%) had other requirements for peer nutrition educators.The most common were senior status (33%),recommendation by faculty (13%),completion of a peer nutrition counseling class (13%),and a three-semester commitment (13%).
Educator training. Twenty-two of the programs (86%) reported that they provided additional training for their peer nutrition educators. Fifty percent of the programs gave academic credit for peer educator training, with an average of 2.5 credit hours for the training.Total hours of training provided ranged from 2 to 51, with an average of 22 hours. Nineteen schools (73%) provided training at no cost to the peer educators. The most common topics covered in training included counseling skills (77%),nutritional assessments (69%),weight control (69%),presentation skills (61%),referral skills (54%),and use of Food Guide Pyramid and nutrition labels (50%).Other popular topics in training included sports nutrition and eating disorders. Most schools provided their training either annually or every semester.A few schools reported that their training was provided through a team approach of partnerships between different departments (e.g., health services and nutrition sciences). Funding and compensation. Programs were most often funded by department funds or student fees but a few were funded through grants. Only three schools paid their peer nutrition educators but most schools (53%) did award credit hours for serving as a peer nutrition educator. Services provided. For the majority of the programs, the educators' time was devoted first to counseling and assessment, then to outreach.The topics that peer educators most frequently counseled were weight management (79%), basic nutrition/healthy diet (58%),low-fat/low-cholesterol diets (25%),sports nutrition (25%),nutritional assessments (17%), eating disorders (17%),diabetes (13%),and vegetarian diets (13%).Three of the four programs that allowed their educators to handle eating disorders required experience beyond the basic training. Topics that peer educators were typically required to refer to professionals included eating disorders (68%),therapeutic diets for any hagnosed medical condition (60%),dabetes (20%),and disorders with moderate to great severity (16%). Most programs reported offering a variety of outreach presentations for their student population.The most frequent outreach presentation topics that peer nutrition educators covered included basic nutrition (89%), weight control (69%),Food Guide Pyramid (69%),the new label (65%),and sports nutrition (39%). Supermarket survival and cooking skills were offered less frequently. A few additional outreach
November
Journal of Nutrition Education Volume 28 Number 6 Table 2.
December 1996
355
Examples of peer nutrition education programs. Program
Coordinated by
Educators
Health services nurse Part of a larger peer health
Associate professor in nutrition
Nutrition science graduate student
science and campus RD
educator program 40 sophomore through senior
15 senior and graduate dietetic
dietetic, health education, and
students
5 junior and senior students dietetic
exercise science students Selection
Rigorous process using
None-course requirement
Self-select
application, group, and individual interviews Training
Training Topics
Program Funding
Every semester, 3-credit
Once a year, through a DPD
Once a year, for 2 full weeks prior to
counseling class taught by
community 2-4 credit nutrition
the fall semester, taught by the
coordinator and nutrition
course, team taught by the
coordinator
professor Counseling, referral,
coordinators Basic nutrition, weight control,
Basic nutrition, presentation and
assessment, soap note, writing and presentation skills
diabetes, eating disorders, and
writing skills, and review of
counseling skills
community resources
Student fees
Department budget
Grant
Up to 10 hrlwk Educator Hours per Week and Compensation Minimum wage Program Emphasis
Program Structure and Location
2 hrlcreditlwk
2-4 hrlwk
Credit hours (1-3)
Volunteer
Counseling, assessment,
Individualized assessment
Outreach presentations, health
outreach presentations, and maintenance of a nutrition
and counseling
fairs, campus newsletter, and
library 40 hrlwk coverage, walk-in and by appointment service at the health center
community referral Variable coverage by appointment
Variable coverage; educators give presentations anywhere on campus
Counseling done at the nutrition assessment room in department
Public Relations
Brochure, newspaper ads,
Health service referrals,
Letters to resident assistants,
posters, and word of mouth
professors, and coaches, and radio
Problems
community nutrition events, and t-shirts Too large at times
Client no show
Scheduling and lack of support staff
presentation topics were identified by respondents through the other category on the survey; these included eating disorders, freshmenUl0,"(avoiding the typical 10 lb weight gain during the first year of college), and fad diets. Most peer nutrition education programs worked with students by appointment (89%),while 34% had a call-in system and 31% had a walk-in system. Most respondents (69%) reported that their programs were accessible during variable part-time hours of service each week; however, five of the programs (19%) provided full 40 hours per week coverage, and fewer programs (7%) had 20 hours per week coverage. Most peer nutrition education services were located and made available in the student health center (40%), followed by a wellness ofice (16%), client's preference (12%), and
department offices or nutrition assessment room (8%).Educators served an average of 3 hours per week.
