The development of the educational modules was based on the Transtheoretical Model and critical thinking approach. Four local WIC agencies and their local EFNEP program partners were randomly selected to implement the intervention. The staff received the educational modules, related training, and support materials. Four additional WIC agencies served as the control sites with no access to the modules. The effectiveness of this educational approach was tested by comparing changes in knowledge, attitudes and behavior of participating clients related to offering vegetables to young children.
This work was partially funded by a 3-year grant (10/1/2001 to 9/30/2004) from the United States Department of Agriculture (USDA) to revitalize educational activities in the WIC Program.
The Transtheoretical Model (TTM), commonly referred to as the Stages of Change model, evolved as a means to determine how and why people change addictive behaviors.1-3 The behavior for which TTM has had the most thorough examination is cigarette-smoking cessation.4-6 The key components of the model are the stages of change and the processes of change. The stages identify when behavior change occurs and the processes identify how people make behavior changes. Five stages have been identified, including:
|Precontemplation:||A person does not intend to make a behavior change.|
|Contemplation:||The person is seriously considering change but is not yet ready make a commitment.|
|Preparation:||The person has unsuccessfully tried some changes in the past year and intends to take action in the next month.|
|Action:||The individual is successfully modifying the behavior.|
|Maintenance:||The person is working to continue action and prevent relapse.|
Within the early stages, people weigh the benefits and barriers to making changes, known as a decisional balance. In the pre-action stages, people tend to focus on the barriers of change; as they move forward to action and maintenance they focus more on the benefits. TTM predicts that identifying an individual's stage of change and tailoring interventions to match the processes to the stage of change will help people achieve success in health-related changes in their behavioral patterns.
Modifications for the study. In this intervention, the staging focused on readiness to feed children vegetables. To make the module development manageable, precontemplation and contemplation stages were combined as were action and maintenance. Precontemplation and contemplation are both stages where no behavior change has yet been made. Action and maintenance are both stages where change has occurred. A similar approach was used in a USDA multi-state project, NC-219, and provided the basis for the screening tool.7
Nutrition decisions often involve value-laden choices that are based on conceptually complex information. The process whereby individuals deliberately analyze, synthesize, and evaluate situations before solving everyday problems is known as critical thinking.8-9 Interactive activities using a critical thinking approach help one to clarify and assess personal values, refine reasoning processes, and strengthen the ability to integrate and analyze information. This approach not only assists clients in making good nutrition decisions, but also helps the individual address problems in all areas of daily life.10 The effectiveness of the critical thinking method is rooted in providing opportunities for reflective thinking and practice as well as personalizing the information so that it is relevant to each participant.