Studying the Nutrition Environment with Community Volunteers

By Elizabeth Kizer

Photo taken June 28, 2013 at the Florence Community Library. from left to right, Dr. Kenneth Schachter (faculty mentor), Danica Johnson (Minority Health Disparities Summer Research Program student), Barbara Suttles (community volunteer), Betty Reiffer (community volunteer), Elizabeth Kizer (researcher), Denise Kollert (community volunteer)

Photo taken June 28, 2013 at the Florence Community Library. from left to right, Dr. Kenneth Schachter (faculty mentor), Danica Johnson (Minority Health Disparities Summer Research Program student), Barbara Suttles (community volunteer), Betty Reiffer (community volunteer), Elizabeth Kizer (researcher), Denise Kollert (community volunteer)

In an earlier blog, I talked about training six community volunteers to become Nutrition Environment Measurement Surveys (NEMS) raters in Florence, AZ.  In this blog, I will to share some strategies and lessons-learned related to collaborating with community volunteers.

To be accurate, there are two NEMS surveys, one for restaurants (NEMS-R) and one for stores (NEMS-S).  Both of the NEMS surveys collect information about many aspects of the nutrition environment.  The NEMS-R measures the availability of healthy items on both adult and children’s menus, compares pricing between healthy and non-healthy options, and identifies barriers to, and facilitators of, healthy eating.  The NEMS-S measures the availability of healthy food options, compares prices between healthy and non-healthy options, and measures the quality of healthy, fresh, foods. 

The community volunteers I worked with were all women, but were diverse in terms of age, prior work history, and knowledge of nutrition.  Three of the volunteers were retirees and three were mothers with small children at home.  In order to accommodate their different schedules and training needs, I made myself available via phone and in person at their convenience, during training and after they had completed surveys to review any questions or concerns.  This worked well for our small project because I was able to address individual training needs with each volunteer personally. The volunteers were not paid for their hours spent in training, but because of the grant funding I received from the Arizona Area Health Education Center (AHEC), I was able to pay volunteers $30 per survey completed.

Although the average time it takes to complete a NEMS-S or NEMS-R survey is one hour,  there is a good amount of training required to learn the skills of a NEMS rater.  The University of Pennsylvania offers an online training that takes about 20 hours to complete; however the training includes information related to project management, scoring of surveys, and data analysis suggestions – information not required for raters, but vital for project managers.  In order to minimize the time required to train volunteers, and to ensure each volunteer felt comfortable with the surveys before using them in the community, I completed the 20-hour online training and then provided training to the volunteers, first in-person and then through a series of hands-on, homework practice exercises.   I met individually, or in groups, with the raters at the local library, and in other convenient settings, to review their work and answer questions.   I continued to provide practice exercises until each rater felt comfortable applying what she had learned. 

After completing their practice exercises, volunteers conducted one, paid “fieldwork exercise” to gain real-world experience and to ensure that each volunteer was rating the same as the others.  For this fieldwork I divided the raters into two groups and assigned one group to each of two restaurants.  Each group visited their assigned restaurant on the same day and completed the NEMS-R survey, but they did not collaborate on completing their individual surveys.  Data from this fieldwork practice were not included in the final analysis, but were informative from a project management standpoint, to ensure the raters had all received adequate training.  I recommend doing this, because it gives the project manager a chance to intervene if any unmet training needs are apparent. 

Two of the volunteers completed 55% of the store surveys.  To prepare, these women electronically reviewed an additional PowerPoint presentation and completed an additional fieldwork exercise at a store outside of Florence where I had completed my fieldwork.  Having these raters rate a store that I had also rated, gave me similar insight into the adequacy of their training.  In a future project, I would probably divide the volunteers into store versus restaurant raters instead of having them do both.  The advantage of them doing both is that they increased their knowledge of the nutrition environment by critically appraising multiple types of food establishments.  The disadvantage is that each rater needed to become an expert in both surveys and thus spent more time in training.

Since there are multiple benefits of community partnerships, I would highly recommend working with community volunteers to complete the NEMS surveys.  First and foremost, each person that collaborates on a project like this contributes to a raised awareness in the community about our shared nutrition environment.  Multiple times, I heard the volunteers express surprise or dismay about the lack of healthy food options in Florence, and I am sure they did not limit their observations and comments to just me.   Intuitively, community residents think they have a sense of what is available, but when they actually quantify the options, the reality can paint a very different picture.  Secondly, the experience is educational both for researchers and community partners.  From my vantage point, I came to understand more about the human resources available in the community in terms of the skills, knowledge, resources, and abilities partners are willing to share.  In a way, I conducted an informal community asset inventory, which may prove helpful as this community-based participatory research project proceeds.  Finally, the strategy of involving community partners helps   to distribute the workload of a very labor-intensive project.  Though I spent approximately 15 hours on providing training activities, it was less than I would have spent completing all of the surveys by myself.  Further, I found working with the volunteers to be a very enjoyable experience.  I am thankful for the opportunity to work with each of them, get to know them, and benefit from their exceptionally  thoughtful and conscientious work.


About the Author

Elizabeth Kizer is a doctoral student studying public health policy and management at the University of Arizona Mel and Enid Zuckerman College of Public Health. Her current research interest is how rural communities can improve their nutrition environments and make healthy foods more available. Her focus is on identifying policy or environmental changes that can affect the availability of healthy foods. Ms. Kizer utilizes community-based participatory research frameworks in order to engage community members facing disparities in terms of access to healthy foods. If you have any questions about this project, please contact Elizabeth Kizer at ekizer@email.arizona.edu

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