MPH 608 Health communication and informatics

Sample Materials for Healthy Eating is a S.N.A.P. Campaign

Final writing assignment; week 8

Steven C. Banjoff

6/12/2015

An examination of the benefits and evaluation methods associated with the “Healthy Eating is a S.N.A.P.” over-sized postcard mail campaign and the “Come meet your grower” community event. A detailed description of both sample materials is located in Appendix A of the document.

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Key Benefits of the postcard mail campaign (Appendix A)

The growing body of evidence that Americans are not eating the recommended amounts

of fruits and vegetables (United States Department of Agriculture, 2009), the USDA launched

the 5 a Day program nearly twenty years ago through public and private partnerships. Yet fruit

and vegetable consumption has actually dropped during the years 1999-2008 (Rossenfeld, 2010),

and many urban, disadvantaged, minority, individuals are increasingly residing in food deserts.

High profile efforts such as the First Lady’s Let’s Move campaign (Office of the First Lady,

2010), the USDA’s 5 a Day program, and the generally accepted belief that fresh foods are

healthier than highly processed foods indicates a growing awareness of the benefits of

consuming more fruits and vegetables. There is a need to communicate to those who are most

vulnerable, residing in food deserts, how they can accomplish the desired behavior of increasing

consumption of fruits and vegetables, while also reinforcing the overall health benefit of their

regular consumption. The over-sized postcard mailer (detailed description found in Appendix

A), a quarterly yearlong campaign, designed using Social Cognitive Theory, and The Health

Belief Model (Schiavo, 2014a). The goal being to improve and compliment existing health

literacy, raise awareness of availability, motivate, facilitate, improve performance, and raise self

efficacy in a cost effective, malleable, and easily adaptable ( i.e. social media, posters, web site,

etc…) campaign.

Health Literacy and Belief Benefits of Postcard Campaign

Demographics indicate that education attainment levels in the target area are lower than

the county average (Cleveland City Planning, 2014) making the possibility of low health literacy

and general reading comprehension a reality. To combat this fact the health message on the front

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of the post-card will turn research-supported evidence into simple, concise, and relevant

messages that are culturally appropriate. Due to the concise nature, inclusion of a Spanish

without becoming cluttered or confusing. The target population has a majority of African

American residents with a growing Hispanic minority (U.S. Census Bureau, 2014). A simple,

understandable health message appeals to the African American’s health belief of illness being a

consequence of an inadequate diet (Schiavo, 2014b). The postcard also improves the perception

of the food environment, which is justifiably negative due to the elements that exist in a food

desert (Fish, Brown, & Quandt, 2015), by raising awareness of the healthy food available in their

area, and nearby farmers markets that accept and participate in the SNAP Double Produce Perks

Program (Cleveland-Cuyahoga County Food Policy Coalition, 2014). The postcard image

depicts multiple ethnicities, shopping together, addressing fear of experiencing discrimination

shopping at an unfamiliar place (Zenk, et al., 2012), while also being comprised of more female

shoppers to mirror the population more likely to be shopping (Hale, 2011). Children and males

still play a role in the scene to reflect a friendly family atmosphere, and all aspects of the image

strive to reflect “people just like you” shop here.

Motivational and Empowerment Benefits of Postcard Campaign

The prominent placement of the phrase, Take Advantage of Double Produce Perks

Today!, located on the lower banner of the front with locations of markets in the area on the back

offering the incentive, is a crucial element of the communication. Surveys conducted by the

Cleveland-Cuyahoga County Food Policy Coalition, have shown of the 1059 SNAP participants

who shopped at farmers markets, 85% felt incentives were extremely important to bringing them

to the market (CCPFC, 2014). Surveys also revealed 37% of the 536 respondents found out

about the incentive program at the farmers market, and 22% informed through word of mouth

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(CCPFC, 2014). Mean households that receive SNAP benefits targeted by the postcard number

nearly 92,000 (U.S. Census Bureau, 2014), greatly increasing first hand communication of this

vital incentive, and where it is offered.

The final aspect of the postcard is the inclusion of a simple, affordable, and tasteful

recipe on the back, created by local chefs. This provides information on how to utilize the

produce they are being encouraged to buy. The recipe also may increase the likelihood of

postcard retention and referencing, increasing exposure to the overall message. A website link

provided enables access to more recipes for those with internet capabilities.

