Development of a questionnaire for the SNAP program: The SNAP Eating Behaviors Questionnaire

1. Development of a questionnaire for the SNAP program: The SNAP Eating Behaviors Questionnaire Arlene P. Little May 11, 2006

2. Agenda • Background information/Public Health problem • What is the SNAP™ program? • The SNAP Eating Behaviors Questionnaire [SEBQ] • Description of the project • Questions & Discussion

3. Background & Public Health Problem • Today’s fast-paced environment makes eating well and getting exercise a challenge • Two-thirds of Americans are overweight or obese • Several serious medical conditions have been linked to obesity, including type 2 diabetes, heart disease, high blood pressure, and stroke • Individuals who are obese have 30 to 50 percent more chronic medical problems than those who smoke or drink

4. Impact on Employers • The cost of obesity to Americans is $117 billion per year • Over 25 percent of the growth in health care spending over the past 15 years is attributable to obesity • Obesity costs U.S. employers $13 billion per year in health insurance costs, paid time off, and life and disability insurance claims • Employers have begun to use worksite health promotion programs more frequently. • Healthy People 2010 recognizes worksite health promotion as an important goal • 8 different objectives contain initiatives to achieve goals in worksite health promotion

5. What is SNAP™? • SNAP is a personalized nutrition and health promotion program developed for use in the workplace • Participants receive customized guidance to assist them with meeting health goals • Based on each individual’s goals, one may receive: • One-on-one nutrition and health guidance • Customized meal and exercise plans • News articles featuring information about health and nutrition • Email messages with healthy eating and exercise reminders • Ongoing support and progress checks

6. What is SNAP™? • Main goals of the SNAP program • Weight Loss • Reduction of BMI • Improvements in the eating behaviors of participants • SNAP participants are educated and coached using the following eating guidelines: • Eating at least 5 servings of fruits and vegetables daily • Eating low-fat or fat-free dairy products daily • Adding very little fat to meat, poultry, and fish • Choosing whole-grain options as often as possible • Limiting intake of fried foods, snack foods, and fast foods • A pilot program is currently be conducted amongst employees at Covance, Inc. • Depending on the program results, the program may be expanded

7. The SNAP Eating Behaviors Questionnaire [SEBQ] • The pilot program revealed the need for an instrument to measure changes in eating behavior within SNAP participants. • Currently, the SNAP program has no formal evaluation tool • The only survey in use is a client satisfaction survey • The SEBQ was developed specifically for the SNAP program and is targeted to the unique needs of employees • Specific feedback was obtained from SNAP participants • Existing tools were modified and new questions were created for the SEBQ • The SEBQ was developed around the constructs of self-efficacy and behavioral intent

8. The SNAP Eating Behaviors Questionnaire [SEBQ] • The SEBQ is made up of 2 sections and has a total of 35 questions • Questions are measured using a 7-point Likert type scale • Section One (20 questions) • Based on the construct of self-efficacy • 4 subscales • Negative emotions • Availability • Social Pressure • Unconscious eating • Section Two (15 questions) • Based on the construct of behavioral intent • Scoring – an overall score and subscores can be calculated

9. Description of the project • The only instrument currently being used by the SNAP program is a client satisfaction survey • This survey does not explore or measure improvements in eating behaviors as influenced by the SNAP program • The behavior targeted by the SEBQ is the ability to practice healthy eating behaviors in a variety of situations. • While an individual’s BMI and weight are easy to quantify, measuring one’s eating behaviors is more complex • Brainstorming sessions with registered dieticians, consultants, SNAP team members and SNAP management were conducted • An extensive literature review was completed to help shape the development of the questionnaire

10. Description of the project • The first version of the SEBQ was reviewed by 2 registered dieticians and 3 members of the SNAP team. • The instrument was then pilot-tested amongst SNAP participants and general Covance employees. • Revisions were made to the SEBQ based upon feedback from these individuals • The final version of the SEBQ will be delivered to future SNAP program participants • The SEBQ has the potential to provide important data regarding individual progress as well as the overall efficacy and effectiveness of the SNAP program.

11. Questions and Discussion