The Rural Health and Nutrition Extension Program Team, in collaboration with Clemson University’s College of Behavioral, Social and Health Sciences, and Prisma Health received a one-year, $100,000 grant from The American Diabetes Association to deliver one hour webinars about the link between Diabetes and Heart Disease. The rationale for delivering this program through the Rural Health and Nutrition team includes the following:
Two-thirds of adults in South Carolina are overweight or obese.
Four out of every five people with diabetes in South Carolina are overweight or obese.
Seven out of every ten people with diabetes have hypertension.
Two out of every three people with diabetes have high cholesterol.
People with Type 2 Diabetes have a higher risk of heart disease, heart attack, and stroke.
Type 2 Diabetes can be prevented and managed.
The Rural Health and Nutrition team offers a program focused on preventing the development of Type 2 Diabetes along with a program focused on educating and supporting people with Type 2 Diabetes management. The one-hour program delivered through this grant is called Know Diabetes By Heart. It is targeted at anyone who has, knows, or cares for people with Type 2 Diabetes.
The project runs from January 2021 to December 2021 with a goal of reaching 1,000 people through this webinar. If you have a group looking for a one-hour health-related webinar, contact Danielle McFall (dem@clemson.edu) on the Rural Health and Nutrition team to set up a session with your group!
Submitted by: Dr. Michelle Parisi, Rural Health and Nutrition Program Team Director
What is EFNEP?
The Expanded Food and Nutrition Education Program (EFNEP) offered by the USDA National Institute of Food and Agriculture and Clemson University Cooperative Extension Service is aimed at providing practical, hands-on nutrition education. The mission of EFNEP is to assist limited-resource audiences in acquiring the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets and to contribute to their personal development and the improvement of the total family diet and nutritional well-being.
Defining the Problem:
Obesity, poor nutrition, and limited physical activity are significant health concerns. Poor health disproportionately affects minority and low-income populations. Educational opportunities and resources are limited.
Investing In The Solution:
EFNEP brings together federal, state, and local resources to target two primary audiences: low-income families with young children and low-income youth. In 2020, EFNEP served 20 counties and delivered both youth and adult programs to diverse audiences. Although the year 2020 was quite a challenge for recruitment and retention due to the COVID-19 pandemic, EFNEP adapted to reach participants virtually by utilizing different platforms (Zoom, Facebook Live private group). EFNEP reached 306 adults directly and 946 family members indirectly. Also, EFNEP reached 2,326 children and youth with a graduation rate of 82%.
Demonstrating Results:
The 24 hours Food recall report showed overall 95% of EFNEP adult Participants improved their dietary intake according to ‘My Plate’ guidelines.
EFNEP Adult Food and Physical Activity Behavior Changes report showed:
• 92% improved Nutrition practices
• 81% improved Food Resource Management practices
• 77% improved Physical Activity practices
• 75% improved Food Safety practices
EFNEP Youth Made a Difference:
• 88% of children & youth improved Nutrition practices
• 58% of children & youth improved Food Safety practices
• 57% of children & improved Physical Activity practices
• 48% of children and youth improved Food Resource Management practices
Why it works?
EFNEP Nutrition Educators follow a research-based learning model that allows them to effectively reach and educate program participants. Educators are:
• Members of the communities they support
• Trained/Supervised by State and County-based faculty
• Skilled in using hands-on interactive teaching methods
• Committed to delivering sounds instructions
• Able to influence changes in behavior and impact the lives of those they teach
• Dedicated to reaching diverse, low-income populations.
Adult Improvement at Competition.Youth Improvement at Competition.
Click here to visit the full impact statement with graphics.
Submitted by: Tarana Khan, State Program Coordinator, EFNEP
The Rural Health and Nutrition team has been hard at work. In reviewing their programmatic impact they found their direct and indirect program participation (number of direct and indirect contacts) have gone up an average of 195% since March.
They have converted six traditional, face-to-face programs to virtual, online programs including the Expanded Food and Nutrition Education Programs for both adults and youth. Their chronic disease prevention and management programs like the Diabetes Prevention Program and the Health Extension for Diabetes Program are now available online as well. People can register for our online offerings by going to the Rural Health and Nutrition Extension Program Team website.
WalkSC was offered virtually and brought in over 600 people through their online platform. Another transition the Rural Health and Nutrition team made was to online health extension for diabetes. This resulted in recruiting an entire year’s worth of participants in three months! The Diabetes Prevention Program is regulated by the CDC and could not be offered virtually, so the agents have been doing health coaching calls until they are able to resume face-to-face classes.
Submitted by: Dr. Michelle Parisi, Program Team Director for Rural Health and Nutrition
The Diabetes Prevention Program (DPP) is continuing to serve residents of Greenville County throughout the COVID-19 pandemic. This year-long program focuses on preventing or delaying the onset of type 2 diabetes through healthy lifestyle changes like healthy eating and physical activity. Due to the COVID-19 pandemic, DPP has transitioned to virtual delivery. To date, all cohorts that began DPP in-person have transitioned to virtual delivery, either by phone or over Zoom. DPP has also begun new groups and these groups will participate virtually for the duration of the year-long program. The program has applied for recognition status for virtual delivery from the Centers for Disease Control and Prevention (CDC). Recognition status from the CDC would allow our DPP to show its effectiveness with program quality and outcomes. To further aid all participants in achieving their goals for the program, participants continue to receive weekly one-on-one conversations with the DPP Lifestyle Coach (Rural Health Agent) delivering the program through phone calls, text messaging, or emails.
Dianna Richardson, Aiken County EFNEP Nutrition Educator, just graduated a group of participants from her first online nutrition program for adults. This particular Eating Smart, Being Active (ESBA) program is being conducted 100% through a private Facebook group, a totally new delivery method for EFNEP.
Recruiting adult EFNEP participants is always challenging. However, it became particularly difficult during the COVID-19 crisis since the traditional EFNEP delivery model relies on in-person classes. Dianna was able to recruit her adult participants through her church as well as word of mouth. As participants expressed interest, she would add them to a private Facebook group. The group members would then say that they knew someone who would also love to participate and the membership grew.
“I just want to meet the needs of the public right now,” says Dianna. A lot of her participants stated that they initially joined only to learn new recipes since they are mostly eating from home now. They were pleased to discover that Eating Smart, Being Active classes included far more than learning new recipes. Participants also learned about money-saving tips at the grocery store, how to stretch recipes to feed more people, and how to increase physical activity levels. Like all EFNEP programs, Eating Smart, Being Active classes are delivered at absolutely no cost to the participants.
Health Extension for Diabetes Photo Credit: Clemson Extension.
The Health Extension for Diabetes (HED) program has recently moved to an online delivery format in order to continue to provide diabetes self-management education and support to people in Greenville County. Program participants meet weekly for four months and meet for both educational sessions and support groups in order to gain the knowledge, skills, and support needed to better manage diabetes, especially important for reducing risks related to COVID-19.
Since moving online in April, HED has developed a direct referral system with local healthcare providers. This new enrollment method has increased awareness and interest in HED with 152 individuals signing up through Eventbrite. As a result of the increased interest, additional cohorts and additional times were added to meet the needs of the community. To date, there have been five cohorts with forty-seven individuals total registered with four additional cohorts scheduled to start through August. As a result of moving programs online, HED has piloted a new way to deliver programming and reach new audiences now, and for the foreseeable future.
The Rural Health and Nutrition Program Team’s Hypertension Management Program (HMP) has been adapted to address the needs of our participants during the COVID-19 crisis. This program is traditionally delivered as an 8-week, face-to-face group program targeting people with high blood pressure (hypertension). The HMP supports participants by providing them with the knowledge, behavior change strategies, and blood pressure monitoring guidance that will help them manage this complicated health condition. With stay-at-home considerations, the RHN team launched a modified version of this program and is now offering it as a series of four webinars facilitated by RHN agent Emily Moody. The online version of this program includes a “visit” during the last session by a Registered Dietitian who can answer more complicated nutrition questions posed by participants. Recruitment was completed using Eventbrite and pre and post data were collected using Qualtrics. Recruitment efforts resulted in thirty-four potential participants. Of those, fifteen met eligibility criteria and were fully enrolled. Eleven have graduated from the first group and four more are in the process of completing the program. Participants provided excellent reviews, “Emily was an enthusiastic, competent instructor who made everyone feel comfortable and willing to contribute to the discussion.” Participants also appreciated “the opportunity for interaction with others who have high blood pressure offering peer support” and “the convenience of being home yet being held accountable.” This program will continue to be offered as an online program allowing the RHN team to reach as many SC community members as possible now and in the future.