Evaluation of Postcard Mail Campaign (Appendix A)

The overall goal of the postcard is to increase the number of individuals, especially those

most at risk, in Cuyahoga County, consuming the recommended amount of fruits and vegetables

from less than 25% (Community Commons, 2015) to a 2-3% increase in recommended

consumption. Determination if the goal is realized through; written and phone surveys of

SNAP participants, random person-to-person surveys at grocery stores, farmers markets, and

other food retailers.

People and Situational Contributing Factors

The situational factors present in the food desert of Greater Cleveland, high population

density, high unemployment, transportation problems, and economic difficulty (United States

Department of Agriculture, 2009) it is important to evaluate if the incentive offered is enough to

overcome real and perceived difficulties. Point of sale surveys, sales data, and phone surveys

should show an increase of use of the produce perks program.

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Resources

The cost of 20,000 color double-sided postcards at Staples is $2,233.98 (Staples, 2014),

this represents an extremely economical communication capable of reaching many individuals at

a low cost per head. The development of the postcard requires limited person-hours to create

and has the ability to be quickly distributed and absorbed. The creation, purchasing, and

distribution of the postcard is well within the organizational budget, with cost savings provided

through donated time, expertise, and resources of our participating partnerships. The USDA

provides the necessary contact information uses existing organizational and multiple partner

competencies. Since partnerships are a vital component, continuing evaluation of

communications between partners through regularly scheduled bi-monthly meetings of key

representatives is an integral part of the evaluation plan concerning the most efficient use of

resources and content.

New Media Strategies and Incorporation of Other Program Components

The content of the postcard is digitally created allowing for transfer into alternate media

strategies i.e. flyers, electronic, posters, and radio script. The content also has the ability to be

easily shared with existing electronic media outlets of other key stakeholders. The incentive

program has been shown to raise overall sales of the vast majority of farmers markets that

participated (CCPFPC, 2014), which provides motivation for those not currently participating in

the program to join and increase capacity. The campaign has quarterly mailings, giving ability to

keep the information relevant, content malleable, and ease of integrating with new emerging

initiatives.

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Short-Term Goals

To increase the number of SNAP participants shopping at local farmers markets, an

important source of quality fresh produce in an otherwise food desert of the urban area of

Cleveland, to at least 2%. Roughly, 1% of the 92,000 households (U.S. Census Bureau, 2014)

utilized farmers markets during 2014 (CCCFPC, 2014). Determination if this increase is realized

will be through survey of participating markets sales reports.

Establish a telephone survey of SNAP recipients to be conducted at the beginning and

end of the yearlong promotion to determine actual food behavior, perceptions, and adequacy of

incentives. A modest improvement of 2-3% of these process and progress indicators should be

seen over the yearly data. The survey will help increase the limited data concerning the complex

relationship of multiple factors concerning food consumption behavior, contributing to the

understanding needed to create a more optimal program.

Key Benefits of the Meet Your Grower Community Event (Appendix B)

Research has indicated use and spoilage concerns (Phipps, Stites, Wallace, & Braitman,

2013), transportation concerns, negative perceptions (Fish, Brown, & Quandt, 2015),

socioeconomic status (Williams, Thorton, Ball, & Crawford, 2011) fear of discrimination (Zenk,

et al., 2012) and convenience (Wiig & Smith, 2008) affect food purchasing behavior. The Meet

Your Grower community event (Appendix B) uses Social Cognitive Theory to ameliorate the

negative impact these concerns create regarding healthy food consumption. The collaborative,

multifaceted effort provides an opportunity to raise awareness, increase role models, increase

social cohesiveness, empower, and motivate concerned individuals to improve their

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environment. The event will be held at the Refugee Empowerment Agriculture Program (REAP)

site, which is the largest contiguous urban farm in the Nation (The Refugee Response, 2010)

giving it the ability to change perceptions of area food availability and be a source of pride.

