I. Progress to Date:

1. Social Marketing Training:

•  Social marketing training offered at the national meeting of Meals on  Wheels  Association of America, November 2001.
•  Partnered with Kansas Nutrition Council to provide keynote speaker on  social marketing, and a speaker on focus groups at their annual  conference, February 2002.
•  Social marketing training at all KNN partner meetings.
   Breakfast promotional campaign in Salina with Sherrie Mahoney. KNN  provided  social marketing training to the committee and oversight of the  campaign development  process.
•  Social marketing training provided to two food stamp promotional  committees in Olathe and El Dorado.
•  Manhattan school district contacted KNN for assistance in developing  focus groups to examine their school lunch menus and prices in the high  school. Kansas Wheat Commission requested assistance in  development of an outreach campaign they are doing.
•  Social marketing training provided to the staff of a nutrition program for  the elderly, serving 18 counties, May 2002.
•  Social marketing training provided to Early Head Start Health  Coordinators workshop in Kansas City, July 2002.

2. Food Stamp Promotional Campaign

•  First campaign in Olathe targeted to families with young children. Focus  groups  conducted to determine what the messages should be and how to  most effectively  reach the target audience. Three displays are planned to  be used at WIC, Head Start, food pantries, two elementary schools, and  other sites. Pre-tested different “styles” of posters to see which was most  appealing to the target audience. Two displays are completed - “New,  Easier Application,” and “How do I apply?” Posters distributed to  agencies  throughout the community
•  First display translated into Spanish.
•  Second campaign beginning in El Dorado.
•  Many presentations done with other community groups about this food  stamp promotional campaign. Several community groups have partnered  with their local food stamp office to do a better job at outreach.
•  The first display won the Kansas Public Health Association Award  for Best Written Material, September 2002.
•  Article about the winning display was featured in an SRS statewide  newsletter. SRS administers the food stamp program in Kansas.  www.srsKansas.org/vision/Fall2002.pdf page 5.

3. Innovative Outreach Techniques

•  Development of a breakfast campaign in Salina to reach low income,  limited reading ability families. The campaign encourages serving a  better  breakfast to young children, looking at making one small change.  Focus  groups conducted, and pre-testing of materials completed.  Materials have  been distributed through the Family Consultants at the    Head Start  program.
•  Focus groups and statewide surveys with child care providers completed  to find out how best to provide them with nutrition and physical activity  training. While most still want the “traditional” two-hour class,  approximately 15% indicated they would be interested in learning via  internet. We’re  exploring that option.
•  SNAP boxes completed and distributed. SNAP “out of the box” web site   is progressing. We have determined that one way to get people to use  available resources is to promote them on the web. Research indicates  that a number of low income older adults get health information from the  web.
•  Nutrition: Good for You! Curriculum for Those Who Care About Children  revisions are completed. The physical activity lesson is new, has been  pretested and evaluated, and a paper has been accepted for publication  with the Journal of Nutrition Education and Behavior. The accompanying  video won Best Audiovisual Material from the Kansas Public Health  Association 2002. See www.kccto.org Autumn 2002 newsletter article  about the award-winning video. Presentation at the Midwest Association  for the Education of Young Children, Milwaukee, April 2002.  Train- the- Trainer workshops were completed for Extension, CACFP, and  others  throughout Kansas.
•  The OrganWise Guys book, “It’s a Teethday Party!” has been developed  and distributed to programs throughout Kansas. This is a book that  incorporates dental health messages for preschool age children and can  be used in conjunction with the curriculum. This is an example of a  collaborative project with KNN partner agencies. No funding from KNN  was used with this project.
•  Ready, Set, Cook, an innovative outreach “event” to promote Heartland  SHARE has been widely utilized, especially in western Kansas. More  people are participating in Heartland SHARE than ever before.
•  Partnered with the Kaw Area Breastfeeding Coalition to provide PSAs  promoting breastfeeding especially among low income persons in the  Topeka area.
•  We continue to work with Kansas Association of Community Action  Programs to find on-going funding of the nutrition calendar that previously  was distributed to 8,000 Head Start families. More than half of the families  surveyed indicated they had used the calendar to find information about  nutrition education or nutrition assistance programs (including WIC, food  stamps, and Heartland SHARE).

