Factors associated with attendance in a voluntary nutrition education program

Purpose. This paper examines factors associated with attendance in a Nation al Cancer Institute-funded randomized trial of nutrition education to incre ase fruit and vegetable consumption among women served by the Special Suppl emental Nutrition Program for Women, Infants, and Children (WIC). Setting. The study took place at 16 WIC sites in Maryland. Subjects. The participants were 1528 women who were enrolled in WIC or who had children enrolled in WIC, were greater than or equal to 18 years of age , and planned to continue enrollment at that WIC site for at least 6 months (68% of eligible women approached agreed to participate). Intervention. Women received personal invitations, letters, and telephone r eminders from peer educators encouraging their attendance at three bimonthl y nutrition sessions. Measures. Demographic data were collected in a baseline survey. Attendance data and telephone and address changes were also collected. The postinterve ntion survey included a question regarding reasons for nonattendance. Focus groups were also held to ascertain reasons for attendance or nonattendance . Chi-square tests of trend and multiple logistic regression, adjusted for within-site correlation, were used in statistical analyses. Results. Fifty-four percent of enrollees attended at least one session. Mul tiple logistic regression analysis showed increased odds of attending with higher age, breast-feeding, and/or knowledge of the recommendation to eat f ive or more servings of fruits and vegetables daily. There were decreased o dds of attending for pregnant women who already had children. There were no nsignificant trends toward decreased attendance among unmarried women compa red with married women and among blacks compared with nonblacks. Reasons gi ven for nonattendance included withdrawal from WIC, moving, conflicting act ivities, negative feelings about nutrition education,and lack of transporta tion or child care. Conclusions. The results suggest that numerous barriers hinder participatio n in nutrition programs aimed at low-income women. These barriers should be considered by health care professionals when planning intervention program s. Overcoming these barriers presents a major challenge.