Health Literacy and Belief Benefits of Meet Your Grower Community Event (Appendix B)

Walking tours of tours of the farm provide tour members the opportunity to bond and

share information among each other while provided growing, nutritional, storage, and usage

information by their guide. In addition to increasing awareness, people who might not have

realized the scale of what is happening in their city, now have a physical sense of its size. The

staff at REAP have experience relating and training of agricultural information and provide an

excellent resource to facilitate the transfer of knowledge and stimulate conversation. Existing

informational materials regarding nutrition and various health associations, healthy recipes, and

area availability allows attendees the ability to pick information most important to them, and

provides an opportunity for further investigation.

Motivational and Empowerment Benefits of Meet Your Grower Community Event

(Appendix B)

The increased knowledge can give the participants the confidence in their abilities to

select, prepare, and grow their own vegetables. A bolstered feeling of self-efficacy may enable

individuals to participate in the local community garden, or investigate starting one in their own

community. The addition of food vendors offering tastes of dishes prepared from the fields they

just toured could motivate individuals to expand their palate to include healthy alternatives. The

experience of learning, sharing knowledge, and sharing food may encourage new partnerships to

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form and foster further exchanges of ideas. The opportunity for bonds to form between suppliers

and consumers is created with the personal glimpse into who grows their food and do grow it,

may encourage greater patronage to establishments that offer locally grown fresh foods.

Participation of representatives from the Cleveland’s Community Garden program,

Summer Sprout and the Cleveland Block Grant Program provide interested individuals with the

tools to change their environment, provide a source of neighborhood pride, and become valuable

role models for others. By communicating what resources such as soil testing, seeds, starter

plants, soil amendments, and funding (Ohio State University, 2015), (City of Cleveland, 2015)

available empowers interested groups who assumed they lacked the resources and expertise to

pursue such an endeavor. Expansion or greater participation of the more than 200 area

community gardens, as of 2009, continue to improve the existing environment and may lead to

the possibility of economic gain (Sturpka, 2009). SNAP representatives are also present to

provide information on eligibility and applications for SNAP. Partnerships between Healthy

Eating is a SNAP, Cleveland Foodbank, neighborhood churches and other organizations ensures

the most vulnerable, those that lack transportation, and others who may not be exposed to flyers,

and Fox 8’s Kickin’ it with Kenny promotional spot an opportunity to participate.

Support and resources made available through political action and programs have been a

critical component to fostering the changes and the continued improvement to the urban

environment in Cleveland. Having political leaders representing the neighborhoods of Cleveland

present to communicate what they are doing, demonstrates commitment to improving healthy

food access by city leaders.

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Evaluation of the Meet Your Grower Community Event

The overall goal of the community event is to increase the consumption of healthy foods in

Greater Cleveland by providing an 8-hour event with scheduled activities, entertainment, and

refreshments that increases awareness and empowerment provided by the various programs

available through the attendance of an event. It seeks to connect the city’s food consumers with

the city’s food producers in a meaningful manner. The population of Cleveland is 390,113 (U.S.

Census Bureau, 2014), if the event reaches approximately 5% of the population it should be

viewed as a success.

People and Situational Contributing Factors

Because the event is being held on the west-side of the city, evaluation of if eastern

neighborhoods attended the event are needed. Informal exit polling can indicate if the event

drew individuals from the eastern portion of town. It would be optimum to have equal

participation from all quadrants of the city, but transportation limitations, convenience, and

competing events may limit participation of some city residents. The use of regular partnership

planning committee meetings is in place to help mitigate, and anticipate these hurdles. The

meetings will also be an excellent opportunity for any participant to air competitive concerns by

hosting the event at REAP’s facility. Since this is an outdoor event, weather considerations will

always be a concern. It is important to evaluate the need for temporary shelter from the

elements, and there are adequate contingency plans in place if the event needs to be canceled or

shortened due to severe weather.

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Resources

The use of multiple partners, with common goals such as, REAP, the Cleveland-

Cuyahoga Coalition on Food Policy, The City of Cleveland Planning Commission, and others

provides a wide array of culturally sensitive, knowledgeable volunteer pool to staff the event.

The area resides alongside Cleveland’s Historic West Side Market and provides ample parking

and is located next a RTA transit station providing easy access from public transportation. The

participation of so many vibrant individuals all looking to improve access to healthy produce is

sure to be infectious and create a positive encounter.