Public relations. The most common methods for advertising the peer nutrition services were posters/flyers (50%), campus newspaper (42%),word of mouth (33%),newsletters to resident assistants and faculty (29%), and health services referral (25%).Some other advertising tactics included classroom invitations, referral by coaches, e-mail, coupons, and promotion through the cafeteria or food services. Program evaluation. Respondents reported the use of a wide variety of techniques to evaluate these programs. The most frequently identified methods were informal partici-
356
Horacek et al./PEER NUTRITION EDUCATION
pant/client evaluation (60%),a formal evaluation form (30%), and self-evaluation (25%). Some of the other evaluation approaches included evaluations by a supervisor,tracking numbers of participants, soap note reviews, and video evaluations.
Problems. Respondents shared problems that they had encountered with their programs. The most common were insufficient time to manage (22%), scheduling (16%),client no show/drop out (16%),quality assurance (16%),follow-up with clients (11%), inadequate support staff (11%), inadequate funding/space (1I%), and others expecting peer educators to do more than they should (11%). Other problems mentioned by respondents were inadequate evaluation of program, lack of demand for services,withdrawal of program funding requiring all volunteer services, inconsistency of selection and training, too many peer educators at times, and ineffective marketing.
Advice.
Respondents had a variety of comments to help others start programs. These included start small and train; adequately design clear-cut goals; communicate with other programs; cooperate with other departments or incorporate the program into an existing class/experience; arrange for sufficient resources (financial, space, personnel); spend ample time on educator recruitment and selection;develop a schedule of services and stick to it; have high expectations for the peer educators;have a support system;be proactive with policies; be prepared to reorganize and refocus as necessary; provide credit for participating peer educators; secure fundmg for advisor/coordinator; and continuously evaluate the program.
DISCUSSION As exemplified by the 26 peer nutrition education programs reviewed, successful programs can be designed using only one to two peer educators a few hours per week or large enough to use 50 peer educators serving students 40+ hours per week.The following are some ideas to help guide a school in the development of a peer nutrition education program. Begin by doing a thorough assessment of the nutritional needs of the student population and identify whether their needs are currently being met. It is also essential to evaluate the potential educators to determine how well they could meet the identified needs.This step is the key to determining where the program might best fit in the array of student services, what the focus of the program should be, who should coordinate it, and what training should be provided to best prepare the peer nutrition educators. Identify and coordinate with a variety of other campus resources. Such resources might include health services, health education, other peer education programs, athletics, counseling department, residence hall system, food service, Greek system,community resources, etc.The peer nutrition education programs offered by other colleges and universities should be reviewed.
