Fish For Your Health

GOAL: Increase employed, adult mens knowledge and awareness of the dietary fats found in fish sources as they relate to the maintenance of heart health to encourage and facilitate fish consumption for the prevention and protection against adverse health outcomes. Educational Needs For the achievement of this programs goals, adult men must be provided with practical information on the effects of dietary fats on the heart; specifically, the bioactivity of healthy fats in the body as they aid in heart protection. In addition, they should understand which types of fats (from fatty fish) promote heart health and specific fish sources for obtaining these fats. Recommendations must be given on the adequate amounts and frequency of consumption to achieve health benefits, suitable and safe fish sources, as well as purchase methods and preparation techniques. Learning Needs Adult men, and adults in general, learn best if presented with concrete information, centered around a specific problem and meaningful to their lives. For the success of this program, educational content should be consistent with program goals, and relevant and individualized to adult mens needs and interests. Assessing the lifestyle, prior knowledge, available resources, and concern for health among the targeted adult male population should inform those principles. This program should also establish a positive learning environment through which individuals can actively participate and collaborate with educators to reinforce key concepts and provide feedback during learning. The presentation of appropriate information, recommendations, and demonstrations should facilitate participant achievement of program goals. OBJECTIVES: 1. At least 75% of participants must be able to define and identify: the type of heart healthy fats found in fish, major fish sources of these fats, and the effects of fish consumption on heart health. 2. Program participants will be able to prepare a recipe containing a fish identified as heart healthy. 3. Increase the percent of men consuming fish at least twice per week by 25% within 6 months after program participation. Program Format This wellness program will consist of 3 lessons. The first will introduce the topic of fish in relation to heart health. It will provide core nutrition information on types of dietary fats found in fish, how they function in the body, how/why fish consumption specifically contributes to heart health, and the major fish sources for healthy fats. The second will focus on incorporating fish into the diet by emphasizing nutritional quality, recommendations for consumption, identifying resources and how tos for purchasing quality fish sources, offering easy meal tips, preparation methods, and recipes.

The third and final lesson will consist of an interactive cooking class enabling men to simply and easily prepare fish and enjoy a meal. Several classes will be offered, allowing men to attend more than one if desired.

This program will be offered as a type of company wellness program to interested businesses in the community. Employed, adult men at participating worksites will be informed and encouraged to participate. The first two lessons will be facilitated by a team of community nutritionists to groups of men (no larger than 20) in a weekend class setting at the local YMCA or community center. Various dates and times will be offered for the pair of lessons, allowing men to enroll in the sessions which best fit their availability and schedule. The third lesson, a cooking class, will be held in a community kitchen on Friday evenings. The classes will be taught by a local chef (involved with community cooking classes through local food stores, culinary school etc) and overseen by one of the programs community nutritionists. Each class will focus on various preparations of one type of fish. Men can select to attend one or more demonstrations from an offering of scheduled dates. Enrollment will be in small groups of 5 men. Completion of each of the three lessons should ideally be achieved within 2 months, allowing for flexibility of scheduling while maintaining consistency in learning.

Lesson Plan An outline for Lesson 1 of the program: This first lesson provides the necessary background information and important nutrition knowledge for making informed dietary decisions relating to heart health. It serves to introduce and thoroughly explain the topic of fish consumption for heart health, sparking interest in participants to make healthful changes in their diets. Lesson 1 instills a concern for health and prompts a desire to act, the tenets of which are the focus for Lesson 2. Title: Getting Hooked on Heart Health Target audience: adult men, employed full time Duration: 75 minutes General Objective: Learn the importance of regularly consuming fish for the maintenance of heart health. Specific Objectives At the end of the lesson, participants will be able to: 1. Identify the specific, heart healthy fats found in fish. 2. Explain how omega-3 fats positively affect heart health 3. Identify major fish sources containing healthy fats