New Media Strategies and Incorporation of Other Program Components

Advertising for the community event will first be created as a digital image, allowing the

components of the resulting flyer to be easily included in a event partner or stakeholder can

include on their own Web site. Local channel Fox 8 has a history of promoting good nutrition in

the Cleveland area. They featured the community supported agriculture endeavor Rising Harvest

on the daily morning Kickin’ it with Kenny segment. Having their support has given the event

valuable television airtime exposure.

Short Term Results

Exit polls conducted at the event indicate: That attendees have a different view of the

availability of area produce. Attendees felt they had learned something new and positive about

their community, something that they could take pride in. They left the event with a greater

sense of empowerment. They had a better understanding of who is growing their food, and the

many different programs and options they have available to purchase them. They intended to tell

others of what they learned at the event. The event left them motivated to consume more fruits

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and vegetables. The event gave them confidence to join a community garden, or to start a garden

of their own.

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Appendix A

Postcard Description

The postcard will be a double sided color print the size of the card is 8.50” x 5.59” to

provide ample room for our message. The upper banner of the front of the card will include

“Healthy Eating is a SNAP” with the word healthy spelled using caricatures of fruits and

vegetables. In smaller font and directly below, this same phrase will be expressed in Spanish.

This is a planned quarterly mailing, the image between the upper and lower banner portion will

vary slightly with the seasons. In general, it will depict women, children, and men of varying

ethnicities, happily buying produce in a market. Photos were taken at the Historic West Side

Market to provide visual effect. The lower banner will feature simple nutrition messages that

correspond to the seasonal availability of produce. For example, since the promotion is due to

start in spring the initial postcard will have “Your (heart symbol) loves leafy greens”. The

reverse portion of the postcard will proclaim, “Take advantage of double produce perks today!

Directly below, again in smaller font this same phrase is expressed in Spanish. The remaining

portion of the postcard will be divided into two equal left-right halves. The left quadrant will

contain the farmers market names and addresses participating in the double perks program. The

right quadrant will have simple, easy to prepare and economical recipes designed by area chefs.

The initial postcard will include a grilled/baked stuffed vegetable dish created by celebrity

Cleveland native chef Michael Symon. The postcard will be made of durable 80lb stock and

glossy making it a durable medium that can be saved and shared.

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Appendix B

The Meet Your Grower Community Event

The Meet Your Grower is a carefully planned and coordinated partnership of area

stakeholders to engage the citizens of Cleveland. The event is being held at the largest

contiguous urban garden in the Nation. REAP has generously volunteered its staff (whom are

already accustomed to giving tours of the farm). In attendance are representatives from area

community supported agriculture, area farmers market owners, political and community leaders.

Musical entertainment is provided by area musicians, along with refreshments and healthy food

items will be available at a nominal cost and provided by local restaurants. The advertisement

content will be digitally created to facilitate the information to be used through several media

channels. The content will be arranged similar to a concert promotion poster. An image of the

various staff members selected from the participating members will be taken with the backdrop

of REAP’s facilities in the background. Information on scheduled tour times, varying program

information opportunities, musical performers, and participating food vendors will also be

prominently featured within the body of the advertisement. The bottom portion will give credit

and appreciation to all the contributors that made the event possible.

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Appendix C

References:City of Cleveland. (2015). Block Grant Program. Retrieved from City of Cleveland Web site:

http://www.city.cleveland.oh.us/CityofCleveland/Home/Government/CityAgencies/CommunityDevelopment/BlockGrantProgram

Cleveland City Planning. (2014). 2014 Neighborhood Fact Sheets. Retrieved from Cleveland City Planning Commission: http://planning.city.cleveland.oh.us/2010census/factsheets.php

Cleveland-Cuyahoga County Food Policy Coalition. (2014). Double Value Produce Perks 2014 Report. Cleveland, OH http://cccfoodpolicy.org/sites/default/files/resources/2013report_final_0.pdf: Cleveland-Cuyahoga County Food Policy Coalition.

