Hpe Final

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Running head: HEALTH PROMOTION PROJECT
Health Promotion Project: Lowering Sodium Intake
Alyssa Collins
University of Southern Mississippi
Revised August 2012; Reviewed August 2016

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HEALTH PROMOTION & EDUCATION
Program Planning Worksheet
The University of Southern Mississippi
Name: Alyssa Collins
Step 1: Community Needs Assessment

What is the name of the organization/group with which you will
implement the HPE project? WIC in Grand Junction, Colorado
What is the name & contact information for the individual with whom
you will collaborate to complete the HPE project? Karla Klemm, karla.klemm@mesacounty.us
What is your PRIORITY ISSUE that you plan to address with this
group? High sodium intake; healthier options for quick meals instead of the higher sodium options, such as
processed foods.
Gather the perspective of the key stake holders:

Write a summary of the views of the stakeholders related to The main population at this WIC location is young white mothers of a lower socioeconomic status and
your intended project related to their interest in this type of their children. The biggest nutrition issue in this population is high sodium intake due to cheap,
project and their areas of concern convenience foods. Sodium intake directly impacts heart health and can lead to hypertension and heart
attacks, both of which are significant health issues in Grand Junction.
Many young mothers are constantly busy; between jobs and taking care of their children, and they are
possibly still in school. This means they gravitate towards easy, convenience foods to feed themselves
and their children. This makes their sodium intake way above the recommended level.
Both mothers and children can benefit from this education session. Once mothers are educated on the
significant impact sodium intake has on health status, they can change the way they prepare foods to
benefit the family. In order to make even more of an impact, the foods must be quickly prepared to fit in
with their hectic lifestyle. Every mother wants her child to live a long and healthy life, and mothers
want to live a healthy life, too. This education session will help them on the path towards achieving this
goal. These goals will be the motivation to implement the necessary changes.
Examine the Literature

Examine the literature for research about projects, Reference: Webster, J. L., Dunford, E. K., & Neal, B. C. (2009). A systematic survey of the sodium
communities, and issues related to your priority issue contents of processed foods. American Journal of Clinical Nutrition, 91(2), 413-420.
Examine previous evaluation findings of similar projects doi:10.3945/ajcn.2009.28688
Review the literature regarding similar types of projects and
recommendations for designs/appropriate interventions Background: Processed foods are very high in sodium due to the need for long term preservation. In a

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fast paced society, people tend to purchase and consume these higher sodium foods due to convenience.
In order to make a change on the amount of sodium consumed, it is important to understand the sodium
content in these foods.
Purpose: The purpose of this study was to examine the amount of sodium in processed Australian food
items and compare the amount to the recommended levels.
Methods: Processed foods that were high in sodium content were identified. These sodium levels were
assessed and put into mg/100 g and mg/100 mL for liquids. These food items were then categorized and
mean values of sodium content were calculated.
Results: Food groups that contained the most sodium included sauces (1238 mg/dL) and processed
meats (846 mg/dL). The lowest sodium content was found in cereals, fruits and vegetables. Of all the
food items assessed, 63% of these fell above the recommended sodium intake.
Conclusion: Foods highest in sodium content include processed meats, breads, meats and sauces. In
order to lower sodium intake, these items need to be reduced in the diet.
Reference: Yang, Q., Zhang, Z., Kuklina, E., Fang, J., Ayala, C., Hong, Y., Merritt, R. (2012). Sodium
intake and blood pressure among US children and adolescents. Pediatrics, 130(4), 611-619.
doi:10.1542/peds.2011-3870d
Background: High blood pressure is directly linked to sodium intake, in both adults and children. When
children are exposed to a high blood pressure in childhood, they are predisposed to hypertension when
they are older. This can also lead to other heart issues such as cardiovascular disease and heart failure.
Purpose: The purpose of this study was to examine the correlation between blood pressure and sodium
intake in children, as well as their weight status.
Methods: The study was composed of 6235 children and teenagers ages eight to eighteen who had
participated in NHANES 2003-2008. Twenty-four hour dietary recalls were used to assess the level of
sodium intake. Blood pressure and weight was measured during visits to the mobile examination center.
Results: The average amount of sodium consumed by the children and adolescents per day was 3387
mg. Of these participants, 37% were obese. Sodium intake was higher in males and in participants of a
normal weight. Non-Hispanic whites were found to have the highest intake. Systolic blood pressure
was directly increased by each 1000 mg of sodium ingested, more so in overweight children rather than
children with a normal weight (P = .010). With every increase in 1,000 mg of sodium per day, the risk
for high blood pressure increased by 74% in overweight and obese subjects and 6% in participants with
a normal weight (P < .05).
Conclusion: High sodium intake directly increases blood pressure in children, specifically those who
are overweight and obese.
Reference: Aburto, N. J., Ziolkovska, A., Hooper, L., Elliott, P., Cappuccio, F. P., & Meerpohl, J. J.
(2013). Effect of lower sodium intake on health: Systematic review and meta-analyses. BMJ, 346.
doi:10.1136/bmj.f1326

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Background: Sodium intake is directly linked with high blood pressure, which in turn can cause health
issues such as heart attack, heart disease, heart failure, atherosclerosis and stroke.
Purpose: The purpose of this meta-analysis was to determine if lowering sodium intake had positive
health outcomes in both children and adults such as lowered blood pressure, lowered risk of heart
disease, changes in lipid levels and better renal function.
Methods: Studies were screened individually, and were chosen based on study characteristics and
outcomes. Each study had to be related to the impact of sodium intake on blood pressure, heart disease,
lipids, and renal function.
Results: Studies found that lowered sodium intake was associated with lowered diastolic and systolic
blood pressure in both adults and children. No associations were linked to lipid levels or renal function.
Risk of stroke, death from stroke and coronary heart disease mortality were associated with increased
sodium intake.
Conclusion: Sodium intake is associated with blood pressure, as well as risk for stroke and death from
coronary heart disease. Lowered sodium intake can positively impact these health outcomes.
Reference: He, F. J., Wu, Y., Feng, X., Ma, J., Ma, Y., Wang, H., Macgregor, G. A. (2015). School
based education programme to reduce salt intake in children and their families (School-EduSalt):
Cluster randomised controlled trial. BMJ, 350. doi:10.1136/bmj.h770
Background: Elevated blood pressure, which is caused by increased sodium intake, accounts for 62% of
strokes and 49% of ischemic heart disease. Education on lowering salt intake should occur for both
children and adults to prevent the development and progression of heart disease.
Purpose: The purpose of this study was to determine if education on lowering salt intake for children
would actually lower salt intake of both the children and their families.
Methods: To be eligible for participation, children who lived in Northern China had to eat at least three
homemade meals a week. Students were randomly assigned to a control group or the intervention
group. The intervention group was educated on the effects on high salt consumption, and were told to
ask their parents to reduce the amount of salt and higher salt foods in cooking. The intervention classes
were 40 minutes every two weeks and lasted for three and a half months. Salt consumption was
measured by urinary output at baseline to the end of the trial. Blood pressure was also measured
throughout the study.
Results: The control group increased salt consumption over the trial time. The intervention group had a
significant decrease in the amount of salt consumed. Both the children (P=0.51) and parents (P<0.05)
of the children in the intervention group had a decrease in blood pressure.
Conclusion: Education programs on lowering salt consumption for children can lower blood pressure
and salt consumption for the children and for their parents.
Collect Health Related Data About your Issue
Morbidity & Mortality reports related to your primary issue Reference: Ayala, C., Kuklina, E. V., Peralez, J., Keenan, N. L., & Labarthe, D. R. (2009). Application
Health behavior & practices related to your primary issue of lower sodium intake recommendations to adults. Retrieved from
found in research journals http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5811a2.htm