Submitted by: Michelle Parisi, Rural Health and Nutrition Program Team Director
Rural Health Team agents Wanda Green and Weatherly Thomas understand that a healthy living environment should be accessible for everyone in South Carolina. However, residents in Lee County face more barriers to healthy living than many in our state. Lee County has an adult obesity rate of forty percent. Twenty-one percent of the county residents qualify as food insecure, and thirty percent of Lee County residents have income levels below the federal poverty threshold. Wanda and Weatherly are charged with addressing the lack of access to healthy food and support for physical activity to residents in Lee County through funding from a 5-year CDC grant (Dr. Sarah Griffin, Department of Public Health Sciences, Principal Investigator and Dr. Michelle Parisi, Clemson Extension, Co-Principal Investigator).
Foodshare Box Photo Credit: Foodshare SC
Wanda and Weatherly’s work requires that they build links between local groups to improve existing community efforts. One of the community groups they have assisted is Mt. Calvary Missionary Baptist Church in Bishopville. This church has been a food provider in Lee County for almost a decade. Mt. Calvary acts as a hub, connecting twenty-five local churches to offer food to 500 families in the Lee County area. During the last six months, Rural Health and Nutrition agents increased the capacity of this grassroots effort by fostering a relationship between Mt. Calvary and FoodShareSC.
The Mt. Calvary-FoodShareSC partnership is now viable and able to offer low-cost fruits and vegetables to all Lee County residents. The partnership places special emphasis on addressing the issues faced by low-income families relating to access to fresh, affordable food.
The Mt. Calvary-FoodShareSC partnership allows Lee County residents to purchase low-cost, quality produce while maximizing purchasing power and maintaining dignity. A typical purchase consists of a family-sized box filled with twelve to fifteen varieties of fresh fruits and vegetables, with the contents changing each month. Each box contains information on the preparation and storage of the produce. Participants can purchase boxes monthly by using either cash or SNAP/EBT. If purchased with cash, the boxes cost $15. If purchased with SNAP/EBT, $5 is charged to SNAP benefits, and $10 is charged to SC Healthy Bucks.
This past February was the official beginning of the Mt. Calvary-FoodShareSC partnership. Despite the COVID-19 pandemic, the number of food boxes sold has nearly doubled, from forty-seven to almost one hundred. The contents of the boxes sold translate to more than 1,000 pounds of fresh produce on dinner tables across Lee County. Wanda and Weatherly have been instrumental in helping the group secure permission to accept SNAP benefits and SC Healthy Bucks as payment. Without these forms of payment, the lower-income households in Lee County would have limited access to participate in the program. It is special to note, this project is the first faith-based, non-profit food buying cooperative approved to accept SNAP and Healthy Bucks benefits in the entire state of South Carolina.
Billboards, word of mouth, and social media have all played a part in promoting FoodShareSC. Most recently, the local Coca-Cola Consolidated operation and Central Carolina Technical College have offered either funding or company employees to volunteer for box packing/distribution days. The funding and increased volunteer base will aid this project in reaching even more households. Lee County First Steps has also confirmed intent to purchase boxes for families enrolled in their program. It is anticipated that orders will exceed 200 boxes by the May 18th order deadline.
Submitted by: Rhonda Matthews, Rural Health and Nutrition Assistant Team Leader, Wanda Green, Lee County Rural Health and Nutrition Agent, & Weatherly Thomas, Lee County Health Extension Agent
Our Rural Health and Nutrition (RHN) Extension Agents in Lee, Hampton, and Marion Counties are working on Policy, System, and Environment initiatives to fight obesity. Prior to and during this COVID-19 crisis, getting healthy foods into local food pantries has been a way to provide healthy eating options for food-insecure individuals.
The RHN agents in Lee county who are working on the CDC grant project are coordinating partnerships through Mt. Calvary Missionary Baptist Church and SC Center for Rural and Primary Healthcare to bring “Foodshare” (local fresh fruit and vegetable produce boxes) to Lee County. Agents assisted Mt. Calvary Missionary Baptist Church with the application to become a SNAP vendor and coordinated distribution of Foodshare boxes to the food pantry. Food pantry clients can now purchase Foodshare produce boxes using SNAP benefits. Through these efforts, our RHN agents have created a new healthy food access point for food-insecure community members in Lee County.
Technology has provided the Rural Health and Nutrition team with the ability to continue to do their weekly follow-ups with the more than 2,000 enrolled participants in their EFNEP, Diabetes Prevention Program, Health Extension for Diabetes, Hypertension Management Program, Baby Café, and School Wellness Checklist programs.
The team also launched a WalkSC Stay-at-Home Edition. During the first 48 hours of the new program, there were over 100 SC enrollees. Enrollment for the program closes on April 9th and over 500 participants are expected to sign up.