The program should be integrated into an existing course or system. For example, it could be part of the community nutrition course or some practicum class. Efforts could be combined with other departments to start a full peer health education service. One avenue might be for upper-class dietetic or other allied health students to provide individualized or group help to students enroled in a basic nutrition or healthy lifestyles course. Alternatively, peer educators could serve through the food service system or the athletic department. If a peer nutrition education program were incorporated into a class, the professor and graduate assistants could coordinate it. Joint coordination could be shared between a position within the health center and a nutrition faculty member, two graduate students, the DPD director, and the campus RD, etc. If the program is a cooperative venture between departments/services, coordination might best be a shared responsibility. Most programs are funded through departments or by student fees; however, a few are funded with grants. Considering the state of most departmental budgets, a moderate grant could be the ideal way to get such a peer nutrition education program started. Foundations and state health departments are prospective avenues for grant funding. As for the peer nutrition educators, successful programs have found that a rigorous selection process leads to a stable committed group of educators. Establishing clear guidelines for what educators can and cannot handle and how to handle referrals enhances educator comfort with the process and avoids difficult/problematic situations.Educators should also be thoroughly trained in criteria identifying persons whose nutritional problems require referral to a professional and the available resources. Using upper-class students and graduate students as educators has advantages, including the increased likelihood that these students are more mature and possess greater nutrition knowledge since they are immersed in the major and practice better eating habit^.'^,^^ While planning a peer nutrition education program, it is important to determine the outcomes desired.The most effective evaluation process is decided in the planning phases, not after a program has been in place for a while or is having some trouble. Decide what changes you would like to see in your counselors, student population, and program and set up a tracking and evaluation system through your planning process. A well-planned, cooperative venture with the best resources on campus can lead to an effective peer nutrition education program. Working such a program into an existing system may be eficient and cost effective. By using a rigorous selection process with clearly defined policies and procedures and appropriate training, a program can operate with a confident and prepared group of peer nutrition educators. In turn, these peer nutrition educators can benefit personally and professionally as a result of their work. Future research should evaluate and summarize the effectiveness of peer nutrition education programs, not only for the student population served but also as a training method
November
Journal of Nutrition Educationvolume 28 Number 6
for dietetic students. Examples of process evaluations used with peer nutrition education program^,'^.'^.'^^^^ as well as client and educator experiential perception^,'^.'^ have been documented; however, a well-designed outcome evaluation is also necessary for understanding the impact upon the clients' dietary attitudes and behaviors and the peer counselors' professional preparation.
December 1996
357
9. Boehm S, Seleves EJ, Raleigh E, et al. College students' perception of vulnerability/susceptibility and desire for health information. Pat Educ
Counseling 1993;21:77-87. 10. Sloane BC, Zimmer CG. The power of peer health education. J Am Call Health 1993;41:241-5. 11. Hertzler AA, Frary RB. College students' nutritional information networks. Fam Cons Sci Res 1995;24:191-202. 12. Kessler L,Jonas JR, Gilham MB.The status of nutrition education in ACHA College and University Health Centers. J Am Coll Health 1992;41:31-4. 13. Edelstein ME, Gonyer l? Planning for the future of peer education. J
REFERENCES
Am Coll Health 1993;41:255-7. 14. Gates G, Kennedy S. Peer educators reach college students with nutri-
1. Beerman KA.Variation in nutrient intake of college students: a comparison by student residence. J Am Diet Assoc 1991;91:343-4. 2. Hertzler AA, Frary RB. Dietary status and eating out practices of college students. J Am Diet Assoc 1992;92:867-9. 3. Hertzler AA, Frary RB. Food behavior of college students.Ado1escence 1989;24:349-56. 4. Melby CL, Femea PL, SciaccaJl? Reported dietary and exercise behaviors, beliefs and knowledge among university undergraduates. Nutr Res 1986;6:799-808.
tional information. J Am Coll Health 1989;38:95-6. 15. Braun TP. Increasing nutritional awareness of college students using peers as consultants. J Coll Stud Personnel 1986;7:376-7. 16. Greene GW. Client perceptions of dietetic students and registered dietitians at a university-based nutrition clinic. J Am Diet Assoc 1990:90:417-21. 17. Kessler LA, Gilham MB,Vicerks J. Peer involvement in nutrition education of college students. J Am Diet Assoc 1992;92:989-91. 18. Greene GW,YesenoskyJ. Preparing nutrition counselors: perceptions of
5. HuangY, Song WO, Schemmel RA, Hoerr SM. What do college stu-
dietetic students in a counseling practicum.J Am Diet Assoc 1990;90:274-6.
dents eat? Food selection and meal pattern. Nutr Res 1994;14:1143-53.