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Health status data related to your primary issue (including According to the Centers for Disease Control and Prevention (CDC), in 2005-2006 around 28% of
social, economic, & environmental indicators) adults in the United States were pre-hypertensive and 29% of adults had hypertension. Consumption of
sodium increases blood pressure, which increases the risk for developing hypertension. In 2005, the
recommended level of sodium intake was less than 2300 mg per day, however the average amount
consumed per day was around 3436 mg. Some individuals may benefit from an even lower amount of
sodium intake per day. In order to determine which populations would benefit from this, the CDC
examined data from the National Health and Nutrition Examination Survey (NHANES) from 1996 to
2006. From this data, it was found that 69.2% of adults in the United States would benefit from a
sodium intake of less than 1500 mg per day. This population includes all persons diagnosed with
hypertension, all black people, and all middle-aged and older adults.
Reference: Luckhaupt, S., & Calvert, G. (2014). Prevalence of coronary heart disease or stroke among
workers aged <55 years United States, 20082012. Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6330a1.htm
Cardiovascular disease accounts for one in three deaths each year in the United States according to data
collected by the Centers for Disease Control and Prevention (CDC). Of these deaths, most of them
occur due to stroke and coronary heart disease (CHD). In order to determine the populations that are
affected most by cardiovascular disease that would benefit from a Total Worker Health Program, the
CDC analyzed data collected by the National Health Interview Survey. The study found that only 1.9%
of employed adults less than 55 years of age reported a history of stroke or CHD. From the adults who
are employed, men and current and former smokers were significantly more likely to report stroke or
CHD. Blue collar jobs were more likely report these compared to people in white collar jobs. Of the
people looking for jobs, 2.5% reported a history of CHD, and 6.3% of people who are retired, stopped
looking for work, homemakers, and students reported a history of these.
Reference: Schieb, L., Greer, S., Ritchey, M., George, M., & Casper, M. (2013). Vital signs: avoidable
deaths from heart disease, stroke and hypertensive disease. Retrieved from
Background: Approximately 800,000 deaths occur each year due to cardiovascular disease. However,
many of these deaths are avoidable by either preventative measures of healthy eating, exercise and
cessation of smoking, or by treatment, once the disease develops.
Purpose: The purpose of this study was to determine the amount of cardiovascular deaths annually that
occur in persons less than 75 years old that are preventable.
Methods: Mortality data was collected from the National Vital Statistics System for the years 2001-
2010. Preventable deaths were defined as deaths that occurred due to underlying causes of ischemic
heart disease, stroke, chronic rheumatic heart disease or hypertensive disease.
Results: In 2010, the number of avoidable deaths was 200,070. This means around one fourth of
cardiovascular deaths are avoidable. In the same year, the amount of cardiovascular deaths decreased
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by 29%. The avoidable cardiovascular deaths that occurred were highest among men and black persons
compared to other ethnicities. The states in which these deaths were the highest were Tennessee,
Mississippi, Louisiana, Oklahoma, and Arkansas. The West, Midwest and Northeast had the lowest
incidence.
Conclusion: Preventative measures such as healthy eating, increasing exercise and smoking cessation
are essential for decreasing deaths that occur due to cardiovascular disease.
Reference: Healthy Mesa County 2012-2017. (2012). Retrieved from

https://www.colorado.gov/pacific/sites/default/files/OPP_Mesa-Healthy-Mesa-County-2012-2017.pdf
According to the Community Health Needs Assessment, heart disease is currently the number one
cause of death in Mesa County, where Grand Junction is located. In 2011, the rate of cardiovascular-
related death in Mesa County is 159.9 per 100,000 people. The Colorado rate is 131.2 per 100,000. This
means Mesa County has a higher rate of deaths from heart disease compared to the state as a whole. In
fact, Mesa County was found to be significantly worse off than Colorado for six of the ten causes of
years of potential life lost. Specifically, they are dying by preventable causes such as suicide, cancer,
unintentional injury and heart disease. Morbidities such as childhood obesity, adult obesity, diabetes,
arthritis and asthma are increasing in Mesa County. Behavioral factors also play into health and quality
of life. There are many citizens of the county who do not exercise or are unable to, have poor nutrition
and smoke tobacco frequently.
Reference: Healthy Mesa County 2012-2017. (2012). Retrieved from

https://www.colorado.gov/pacific/sites/default/files/OPP_Mesa-Healthy-Mesa-County-2012-2017.pdf
Poverty is a significant problem that affects the population of Grand Junction. Around 14.7% of the
population lives below the poverty level. The per capita personal income of Mesa County is $34,379.
According to the Food and Drug Administration 39% of students in Mesa County schools were eligible
for the free lunch program in 2009. This means there were 8,796 students whose families fall below
130% of the federal poverty level guideline for the lunch program. Additionally, these low income
families in Grand Junction are likely to live in areas where grocery stores or convenience stores do not
offer nutritious food items. These families living in poverty are also more likely to be uninsured. Mesa
County has undergone one of the highest rises in uninsured citizens in the state of Colorado. Twenty-
two percent of the population does not have health insurance. Of the Hispanic population, 34% are
uninsured.
Review Existing Mandates

Mandate of the organization/group with which you are Reference: The Colorado Department of Public Health and Environment. (2016). WIC families.
working Retrieved from https://www.colorado.gov/pacific/cdphe/wic-families

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Legislation, regulations, and/or health policies Colorado citizens are eligible for WIC participation if they are pregnant, breastfeeding, or have a child
Professional standards and ethical guidelines less than five years of age, or have a foster child under age five. Participants are also eligible if they
Political agendas have are currently receiving Temporary Assistance for Needy Families (TANF), food stamps or
Medicaid. For the year 2016-2017, the family income must be less than $21,978 per year for a one-
Mandates of potential partners and/or competitors
person household, $29,637 for a two-person household, $37,296 for a three-person household, etc.
Since WIC is an agency of the United States Department of Agriculture, it must be in accordance with
the civil rights regulations and policies that prohibit discrimination of any kind. Any individuals who
disagree with either their eligibility or benefits given, they can request a Fair Hearing within 60 days of
the incident. Removal from the WIC program can occur with two missed appointments, misuse of WIC
benefits, or if receiving benefits from both the Commodity Supplement Food Program and WIC at the
same time.
Write a 2-3 page community needs assessment using the data collected See attached.
above, using APA format & provide a reference list
Write 3 PES statements that summarize the priority issue and tie with
the information collected in the community needs assessment. Excessive sodium intake related to food- and nutrition-related knowledge deficit concerning food and
overconsumption of a limited variety of foods as evidenced by estimated intake containing high
amounts of sodium compared to reference intake standard.
Food- and nutrition-related knowledge deficit related to lack of prior nutrition-related education as
evidence by demonstrated inability to apply food- and nutrition-related information by purchasing and
consuming high sodium, processed foods.
Undesirable food choices related to perception that lack of time and finances prevent selection of food
choices consistent with recommendations as evidenced by inability to select or unwillingness or
disinterest in selecting food consistent with the guidelines.

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CommunityNeedsAssessment
AlyssaCollins
UniversityofSouthernMississippi

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ThecurrentleadingcauseofdeathintheUnitedStates,andinMesaCounty,isheartdisease(Healthy
MesaCounty,2012).Heartdisease,alsoknownascardiovasculardisease,referstoconditionsthatcause
narrowingorblockingofarteries,causinglowerbloodandoxygenflowtotheheartandbody.Whenarteries
arenarrowed,thiscausesanincreaseinbloodpressure.Increasedbloodpressure,orhypertension,cancause
ischemiccardiovasculardisease.AccordingtotheCentersforDiseaseControlandPrevention(CDC),in2005
2006around28%ofadultsintheUnitedStateswereprehypertensiveand29%ofadultshadhypertension.
Hypertensioncanbecausedbyanumberoffactors,includingoverweightorobeseweightstatus,stress,
genetics,lackofphysicalactivity,highsaturatedfatintake,andhighsodiumintake(Yang, et al., 2012).
AlloftheseriskfactorsareaffectedbythefactthattheUnitedStatesisafastpacedsociety,withalarge
emphasisonproducingworkinashortamountoftime.Healthandnutritionstatusbecomesalessimportant
issuetomanycitizensduetothedemandsofworkandcostsofdailyliving.Insteadoftakingthetimetocook
nutritiousmeals,familiesareoptingforfaster,moreconvenientalternatives.Additionally,thesefasterfood
optionsappeartobecheaperthanthefreshfruitsandvegetables,whichareknowntobehealthier.Therefore,
time,convenience,andcostplaypivotalrolesinthemealchoicesAmericansmakeeveryday.
Processedfoodsaregenerallyhighinfatandsodiuminordertobepreservedforlongerperiodsoftime.
Asurveyconductedonprocessedfoodindicatedthathighestsodiumlevelsperservingwerefoundinprocessed
meats,breadsandsauces.Thesamestudyalsofoundthat63%ofprocessedfoodsfellabovetherecommended
sodiumintake(Webster,Dunford,&Neal,2009).Sincetheseprocessedfooditemsarelessexpensive,itisno
wonderthatlowincomefamiliespurchasethesefoods.Thesefoodsaregenerallyhighincaloriesbutlowin
necessaryvitaminsandminerals.InastudyconductedonparticipantsoftheSupplementalNutritionAssistance
Program(SNAP),itwasfoundthatmanylowincomefamiliesexceededtherecommendedamountsof

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processedmeats,whicharehighinsodium(Leung,etal.,2012).ManyofthesameSNAPparticipantswould
alsobeeligiblefortheWomen,InfantsandChildren(WIC)programinMesaCounty.
TobeapartoftheWICprogram,itisarequirementinColoradothatafamilybeconsideredlow
income.InMesaCounty,lowincomeisdefinedas$21,978peryearforaonepersonhousehold,$29,637fora
twopersonhousehold,and$37,296forathreepersonhousehold(WICFamilies,2016).Theamountoflow
incomefamiliesinMesaCountyisconsiderablyhigh;around14.7%ofthepopulationlivesbelowthepoverty
level(HealthyMesaCounty,2012).Othereligibilityrequirementsincludehavingafamilymemberthatis
pregnantorbreastfeedingorhavingachildunder5yearsold.Participantscanalsobequalifiediftheyreceive
TemporaryAssistanceforNeedyFamilies(TANF),foodstamps,orMedicaid(WICFamilies,2016).
Astudyconductedonschoolchildrenfoundevidencethataneducationalprogramforchildrenon
loweringsaltconsumptioncanlowerbloodpressureandsaltconsumptionforthechildrenandfortheirparents
(Heetal.,2015).Thisshowsthataneducationalsessiononloweringsaltconsumptiontoreducebloodpressure
andsubsequentlycardiovasculardiseasewouldbebeneficialforboththechildrenandmothers.
In2011,therateofcardiovascularrelateddeathinMesaCountywas159.9per100,000people(Healthy
MesaCounty,2012).Manyoftheriskfactorsforhypertensionandheartdiseasearemodifiable,especially
exercise,weightstatus,anddiet(Schieb,Greer,Ritchey,George,&Casper,2013).InMesaCounty,processed
foodintakeandsubsequentlysodiumintakemustbeaddressedtoimprovehealthstatus.Ashighsodium,
processedfoodconsumptionismodifiable,aneducationalsessiononhealthier,lowsodium,quickmealoptions
wouldbenefitWICfamiliesgreatly.Therefore,inordertoaddresstherateofcardiovascularrelateddeaths,an
educationprogramatthelocalWICofficewouldbebeneficialforthelowincomepopulation.Teachingand
encouragingthesefamiliestodecreasesaltintakebyimplementinghealthier,quickmealitemswillbenefittheir
healthstatusandimprovetheiroverallqualityoflife.

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References
Ayala,C.,Kuklina,E.V.,Peralez,J.,Keenan,N.L.,&Labarthe,D.R.(2009).Applicationoflowersodium
intakerecommendationstoadults.Retrieved
fromhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5811a2.htm
He,F.J.,Wu,Y.,Feng,X.,Ma,J.,Ma,Y.,Wang,H.,Macgregor,G.A.(2015).Schoolbasededucation
programmetoreducesaltintakeinchildrenandtheir
families(SchoolEduSalt):Clusterrandomisedcontrolledtrial.BMJ,350.doi:10.1136/bmj.h770
HealthyMesaCounty20122017.(2012).Retrievedfrom
https://www.colorado.gov/pacific/sites/default/files/OPP_MesaHealthyMesaCounty20122017.pdf
Leung,C.W.,Ding,E.L.,Catalano,P.J.,Villamor,E.,Rimm,E.B.,&Willett,W.C.(2012).Dietaryintake
anddietaryqualityoflowincomeadultsintheSupplementalNutritionAssistanceProgram.American
JournalofClinicalNutrition,96(5),977988.doi:10.3945/ajcn.112.040014
Schieb,L.,Greer,S.,Ritchey,M.,George,M.,&Casper,M.(2013).Vitalsigns:
Avoidabledeathsfromheartdisease,stroke,andhypertensivedisease.Retrievedfrom
The Colorado Department of Public Health and Environment. (2016). WIC families. Retrieved from
https://www.colorado.gov/pacific/cdphe/wic-families
Webster,J.L.,Dunford,E.K.,&Neal,B.C.(2009).Asystematicsurveyofthesodiumcontentsofprocessed
foods.AmericanJournalofClinicalNutrition,91(2),413420.doi:10.3945/ajcn.2009.28688

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Step 2: Define Program Goals & Objectives* (add additional goals/objectives as needed)
Goal 1 Participants will understand how lowering sodium intake positively impacts health status
Objective 1a. There will be a 10% improvement in pre- and post-test scores on sodium, blood pressure and health
implications for 100% of adult participants.
Objective 1b. 100% of child participants will be able to improve by 10% on pre and post-test scores on drawing which
parts of the body are affected by high salt intake
Goal 2 Participants will be able to pick out low sodium options when grocery shopping
Objective 2a. Adult participants will be able to improve label reading skills by 10% between first and second lesson by
correctly identifying how much sodium is in a serving size and the whole package (pre and post-test)
Objective 2b. Child participants will improve by 10% on pre and post-test scores on circling foods that are high in sodium
Goal 3 Participants will learn healthier, quick food options through a recipe demo and handouts
Objective 3c. 100% of adult participants will bring in 2 low-sodium recipes that they found and made between the first
and second session
Objective 3d. 100% of child participants will be able to state 2 of their favorite low salt foods they ate between the first
and second session
Goal 4 Adult participants will create one personal SMART goal on lowering salt intake
Objective 4a. 100% of adult participants will write down personal goal, and will evaluate if they reached that goal at the
second session
Based on the PES statements created in step 1 (specifically the signs and symptoms) and the objectives list all of the data that you will need to collect and how it will be collected
before, during, and/or after the program.
In other words, how will you know if your program was a success?
Data/measure/monitor needed (list ALL data How will it be collected? When will the data be collected?
that you will need to collect as part of your Interviews, pre-/post-test, game, contest, anthropometric data, Before, during, and/or after the intervention
HPE project) demographic data, etc.
Knowledge of what high sodium intake does Pre- and post-test Before and after
to the body
Label reading knowledge, specifically Pre- and post-test Before and after
pertaining to sodium content
Knowledge of which food items are high in Pre- and post-test Before and after
sodium

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Knowledge of which food items are low in Pre- and post-test Before and after
sodium
Ability to cook quick food items that are low Cooking demo, participants bringing in recipes to second session During and after
in salt
Personal SMART goal for lowering salt Keep copy of goal, see if they met goal at second session During and after

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Step 3: Develop a Program Plan (Intervention/Nutrition Education Component)
Intervention Strategy
Conduct a Target Contextual Analysis

How many people might be involved? There is a potential for 10-30 participants.
At what times are the potential participants able to attend The WIC office is open Monday through Friday, 8:00 am through 5:30 pm.
sessions?
What are the ages of the potential participants? Ages of the participants will range from three to 40 years.
What race, gender, ethnicity, and social class are the potential Participants will most likely be white females and their children of a lower socioeconomic class.
participants?
What is the best way to disseminate the information to the Based on the demographic characteristics of the participants, the best way to disseminate information to them
participants (based on type of information and demographic would be cooking demonstrations, easy to read handouts with visual aids, and explaining thoroughly all
characteristics of the participants)? information in an easy to understand method.
Why do the potential participants want to enroll or be Most participants will be enrolled in the program for the WIC benefits. The women will want to be enrolled in
involved in the program? this particular class for health information for themselves and their children.
Are the potential participants motivated to learn this material, For the mothers, their primary motivation will come intrinsically; they will want to learn about this particular
and if so, what are the primary motivators? health topic so that they can provide a healthier life for themselves and for their children.
What are the costs (for example, for fees, loss of job time, Participation in the program would be free of charge however costs such as missed work and for travel might
travel, and childcare) to the potential participants for attending affect some participants.
the program?
Outline the Instructional Plan

Course/Session Title(s)List the titles for the overall HPE Heart-healthy eating: Tips to lower sodium for you and your family is the overall title for the project.
project and the titles for each individual session Session one: How does sodium affect your heart?
Session two: Low-salt recipes for you and your family
Proposed date(s) and timeframe for implementation of the The timeframe of the project will be three weeks. Participants will meet once during the week of Monday, January
intervention 30th through Friday, February 3rd. They will then meet again on the third week of Monday, February 13th through
Friday, February 17th.
Learning Objectives for EACH sessionWhat the participant Session one:
will learn as a result of attending the education or training The participants will acquire new knowledge from learning what sodium does to blood pressure and the heart.
session? These should tie back to the program objectives. They will enhance cognitive skills such as learning how to read a label to determine the amount of sodium that is
Revised August 2012, Reviewed August 2016

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These should be written as, The participants will in a certain food item. This will also strengthen the participants problem-solving skills. The participants will also
change their attitudes and feelings towards sodium by understanding what a significant impact decreasing sodium
can have on overall health. The participants will be given quick low-sodium recipes to implement in their daily
life.
Session two:
Participants will increase the scores on the post-test by 30%. By session two, the last question 6. Do you think
that watching salt in the diet is important? will be answered with 100% of participants circling yes. The
participants will acquire new knowledge of recipes that are low in sodium and easy to make. They will enhance
their cognitive skills through improving their test scores from the first session to the second. They will assist in
the cooking demo to develop their cooking skills and to learn a new recipe.
Proposed activities for EACH session Session one:
Proposed activity one:
Adult participants will take a pre-test that will assess their knowledge on foods high in sodium, the effects of
sodium on the heart, label reading with a general questionnaire on how often they eat foods high in salt. Child
participants will take a pretest where they will draw what foods they like to eat and draw what foods they think
are high in salt.
Proposed activity two:

Participants will sit through an educational presentation on the effect of sodium on blood pressure and the heart.
The presentation will include information on the recommended amount of sodium to eat per day, how to read
labels and how to spice food without salt. The presentation will be for both adults and children. At the end, there
will be time to answer questions.
Proposed activity three:

Both adult and children participants will play an interactive game that will allow them to guess how much sodium
is certain processed food items. The game will consist of pictures of popular food items, as well as pictures of
amounts of salt. They will work in teams to match the food items with the amounts of salt. At the end of the game,
there will be a discussion on the correct answers.
Proposed activity four:

Quick, easy, low-sodium recipes will be given to the participants and encouraged to use the recipes at home. Adult
participants will be encouraged to involve the children in cooking meals.
Proposed activity five:

Participants will create one S.M.A.R.T. goal that they will implement before the following session. One copy of
the S.M.A.R.T. goal will be kept for assessment purposes and one copy will be taken home.
Session two:
Proposed activity one:
Adult participants will write down a 24-hour recall when they enter the room. Children participants will draw
their 24 hour recall. The 24 hour recall will be taken up and used for assessment.
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Proposed activity two:
A cooking demonstration with low-sodium recipe will be given for all participants. They will be able to eat the
recipe for lunch. This will be used as an incentive for returning. The recipe for the cooking demo will be given to
the participants during lunch.

