The Peer Nutrition Program
The Peer Nutrition Program delivers culturally and linguistically appropriate nutrition programs to parents, grandparents and caregivers of children aged six months to six years in diverse underserved communities. The program is currently offered in 32 different languages and at more than 70 locations across the City of Toronto. Program participants receive direct education from 16 peer facilitators, called community nutrition assistants, with the support of six dietitians, two nutritionists and two managers who both have a nutrition background. Visit Website
I. Citation Information and Links
Primary Source Document
Authors: Moscovitch, Arlene Document Title: Peer Nutrition Program: Developing a Model for Peer Based Programs Aimed at Diverse Communities Publication or Source: préparé pour la Santé publique de Toronto et Santé publique du Canada Date: 2006-04-01
Type of Source
Publicly available report (including via Web site)
Language
English
Web Links
For site where document is available
II. About the intervention: General Characteristics
Intervention's Country of Origin
Canada
Canadian Intervention
Ontario
Health Issues Addressed
Chronic Disease Prevention
Chronic Disease Prevention General Chronic Disease Prevention: primary prevention Health Promotion & Behaviour-related Protective Factors Health Literacy Healthy Eating nutrition education and food skills Determinants of Health Ethnicity/Culture Education and literacy Personal health practices and coping skills Healthy child development Gender Sensitivity Most participants are women: mothers 79%, grandmothers 8.8%, caregivers 7.35% and fathers 2.6%. The linguistic and cultural specificity creates a supportive environment to feel safe and respected, to voice concerns, absorb new information and skills. Participants in second phase are comfortable in mixed ethno-cultural/racial settings Priority/Target Population for Intervention Delivery:
Sex
Female Male
Life Stage
Early infancy (age 1-3) Early childhood (age 3-6) Children (age 6-12) Teenagers/Youth (age 13-17) Young adult (age 18-34) Adults (age 35-49) Older adults (age 50-69)
Aboriginal Peoples
First Nations
Location of Aboriginal Peoples
Off-reserve
Ethnic/Culture/Language-specific Designation
Yes; Aboriginal, Filipino, Afghani, mixed South Asian, Spanish-speaking, Caribbean, Ghana, Tamil, Middle East and Eastern Europe and Portuguese, Filipino, Tibetan
Newcomers/Immigrants
Immigrants with a length of stay in host society for more than 10 years The population addressed in the intervention faces the following challenges/risks Extreme poverty Low income Income from a government transfer program Not fluent in English Access to affordable, nutritious food Access to housing ? affordability, quality, homelessness, street life Access to quality affordable child care Access to affordable recreation activities Relevant Ecological Levels Individual level (e.g., individual behaviour, knowledge, beliefs, attitudes) Interpersonal level (e.g., family, friends) Organizational level (e.g., workplaces, schools, NGOs, health service organizations/institutions/systems) Community level: (e.g., community groups, neighbourhood) Geographic Level of Intervention Urban Setting
Other Community Settings:
Community/neighbourhood Health care setting Policy/Administrative Level of Intervention: Municipal/Regional
III. Foundations of the Intervention
Developers of the Intervention
The intervention was designed by: a partnership of organizations
The impetus to create the program came from several sources. Chief among them were the Children and Youth Action Committee's 1999 Toronto Report Card on Children and the 2000 Ornstein Report on Ethno-Racial Inequality in Toronto, based on 1996 Census data
Intervention Goals and Objectives
Multiple goals including: enhance nutritional status of children 6 months-6 years in diverse communities; deliver multicultural/ multilingual healthy eating messages; encourage activities to integrate food-related beliefs/ practices from diverse cultures; deal with food insecurity issues; offer social supports and building leadership skills.
Funding resources used to develop, implement and/or evaluate the intervention
Long-term funding (3+ years) Through the Child Youth and Action Committee, an initial grant of $459,000 was received in July 2000 for 6 months. In 2001, the same amount was annualized by Toronto Public Health.