19. Barnes LC, Brevard PB, Pearson JM. Eating habits and nutrient intakes
6. Cotugna N,Vickery CE. College students' awareness, knowledge and
of dietetic and nondietetic students in Virginia. J Am Diet Assoc
compliance with food guide pyramid recommendations. Am J Health Prom 1994;8:417-9. 7. van den Reek M, Keith RE. Knowledge and use of United States dietary goals by university students. Nutr Rep Int 1984;29:559-64. 8. Hertzler AA,Webb R , Frary RB. Over consumption of fat by college students: the fast food connection. Ecol Food Nutr 1995;34:49-57.
1993;93(Suppl 9):A-79. 20. Reinstein N, KoszewskiWM, Chamberlin B, Smith-Johnson C. Prevalence of eating disorders among dietetics students: does nutrition education make a difference? J Am Diet Assoc 1992;92:949-53. 21. Croll N,Jurs E, Kennedy S.Total quality assurance and peer education. J Am Coll Health 1993;41:247-9.
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Peer Nutrition Education Programs on College Campuses TANYA M . H O R A C E KN , A N C YM . BETTS,A N D J O Y RUTAR University of Nebraska, Lincoln, Lincoln, Nebraska 68583-0806
INTRODUCTION Although college students have consistently consumed inadequate diets,'-* they are interested in nutrition.When comparing the importance of various health issues, nutrition was one of the most highly ranked by students,and 60% of a midwest student population indicated interest in receiving nutriCollege students' most tional information and assi~tance.~ used source for nutritional information is their family and peer group.l0.l1 In general, insufficient nutrition education resources are in place on most college campuses to really make a difference in the students' diets.A few of the sources of nutrition information include nutrition and health classes, health services, and campus dietitians. Seventy-nine percent of the responding 160 American College Health Association health centers provided some type of nutrition education.12Among those, 121 provided one-on-one counseling. Use of peer educators has been advocated as a way to enhance the scope of nutrition education services for college ~ t u d e n t s . l ~ J ~ ~ ' ~ Peer educators are cost effective because they will usually serve in a voluntary capacity in order to acquire experience.15 Peer educators can serve as effective role models for the college student populationlo and, as students are much more responsive to their peers,16 peer educators may be effective in encouraging behavioral changes.14Kessler et a l l 7 found 51 health centers (41% of those surveyed) that used student volunteers as nutrition peer educators.These students typically had completed a basic nutrition course and usually majored in nutrition or some other health field. Between 1 and 30 students served as peer educators per year, with an average of 6.6. Student volunteers were used most for outreach presentations (16.9%), weight management (16.5%), individual (7%),and cholesterol reduction (3%) counseling. Students majoring in dietetics or other allied health fields can act as peer educators. Doing so often provides an invaluable, practical experience for these student^'^^^^ that enhances the quality of their education and consequently their readiness to act as professionals. Upper-class dietetic majors have
Address for correspondence: Nancy M. Betts, Ph.D., R.D., University of Nebraska, Lincoln, 316 Ruth Leverton Hall, Lincoln, NE 68583-0806;Tel: (402) 472-1584; Fax: (402) 472-3716. O 1996 SOCIETY FOR NUTRITION EDUCATION
been shown to exhibit more positive eating behaviors than freshmen nutrition major^,'^.^^ in part due to their educational experiences. As peer educators, dietetic and healthrelated majors could be effective role models as well as sources of information. The purpose of this study was to determine the prevalence and scope of peer nutrition education programs on college campuses and to make recommendations for starting such a program.
METHODS Surveys were sent to all 234 directors for Didactic Programs in Dietetics (DPD).The directors' names and addresses were obtained from the 1994-1995 Directory of Dietetics Programs.The survey included items regarding the existence of peer nutrition education programs, how long such programs had been in place, how the programs were coordinated, peer educator demographics and training, program funding, services provided, program evaluation, and other areas of interest, such as problems experienced and advice for starting a program.The survey was developed based upon the literature and piloted with three nutrition science faculty. The DPD directors were asked to fill out the survey or to forward it for response to the most appropriate person on their campus. Descriptive statistics including mean, range, frequencies, and percentages were used to summarize the results.