Participants will break off into groups and discuss their S.M.A.R.T. goals with each other. This will facilitate
bonding between the participants and hopefully give the families more ideas for goals that they can accomplish
with lowering salt and processed food intake.

The adult participants will complete a post-test with the same questions as the pre-test. The answers will be
provided at the end of the test, as well as a handout and more recipes to take home. Children will draw the same
information as asked in their pre-test. Time for any questions will be provided at the end.
Assessment plan for EACH session (these should tie back to Session One:
your objectives for each session) Proposed activity one: Formal assessment will take place in the format of a pre-test. Pre-tests will be collected
after they are taken, and not returned to the participants.
For adult participants:
1. How much sodium (salt) is the recommended amount per day?

a. 1 teaspoon (2400 mg sodium)
b. 1 tablespoon (7200 mg sodium)
c. teaspoon (1200 mg sodium)
d. tablespoon (3,600 mg sodium)
2. Does eating lots of salt increase your blood pressure, or decrease your blood pressure?
a. Increase
b. Decrease
3. What foods contain the most amount of salt?
a. Fruits
b. Whole grains
c. Processed meats and sauces
d. Dairy products
e. Vegetables
4. When reading the nutrition label below, how much sodium is in one serving?
a. 325 mg
b. 1300 mg
c. 650 mg
d. 217 mg
5. When reading the nutrition label below, how much sodium is in the whole package?
a. 1300 mg
17
b. 650 mg
c. 1950 mg
d. 217 mg
6. Do you think that watching salt in the diet is important?

a. Yes
b. No
c. I dont know
For child participants:
1. Draw your favorite foods to eat

2. Draw foods that you think have lots of salt in them
Proposed activity two: There will be an informal assessment of knowledge gained by a few questions asked to the
audience following the presentation such as: How much salt should you eat per day?, Why is watching salt
important for the body?, What foods contain lots of salt?, What can you do to decrease salt intake? etc.
There will also be time for participants to answer questions.
Proposed activity three: Assessment will be informal. Answers to the match-up game will be provided and the
18
participants will see what they got right and wrong. There will be no data collected from the game; it is mostly for
the participants to gain knowledge.
~1/3 teaspoon (710 mg sodium) One third of daily intake!

McDonalds Happy Meal Burger, Small Fries,
and Small Sprite
One Oscar Meyer hot dog (without bun) ~1/5 teaspoon (461 mg sodium) One fifth of daily intake!

19
One serving size (1/6 of container) ~2/5 teaspoon (880 mg sodium) Almost half of daily intake!
One cup of Hamburger Helper ~4/5 teaspoon (1905 mg sodium) Over of daily
intake!

20
One cup prepared Rice-A-Roni ~2.4/5 teaspoon (1060 mg sodium) Almost half of daily intake!
Proposed activity four: There will be no assessment; the recipes will be handed out for the participants benefit.
Proposed activity five: One copy of the S.M.A.R.T. goal will be kept for assessment during the second session.
Session 2:
Proposed activity one: A 24-hour recall will be taken for each adult participant and the amount of salt will be
calculated to see how much was consumed in the last 24 hours. The goal is for the amount of salt to be within a 20
percent range of the recommended daily amount of salt.
Proposed activity two: There will be no assessment of the cooking demonstration, it is solely to engage the
audience and provide them with a healthy lunch and a new recipe to take home.
Proposed activity three: The assessment will be informal. As the groups are discussing their goals, informal
conversations will be had about if they met their goal and if they have any further goals.
Proposed activity four: Assessment of the post-tests will be a formal comparison to the pre-test scores. The pre-
test and post-test will consist of the same questions. The objective is for the scores to increase by 30 percent as a
group. After the post-test there will be an informal discussion on the correct answers, as well as answering any
further questions.
Estimated time for each major part of the learning activity or Session One: Proposed Time Schedule
activities to be completed 10 minutes for introduction and pre-test
20 minute presentation on sodium and the heart
15 minute activity on guessing the amount of sodium in certain popular processed food items
10 minutes to create SMART goal
21
5 minutes for questions
Session Two: Proposed Time Schedule

10 minutes for 24-hour recall
30 minutes for cooking demo and eating
10 minutes for discussing SMART goal accomplishments
10 minutes for post-test and questions
Lesson Plan for EACH lesson See attached
Marketing the Program (The 4 Ps)

Product (Comprehensive description of the program) Two educational sessions, one hour for each session, will be given to mothers and children who are members of
the WIC program in Grand Junction, Colorado. One session will focus mainly on the health outcomes of eating
processed foods containing large amounts of sodium. This session will teach the mothers how to read labels, and
how to spice foods without salt. The second session will be aimed at teaching a specific low sodium recipe, as
well as handing out recipes, and will practice to see if information was retained from the first session and if it was
implemented by the participants. Children will be given activities in each section that are related to the lesson,
although tailored towards their age.
Price (The cost charged to the participants) The sessions will be free of charge to the participants.
Place (The location must be consistent with the program The location of the educational sessions will be the WIC office in Grand Junction, Colorado.
design, audience, and budget)
Promotion (Strategies and materials aimed at generating or See below
increasing enrollment)
Marketing/Promotion Plan
Name of Program and Proposed Dates The proposed dates for Heart-healthy eating: Tips to lower sodium for you and your family are Friday, February
3rd and Friday, February 17th.
Target Audience The target audience of the program is young white mothers and their children of a lower socioeconomic class.
List of promotional materials used to advertise (e.g. Flyers in WIC office
Newspaper, posters, personal contacts, websites, flyers, etc.) Personal contacts from WIC dietitian
and sample copies Copy of flyer attached below*
Timeline for dissemination of promotional materials January 30th: Bring in flyers to hang around WIC office, email contacts from dietitian
February 1st: Second email to contacts from dietitian
February 13th: Email to participants about second meeting

22
LESSON PLAN FOR
_____________________Session One_______________________
Name of Intern: Alyssa Collins
Setting: WIC office in Grand Junction, Colorado
Time Allotment: One hour
Estimated Number of Learners: 16
I. Goals and Rationale
# Goal Rationale for Goal

1. Participants will understand how Some participants may not realize that high sodium
lowering sodium intake positively intake has negative health effects. Learning what high
impacts health status. sodium can do to the body might motivate some
participants to lower consumption of salt.
2. Participants will learn which food When participants learn that some food items that they
items are higher in sodium. are consuming are high in sodium, they may decide to
make healthier food options.
3. Participants will be able to pick out In order to make healthier food items for their families,
low sodium options when grocery participants will need to understand which food items
shopping. are lower in salt, and be able to pick these items out in a
grocery store. This will involve learning how to read a
nutrition label.
4. Participants will create one This allows for participants to create a goal that will be
S.M.A.R.T. goal to implement personalized. The rationale is that the goal will be
before the following session. specific to the participant, and therefore will be easier
to accomplish for them. The goal will also hold them
accountable for the following session and will be
something for them to take home and remember.
II. Objectives
# Objective
1. 100% of participants will be able to list 3 food items, or food groups, that are high in sodium by the
end of the first session. This will be assessed informally.
2. 100% of participants will be able to correctly state how salt affects blood pressure, and which organ
in the body this affects by the end of the first session. This will be assessed informally.
3. 100% of participants will be able to correctly read a nutrition label to determine the amount of salt
per serving and per container after the first session.
III. Teaching/Learning Procedures
Motivation/Introduction Introduce self and explain what the session will be about. Start by asking
the participants what high salt consumption does to the body, if they think

23
they eat excess salt, and if they think it is important to watch salt intake.
Explain to the participants that most Americans are consuming too much
salt, and why it is important to decrease this amount. Explain that meals
can be easy to make and low in salt, and processed food is not the only
option for fast meals.
Teaching/Learning Activities There will be a PowerPoint presentation on salt, blood pressure and the
heart. This presentation will also include how to read a nutrition label, and
tips for using other spices in place of salt. Participants will take a pre-test
to assess the starting point of knowledge. They will play a matching game
to become aware of the amount of salt in certain processed foods. They
will then create a goal to implement before the next session. Handouts on
low-sodium recipes will be provided to take home.
Closure Closure will include reminding participants about coming to the next
session for the cooking demonstration and free lunch. They will take
home a copy of the S.M.A.R.T. goal and recipes. Answering further
questions will be the final closure, followed by thanking the participants
for coming.
Informal Assessment Informal assessment will take place by asking participants what food
items are lower in salt, and on label reading during the presentation.
Participants will be given the correct answers to the matching game. They
will talk briefly about the S.M.A.R.T. goals they plan on implementing
before the following session.
Formal Assessment The pre-test will be the formal assessment of baseline knowledge.
IV. Materials/Media (attach a sample)
PowerPoint Presentation Computer