Other resources used to develop, implement and/or evaluate the intervention
Staff resources
Program Sponsor/Funder
Government
Duration/Timing for Implementation
Number of months required to develop the intervention: 1996-1999 Number of months required to evaluate the intervention: 2 months (feb-mar 2006)
Theories/Conceptual Frameworks:
No theory/conceptual framework indicated
Evidence
Comprehensive literature review Unpublished prior intervention-based research/evaluation (from own or other organization) Consultation with content experts Consultation with staff
IV. Implementation of the Intervention
Strategies
Individual education/skill development Individual behaviour change Individual asset development Health communication/social marketing
Community development and mobilization
Key Activities of the Intervention
Partnership development Group process/program Create a community coalition Offer brief counselling to those who are at high risk for a chronic disease Other training session
Implementers
Delivery Agents - Professionals Delivery Agents - Para-professionals Delivery Agents - Peer worker/Lay worker Delivery Agents - Volunteers
Strengths of the Intervention
Strong understanding of the issue-related environment (physical, psychological, social, political, economic) Synergies with other strategies Broad range of expertise Community ownership Links to existing community infrastructure Collaborative and inclusive decision-making. Adequate resources such as funding, equipment, time, skills, organizational support and understanding Food functions as a non-threatening, culturally acceptable entry point into other community services and resources. When developing programs, it may be useful to look for linkages between food and other topics that are considered more controversial by some communities.
Challenges of the Intervention
Funding ; developing strategies to deal with food insecurities; connection with other programs
V. Evaluation Design of the Intervention
Qualitative Research Design
Case study
Methods
Qualitative In-depth open-ended interviews Focus groups Participant observation conversation
Quantitative Individual behaviour measures: participants socio-demographic data; program participant statistics
Stakeholder Information Sources
Members of priority population who are participants in the program Front-line implementers
Recruitment
The Community Reference Group identified organizations, community centers, and places of worship, as well as the gatekeepers in various organizations and agencies who would want to co-sponsor the program. Advertisements were taken out in the ethnic media and hundreds of faxes were sent to community organizations. Was rigour used in the recruitment/selection of participants? No information available
Research Limitations
Limitations identified by authors Funding; Outreach to other communities and vulnerable groups; Perceived lack of recognition and support.
Nature of Processes
Quality assurance methods were used No information available
Ongoing results from research and evaluation were collected and acted on?
Yes
VI. Intervention Outcomes
What percentage of the interventions' process implementation objectives were achieved?
High (75-100%)
Specific Intervention Outcomes
Health and Behaviour Outcomes - Evidence provided regarding:
Positive outcomes on health Knowledge, Skills, Attitudes and Intentions Outcomes - Evidence provided regarding: Positive outcomes on health Physical Environment Outcomes - Evidence provided regarding: No evidence provided Community and social level outcomes - Evidence provided regarding: Positive outcomes on health Organizational Outcomes - Evidence provided regarding: Positive outcomes on health Political/Economic Outcomes - Evidence provided regarding: No evidence provided Other Outcomes - Evidence provided regarding: Positive outcomes on health Impact of Intervention on health-related outcomes - Evidence provided regarding: Positive outcomes on health
VII. Adaptation
Do the results indicate the intervention can be generalized to the general target population?
No
Has this initiative been adapted from another jurisdiction?
Yes
Circumstances that the intervention would fit best:
groups with combined vulnerabilities( i.e. women, socio-economic status; migrant; aboriginal; single parent, etc?); groups where participant-peer worker trust is an important factor in long term participation; outreach to isolated communities
Briefly describe in what ways the intervention must not be modified without endangering
expected positive results:
Community input; Proper needs assessment (census/epidemiologist); Recruiting peer facilitators with language skills
Has the intervention been replicated?
Yes. Throughout the GTA since 2001
Are there supports available for implementation?
Yes