5 A Day Peer Education Program

The U.S. Department of Health and Human Services and the U.S. Department of Agriculture recommend that Americans eat at least five daily servings of fruit and vegetables.  Though these foods seem to confer protection against several forms of cancer and other diseases, Americans consume fewer servings than recommended.  Further, national efforts to increase consumption relying on mass media messages, point-of-purchase promotions, and product labeling may not be reaching important subpopulations, such as minority and lower socioeconomic adults who currently consume fewer servings than White and more affluent Americans.  A peer-based health education program at the workplace may overcome barriers to health promotion for these subpopulations by tailoring information to their cultural values, and relying on the informal networks present at work to influence behavior. 

The 5 A Day Peer Education program employs peer educators and their social networks to deliver nutrition education to co-workers in the workplace during the workday.  Trained peer educators promote the 5 A Day message using their own informal methods of communicating and modeling dietary change, presenting their co-workers with a monthly booklet of information to help them make a transition to a healthier diet, and sharing gifts with their co-workers to remind and support them in dietary change efforts.  The distributed materials contain culturally and regionally appropriate nutrition information for Anglo and Mexican diets in Arizona to influence knowledge, attitudes, stages of change, skills, and barriers for eating fruits and vegetables.

The program was delivered over a nine-month period.    Peer educators spent approximately two hours each week with co-workers to discuss eating fruits and vegetables as part of a healthy diet.   Peer educators were also required to attend a 16-hour training program held over an eight-week period, and eight 2-hour in-service sessions.

Participants were non-managerial, labor, and trade blue-collar employees in Tucson and Phoenix, Arizona.  Participants averaged 42 years of age and were represented as follows: 43% Hispanic; 46% White; 75% male; and 17% with an associate or bachelor's degree.  Peer health educators averaged 41 years of age and were represented as follows: 71% male; 53% Hispanic; 36% White; and 19% with an associate's degree.

The intervention is suitable for implementation in the workplace.  Study participants were employees of county and city governments, public universities, community colleges, and public school districts.

The 5 A Day for Better Health Peer Health Educator Training Manual, the 5 A Day Guidebook containing nine booklets, and the 5 A Day Way newsletters are required.  Participants also received small gifts of water bottles, recipe books, vegetable seeds, insulated lunch bags, and produce.  These items are suggested, but not required.  Costs associated with the program's implementation are not provided.

Ninety-three informal social networks, or "cliques" with 1007 employees were randomly assigned to receive the 5 A Day Peer Education program delivered in context of a formal work-site nutrition program (experimental), or the General 5 A Day worksite nutrition education program (control).  From each clique randomized to the peer education group, one employee was identified through network analysis as highly central within the clique's communication environment and was recruited to be the peer educator.  Peer educators participated in 16 hours of training and eight two-hour in-service sessions.  Peer educators provided their co-workers with a monthly 5 A Day Guidebook and a small gift (e.g., water bottle, recipe books, vegetable seeds) and a newsletter every other month.  Peer educators were expected to spend two hours each week discussing eating fruits and vegetables with their co-workers.  Outcomes measures were collected at baseline, posttest, and at a 6-month follow-up.

• Results indicated:
  Employees receiving the peer education program increased their total daily servings of fruits and vegetables compared to employees in the control arm by 1.01 servings.
   
• At 6-month follow up, and according to the 24-hour intake recall measure, total daily servings of fruits and vegetables remained higher for employees in the peer education program compared to employees in the control arm.

•  At 6-month follow-up, employees in the peer education arm increased their awareness of the 5-A-Day program, knowledge of the 5-A-Day concept and the number of daily servings considered appropriate, and their positive attitudes toward fruit and vegetable intake compared to employees in the control arm.