Recipe Handouts Projector
Matching game materials Pens/pencils
Pre-test papers Tables/chairs
Assessment of Participants Learning
Activity One: Pre-test

1. How much sodium (salt) is the recommended amount per day?
e. 1 teaspoon (2400 mg sodium)
f. 1 tablespoon (7200 mg sodium)
g. teaspoon (1200 mg sodium)
h. tablespoon (3,600 mg sodium)
2. Does eating lots of salt increase your blood pressure, or decrease your blood pressure?
c. Increase
d. Decrease
3. What foods contain the most amount of salt?
f. Fruits
g. Whole grains

24
h. Processed meats and sauces
i. Dairy products
j. Vegetables
4. When reading the nutrition label below, how much sodium is in one serving?
e. 325 mg
f. 1300 mg
g. 650 mg
h. 217 mg
5. When reading the nutrition label below, how much sodium is in the whole package?
e. 1300 mg
f. 650 mg
g. 1950 mg
h. 217 mg
6. Do you think that watching salt in the diet is important?

d. Yes
e. No
f. I dont know
For child participants:

1. Draw your favorite foods to eat
2. Draw foods that you think have lots of salt in them
Activity Two: Matching game

25
~1/3 teaspoon (710 mg sodium) One third of daily intake!

McDonalds Happy Meal Burger, Small Fries,
and Small Sprite
One Oscar Meyer hot dog (without bun)~1/5 teaspoon (461 mg sodium) One fifth of daily intake!
One serving size (1/6 of container) ~2/5 teaspoon (880 mg sodium) Almost half of daily intake!

26
One cup of Hamburger Helper ~4/5 teaspoon (1905 mg sodium) Over of daily intake!
One cup prepared Rice-A-Roni ~2.4/5 teaspoon (1060 mg sodium) Almost half of daily intake!

27
LESSON PLAN FOR

__________________Session Two_____________________
Name of Intern: Alyssa Collins
Setting: WIC office in Grand Junction, Colorado
Time Allotment: One hour
Estimated Number of Learners: 16
V. Goals and Rationale
# Goal Rationale for Goal

1. Participants will learn healthier, quick The cooking demonstration will help participants learn how
food options through a recipe demo to create a healthy and quick meal option for their families.
and handouts. The recipe handouts will be for them to take home. This
will hopefully help participants to feel more comfortable
and confident with making the lower sodium meals.
2. Participants will improve scores on the The overall goal of the education is to help these families
post-test. lower sodium intake to improve heart health. Improving the
test scores will show that the participants learned something
and will hopefully be able to implement changes to their
diet with the new knowledge.
3. Participants will have met their Hopefully the goals that the participants created will be
S.M.A.R.T. goal. met. This will allow for them to create new goals to
implement and create a healthier lifestyle. It will build
confidence and will make the diet seem more achievable.
4. Participants will be able to implement This is the main goal for the educational sessions. In
a lower sodium diet into their general, this population eats lots of high salt, processed
everyday life. foods. This program will help them learn why lowering salt
consumption is important, and how they can do that easily.
VI. Objectives
# Objective
1. There will be a 10% improvement in pre- and post-test scores for 100% of participants.
2. 100% of the participants sodium intake will be at or below 2,400 mg as assessed by the 24-hour
recall.
VII. Teaching/Learning Procedures
Motivation/Introduction The second session will start with thanking the participants for returning,
and explaining that the session will be about how to cook a quick, low-
salt recipe for the family. This will be a more relaxed session for the

28
participants to ask any questions and to enjoy eating a healthy lunch.
Teaching/Learning Activities The session will start with a 24-hour recall. There will be no discussion
about the recall. The information will be analyzed to determine the
amount of sodium in each participants diet following the first session.
The following activity will be a cooking demonstration that will show the
participants how to make a quick, low-sodium meal for their family. They
will then be able to enjoy the meal. During the meal participants will
discuss if they met their S.M.A.R.T. goals in small groups. A post-test will
follow the meal to determine if the participants retained knowledge from
the first session.
Closure Closure will contain summarizing the main points of why lowering
sodium is important, asking for any further questions, and thanking the
participants for their time.
Informal Assessment Informal assessment will take place in asking participants random
questions throughout the cooking demonstration. They will also discuss in
small groups if they met their S.M.A.R.T. goal and why or why not.
Formal Assessment Formal assessment will take place in the form of the post-test.
VIII. Materials/Media (attach a sample)
Recipe handouts Pots/pans/necessary cooking 24-hour recall paper

equipment
Post-test material Oven/stove Tables/chairs
Pens/pencils Spices
Food for cooking demonstration Plates/bowls/cutlery
Assessment of Participants Learning (attach sample)
Pre-test (see lesson plan for session one)

29
24-hour recall:
Start with your last food item you ate before bed and then move down through the day. Include all snacks, meals
and drinks. Please try to guess the portion sizes as best as you can. Be honest!
Before bed snack:
Dinner:
Afternoon snack:
Lunch:
Mid-morning snack:
Breakfast:

30
*Flyer:

31
References:
Calories in Cheeseburger Macaroni. (n.d.). Retrieved from
https://www.caloriecount.com/calories-hamburger-helper-cheeseburger-macaroni-i84650
Warner, M. (2006). Mcdonald's Value Menu. Retrieved from
http://eatdrinkpolitics.com/CSPI/Happy_Meals_Nutrition_List%20061510.pdf
What is the Difference Between a Hot Dog, Weiner, Frank, and Sausage? (n.d.). Retrieved from
http://www.wisegeek.org/what-is-the-difference-between-a-hot-dog-weiner-frank-and-sausage.htm
4 Tips For Reading Food Labels That Will Change the Way You Shop. (2016). Retrieved from
http://www.forksoverknives.com/reading-food-packages-and-nutrition-labels-four-tips-
for-savvy-shopping/

32
Steps 4/5: Management System

33
Budget The University of Southern Mississippi
Dietetic Internship
Sample Budget for Health Promotion and Education Program
Expenses
Salaries and wages (list specific positions below)
Manager Mesa County WIC ($18/hour) $36.00
Dietitian Mesa County WIC ($27/hour) $52.00
Staff (5 people $9.30/hour) $93.00
Travel
Air fare $0.00
Mileage (total miles for each
participant X $.55) $752.00
Hotels $0.00
Meals $0.00
Other ground transportation $0.00
Equipment and supplies (list items below)
Pens (pack of 60) $3.89
Pot (cooking demo) $50.00
Spoon (cooking demo) $15.00
Food items (cooking demo) $35.00
Bowls (cooking demo) $2.72
Spoons (cooking demo) $2.84
Napkins (cooking demo) $3.03
Education Materials (list items below)
Pre and post tests (50 copies) $3.00
Recipe handouts (50 copies) $3.00
Matching activity (25 copies) $1.50
PowerPoint presentation $0.00
Projector $100.00
Office Space Rental $200.00

Utilities $2.50
Other indirect costs

34
Total Expense $1,174.48
Budget
justificationfor Pens are required for each participant to fill out the pre and post-tests. They may also use the pens to take notes during the presentation if they desire.
each item in the
budget, complete a The pot, spoon and food items are required to cook the low sodium meat and vegetable soup. This soup will be used as an incentive for participants to come
narrative to the second session, and will be made as a cooking demonstration for the participants. Bowls, spoons and napkins will be necessary for the participants to
explaining the eat the soup.
rationale for the
item(s) Printer paper will be needed for the pre and post-tests, the recipe handouts and the matching activity. These activities will be used as learning devices for the
participants, as well as a way to measure their gained knowledge.
The projector will be necessary to display the PowerPoint presentation. This presentation will give the audience a reason for limiting salt intake and will help
them understand why it is necessary to make the dietary changes for their health.
Potential funding
sourceswrite a
summary of the The goals of the health promotion education sessions are for the participants to understand how lowering sodium intake positively impacts health status, to
type of funding be able to pick out low sodium options when grocery shopping, to learn healthier, quick food options through a recipe demo and handouts, and to create one
that is required to personal SMART goal on lowering salt intake. The objectives include 10% improvements on the post-tests for both the child and adult participants, a 10%
achieve the goals improvement on label reading for adult participants and a10% improvement on identifying high sodium foods for child participants. Other objectives
and objectives of include 90% of adult participants bringing in two low sodium recipes that they made between the first and second sessions, and discussing whether or not
your project they achieved their SMART goal.
Due to the goals and objectives of this program for the members of WIC potential funding sources could come from a state or federal level. On a federal
level, the funding could come from the United States Department of Agriculture Food and Nutrition Services. The USDA FNS offer grants for nutrition
education sessions for children and adults who are at risk for malnourishment. The grant below is from Health Resources and Services Administration.
Grant application/
description GENERAL INFORMATION
DocumentType: GrantsNotice
FundingOpportunityNumber: HRSA17060
FundingOpportunityTitle: MaternalandChildHealthResearchNetworkProgramChildrenwithSpecialHealthCareNeedsResearch
Network(CSHCNRN)
OpportunityCategory: Discretionary
OpportunityCategoryExplanation:
FundingInstrumentType: CooperativeAgreement

35
CategoryofFundingActivity: Health
CategoryExplanation: https://grants.hrsa.gov/2010/Web2External/Interface/FundingCycle/ExternalView.aspx?
fCycleID=a42ae77054c641c18e8cc2721a84dd5d
ExpectedNumberofAwards: 1
CFDANumber(s): 93.110MaternalandChildHealthFederalConsolidatedPrograms
CostSharingorMatchingRequirement: No
Version: Synopsis1
PostedDate: Jan13,2017
LastUpdatedDate: Jan13,2017
OriginalClosingDateforApplications: Mar16,2017
CurrentClosingDateforApplications: Mar16,2017
ArchiveDate: May15,2017
EstimatedTotalProgramFunding: $1,000,000
AwardCeiling: $0
AwardFloor: $0
ELIGIBILITY
EligibleApplicants: Others(seetextfieldentitled"AdditionalInformationonEligibility"forclarification)
AdditionalInformationonEligibility: Eligibleapplicantsincludeonlypublicornonprofitinstitutionsofhigherlearningandpublicorprivate
nonprofitagenciesengagedinresearchorinprogramsrelatingtomaternalandchildhealthand/orservicesfor
childrenwithspecialhealthcareneeds.ForeignentitiesarenoteligibleforHRSAawards,unlessthe
authorizinglegislationspecificallyauthorizesawardstoforeignentitiesortheawardisforresearch.This
exceptiondoesnotextendtoresearchtrainingawardsorconstructionofresearchfacilities.
ADDITIONAL INFORMATION
AgencyName: HealthResourcesandServicesAdministration
Description: ThisannouncementsolicitsapplicationsfortheChildrenwithSpecialHealthCareNeedsResearchNetwork
(CSHCNRN)Program.Thiscooperativeagreementopportunitywillestablishandmaintainan
interdisciplinary,multisite,collaborativeResearchNetwork(hereafterreferredtoas"theNetwork").The
Networkwilllead,promote,andcoordinatenationalresearchactivitiestoadvanceandstrengthentheevidence
baserelatedtokeycomponentsofacomprehensive,highqualitysystemofcareforchildrenwithspecialhealth
careneeds(CSHCN).TheNetworkwillextendandrefineevidenceutilizedtoestablishthenationalStandards
forSystemsofCareforChildrenandYouthwithSpecialHealthCareNeed2
(http://www.amchp.org/AboutTitleV/Resources/Documents/Standards%20Charts%20FINAL.pdf).The
36
networkinfrastructurewillsupportthedesignofaportfolioofmultisite,interdisciplinaryresearchthatfocuses
onfosteringtheimplementationofmultisiteresearchstudies,translationofresearchtopolicyandpractice,
andprovisionofmentoringenvironmenttotrainanewgenerationofclinicalandnonclinicalpediatric
researchers.
LinktoAdditionalInformation:
GrantorContactInformation: Ifyouhavedifficultyaccessingthefullannouncementelectronically,pleasecontact:
DepartmentofHealthandHumanServices,HealthResourcesandServicesAdministration
RAzuine@hrsa.gov
ContactRomuladusE.Azuine,DrPH,MPH,RNat(301)4432410oremailRAzuine@hrsa.gov

37
Step 6: Implement the Intervention
Content Area Proposed Intervention (Copy from Step 3) Actual Intervention

Course/Session Title(s)List the titles for the Heart-healthy eating: Tips to lower sodium for you and Heart-healthy eating: Tips to lower sodium for you and your
overall HPE project and the titles for each individual your family is the overall title for the project. family is the overall title for the project.
session Session one: How does sodium affect your heart? Session one: How does sodium affect your body?
Session two: Low-salt recipes for you and your family Session two:
Proposed date(s) and timeframe for implementation The timeframe of the project will be three weeks. The first session occurred on March 2nd from 1:30-2:30 pm
of the intervention Participants will meet once during the week of Monday, and the second session took place on March 9th from 1:30-
January 30th through Friday, February 3rd. They will then 2:30 pm.
meet again on the third week of Monday, February 13th
through Friday, February 17th.
Proposed activities for EACH session Session one: Session one:
Proposed activity one: Activity one: All participants took a pre-test to assess their
Adult participants will take a pre-test that will assess their knowledge on foods high in sodium, the effects of sodium on
knowledge on foods high in sodium, the effects of sodium the heart and label reading. A lot of the participants needed
on the heart, label reading with a general questionnaire on assistance with reading the questions. Each participant was
how often they eat foods high in salt. Child participants encouraged to do their best and not worry about getting
will take a pretest where they will draw what foods they questions incorrect.
like to eat and draw what foods they think are high in salt.
Activity two: Participants sat through an educational
Proposed activity two: presentation on the effect of sodium on blood pressure and
Participants will sit through an educational presentation on the body. The presentation included information on the
the effect of sodium on blood pressure and the heart. recommended amount of sodium to eat per day, which foods
The presentation will include information on the are high in sodium, what increased sodium consumption does
recommended amount of sodium to eat per day, how to to the body, how to read labels and how to spice food without
read labels and how to spice food without salt. The salt. At the end of the presentation there was a small question
presentation will be for both adults and children. At the and answer session. Many participants were more interested
end, there will be time to answer questions. in foods high in sodium, so the bulk of questions pertained to
food items. Handouts on lowering sodium consumption were
Proposed activity three: given at the end of the presentation. See Appendix A for
Both adult and children participants will play an sodium handout.
interactive game that will allow them to guess how much
sodium is certain processed food items. The game will Activity one and two ended up taking over an hour to
38
consist of pictures of popular food items, as well as complete, and therefore no other activities occurred. Recipes
pictures of amounts of salt. They will work in teams to were printed for the participants; however upon visiting the
match the food items with the amounts of salt. At the end assisted living facility, I learned that none of the residents
of the game, there will be a discussion on the correct cooked their own meals, and so they were not given to the
answers. participants.
Proposed activity four: Session two:

Quick, easy, low-sodium recipes will be given to the Activity one: A quick recap of the previous session occurred.
participants and encouraged to use the recipes at home. This recap included information on why it is important to
Adult participants will be encouraged to involve the lower sodium, what foods are low in sodium, and the
children in cooking meals. recommended amount of sodium per day. Most participants
remembered none of the information from the previous
Proposed activity five: session.
Participants will create one S.M.A.R.T. goal that they will
implement before the following session. One copy of the Activity two: To use the information provided from session
S.M.A.R.T. goal will be kept for assessment purposes and one and the recap a game of Sodium Bingo was created for
one copy will be taken home. the residents. The game was played by the presenter reading
questions and the participants would then cross the answers
Session two: off their bingo board. When a participant got five in a row,
Proposed activity one: he or she won. See Appendix B for Sodium Bingo.
Adult participants will write down a 24-hour recall when
they enter the room. Children participants will draw their Activity three: The participants took the post-test, which
24 hour recall. The 24 hour recall will be taken up and included the same questions from the pre-test. The scores
used for assessment. were calculated and returned to the participants. The
questions that were wrong were marked down for analysis on
Proposed activity two: improvement. After the post-test there was a final question
A cooking demonstration with low-sodium recipe will be and answer session.
given for all participants. They will be able to eat the
recipe for lunch. This will be used as an incentive for
returning. The recipe for the cooking demo will be given
to the participants during lunch.

Participants will break off into groups and discuss their
S.M.A.R.T. goals with each other. This will facilitate
bonding between the participants and hopefully give the
families more ideas for goals that they can accomplish
with lowering salt and processed food intake.

The adult participants will complete a post-test with the
same questions as the pre-test. The answers will be
39
provided at the end of the test, as well as a handout and
more recipes to take home. Children will draw the same
information as asked in their pre-test. Time for any
questions will be provided at the end.
Assessment plan for EACH session Session One: Session one:
Proposed activity one: Formal assessment will take place Activity One: Formal assessment will take place in the format
in the format of a pre-test. Pre-tests will be collected after of a pre-test. Pre-tests will be collected after they are taken,
they are taken, and not returned to the participants. and not returned to the participants.