Procedure Intro: The lesson will begin with a brief, introductory activity asking men (in small groups) to come up with a list of factors (both nutrition-related behaviors and biological issues like high

cholesterol or hypertension) that contribute to poor heart health/risk for disease. Men will volunteer their answers to the larger group. The program educator will comment on the accuracy of mens contributions, and introduce the importance of consuming adequate amounts of heart healthy fats, specifically those found in fish, for the maintenance of heart health and prevention of discussed factors. Men will then be asked to complete a short pre-test assessing general awareness of the relationship between fats in fish and heart health. Body: The educator will first present brief background information on the types of dietary fats (saturated, unsaturated, trans etc) in food sources, and which are generally better or worse for consumption. The unsaturated fats, specifically the polyunsaturated fats found in fish, will be introduced and defined. The educator will discuss the interactions of these healthy fats in the body, how they contribute to a healthy heart, and in which fish sources they may be obtained. Images of appropriate fish sources will be provided for visual recognition and reinforcement. Men will then participate in an interactive True/False question session, presented by the educator. A post-test will be administered for comparison to pre-test and assessment of learning objectives. Closure: Remind men that regular consumption of heart healthy fats, like those found in fish, are essential to the protection of heart health. In addition, remind older men that they must be particularly vigilant of heart healthy choices due to their risk for heart disease and heart attack. Messages: -Heart healthy fats, like the omega-3 fatty acids found in fish, are essential to the maintenance of heart health. -Consuming fish twice a week can help protect from risk factors of heart disease. -Fatty fish like salmon, mackerel, herring, lake trout, sardines and albacore tuna are high in heart healthy fats. Activities: -Introductory activity and group discussion on contributing factors to poor heart health -Pre and posttests -Completion of a goal sheet: Aim to consume a serving of fatty fish twice per week -True or False game: Present a variety frequently asked T/F questions relating to fish consumption and heart health to the group. (For example: True or False: Taking fish oil supplements provides the same health benefits as consuming fish?) Materials: Educator manual- includes all presented information on achieving heart health through fish consumption Pre and post tests- Ten question assessment of knowledge related to types of dietary fats and their contributions to heart health, fish sources of healthy fats, and consumption recommendations. Slides- visuals of fish sources; T/F questions for activity Handout: Fish 101, with information from AHA- includes recommendations for fish consumption, names and description of essential healthy fats in fish, and major sources. Handout: Goal Sheet

Evaluation: Comparison of scores from pre and posttests, survey of participants, questions and comments

Evaluation Formative: This program could be evaluated formatively through focus group sessions with selected members of the target population. During program design, the community nutritionist may invite a few small groups of employed men (prospective participants) from the community to review the instructional materials for appropriateness, usefulness, and ease of understanding. The men may review and comment on the Fish 101 handout to assess whether the information provided would be informative and useful in helping similar individuals make informed decisions about fish consumption. In addition, these focus group members could review the pre and posttests for readability and content so that program facilitators may make important revisions prior to program implementation. Finally, mens interest in attending a cooking class as the third lesson should be considered when designing an effective lesson method for increasing mens self-efficacy in the kitchen. Process: Process evaluation for this program may be achieved by assessing whether program activities are occurring as expected. By examining records kept on program participants, I can verify whether the program reached the target audience (adult, working males). Also, attendance and participation rates compared to initial program enrollment can be used to determine the drop out rate and whether the target audience successfully completed the program lessons/activities. Of the completed nutrition lessons, educators may report the successful completion of all lesson activities and presentation of all required content to assess standardization of teacher instruction among lessons. Finally, conducting surveys of the target audience and program participants will be useful in revealing: how individuals heard of the program (effectiveness of marketing/advertising), personal characteristics or attitudes which compelled them to enroll (qualities of users of the program), why the program was used (reaching target), how many of the three lessons were used and how well the lessons were implemented by educators (successful implementation). Impact: To determine whether the program was successful in achieving its stated objectives, surveys and food frequency questionnaires could be used to respectively examine the attitudes, knowledge, and beliefs of participants following the lessons as well as mens intake of fatty fishes after completion of the three lessons. Surveys will assess the effectiveness of lesson teaching and mens knowledge of program content, their attitudes toward fish consumption for heart health, and confidence in preparing approved fish sources. The food frequency questionnaires will assess achieved behavior change, or the frequency of consumption of fish (high in omega-3 polyunsaturated fats) several months following the program. By determining if a majority of men report consumption of fatty fishes at least twice per week after completing the lessons, the programs success may be reviewed. Slogan Fall hook, line, and sinker. Catch YOUR healthy heart with three simple parts.