RESULTS Forty-nine percent of the surveys (n = 115) were returned in the postage paid envelopes included with the mailing. Of the returns, 74 schools did not currently have a peer nutrition education program. Of these 74 schools, 5 had had a peer nutrition education program in the past but discontinued it and 5 were in the process of starting one. Forty-six schools explained why they did not currently have a program (or discontinued it).The four most common reasons were (1) such a program has never been considered (23%), (2) services already provided by another area (23%),(3) insufficient faculty exist to coordinate (13%),and (4) insufficient time available to organize (10%). Other reasons of interest included
354
Horacek et al./PEER NUTRITION EDUCATION
lack of financial resources, potential legal liability, and low student population. Fifteen schools reported that they did not have a formal peer nutrition education program but did list their informal nutrition education activities. A list of these activities is included in Table 1.
Peer nutrition education programs. Twenty-six of the respondents reported that their schools had peer nutrition education programs. The school populations ranged in size from less than 1000 to 48,000 students, with an average size of 15,000 students.The surveyed programs had been in place from 1 to 20 years, with an average duration of 7 years.The programs were most frequently coordinated by health services staff (36%),followed by nutrition professors (25%),DPD directors (14%),and graduate students (10%).Some schools indicated that two positions shared the responsibility for coordination of the program-for example, a registered dietitian (RD) and a health educator, the health services RD and a nutrition professor, and the peer wellness center nurse and the DPD director.Three examples of programs are outhed in Table 2. Peer nutrition educator demographics. Most of the programs (92%) used dietetic students as educators, with the number of peer educators participating in the programs ranging from 1 to 50, with an average of 14 per program. Some schools (19%)also used health education and/or exercise science majors as peer nutrition educators. Most schools used upper-class peer educators, with only one responhng school
Table 1. Informal peer nutrition education activities. Volunteer tutor system Via class assignments Dietary assessment of peers Workshops within the residence halls Counseling clients at the campus fitness center Field experience for community practicum Short-term practicums Undergraduate and graduate nutrition club Senior dietetic students team teaching with a nutrition science faculty member 3 weeks of a freshmen wellness course
Through the student health center One-on-one counseling Diabetes education Computer nutrient analysis Projects to promote National Nutrition Month Graduate assistant acting as a peer educator through the dining services Residence hall presentations
using freshmen and six (23%)using sophomores. Seven of the programs (27%) used graduate students as peer educators. One half of the respondmg schools had established course prerequisites as a condition to a student's serving as a peer educator, but only five had grade point average requirements. Fifteen of the programs (57%) had other requirements for peer nutrition educators.The most common were senior status (33%),recommendation by faculty (13%),completion of a peer nutrition counseling class (13%),and a three-semester commitment (13%).
Educator training. Twenty-two of the programs (86%) reported that they provided additional training for their peer nutrition educators. Fifty percent of the programs gave academic credit for peer educator training, with an average of 2.5 credit hours for the training.Total hours of training provided ranged from 2 to 51, with an average of 22 hours. Nineteen schools (73%) provided training at no cost to the peer educators. The most common topics covered in training included counseling skills (77%),nutritional assessments (69%),weight control (69%),presentation skills (61%),referral skills (54%),and use of Food Guide Pyramid and nutrition labels (50%).Other popular topics in training included sports nutrition and eating disorders. Most schools provided their training either annually or every semester.A few schools reported that their training was provided through a team approach of partnerships between different departments (e.g., health services and nutrition sciences). Funding and compensation. Programs were most often funded by department funds or student fees but a few were funded through grants. Only three schools paid their peer nutrition educators but most schools (53%) did award credit hours for serving as a peer nutrition educator. Services provided. For the majority of the programs, the educators' time was devoted first to counseling and assessment, then to outreach.The topics that peer educators most frequently counseled were weight management (79%), basic nutrition/healthy diet (58%),low-fat/low-cholesterol diets (25%),sports nutrition (25%),nutritional assessments (17%), eating disorders (17%),diabetes (13%),and vegetarian diets (13%).Three of the four programs that allowed their educators to handle eating disorders required experience beyond the basic training. Topics that peer educators were typically required to refer to professionals included eating disorders (68%),therapeutic diets for any hagnosed medical condition (60%),dabetes (20%),and disorders with moderate to great severity (16%). Most programs reported offering a variety of outreach presentations for their student population.The most frequent outreach presentation topics that peer nutrition educators covered included basic nutrition (89%), weight control (69%),Food Guide Pyramid (69%),the new label (65%),and sports nutrition (39%). Supermarket survival and cooking skills were offered less frequently. A few additional outreach
November
Journal of Nutrition Education Volume 28 Number 6 Table 2.
