1. "Community Nutrition Advocate Program (CNAP)"
Rural areas experience special challenges in the provision of heart health promotion programs because of geographic isolation, fewer channels for mass communication, and reduced availability of heart healthy food choices. To address these challenges, the innovative "Community Nutrition Advocate Program" (CNAP) trained lay volunteers from rural communities in Saskatchewan to act as healthy-nutrition advocates. The project was carried out in Croteau Hills, one of the demonstration sites of the Canadian Heart Health Initiative in rural Saskatchewan. It was a joint initiative between the Saskatchewan Heart Health Program, the Croteau Hills Heart Health Coalition (CHHHC), and the University of Saskatchewan Department of Pharmacy and Nutrition
The overall goals of CNAP were provide technical support to nutrition initiatives of the CHHHC, to develop a nutrition-based program founded on a peer teaching model and advocacy for positive individual and community changes, and to examine the possibility of this program satisfying nutrition outreach program demands for rural and geographically isolated areas. These goals were addressed through the development of a workshop to train lay volunteers to become nutrition advocates.
The CNAP workshop concept was developed by two dietetic interns from the Saskatchewan Community Nutrition Internship Program. It was based on the principles of adult learning, and incorporated both didactic and small group sessions. The specific objectives of the workshop were to increase participantísí knowledge of heart healthy nutrition and advocacy, and to develop skills for improving the availability of lower-fat food choices in rural areas. Topics covered included nutrition for heart health, label reading, recipe modification, healthier restaurant food choices, and healthy body weights. The strengths and difficulties of the nutrition advocacy role were clearly articulated. During the workshop, participants also engaged in practical sessions relating to label reading and group presentation.
The CNAP workshop was delivered by the nutrition interns in Coteau Hills, in two Saturday sessions two weeks apart, in January 1995. There were 10 participants recruited locally from the Coteau Hills region. In addition to the core sessions, a half-day follow-up session was conducted six weeks later to share experiences, challenges and resources. Ongoing follow-up technical support was provided via toll-free telephone contact with a public health nutritionist, and access to the SHHP Resource Inventory of educational materials.
After participating in the workshop, participants reported that their knowledge, skills and confidence to deal with nutrition education and advocacy issues, had increased as a result of the training. In the six months following their training, nutrition-related activities initiated by the CNAs were many and varied, and reached large numbers of the target population. Activities included, among others, presentations on a variety of nutrition-related issues at community events such as school health fairs as well as in local community groups ( hospital auxiliary, a weight control group, fitness groups, Home Care client groups), a trade show soup-sampling, improving food options in skating arenas, menu planning for banquets, and individual counseling .
Although the program is no longer available in Croteau Hills, the Midwest District Health adopted the program, and components of the program are being implemented by the local public health nutritionist. With some refinement, this program could serve as a model for use in other rural communities wishing to use volunteers for health promotion and health advocacy work.