Fish
Logo:

For Your Health

Challenges Potential challenges in delivering this program to an audience of working, adult men may include: lack of mens motivation or interest in changing dietary behaviors, participants that dislike fish, belief that attending attending a cooking class is not masculine, having a wife in charge of meal preparation that is disinterested in making changes, or an inability to make time in the schedule to accommodate lessons. I could address each of these potential issues respectively by using advertising to: inform the target population of the severity of heart disease and their susceptibility for poor heart health as an older male; reassure men that even small changes in the diet can have a great impact on health outcomes; emphasize the variety of fish and preparation methods to convince unwilling participants that they may actually enjoy the taste of fish; explain that cooking can be simple, fast, easy, and fun for all people; encourage joint participation with coworkers; provide encouragement for learning to cook such as wanting to treat/impress your significant other, developing a new skill or hobby, feeling empowered in the kitchen and in charge of ones diet; explain that incorporating fish into the diet does not have to replace favorite foods and that consuming fish can take place outside of the home environment if familys are unwilling to participate; promote the efficiency of each lesson and short time commitment; make men feel capable and inspired to take care of their heart for prolonged health. In addition, participating worksites may offer incentives for employee participation such as covering the cost of program participation. Partners Local grocery stores- Stores may provide discounts on the ingredients and resources for the cooking demonstration classes in exchange for publicity and promotion of the stores products to the local community as well as tax deductions for donations. YMCA/Community center- partnering with local facilities may eliminate/reduce the cost of renting space to offer nutrition education lessons/hold cooking class and encourage community use of the facility and awareness of other programs offered there. Local affiliate of the AHA- obtain complimentary nutrition education materials for the lessons to limit cost of printing Local fish purveyors- Obtain program support from local fish markets/purveyors to promote fish consumption and encourage participants to utilize fresh, local resources. Companies/Businesses of employed men- worksite promotion may increase reach of program by offering incentives for employee participation, as well as locations for advertising. Benefit to business may be reduced health care expenses.

Management Organizational Structure: The community nutritionist in charge of developing the program will serve as the program supervisor and creator. He/She will gather of a team of educated nutrition professionals to serve as program employees (such as dietitians from local grocery stores, clinical dietitians from local health centers/hospitals, or private nutrition counselors) who will be trained to facilitate the two nutrition education lessons. A team of 5 educators should be sufficient to facilitate lessons and oversee cooking classes. Two trained cooking professionals will also be employed to host the cooking classes. In addition, the program requires a communications/marketing consultant to design and implement marketing and advertising strategies, a public relations manager to contact participating worksites and establish program partners, and a financial counselor to assess program budget. Upon successful completion of program components, the team may gather to discuss effectiveness of program materials, outcomes, participation, enrollment, and cost to make necessary changes for future use among the target audience. Marketing/Advertising: The target market for this nutrition education program is adult men, employed full time. The product or service offered will be 2 class-based nutrition lessons and a cooking class, thus providing participants with knowledge and awareness of an important health topic as well as access to local resources and valuable skills for maintaining good heart health. Place in this context will be the local community center/YMCA and community kitchen where the lessons will be presented. As for price, program participation will require an investment of time (75 minutes for each nutrition lesson, and a 90 minute cooking class); effort on behalf of the participants to travel to the community center, actively engage in lesson plans and the cooking class, and implement dietary changes; and a small participation fee to cover costs of the cooking class and employee wages. To promote program enrollment a variety of informative and persuasive advertisements through a variety of channels may used. Advertising strategies may include promoting the program logo and slogan on posters and signs at the local community centers and YMCA where lessons will be presented as well as at participating worksites, sending memos to male employees of participating work sites, sending direct mail to the households of employed males, using classifieds in the local newspaper (which working, adult men would be likely to read), offering handouts and brochures through partner organizations, participating businesses, and health clinics.