Community Commons. (2015). Community Health Needs Assessment Full Health Indicators Report. Retrieved from Community Commons, date accessed 4/3/15: http://assessment.communitycommons.org/CHNA/report.aspx?page=1&id=710

Fish, C., Brown, J., & Quandt, S. (2015). African American and Latino Low Income Families’ Food Shopping Behaviors: Promoting Fruit and Vegetable. Journal of Immigrant and Minority Health, Volume 17 Issue 2, 498-505, DOI 10.1007/s10903-013-9956-8.

Hale, T. (2011, March 11). In U.S. Men are Shopping More Than Ever, While Women are Watching More TV. Retrieved from Neilsen Consumer: http://www.nielsen.com/us/en/insights/news/2011/in-u-s-men-are-shopping-more-than-ever-while-women-are-watching-more-tv.html

Office of the First Lady. (2010, February 9). First Lady Michelle Obama Launches Let's Move: America's Move to Raise a Healthier Generation of Kids. Retrieved from The White House Web site, date accessed 6/12/2015: https://www.whitehouse.gov/the-press-office/first-lady-michelle-obama-launches-lets-move-americas-move-raise-a-healthier-genera

Ohio State University. (2015, August 13). 2014 Summer Sprout Report. Cleveland, http://cuyahoga.osu.edu/sites/cuyahoga/files/imce/Program_Pages/ANR/SummerSprout/2014%20Summer%20Sprout%20Report.pdf: OSU extension Cuyahoga County. Retrieved from Burton, Bell, Carr Developement Web site .

Phipps, E., Stites, S., Wallace, S., & Braitman, L. (2013). Fresh Fruit and Vegetable Purchases in an Urban Supermarket by Low-income Households. Journal of Nutrition Education and BehaviorVolume 45, Issue 2,, 165-170, doi:10.1016/j.jneb.2012.04.018.

Rossenfeld, A. (2010). The Fruit and Vegetable Challenge: How Federal Spending Falls Short of Addressing Public Health Needs. Web. http://www.pbhfoundation.org/: Produce for Better Health Foundation.

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Schiavo, R. (2014a). Current Health Communication Theories and Issues, Key Theoretical Influences in Health Communication (chapter 2). In R. Schiavo, Health Communication from Theory to Practice (pp. 33-82). San Francisco, CA: Jossey-Bass.

Schiavo, R. (2014b). Culture and Other Influences on Health Conceptions of Health and Illness, chapter 3. In R. Schiavo, Health Communication from Theory to Practice, second edition (pp. 83-100). San Francisco, CA: Jossey-Bass.

Staples. (2014). Staples Copy and Print. Retrieved from Staples Web site: http://www.staples.com/sbd/content/copyandprint/postcards.html

Sturpka, M. (2009, July 6). Cleveland's for profit community gardens are growing. Retrieved from Cleveland.com: http://blog.cleveland.com/metro/2009/07/clevelands_forprofit_urban_gar.html

The Refugee Response. (2010). The Refugee Empowerment Agriculture Program. Retrieved from The Refugee Response Web site: http://therefugeeresponse.org/our-work/reap

U.S. Census Bureau. (2014). American Fact Finder. Retrieved from U.S. Department of Commerce United States Census Bureau: http://factfinder.census.gov/rest/dnldController/deliver?_ts=445011178441

United States Department of Agriculture. (2009, June). Access to Affordable and Nutrious Food: Measuring and Understanding Food Deserts. Retrieved from USDA Web Site, date accessed 6/5/2015: http://www.ers.usda.gov/media/242675/ap036_1_.pdf

Wiig, K., & Smith, C. (2008). The art of grocery shopping on a food stamp budget: factors influencing the food choices of low-income women as they try to make ends meet. Public Health Nutrition: 12(10), 1726–1734 doi:10.1017/S1368980008004102.

Williams, L., Thorton, L., Ball, K., & Crawford, D. (2011). Is the objective food environment associated with perceptions of the food environment? Public Health Nutrition: 15(2), 291-298, doi:10.1017/S1368980011001947.

Zenk, S., Shulz, A., Israel, B., Mentz, G., Miranda, P., Opperman, A., & Odoms-Young, A. (2012). Food shopping behaviours and exposure to discrimination. Public Health Nutrition: 17(5), 1167-1176, doi:10.1017/S136898001300075X.