1. How much sodium (salt) is the recommended amount per
1 How much sodium (salt) is the recommended day?
amount per day? e 1 teaspoon (2400 mg sodium)
a 1 teaspoon (2400 mg sodium) f 1 tablespoon (7200 mg sodium)
b 1 tablespoon (7200 mg sodium) g teaspoon (1200 mg sodium)
c teaspoon (1200 mg sodium) h tablespoon (3,600 mg sodium)
d tablespoon (3,600 mg sodium) 2. Does eating lots of salt increase your blood pressure, or
2 Does eating lots of salt increase your blood decrease your blood pressure?
pressure, or decrease your blood pressure? c Increase
a Increase d Decrease
b Decrease 3. What foods contain the most amount of salt?
3 What foods contain the most amount of salt? f Fruits
a Fruits g Whole grains
b Whole grains h Processed meats and sauces
c Processed meats and sauces i Dairy products
d Dairy products j Vegetables
e Vegetables 4. When reading the nutrition label below, how much sodium
4 When reading the nutrition label below, how is in one serving?
much sodium is in one serving? e 325 mg
a 325 mg f 1300 mg
b 1300 mg g 650 mg
c 650 mg h 217 mg
d 217 mg 5. When reading the nutrition label below, how much sodium
5 When reading the nutrition label below, how is in the whole package?
much sodium is in the whole package? e 1300 mg
a 1300 mg f 650 mg
b 650 mg g 1950 mg
c 1950 mg h 217 mg
d 217 mg

40
6 Do you think that watching salt in the diet is 6 Do you think that watching salt in the diet is
important? important?
a Yes d Yes
b No e No
c I dont know f I dont know
For child participants: Activity two: There was an informal assessment of

knowledge gained by a few questions asked to the audience
1 Draw your favorite foods to eat following the presentation such as: How much salt should
2 Draw foods that you think have lots of salt in you eat per day?, Why is watching salt important for the
them body?, What foods contain lots of salt?, What can you
do to decrease salt intake? etc. A lot of the discussion
Proposed activity two: There will be an informal revolved around what the residents could do in their living
assessment of knowledge gained by a few questions asked situation to watch the amount of salt they eat. We discussed
to the audience following the presentation such as: How watching portion sizes and trying to choose the healthier
much salt should you eat per day?, Why is watching salt options.
important for the body?, What foods contain lots of
salt?, What can you do to decrease salt intake? etc. Session two:
There will also be time for participants to answer Activity one: The recap of information included informal
41
questions. assessment of knowledge. This included the same questions
from the previous session such as: How much salt should
Proposed activity three: Assessment will be informal. you eat per day?, Why is watching salt important for the
Answers to the match-up game will be provided and the body?, What foods contain lots of salt?, What can you
participants will see what they got right and wrong. There do to decrease salt intake? etc.
will be no data collected from the game; it is mostly for
the participants to gain knowledge. Activity two: The sodium bingo game was used as a tool to
Proposed activity four: There will be no assessment; the see how much information the participants could remember
recipes will be handed out for the participants benefit. from the recap and the previous session. The participants all
ended up helping each other out, or yelling out the answers
Proposed activity five: One copy of the S.M.A.R.T. goal to the questions, so the success of the game was skewed by
will be kept for assessment during the second session. them working together. However, it was good to see which
participants did remember the answers and which were
Session 2: struggling to remember the answers.
Proposed activity one: A 24-hour recall will be taken for
each adult participant and the amount of salt will be Activity three: The participants took the post-test, which
calculated to see how much was consumed in the last 24 included the same questions from the pre-test. The scores
hours. The goal is for the amount of salt to be within a 20 were calculated and returned to the participants. The
percent range of the recommended daily amount of salt. questions that were wrong were marked down for analysis on
improvement from the first session to the second session.
Proposed activity two: There will be no assessment of the The answers were then gone over again for the participants
cooking demonstration, it is solely to engage the audience to see which they got wrong and why.
and provide them with a healthy lunch and a new recipe to
take home.
Proposed activity three: The assessment will be informal.

As the groups are discussing their goals, informal
conversations will be had about if they met their goal and
if they have any further goals.
Proposed activity four: Assessment of the post-tests will

be a formal comparison to the pre-test scores. The pre-test
and post-test will consist of the same questions. The
objective is for the scores to increase by 30 percent as a
group. After the post-test there will be an informal
discussion on the correct answers, as well as answering
any further questions.
INSERVICE EVALUATION FORMS MUST BE COMPLETED FOR EACH INTERN BY THOSE ATTENDING YOUR INTERVENTION
SESSIONS.
42
Appendix A. Sodium Handout
Lowering Sodium in the Diet
What is Sodium?
Sodium is another word for salt. Sodium is an important mineral that helps your body function properly.
However, too much sodium in the diet can lead to health problems.
How much salt should I eat?

Most Americans consume around 3400 milligrams of salt per day. The recommended amount of salt per day is
2400 milligrams. This is about one teaspoon of salt per day. When reading a nutrition label, aim for foods that
have 140 mg of sodium or less per serving.
What can too much salt do to the body?

High sodium intake can lead to an increase
risk for developing high blood pressure, heart
disease, heart failure, stroke, osteoporosis,
stomach cancer, kidney stones, and kidney
disease.
How do I know how much sodium I am

eating?
Read the nutrition facts label!
This is an example of a label from one box of

Kraft Macaroni and Cheese.
At the top of the nutrition label you can see

that one serving is 2.5 oz (a little more than
cup).
You can also see that there are about 3

servings per container.
There are 570 milligrams (mg) of sodium in

one serving.
In the entire box (3 servings) there are 1,710

mg of sodium. (570 mg x 3 servings = 1710
mg) This is about half the recommended
amount for an entire day!
Here are some other common labels on food:

43
Label What It Means
Salt/Sodium-Free Less than 5 mg of sodium per serving

Very Low Sodium 35 mg of sodium or less per serving
Low Sodium 140 mg of sodium or less per serving
Reduced Sodium At least 25% less sodium than the regular product
Light in Sodium or At least 50% less sodium than the regular product
Lightly Salted
No-Salt-Added or No salt is added during processing but these products may not
Unsalted be salt/sodium-free unless stated
How can I lower the amount of salt I eat?
1 Prepare your own food when you can

Limit packaged sauces, mixes, and instant products (including flavored rice, instant noodles, and
ready-made pasta).
2 Add flavor without adding sodium
Limit the amount of salt you add to foods when cooking, baking, or at the table. Try no-salt seasoning
blends and herbs and spices instead of salt to add flavor to your food.
3 Buy fresh
Choose fresh meat, poultry, and seafood, rather than processed varieties. Also, check the package on
fresh meat and poultry to see if salt water or saline has been added.
4 Watch your veggies
Buy fresh, frozen (no sauce or seasoning), or low sodium or no-salt-added canned vegetables.
5 Give sodium the rinse
Rinse sodium-containing canned foods, such as beans, tuna, and vegetables before eating. This removes
some of the sodium.
6 Unsalt your snacks
Choose low sodium or no-salt-added nuts, seeds, and snack products (such as chips and pretzels) or
have carrot or celery sticks instead.
7 Consider your condiments
Sodium in condiments can add up. Choose light or reduced sodium condiments, add oil and vinegar to
salads rather than bottled dressings, and use only a small amount of seasoning from flavoring packets
instead of the entire packet.
8 Reduce your portion size
Less food means less sodium. Prepare smaller portions at home and consume less when eating out
choose smaller sizes, split an entre with a friend, or take home part of your meal.
9 Make lower-sodium choices at restaurants
Before going to a restaurant, look up the nutrition information online and look for lower sodium options.
Ask for your meal to be prepared without salt and request that sauces and salad dressings be served on
the side, then use less of them. If a restaurant item or meal includes a claim about its nutrient content,
such as low sodium or low fat, then nutrition information to support that claim is required to be
available at the point of purchase.

44
Appendix B. Sodium Bingo Game
Sodium Bingo
1 Another word for salt (Sodium)
2 Food high in salt that you put on sandwiches (deli meat)
3 The food served at this type of restaurant is high in salt (fast food)
4 The recommended amount of salt per day (1 teaspoon)
5 The amount of sodium recommended per serving (140 mg)
6 What does eating a lot of salt do to your blood pressure? (increase)
7 What condition can high salt consumption lead to? Hint: deals with bones (osteoporosis)
8 What types of foods are naturally low in sodium? (fruits and vegetables)
9 This type of food is high in sodium and you usually put it on a bun (hotdog)
10 When you start to lower the amount of salt in your diet, what does this do to blood pressure? (decrease)
11 Is it healthy to completely remove salt from the diet? (no)
12 When you have a high blood pressure this increases your chance for what? Hint: has to do with an organ
that most people associate with love (heart disease)
13 What is the serving size on the nutrition label? (2/3 cup)
14 How much sodium is in one serving? (160 mg)
15 How many servings per container? (8)
16 If you had two servings, how much salt would you be eating? (320 mg)
17 Is watching the amount of salt you eat important? (yes)
18 This type of food is high in sodium and is usually eaten by the slice (pizza)

45

46
Increase
teaspoon blood Deli meat 160 mg 1 tablespoon
pressure
Heart Fruits and 1 teaspoon 320 mg 10,000 mg

Disease Vegetables
Decrease
140 mg Osteoporosis Sodium 2/3 cup blood
pressure
Yes Hotdog Fast Food 24 servings No

Restaurant
3 Pizza cup 8 servings 1 cup

tablespoons

47
Step 7: Evaluate the Intervention
What were your original goals and objectives for your education session? (list below)
Goal 1 Participants will understand how lowering sodium intake positively impacts health status
Objective 1a. There will be a 10% improvement in pre- and post-test scores on sodium, blood pressure and health
implications for adult participants
Objective 1b. Children participants will be able to improve by 10% on pre and post-test scores on drawing which parts of
the body are affected by high salt intake
Goal 2 Participants will be able to pick out low sodium options when grocery shopping
Objective 2a. Adult participants will be able to improve label reading skills by 10% between first and second lesson by
correctly identifying how much sodium is in a serving size and the whole package (pre and post-test)
Objective 2b. Children participants will improve by 10% on pre and post-test scores on circling foods that are high in
sodium
Goal 3 Participants will learn healthier, quick food options through a recipe demo and handouts
Objective 3a. Adult participants will bring in 2 low-sodium recipes that they found and made between the first and second
session
Objective 3b. Children participants will be able to state 2 of their favorite low salt foods they ate between the first and
second session
Goal 4 Adult participants will create one personal SMART goal on lowering salt intake
Objective 4a. Adult participants will write down personal goal, and will evaluate if they reached that goal at the second
session
Briefly describe how you used these to develop your intervention evaluation.
Although my original goals did not match with my final intervention, the overarching goals of learning the importance of lowering sodium
intake and how to do so were still used to implement the intervention evaluation. The evaluation conducted was in the form of a pre- and post-test.

