Work context matters: Paraprofessional nutrition educators' perceptions of program value management are related to nutrition program outcomes

Effective interpersonal communication to promote improved dietary practices among low-income families depends on the motivation and performance of front-line nutrition educators. This is the first study to examine the influence of nutrition program management and work context on both the educators and program outcomes. We explored these issues in the Expanded Food and Nutrition Education Program, conducting a survey of paraprofessional Community Nutrition Educators (CNEs) in 30 sites in New York State. Program effectiveness (reported behavior change among participants) was predicted in multivariate regression analysis (Adj. R2=0.80) by CNE perceptions of program benefits for participants; CNE ratings of their managers' planning, clarifying, motivating, monitoring, and problem-solving behaviors; the proportion of participants who received individual instruction; and low dietary practice scores at program entry. Program efficiency (number of program graduates per CNE) was highest in densely populated sites that utilized group methods of instruction (p&@_3C0.01). Outside of metropolitan sites, however, efficiency was negatively associated with CNEs' perceptions of program value (p&@_3C0.05). Policy and program decisions aimed at maximizing efficiency by focusing on urban sites and on group instruction may decrease equity of access and program effectiveness. Funded in part by USDA: Hatch NYC-199411.