4. KNN Network

•  We had our 5th Year Celebration in October 2001. Stella Nash attended  from the Regional Office.
•  We funded a small evaluation of the Network. Partners and staff were  called and asked what they see as the strengths of KNN and how well  KNN  is meeting its goals. The report was very positive and  highlighted  the very high level of functioning of the Network. At the same time, KNN  needs  to reach out to other potential partners and find ways to work more  effectively  with many of the existing partners. The administrative summary  is included  following this narrative.
•  We bid out a social marketing and evaluation proposal, and accepted the  bid from Fleishman-Hillard. We want to develop a plan to more effectively  work with partner agencies in coordinating nutrition education  programming throughout the state. We want to expand KNN to include  more partners. We want assistance in developing a better evaluation tool  to measure our effectiveness.

5. Assessment of the Effectiveness of KNN

•  Process evaluation of the KNN workplan. Did the activities happen? The  activities took place as planned.
•  Outcomes evaluation for individuals.
  
  Did food stamp participation increase in the selected communities in which promotional campaigns were implemented? Yes.

  Did participation in nutrition education and assistance programs that partner with KNN increase? Participation in Heartland SHARE increased.

  Did food insecurity in Kansas decrease? At the present time, we have no means to determine this. KNN is partnering with the Kansas Health Institute to study food security in Kansas.

  Dietary Quality: BRFSS data on fruit and vegetable consumption is attached. Data show that the percentage of the population consuming five or more servings of fruits and vegetables each day is decreasing, and the percentage consuming none or less than one serving is increasing. Upcoming KNN and FNP programming will be focusing more on increasing fruit and vegetable consumption and we are anticipating a reversal in these trends during the next few years.

•   Outcomes evaluation for programs.
  
  Are additional agencies participating in the Mini Projects Grants? We have two commitments for fiscal year 2003. This has been a difficult concept for KNN to “market.” We continue to emphasize the importance of working with local projects, but have found the match part to be difficult for agencies to understand.

  Are food stamp promotional campaigns being conducted in communities throughout the state? Yes. KACAP received funding to work with faith communities to help develop food stamp outreach. KACAP also received funding to coordinate two statewide meetings of groups doing food stamp outreach. One meeting has taken place; the second is scheduled for early November. These meetings are assisting organizations throughout the state to share their innovative techniques at food stamp outreach. Additionally, the award winning display was highlighted in an SRS newsletter www.srsKansas.org/vision/Fall2002.pdf .

  Are more agencies using social marketing techniques to reach more low income clients and connect them to the agencies’ nutrition assistance or nutrition education programs? Are innovative techniques developed and/or evaluated by KNN being used by agencies to improve outreach and nutrition education to low income Kansans? Yes. The Breakfast Project in Salina, KCNS development of volunteer materials, SNAP, Nutrition: Good for You! are examples of social marketing outreach efforts and dissemination of materials.

•   Sustainability and impact of KNN

  Has the number of partner agencies increased? No, not at this time. KNN is developing a plan with Fleishman-Hillard to accomplish this goal.

  Has the depth of partnerships increased? KNN has adapted a chart from the JNE Supplement 1, 2001 to measure depths of partnerships. Levels of partnership is discussed at the end of this section.

  Is KNN being recognized as a leader in providing social marketing training? Yes. KNN has been asked to present on social marketing at such varied meetings as the Meals on Wheels national meeting and the Wichita District Dietetics Association.

II. Describe several of your key projects and interventions

A. Nutrition: Good for You! to promote healthy weight: Nutrition: Good for You! A Curriculum for Those Who Care About the Health of Children focuses on nutrition and physical activity in the preschool child within the context of the Dietary Guidelines. The five-lesson curriculum was developed as a collaborative effort of the Kansas Department of Health and Environment (KDHE), KNN, Kansas State Department of Education (KSDE), and Kansas Child Care Training Opportunities, Inc (KCCTO). Training providers to be activity-conscious is the primary goal of the newly developed lesson, Let’s Move, Learn, and Have Fun!

The purpose of Let’s Move, Learn, and Have Fun! is to train child care providers on the integral role of physical movement and diet in developing a healthy lifestyle in preschool children. The lesson focuses on three groups: children, parents, and community. When implemented, providers will support the physical movement of children in their care by intentionally integrating daily physical activity, communicating with parents on the importance of vigorous movement, and supporting physical activity efforts within the community.
Child care providers participated in a 2-hour training which included introduction of the goals of the lesson, discussion of nutrition-exercise relationship, and demonstration of and participation in movement activities. Many of the gross motor activities integrate a nutrition theme to encourage children to eat healthy.
The ultimate outcome of this training was for providers to implement the knowledge and activities with the children in their care. The evaluation, therefore, attempted to assess to what degree trained providers had implemented physical activities with children, parents, and the community, in addition to identifying the successes and challenges of incorporating physical activities into their daily routines. Providers’ observations of children’s response to nutrition-integrated movement activities was also desired to ascertain if the relationship between healthy eating, movement, and physical well-being was understood and to what degree the motor skills, prosocial skills, and cognitive skills of children were affected.

Providers in family homes, centers, and Head Start (n = 180) participated in four training sessions. All providers were invited to participate in a follow-up telephone interview one month after the training. Forty-nine providers agreed to participate and were contacted. The majority (n = 44) reported they were implementing daily movement activities with the children and sharing the activities with parents through daily written reports and copies of the training material. Providers requested handouts for parents to facilitate their communication. However, 63% of providers reported they had not shared information in the community indicating a need for more integrative ideas.

Providers reported greater awareness of themselves as healthy adult role models, the need and ease of incorporating movement into daily routines, and the importance of integrating diet and movement to effect change in children’s health. Providers also reported that the preschool children responded enthusiastically to the activities and had, in some cases, choreographed their own movements. Children appeared to understand the relationship between movement and healthy eating by stating it helps, “…their muscles grow bigger” and they, “…better eat nutritious foods.” Prosocial and cognitive skills were enhanced as children cooperated with one another, followed directions well, incorporated singing into their play, and demonstrated greater engagement in routine activities following exercise.

Seven train-the-trainer workshops were conducted in April and May 2002, across the state of Kansas. 172 persons from Extension, CACFP, KCCTO, Health Departments and other organizations attended these workshops and will be sharing the curriculum with child care providers, parents and others interested in the nutrition, physical activity and health of young children.

A paper has been accepted by the Journal of Nutrition Education and Behavior for publication this fall/winter. The video won Best Audiovisual Material by the Kansas Public Health Association 2002.

B. Ready, Set, Cook: Increasing fruit and vegetable consumption
Vickie L. James, RD, LD, Healthy Kids Challenge Director, and creator of Ready, Set, Cook! vickie@st-tel.net www.healthykidschallenge.com

Take a few tips and ideas from existing marketing practices out there in the industry and apply social marketing strategies so change is fun, easy, and popular. Thus was born Ready, Set, Cook! RSC is an event that showcases community programs that benefit persons with limited resources, including Heartland SHARE, WIC, congregate meals for the elderly, etc., and offers cooking and nutrition information in ways that are fun and entertaining, especially eating more fruits and vegetables.

How does this event work? Three teams, each consisting of 3-4 participants from the audience and a team leader (FACS agent, Program Development committee member, local chef, etc.) are given approximately 45 minutes to prepare a meal using items from a grocery sack. If Heartland SHARE is the showcase program, the items in the sack represent a SHARE. If WIC is the showcase program, the items include WIC-approved foods. The foods that are prepared are tasty, inexpensive and offer a balance of good nutrition. Low fat cooking techniques are emphasized.

While the teams are doing their work, an emcee roves among the audience, offering menu planning information, ways to use your food dollar wisely, benefits of the “featured” programs, and just adding fun and a “can do” attitude to healthy eating! Since 5 A Day is a central focus, games, trivia, and even some physical activity with the audience are led with a 5 A Day message.

Initial program development utilized focus groups to determine the interest in such an event and the barriers to participating in Heartland SHARE. A pilot site was selected in Western Kansas, in the community of Meade. The FACS agent there was eager to offer such a program to her community. Her diligence and effort with the design and implementation of the first RSC set the stage for the success of the program today. On a snowy, blustery spring day, more than 100 people from local communities came to RSC!

A training video was produced from that initial event. This, along with a training materials kit of “how to’s” was packaged for RSC. I provided a one-day training for FACS agents to assist them with how to implement this program in their counties.

Since that initial program, approximately 15 additional RSC programs have been held throughout the state, and more are scheduled in the coming months. The audience size averages 75. The diversity of audience is wonderful! The program attracts both women and men, young families with children, all ages of children, 4-Hers, retired senior citizens, various ethnic groups local to the different regions where the program is offered, professionals, and homemakers. On many occasions, an area resource person has been utilized to interpret for the Hispanic population in an effort to reach out to this group and best meet their needs. Continuing education hours have been received for childcare providers to encourage this population to attend the program.

Three boxes were put together by KNN for use with this project. Each box contains all the bowls, cutting boards, knives, etc. that a team needs for their quick, simple food preparation. Often times people comment as to the simplicity of what few items are in the boxes. This delivers the point that we do not have to have expensive, complicated equipment to create simple, tasty, healthy meals. This message is encouraging and supportive of the ability to meet the healthy eating challenge for the limited income ethnic/racial populations, the senior citizen living on a limited income, or the busy family with limited time and budget! The equipment boxes are housed by Heartland SHARE. Policies involving lost or broken items are in place to keep the boxes ready to use. Food safety is a top consideration here as seen by the inclusion of bacterial wipes for hand washing, cleanups, and multiple cutting boards to prevent cross-contamination.

Results/Evaluation – This can be measured in various ways including the following:

1. RSC has been incorporated into the program plans of several county extension programs and is no longer limited to promotion and implementation by KNN.
2. The Heartland SHARE program has seen an increase in the number of people signing up for the program, as well as the number of shares purchased per month
3. Numbers of participants attending these events are some of the largest attendance records for this type of event as reported by the communities holding the events. This has allowed for an increase in dissemination of nutrition education materials beyond what has been an available means in the past to these population groups being targeted.

The number, type, depth and strength of partnerships involved in the social marketing of nutrition education efforts can be important indicators of change. The greater the number and variety of community partnerships and the deeper the collaborations among these partners, the greater will be the exposure of target audiences to social marketing messages and affordable nutritious food . . . . Measures important to assessing change in partnerships include the actual number and types of organizations in a partnership, the depth of relationship between and among partners, time and resource contributions by each partner, and the fiscal resources leveraged by each partner. (Journal of Nutrition Education Supplement 1, 2001, pp S8-9)

KNN has modified a chart from this JNE Supplement to record KNN’s depth of partnerships. Partners have been completing this chart throughout the year.

Depths of Involvement:

1. Network members attend meetings, participate in on-going dialog and information sharing.
2. Providers share brochures, handouts, or other materials from their own organizations.
3. Cooperators assist with the outreach of other KNN partner organizations, such as distributing brochures of other agencies.
4. Partnerships collaborate to create something new, such as a joint grant application or joint project.

KNN partner agencies were asked to determine their own “depth of involvement at each KNN meeting and at events between meetings. For example, at a health fair, Organization 1 passed out brochures about Organization 2. Organization 1 would be a Cooperator. Organization 2 would be a Provider.

“Partnerships” are deeper collaborations than “members.” It is one goal of KNN to move agencies from being members that come to meetings to a deeper level of commitment as cooperators assisting other organizations or as partners involved in joint projects.

KNN has extensively partnered with Social and Rehabilitation Services (SRS) which administers the food stamp program in Kansas. The following summarizes some of the collaborative efforts that were facilitated through KNN partnerships. These illustrate SRS and other KNN partner agencies acting as “providers,” “cooperators,” and “partners.”

KNN meetings have provided the opportunity for SRS to collaborate with many nutrition partners in food stamp outreach. KACAP, a KNN partner agency, received a grant to do food stamp outreach. SRS and KACAP are providing training to community liaisons in eight low income counties in Kansas. Nutrition information was provided to SRS by the Kansas Beef Council and Midwest Dairy Council, KNN partner agencies, and distributed to participants at these training sessions. The same grant provided for two statewide outreach coordination meetings chaired by KNN. Grant money also was provided for the translation of outreach materials into other languages.

A collaborative effort between Heartland SHARE and SRS developed when Heartland SHARE allowed SRS to put food stamp brochures at SHARE’s booth at the Kansas State Fair in September. KNN linked SRS with the Kansas Department of Education (KSDE) to collaborate on an outreach project during school enrollment. A food stamp fact sheet and list of outreach coordinators was provided to all Kansas school nurses. SRS and KSDE also collaborated on food stamp outreach during summer food service program training. Inter-Faith Ministries Campaign to End Childhood Hunger provided food stamp outreach materials in one of their campaigns.

The Depth of Partnership for KNN is summarized in the chart on the following page. The left axis is the number of times KNN partner agencies reported that they were involved as a member, provider, cooperator or partner.

The following is from the Executive Summary of the evaluation conducted by Best Start (the full Executive Summary is attached), illustrating KNN’s depth of partnerships and the network partners’ satisfaction with KNN.

What stands out in this series of interviews is the overwhelming
positive experience that partner representatives share regarding their participation in KNN. While ideas and recommendations for future direction of the organization are offered, there are no negative findings in the data, nor negative comments found among interviews. This is highly unusual in studies of partnership and stakeholder relations that Best Start has previously conducted. Partner representatives perceive KNN as an organization that is functioning at a high level in terms of meeting the partner organization’s needs, achieving organizational goals, and effectively supporting interaction among partner organizations.