EAL

FNOA: Aging Programs (2012)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To evaluate data from the first Senior Farmer's Market Nutrition program (SFMNP) in South Carolina and determine if SFMNP participants increased fruit and vegetable consumption.

Inclusion Criteria:

Participants in the Seniors Farmers' Market Nutrition program (SFMNP) in 13 counties in South Carolina who met income eligibility for the program.

Exclusion Criteria:

No exclusion criteria were described.

Description of Study Protocol:

Recruitment

Participants were not recruited; they were participating in the SFMNP and were randomly chosen to receive a survey.

Design

Surveys were mailed to a random sample of 1,500 of the 15,000 participants in the SFMNP. The survey was modeled after one used for the WIC Farmers' Market program. The survey included 18 questions about participation in the SFMNP, including where they received their coupons, how often they used their coupons and whether the coupons changed the way they eat.

Statistical Analysis

No statistical analysis of data was reported.

Data Collection Summary:

Timing of Measurements

The SFMNP program was effective May 1, 2001 to September 30, 2001, which is when vouchers for fruits and vegetables could be used. The timing of the distribution of the follow-up survey was not described.

Dependent Variables

Fruit and vegetable intake was measured by a survey that was mailed to participants.

Independent Variables

Use of coupons for Senior Farmers' Market Nutrition program.

Description of Actual Data Sample:

Initial N: Surveys were sent by mail to 1,500 participants in the SFMNP
Attrition (final N): 658 surveys were returned (44%)
Age: Participants met the age requirements for the SFMNP, which was not specified in the study
Location: Thirteen counties in South Carolina.

Summary of Results:

Other Findings

Nearly all respondents (98%) used one of more of the vouchers for fruits and vegetables that were provided by the Senior Farmers' Market Nutrition program
526 respondents (81.8% of survey responders) did not purchase a fruit or vegetable that they had never tried before
413 respondents (64.2% of survey responders) said that having the coupons changed the way they ate
569 respondents (88.5% of survey responders) said that they would eat more fruits and vegetables all year-round because of the program
Farmers reported benefits from the program, have a positive attitude about it and are willing to make certain accommodations to participate in it again.

Author Conclusion:

The authors conclude that, based on the purchasing behavior and self-reports of behavior change, seniors participating in the SFMNP increased their fruit and vegetable consumption.

Funding Source:

University/Hospital:

Clemson University

Reviewer Comments:

The reviewer noted that although the goal of the study was to determine if the SFMNP increased their fruit and vegetable intake, there was no question on the survey to address that specific issue. Questions were asked about using the coupons (how often, how many did you use), as was a question that asked if the coupons changed the way they ate. Another question asked was, "Will you eat more fruits and vegetables all year round because of this program?" However, there was no specific question or any follow-up investigation to address changes in fruit and vegetable intake during the period covered by the survey.
It is unclear to the reviewer when the follow-up survey was sent to participants. Timing of the survey could affect participant's recollection and responses to the survey.
All information on use of coupons and changes in eating habits was self-reported by participants so could be skewed by many factors
There was no information provided on age, demographics, gender, functional ability or ethnicity of responders
Data was collected by written survey and could have been skewed by the responder's age, functional ability, cognitive ability, vision and whether or not a spouse or caregiver helped the survey responder
No statistical analysis of data was reported, so statistical significance of these results cannot be evaluated
The authors' conclusion is based in part on purchasing behavior. Purchase of fruits and vegetables using coupons is no indicative of intake of fruits and vegetables.
The "results and discussion" section of this article contained mostly information on a survey of farmers who participated in the program. This information was not applicable to original the research purpose that was outlined in the paper. There was little discussion about the potential confounding factors of measuring intake in fruits and vegetables as a result of participation in the Senior Farmers' Market Nutrition program.
Authors noted that the survey return rate was low and likely not representative of the 15,000 seniors who received the vouchers.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		???
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	No
	2.2.	Were criteria applied equally to all study groups?	N/A
	2.3.	Were health, demographics, and other characteristics of subjects described?	No
	2.4.	Were the subjects/patients a representative sample of the relevant population?	???
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		???
	4.1.	Were follow-up methods described and the same for all groups?	???
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	???
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	???
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		N/A
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	N/A
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		N/A
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	N/A
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		No
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	N/A
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	???
	7.5.	Was the measurement of effect at an appropriate level of precision?	No
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	No
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		No
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	No
	8.2.	Were correct statistical tests used and assumptions of test not violated?	No
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	No
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	No
	8.6.	Was clinical significance as well as statistical significance reported?	No
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		No
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	No
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes