Lunch4Tots Group 1: Elizabeth Griffin, Katy Hamlin, Donna Javellana,

Liyana Abdul Kadir, Judy Mendel

Background Concept: A texting program focusing on the importance and

practice of packing healthy, well-balanced lunches and snacks for toddlers.

Target Population: Parents of toddlers, age 2 – 5, who attend a daycare/preschool/pre-K that requires parents to provide packed lunches in the greater D.C. metropolitan area.

Objectives

Behavioral Objective: Increase the number of fruits, vegetables and whole grains parents pack for their 2 – 5 year olds lunches/snacks over the course of 2 weeks by 40%.

Health Objective: To increase by 50% the percent of toddlers within the program who achieve the recommended daily nutritional standards for their age group, as defined by the American Academy of Pediatrics.

Communication Objectives Based on the Health Belief Model Perceived Benefits: By the midpoint of the study, 100% of

parents will be aware of the health benefits of packing a healthy home-made lunch for their toddler.

Perceived Barriers: By the midpoint of the study, 100% of parents will be aware of time management tips to prepare healthy meals.

Perceived Severity: By the end of the first week of the campaign, 80% of parents will be aware of the serious consequences poor nutrition can have on a developing toddler.

Communication Objectives Based on the Health Belief Model

Self-Efficacy: By the end of the texting campaign, 75% of parent participants will feel confident in their ability to pack healthy lunches.

Cues to Action: By the end of the texting campaign, 50% of parent participants will use a text tip to help pack a healthy lunch for their toddler.

Lunch4Tots Text Messaging Program Recruited 7 mothers

Eligibility criteria: Have children between the ages of two and five years Reside in the D.C. metro area Have a toddler attending a daycare or preschool that

requires them to bring a packed lunch each day

Pre-test administered Two week text messaging pilot program ~2 text messages sent/day Post-test administered at end of pilot program

Message & Construct Examples

Message HBM Construct

Lunch4Tots: Make meal planning easy. Create a grocery list for the whole week.

Perceived Barriers

Lunch4Tots: Challenge your little ones to follow the rainbow! Pack colorful fruits and veggies, they will get a healthy boost of vitamins and minerals.

Perceived Benefits

Lunch4Tots: Try making tiny tea sandwiches on whole grain bread. Cucumber and low-fat cream cheese or egg salad are yummy fillings.

Cue to Action

Lunch4Tots: An interactive lunch-packing activity! Help your tots make trail mix with their favorite dried fruit and whole grain cereal.

Self Efficacy

Participants 6 out of 7 participants completed the pre/post test

Average age: 37.8 years

Race: 33.3% white (2 participants) 33.3% Asian American (2 participants) 16.7% Did not specify (1 participant) 16.7% Latina (1 participant)

Number of toddlers in household 83.3% with 1 toddler (5 participants) 16.7% with 2 toddlers (1 participant)

Results

What are the recommended daily servings of fruits for toddlers?

Pre-test: ¼ cup ½ cup 1cup – 83.3% (5 participants) 3 cups - 16.7% (1 participant)

Post-test:¼ cup – 16.7% (1 participant) ½ cup – 16.7% (1 participant) 1 cup – 50.0% (3 participants) 3 cups – 16.7% (1 participant)

What are the recommended daily servings of vegetables for toddlers?

¼ cup ½ cup – 16.7% (1 participant) 1cup – 33.3% (2 participants)3 cups - 50.0% (3 participants)

¼ cup – 16.7% (1 participant) ½ cup – 16.7% (1 participant) 1 cup – 50.0% (3 participants) 3 cups – 16.7% (1 participant)

Results

Which of the following foods listed below is a good source of protein for your toddler?

HummusEggsChickenTunaAll of the above - 100% (6 participants)

Hummus - 16.7% (1 participant) EggsChickenTunaAll of the above - 83.3% (5 participants)

Which of the following represents the LEAST healthy option for your toddler's lunch?

Pita pocketsWheat bread – 16.7% (1 participant)White Bread – 66.7% (4 participants)English muffins – 16.7% (1 participant)

Pita pocketsWheat breadWhite Bread – 83.3% (5 participants)English muffins – 16.7% (1 participant)

Which beverage item has the most nutritional value for your toddler?

Skim Milk – 100% (6 participants)Fruit flavored juicePowdered drink mix (sugar added)Soda

Skim Milk – 100% (6 participants)Fruit flavored juicePowdered drink mix (sugar added)Soda

Results

I am confident that my toddler’s diet meets the recommended daily nutritional standards.

Pre-test: Strongly Agree – 16.7% (1 participant)AgreeNeutral – 16.7% (1 participant)Disagree – 66.7% (4 participants)Strongly Disagree

Post-test:Strongly Agree – 16.7% (1 participant)Agree – 33.3% (2 participants)Neutral – 33.3% (2 participants)Disagree – 16.7% (1 participant)Strongly Disagree

I am satisfied with the lunches I pack for my toddler.

Strongly AgreeAgree – 20% (1 participant)Neutral – 20% (1 participant)Disagree – 60% (3 participants)Strongly Disagree

Strongly Agree – 16.7% (1 participant)Agree – 66.7% (4 participants)Neutral – 16.7% (1 participant)DisagreeStrongly Disagree

ResultsI am confident in my ability to utilize time management skills

in order to pack a healthy lunch for my toddler.Pre-test:

Strongly Agree – 16.7% (1 participant)Agree –16.7% (1 participant)Neutral – 33.3% (2 participants)Disagree – 33.3% (2 participants)Strongly Disagree

Post-test:Strongly Agree Agree – 66.7% (4 participants)Neutral –16.7% (1 participant)Disagree –16.7% (1 participant)Strongly Disagree

Text messages help me remember to pack a healthy lunch for my toddler.

Strongly AgreeAgreeNeutral – 100% (6 participants)DisagreeStrongly Disagree

Strongly AgreeAgree – 50% (3 participants)Neutral – 16.7% (1 participant)Disagree – 33.3% (2 participants)Strongly Disagree

What did moms think? How often did you use a Lunch4Tots tip to help you pack a lunch?

Sometimes – 83.3% (5 participants)

What did you like about the Lunch4Tots text messaging program? I like the concise information. It was encouraging. Creative tips for lunch-packing (i.e ants on a log)

Would you recommend Lunch4Tots to a friend/family member? Yes – 50% (3 participants) Maybe – 16.7% (1 participant) No – 33.3% (2 participants)

Recommendations from Moms

What would you like to see improved?

Shorten URLs – links hard to read on smart phone Adjust timing and frequency of text messages Send tips via e-mail Link to user-friendly (less text heavy) websites Provide more specific lists of options to pack

SAM Evaluation

• Nine sets of 100 words in Lunch4Tots• Average # of sentences = 11.9• Average # of syllables = 134.6

• 4th Grade Reading Level = Superior

Fry Graph and Reading Grade Level

SAM Areas For Improvement Consider including a summary or review of messages

Provide more context before message SMS limits

Improve and incorporate layout factors Visual cuing devices Consistent sequence of information

Match to cultural logic, language, experience (LLE) Foods rarely eaten or unavailable

Cultural images and examples Cultural images and foods presented in positive way

Considerations for Future & App

Design graphic sections of Lunch4Tots with SAM evaluation in mind Cover graphics show purpose Type of graphics Relevance of illustrations List, tables, etc. explained Captions used for graphics

Recalculate SAM score to incorporate changes in program

Questions?