December 1996
355
Examples of peer nutrition education programs. Program
Coordinated by
Educators
Health services nurse Part of a larger peer health
Associate professor in nutrition
Nutrition science graduate student
science and campus RD
educator program 40 sophomore through senior
15 senior and graduate dietetic
dietetic, health education, and
students
5 junior and senior students dietetic
exercise science students Selection
Rigorous process using
None-course requirement
Self-select
application, group, and individual interviews Training
Training Topics
Program Funding
Every semester, 3-credit
Once a year, through a DPD
Once a year, for 2 full weeks prior to
counseling class taught by
community 2-4 credit nutrition
the fall semester, taught by the
coordinator and nutrition
course, team taught by the
coordinator
professor Counseling, referral,
coordinators Basic nutrition, weight control,
Basic nutrition, presentation and
assessment, soap note, writing and presentation skills
diabetes, eating disorders, and
writing skills, and review of
counseling skills
community resources
Student fees
Department budget
Grant
Up to 10 hrlwk Educator Hours per Week and Compensation Minimum wage Program Emphasis
Program Structure and Location
2 hrlcreditlwk
2-4 hrlwk
Credit hours (1-3)
Volunteer
Counseling, assessment,
Individualized assessment
Outreach presentations, health
outreach presentations, and maintenance of a nutrition
and counseling
fairs, campus newsletter, and
library 40 hrlwk coverage, walk-in and by appointment service at the health center
community referral Variable coverage by appointment
Variable coverage; educators give presentations anywhere on campus
Counseling done at the nutrition assessment room in department
Public Relations
Brochure, newspaper ads,
Health service referrals,
Letters to resident assistants,
posters, and word of mouth
professors, and coaches, and radio
Problems
community nutrition events, and t-shirts Too large at times
Client no show
Scheduling and lack of support staff
presentation topics were identified by respondents through the other category on the survey; these included eating disorders, freshmenUl0,"(avoiding the typical 10 lb weight gain during the first year of college), and fad diets. Most peer nutrition education programs worked with students by appointment (89%),while 34% had a call-in system and 31% had a walk-in system. Most respondents (69%) reported that their programs were accessible during variable part-time hours of service each week; however, five of the programs (19%) provided full 40 hours per week coverage, and fewer programs (7%) had 20 hours per week coverage. Most peer nutrition education services were located and made available in the student health center (40%), followed by a wellness ofice (16%), client's preference (12%), and
department offices or nutrition assessment room (8%).Educators served an average of 3 hours per week.
Public relations. The most common methods for advertising the peer nutrition services were posters/flyers (50%), campus newspaper (42%),word of mouth (33%),newsletters to resident assistants and faculty (29%), and health services referral (25%).Some other advertising tactics included classroom invitations, referral by coaches, e-mail, coupons, and promotion through the cafeteria or food services. Program evaluation. Respondents reported the use of a wide variety of techniques to evaluate these programs. The most frequently identified methods were informal partici-
356
Horacek et al./PEER NUTRITION EDUCATION
pant/client evaluation (60%),a formal evaluation form (30%), and self-evaluation (25%). Some of the other evaluation approaches included evaluations by a supervisor,tracking numbers of participants, soap note reviews, and video evaluations.
Problems. Respondents shared problems that they had encountered with their programs. The most common were insufficient time to manage (22%), scheduling (16%),client no show/drop out (16%),quality assurance (16%),follow-up with clients (11%), inadequate support staff (11%), inadequate funding/space (1I%), and others expecting peer educators to do more than they should (11%). Other problems mentioned by respondents were inadequate evaluation of program, lack of demand for services,withdrawal of program funding requiring all volunteer services, inconsistency of selection and training, too many peer educators at times, and ineffective marketing.
Advice.
Respondents had a variety of comments to help others start programs. These included start small and train; adequately design clear-cut goals; communicate with other programs; cooperate with other departments or incorporate the program into an existing class/experience; arrange for sufficient resources (financial, space, personnel); spend ample time on educator recruitment and selection;develop a schedule of services and stick to it; have high expectations for the peer educators;have a support system;be proactive with policies; be prepared to reorganize and refocus as necessary; provide credit for participating peer educators; secure fundmg for advisor/coordinator; and continuously evaluate the program.
DISCUSSION As exemplified by the 26 peer nutrition education programs reviewed, successful programs can be designed using only one to two peer educators a few hours per week or large enough to use 50 peer educators serving students 40+ hours per week.The following are some ideas to help guide a school in the development of a peer nutrition education program. Begin by doing a thorough assessment of the nutritional needs of the student population and identify whether their needs are currently being met. It is also essential to evaluate the potential educators to determine how well they could meet the identified needs.This step is the key to determining where the program might best fit in the array of student services, what the focus of the program should be, who should coordinate it, and what training should be provided to best prepare the peer nutrition educators. Identify and coordinate with a variety of other campus resources. Such resources might include health services, health education, other peer education programs, athletics, counseling department, residence hall system, food service, Greek system,community resources, etc.The peer nutrition education programs offered by other colleges and universities should be reviewed.
The program should be integrated into an existing course or system. For example, it could be part of the community nutrition course or some practicum class. Efforts could be combined with other departments to start a full peer health education service. One avenue might be for upper-class dietetic or other allied health students to provide individualized or group help to students enroled in a basic nutrition or healthy lifestyles course. Alternatively, peer educators could serve through the food service system or the athletic department. If a peer nutrition education program were incorporated into a class, the professor and graduate assistants could coordinate it. Joint coordination could be shared between a position within the health center and a nutrition faculty member, two graduate students, the DPD director, and the campus RD, etc. If the program is a cooperative venture between departments/services, coordination might best be a shared responsibility. Most programs are funded through departments or by student fees; however, a few are funded with grants. Considering the state of most departmental budgets, a moderate grant could be the ideal way to get such a peer nutrition education program started. Foundations and state health departments are prospective avenues for grant funding. As for the peer nutrition educators, successful programs have found that a rigorous selection process leads to a stable committed group of educators. Establishing clear guidelines for what educators can and cannot handle and how to handle referrals enhances educator comfort with the process and avoids difficult/problematic situations.Educators should also be thoroughly trained in criteria identifying persons whose nutritional problems require referral to a professional and the available resources. Using upper-class students and graduate students as educators has advantages, including the increased likelihood that these students are more mature and possess greater nutrition knowledge since they are immersed in the major and practice better eating habit^.'^,^^ While planning a peer nutrition education program, it is important to determine the outcomes desired.The most effective evaluation process is decided in the planning phases, not after a program has been in place for a while or is having some trouble. Decide what changes you would like to see in your counselors, student population, and program and set up a tracking and evaluation system through your planning process. A well-planned, cooperative venture with the best resources on campus can lead to an effective peer nutrition education program. Working such a program into an existing system may be eficient and cost effective. By using a rigorous selection process with clearly defined policies and procedures and appropriate training, a program can operate with a confident and prepared group of peer nutrition educators. In turn, these peer nutrition educators can benefit personally and professionally as a result of their work. Future research should evaluate and summarize the effectiveness of peer nutrition education programs, not only for the student population served but also as a training method
November
Journal of Nutrition Educationvolume 28 Number 6
for dietetic students. Examples of process evaluations used with peer nutrition education program^,'^.'^.'^^^^ as well as client and educator experiential perception^,'^.'^ have been documented; however, a well-designed outcome evaluation is also necessary for understanding the impact upon the clients' dietary attitudes and behaviors and the peer counselors' professional preparation.
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9. Boehm S, Seleves EJ, Raleigh E, et al. College students' perception of vulnerability/susceptibility and desire for health information. Pat Educ
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