48
The questions in the test were created with the goals in mind. The participants took the pre-test before the initial session and then took the post-test at
the very end of the second session.
Actual data collection:

What data did you actually monitor How was the data collected? What were the Results (please attach copies of the actual data that were collected)?
as part of the intervention? You MUST provide copies of the actual data Descriptive data (i.e. means, standard deviations, percentages, etc.)
collection instruments/evaluation forms.
The participants knowledge of the Pre and post-test See attached
recommended amount of sodium per
day.
The participants knowledge of the Pre and post-test See attached
effect of high sodium intake on blood
pressure.
The participants knowledge of foods Pre and post-test See attached
high in sodium.
The participants knowledge of how Pre and post-test See attached
to read a nutrition label.
The participants thoughts on if Pre and post-test See attached
watching salt in the diet is important.
Raw Data:
There were a total of 11 participants who came to the session and took the quiz both times. The chart below is the data collection results.
Question Number of participants who missed the Number of participants who missed the
question on the pre-test question on the post-test
1 6 4
2 5 1
3 1 3
4 5 4
5 8 4

49
Missed Questions
9
8
7
6
Pre-test
5
Post-test
Number of Participants 4
3
2
1
0
1 2 3 4 5
Question
Percentages of missed questionsfor total number of participants (questions 1-5)

Pre-test Post-test Improvement
55% 36% 19%
45% 9% 36%
9% 27% None
45% 36% 9%
73% 36% 37%
Below is the chart used to collect information on question 6, as it was an opinion question.
Question 6 Pre-test Post-test
Yes 6 10
No 2 0
I dont know 3 1

50
Conclusions, Recommendations, and Strategies to Improve the Program:
Originally this program was designed to be implemented at the WIC office in Grand Junction, Colorado.
Unfortunately, the educational sessions were unable to be completed at this location, and therefore the sessions
were adjusted to be implemented at Grand Villa Assisted Living Facility in Grand Junction. The original PES
statements for the participants were: Excessive sodium intake related to food- and nutrition-related knowledge
deficit concerning food and overconsumption of a limited variety of foods as evidenced by estimated intake
containing high amounts of sodium compared to reference intake standard; Food- and nutrition-related
knowledge deficit related to lack of prior nutrition-related education as evidence by demonstrated inability to
apply food- and nutrition-related information by purchasing and consuming high sodium, processed foods;
Undesirable food choices related to perception that lack of time and finances prevent selection of food choices
consistent with recommendations as evidenced by inability to select or unwillingness or disinterest in selecting
food consistent with the guidelines. Of these nutrition diagnoses, the most relevant diagnosis to the participants
living in Grand Villa would be food and nutrition-related knowledge deficit. This nutrition diagnosis was used
to design the project goals and objectives.
The results and improvements seen between the pre and post-test are impressive when associated with
the session participants. The participants live in an assisted living facility; many had dementia, hearing loss,
vision loss, and other medical conditions that may have prohibited their memory and learning. Any
improvement on the tests is positive for the participants, no matter how small or large the percent improvement,
which was iterated to the participants. From the data collected above, there was improvement seen for the whole
group of participants on majority of the questions. However this was not true for question three, where there
was actually an increase in the number of participants who answered the question incorrectly. This may have
been due to the fact that the participants had just finished playing the sodium bingo game and were flustered by
the amount of knowledge they needed to maintain. There was an improvement on the amount of participants
who now believe watching sodium in the diet is important. On the post-test only one person chose I dont know,

51
however this person was severely demented. Overall, the results are positive for the group as a whole. When
observing the results, the improvements show that the goals and objectives as well as the PES statement of food
and nutrition knowledge deficit were addressed and implemented during the sessions.
The most successful part of the sessions were discussing which foods are high in sodium and how the
participants could lower the amount of sodium they eat. The discussion allowed for the participants to think
about their situation and how they personally could adapt their habits. They were able to list many foods that
were high in sodium, and were able to discuss lowering portion sizes and not using a salt shaker at the table.
The participants seemed to enjoy discussing these topics as it related directly to their living situation.
There are many changes that could be made to improve this program. Firstly, knowing that the
participants do not cook their own meals in the assisted living facility would have changed the direction of the
program significantly. Many of the topics presented in the sessions did not apply to the participants as they do
not grocery shop or prepare meals. Had the demographics and mental status of the participants been better
known before implementing the program, the sessions could have been better tailored to suit their needs. The
participants could have benefited more from a session on physical activity, or easier topics such as increasing
fruit, vegetable or calcium consumption.
The participants enjoyed the sodium bingo game, yet some were confused by the rules. Additionally,
some participants were able to take the quizzes on their own, while others needed help with thinking through
the questions. Therefore the results may be skewed when a participant asked for help with the quiz. The topic of
reading a food label was also incredibly difficult for some of the participants to grasp. Even finding the serving
size on the nutrition label was difficult for a few participants. The size and content of the quiz was good; it did
not take too long to complete and the questions are not too difficult following the discussion topics. However, it
would have been interesting to collect data on each individual participant to see how each person improved
between the tests. Additionally, more data should have been collected on the percentages achieved on both the
pre and post-test for each individual in order to see the overall improvement on total quiz scores.

52
The program itself may have been more successful with older participants who had more improved
cognitive function. If this exact program were to be implemented again, it would need to be somewhere where
the adults were able to purchase foods and cook on their own so the program would be more relevant to the
participants. If this were possible, these sessions would be more beneficial to the participants.

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1

Running head: HEALTH PROMOTION PROJECT

Health Promotion Project: Lowering Sodium Intake

University of Southern Mississippi

Revised August 2012; Reviewed August 2016

Name: Alyssa Collins

Step 1: Community Needs Assessment

Gather the perspective of the key stake holders:

Examine the Literature

Revised August 2012; Reviewed August 2016

Revised August 2012; Reviewed August 2016

Revised August 2012; Reviewed August 2016

Reference: Healthy Mesa County 2012-2017. (2012). Retrieved from

Reference: Healthy Mesa County 2012-2017. (2012). Retrieved from

Review Existing Mandates

Revised August 2012; Reviewed August 2016

Revised August 2012; Reviewed August 2016

Revised August 2012; Reviewed August 2016

genetics,lackofphysicalactivity,highsaturatedfatintake,andhighsodiumintake(Yang, et al., 2012).

Revised August 2012; Reviewed August 2016

Revised August 2012; Reviewed August 2016

Revised August 2012; Reviewed August 2016

Name: Alyssa Collins

Revised August 2012; Reviewed August 2016

Revised August 2012; Reviewed August 2016

Name: Alyssa Collins

Step 3: Develop a Program Plan (Intervention/Nutrition Education Component)

Conduct a Target Contextual Analysis

Outline the Instructional Plan

Revised August 2012, Reviewed August 2016

Proposed activity two:

Proposed activity three:

Proposed activity four:

Proposed activity five:

Proposed activity three:

Proposed activity four:

For adult participants:

1. How much sodium (salt) is the recommended amount per day?

6. Do you think that watching salt in the diet is important?

For child participants:

1. Draw your favorite foods to eat

~1/3 teaspoon (710 mg sodium) One third of daily intake!

Revised August 2012, Reviewed August 2016

Revised August 2012, Reviewed August 2016

Session Two: Proposed Time Schedule

Marketing the Program (The 4 Ps)

Revised August 2012, Reviewed August 2016

Name of Intern: Alyssa Collins

Setting: WIC office in Grand Junction, Colorado

Time Allotment: One hour

Estimated Number of Learners: 16

I. Goals and Rationale

# Goal Rationale for Goal

III. Teaching/Learning Procedures

Revised August 2012, Reviewed August 2016

IV. Materials/Media (attach a sample)

PowerPoint Presentation Computer

Assessment of Participants Learning

Activity One: Pre-test

For adult participants:

Revised August 2012, Reviewed August 2016

6. Do you think that watching salt in the diet is important?

For child participants: