Cooking Matters Course Impact Evaluation - · PDF file6/29/2015 · Cooking Matters...

Cooking Matters Course Impact Evaluation

Final Report

March 2016

Prepared by: Altarum Institute 2000 M Street, N.W., #400 Washington, DC 20036

Submitted to:

Share our Strength 1030 15th St, N.W., #1100W Washington, DC 20005

Cooking Matters Course Impact Evaluation Final Report

March 2016

Authors: Loren Bell Ruth Morgan Jennifer Pooler Margaret Wilkin

Prepared by: Prepared for:

Altarum Institute Share Our Strength

2000 M Street, NW 1030 15th St NW

Suite 400 Suite 1100W

Washington, DC 20036 Washington, DC 20005

Project Director: Project Officer:

Loren Bell Karen Wong

Suggested Citation:

Share Our Strength, Cooking Matters Course Impact Evaluation: Final Report by Loren Bell, Ruth Morgan, Jennifer Pooler, Margaret Wilkin. Project Officer: Karen Wong. Washington, DC: March 2016.

Table of Contents

I. Introduction ............................................................................................................................................... 1

A. Background ........................................................................................................................................... 1

B. Purpose of the Evaluation ..................................................................................................................... 1

C. Organization of the Report ................................................................................................................... 2

II. Methodology ............................................................................................................................................. 3

A. Study Design...................................................................................................................................... 3

B. Participant Enrollment and Data Collection Timeline ....................................................................... 3

Intervention Group ............................................................................................................................... 3

Comparison Group ................................................................................................................................ 3

C. Data Collection Instruments ......................................................................................................... 4

Data Collection ...................................................................................................................................... 4

D. Measures .............................................................................................................................................. 5

Dependent Variables............................................................................................................................. 5

Independent Variables .......................................................................................................................... 9

F. Data Analysis ....................................................................................................................................... 10

Descriptive and Bivariate Analysis ...................................................................................................... 10

Statistical Models to Assess the Effects of Cooking Matters .............................................................. 10

III. Impact Evaluation Findings .................................................................................................................... 12

A. Participant Enrollment and Characteristics at Baseline ..................................................................... 12

Study Enrollment ................................................................................................................................ 12

Baseline Characteristics ...................................................................................................................... 13

B. Pre- to Immediate Post-Course Findings for Cooking Matters Participants .................................. 13

Characteristics of Immediate Post-Course Respondents .................................................................... 13

Immediate Post-Course: Short-Term Outcomes................................................................................. 14

Immediate Post-Course: Intermediate Outcomes .............................................................................. 14

C. Pre- to 3-Month Post-Course Findings ....................................................................................... 19

Characteristics of Baseline to 3-Months Post-Course Respondents ................................................... 19

3-Months Post-Course: Short-Term Outcomes .................................................................................. 19

3-Months Post-Course: Intermediate Outcomes ................................................................................ 20

3-Months Post-Course: Long-Term Outcomes ................................................................................... 22

D. Pre- to 6-Month Post-Course Findings ........................................................................................ 27

Characteristics of Baseline to 6-Month Post-Course Respondents .................................................... 27

6-Months Post-Course: Intermediate Outcomes ................................................................................ 27

6-Months Post-Course: Long-Term Outcomes ................................................................................... 30

IV. Qualitative Findings from Focus Groups and Interviews ....................................................................... 34

A. Participant Characteristics .............................................................................................................. 34

B. Program Access ............................................................................................................................... 35

Recruitment into the Class .................................................................................................................. 35

Reasons for Participating .................................................................................................................... 35

C. Perceptions of Cooking Matters ................................................................................................. 36

Favorite Aspects of the Program ........................................................................................................ 36

Receipt and Use of Program Materials ............................................................................................... 36

Usefulness of the Information ............................................................................................................ 37

D. Impact of Cooking Matters ......................................................................................................... 37

General Perceptions of Cooking ......................................................................................................... 37

Food Resource Management .............................................................................................................. 38

Healthy Eating ..................................................................................................................................... 38

E. Recommendations for Improvement ............................................................................................. 39

V. Limitations .............................................................................................................................................. 41

VI. Conclusions and Discussion ................................................................................................................... 42

VII. Recommendations for Program Implementation ................................................................................ 47

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I. Introduction

A. Background

The Share our Strength (Share our Strength) Cooking Matters program, developed in 1993, has reached

more than 369,000 low-income families through courses and tours across the United States. Sponsored

by Walmart, Cooking Matters provides families with the knowledge and skills to prepare healthy,

affordable meals. A collaboration between culinary and nutrition professionals, Cooking Matters

employs a practical hands-on teaching approach designed for a broad audience. Cooking Matters

comprises signature courses that target specific audiences: adults, parents, kids, families, teens, and

child care professionals.

The Cooking Matters program includes hands-on, 6-week courses and interactive grocery store tours,

which educate families on how to shop for healthy food while saving money. Cooking Matters also

provides educational tools, such as recipes and materials to further assist families in stretching their

food budgets and preparing healthy meals.

The primary goals of Cooking Matters include (1) supporting increased knowledge, confidence, and skills

sets so that target audiences can build their knowledge base of healthy meal preparation, shopping, and

eating; and (2) helping participants apply the newly gained knowledge, confidence, and skill sets to

change meal preparation, shopping, and eating behaviors in a way that promotes healthy eating.

B. Purpose of the Evaluation

Share our Strength contracted with Altarum Institute to conduct a rigorous impact evaluation of the 6-

week Cooking Matters for Adults1 (CMA) program. The evaluation aimed to assess the extent to which

knowledge and attitudes were improved during the course of the program and whether behavior

changes resulting from the program are maintained over time. These findings will determine whether

the program’s desired short- and immediate-term outcomes are achieved and will provide a better

understanding of the long-term impacts of participating in the CMA program. The primary objectives of

the study are as follows:

Demonstrate Cooking Matters course effectiveness through sustained behavior change in food resource

management, nutrition choices, and cooking or at-home meal preparation;

Consider the long-term impact of the program on health and food security;

Explore how factors such as participant characteristics are associated with sustained or disrupted

behavior change.

1 Study participants were also drawn from Cooking Matters EXTRA for Parents of Preschoolers, Cooking Matters EXTRA for Diabetes, and Cooking Matters EXTRA for Wellness.

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Based on these overarching goals, an initial set of research questions were developed by Share our

Strength (Table 1) and are subsequently addressed in the study. Altarum crafted a logic model

(Appendix A) to guide the development of the evaluation plan with these specific outcomes identified as

the desired impacts of Cooking Matters participants. The research questions were modified during the

course of the study, which is addressed in the methods section.

Finally, the study sought to explore how these

intended outcomes may differ for subpopulations

of participants, including Supplemental Nutrition

Assistance Program (SNAP) participants and Share

our Strength’ priority audience: women with young

children.

C. Organization of the Report

This report is organized into six chapters. Chapter

II, “Methodology,” provides a brief description of

the primary methods employed in the study, as

well as the construction of key analytic variables

that are the subject of the analysis. This section

also provides information on analytical methods

employed and how they are presented in the

findings. Chapter III, “Impact Evaluation Findings,”

is divided into four subsections that describe (1)

study participant characteristics at enrollment; (2) key findings related to immediate impact of

participation in the Cooking Matters course on cooking, nutrition, food resource management, and

other behaviors; (3) key findings from the pre- to 3-month post-course period; and (4) key findings from

the pre- to 6-month post-course period. Chapter IV presents the qualitative findings from focus group

and interviews conducted with participants. Chapter V briefly discusses the limitations of the study

design and methods. Chapter VI presents the conclusions and discussion, with a brief review of some of

the key findings related to participant outcomes during the three points in the study and how findings

evolve over time. The discussion will focus on the importance of these findings in the context of both

the Cooking Matters program and helping low-income families improve their health through positive

changes in healthy eating behaviors, food preparation, and food resource management skills. Finally,

Chapter VII, “Recommendations for Program Implementation,” synthesizes study findings and

conclusions to provide clear recommendations for enhancing or improving the Cooking Matters program

for the benefit of its participants.

Table 1. Proposed research questions

Short-term outcomes

1) Do participants’ attitudes toward foods and cooking change?

2) Have skills in key behaviors increased? 3) Has self-efficacy for key behaviors

increased?

Intermediate outcomes

4) Do participant dietary behaviors and patterns change?

5) Do participants make changes to maximize food budgets as a result of participating in the course?

Long-term outcomes

6) Are participants’ improvements in key behaviors maintained over time?

7) Do participants experience increased household food security after participating in CMA?

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II. Methodology

A. Study Design

Altarum conducted a mixed-method, quasi-experimental impact evaluation of the Cooking Matters

course to assess changes in behavior, self-efficacy, and outcomes related to nutrition and food resource

management. The study incorporated a series of pre- and post-course surveys for Cooking Matters

participants and a comparison group who did not receive any services. Both groups completed surveys

before the intervention, at 3 and 6 months post-course. The Cooking Matters participants (intervention

group) also completed a survey during the last Cooking Matters class session.

Focus groups were also conducted with Cooking Matters participants to gain more in-depth

understanding of the study findings, as well as successes and challenges that participants face after

completion of the course. A limited number of interviews were conducted with Spanish-speaking

participants to assess similar experiences specific to that Cooking Matters population.

B. Participant Enrollment and Data Collection Timeline

Intervention Group

Intervention group participants were recruited from English and Spanish Cooking Matters classes from

late April 2014 through the end of July 2014 in six states: California, Colorado, Maine, Massachusetts,

Michigan, and Oregon. Participants were enrolled in the study during the first class by course

coordinators who were trained and provided scripts to administer the informed consent, contact

information form, and pre-course survey to potential study participants. Those opting to complete the

contact information and pre-course survey were enrolled in the study. Participants were retained in the

study if they completed the post-course survey at the end of the sixth class.

Comparison Group

English- and Spanish-speaking comparison group participants were enrolled in the study by using an

intercept recruitment procedure at sites similar to those serving Cooking Matters participants in the

same six states. Sites were identified in communities with similar demographic characteristics (e.g.,

poverty, race and ethnicity, urbanicity) as those offering Cooking Matter classes and generally included

SNAP offices, WIC clinics, food pantries, YMCAs, and community recreation centers. By matching on

geographic characteristics and identifying sites that serve similar populations, Altarum aimed to recruit a

comparison group with similar demographic characteristics to those of Cooking Matters participants.

People were intercepted at sites and asked whether they were the main cook or shopper in their

household and if they were over age 18. If meeting these eligibility criteria, they were also asked

whether they had ever participated in a nutrition education or cooking class. Those responding that they

had taken Cooking Matters were not enrolled in the study. Those opting to complete the contact

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information and baseline survey in person were enrolled in the study and provide a $5 cash incentive for

participating.

C. Data Collection Instruments

The primary data collection instruments (baseline and post-surveys) used for the impact evaluation

were based heavily on the existing Cooking Matters pre- and post-course surveys developed by Share

our Strength and their partners. In order to fully address the research questions, the study team added a

brief measure to assess food security: a six-item food security screener developed by the U.S.

Department of Agriculture (USDA); one question asking participants to report their household income;

one item to assess number of meals cooked; three additional items to assess food resource

management self-efficacy, and two additional items to assess food resource management behaviors. All

materials were translated into both English and Spanish, and Social Solutions International, Inc. provided

institutional review board approval.

The qualitative data collection instruments included a focus group discussion guide and an in-depth

interview guide based on the same questions. The questions highlighted several key program aspects

including: access (how participants learned about and gained entry into the program), process

(participants’ experience with how the program was implemented), impact (participant changes to at-

home meal preparation, food resource management, and healthy eating; this section also included

specific questions for parents with children), and recommendations for improvement. The focus group

guides were administered onsite (i.e., in the general areas where course participants reside) in English.

The interview guide was translated into Spanish for administration by phone among Colorado

participants due to the large population of Spanish-speaking individuals in the Cooking Matters program

areas targeted for data collection.

Data Collection

Pre- and post-course surveys

The data collection schedule and survey incentive structure is shown in Table 2. Three- and six-month

follow-up was based on course completion dates for Cooking Matters participants, and the baseline

survey completion for the comparison group participants. All comparison group participants and any

Cooking Matters participants responding to the post-intervention survey were contacted at 3 months.

Those responding to the 3-month survey in both groups were then contacted at 6 months.

All participants were asked for mailing and email addresses and were given the opportunity to respond

to the survey via either method. The first mailing for the 3-month and 6-month post-intervention data

collection was followed-up by a postcard reminder at 2 weeks and a second and final mailing at 4 weeks.

Web surveys for the 3-month and 6-month post-intervention data collection were also followed-up with

2-week, 4-week, and final (sent 3 days later) email reminders. The 6-month post-intervention data

collection included lead letters from the Cooking Matters program (for the intervention group) and

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Altarum (for the comparison group) 2 weeks before the first survey mailing. The lead letters thanked

participants for remaining in the study and reminded them to be on the lookout for the final survey. The

6-month post-course lead letter also included a $2 cash incentive for all participants.

Table 2. Data collection time frame and incentive structure

Intervention Comparison

Time frame Incentive Time frame Incentive

Baseline survey completed

(Course start date) April 18–July 31 0 June 16–30 $5

Post-intervention completed

(Course end date) May 25–September 10 0 n/a n/a

3-month post-intervention

(4-week intensive follow-up) September 7–January 15 $5

September 20–October 10

$10

6-month post-intervention

(4-week intensive follow-up) December 9–March 31 $10 January 2–February 2 $15

Focus groups and in-depth interviews

To ensure that impact evaluation findings were not influenced by participant involvement in focus

groups, Altarum recruited participants from CMA courses not enrolled in the study. Participants

graduating from courses ending in October–December 2014 and located in Colorado, Maine, and

Michigan were eligible for focus group recruitment. Focus groups were held between January and

March 2015 (approximately 3–6 months after respondent participation in the course) at public libraries

and other central community locations recommended by lead agencies. Focus group participants

received a $25 gift card after attendance in a 90-minute Altarum-staff moderated discussion.

Since participation rates were higher for Spanish-speaking participants in Colorado, Altarum conducted

in-depth interviews in Spanish, using the same questions as those used with the focus group

participants. Participants were recruited by phone and received a $15 gift card if they completed the

phone interview.

D. Measures

Dependent Variables

The primary data collection instruments include a number of short- and long-term outcome measures to

address the research questions stated above. Individual-level outcome measures focus on short- and

intermediate-term changes in self-efficacy, cooking barriers, cooking behaviors, and food resource

management, while a single household measure was created to examine changes in household food

security.

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The Cooking Barriers Scale, previously tested and validated by Gretchen Swanson Center for Nutrition2,

will assess changes in participants’ barriers to cooking at home. The Cooking Barriers Scale comprises

respondents’ level of agreement with three statements: “Cooking takes too much time,” “Cooking is

frustrating,” and “It is too much work to cook.” The Likert-type scale responses for each question range

from 1 (strongly disagree) to 5 (strongly agree). The Cooking Barriers Scale will be calculated based on

an average of responses to the three questions where no items are missing. In the event that a response

is missing, the Cooking Barriers Scale response will also be missing.

The Cooking Confidence Scale is also based on previously validated research and will be used to assess

changes in participants’ confidence related to cooking behaviors (Research Question #3: Has self-

efficacy for key behaviors increased?) with respect to cooking skills. Four questions are used to calculate

respondents’ level of cooking confidence, specifically how confident they are that they can do the

following:

Use basic cooking skills, like cutting fruits and vegetables, measuring out ingredients, or following a recipe;

Buy healthy foods for their family on a budget;

Cook healthy foods for their family on a budget; and

Help their family eat more healthily.

The Cooking Confidence Scale will be calculated by averaging non-missing responses for each item,

which range from 1 (not at all confident) to 5 (very confident). If any responses are skipped or missing,

the respondent will be assigned a missing value for the Cooking Confidence Scale variable.

Changes in Dietary Choices are measured by using responses to six questions about healthful choices

that participants may make (Research Question #1: Do participants’ attitudes toward foods and cooking

change?):

When you have milk, how often do you choose low-fat milk (skim or 1 percent)?

When you eat dairy products, like yogurt, cheese, cottage cheese, and sour cream, how often do you choose low fat or fat-free options?

When you eat grain products, like bread, pasta, and rice, how often do you choose whole-grain products?

How often do you choose low-sodium options when you buy easy-to-prepare, packaged foods, like canned soups or vegetables or frozen meals?

When you buy meat or protein foods, how often do you choose lean meat or low-fat proteins, like poultry or seafood (not fried), 90 percent or above lean ground beef, or beans?

When you eat at fast-food or sit-down restaurants, how often do you choose healthy foods?

Each item is rated on a 5-point Likert-type scale ranging from 1 (never) to 5 (always). Changes in dietary

choices were analyzed as individual outcome measures.

2 Smith TM, Chapman M, Pinard CA, Yaroch AL. Report of Cooking Matters for Adults: cognitive interviews, psychometrics, and pre-post analysis. Washington, DC: Share our Strength; 2013.

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A number of variables will be used to assess intermediate changes in participant behaviors (Research

Question #4), including changes in measures related to dietary patterns or healthful eating, healthy food

preparation, and the number of days that participants cook supper or dinner at home.

Dietary Patterns are measured by ten items (based on Share Our Strength validated measures) to assess

how often respondents typically eat or drink the following:

Dietary Patterns

Fruits like apples, bananas, or melons;

Green salad;

Fried potatoes, like home fries, hash browns, or tater tots;

Any potatoes not fried;

Refried beans, baked beans, pinto beans, black beans, or other cooked beans;

Other non-fried vegetables, like carrots, broccoli, or green beans;

A meal from a fast-food or sit-down restaurant;

100 percent fruit juices, like orange, apple, or grape juice;

A can, bottle, or glass of regular soda pop, sports drink, or energy drink; and

A bottle or glass of water.

Each item is rated on a 5-point Likert-type scale: not at all (1), once a week or less (2), more than once a

week (3), once a day (4), and more than once a day (5). Increases in the scale over time for most items

will indicate improved dietary patterns, while decreases in consumption of fried potatoes, out-of-home

meals, and soda will show positive changes in healthful eating.

In order to assess whether Cooking Matters participants increase meal preparation and eating at home,

a single question from the National Health and Nutrition Examination Survey 2009–2010 Consumer

Behavior component was added to the instrument: “During the past 7 days, how many times did you

cook food for dinner or supper at home?” Respondents could select an integer ranging from 0 to 7 to

indicate on how many days they did so.

The Healthy Food Preparation Scale, a previously tested and validated measure of food preparation

practices (by the Gretchen Swanson Center), comprises eight questions, six assessing the frequency of

certain behaviors and two assessing respondents’ confidence in areas related to food preparation:

How often do you…

Eat food from each food group every day?

Use the “nutrition facts” on food labels?

Adjust meals to be more healthy, like adding vegetables to a recipe, using whole-grain ingredients, or baking instead of frying?

Adjust meals to include specific ingredients that are more “budget friendly,” like on sale or in your refrigerator or pantry?

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Make homemade meals “from scratch” using mostly basic whole ingredients, like vegetables, raw meats, and rice?

Eat breakfast within 2 hours of waking up?

How confident are you that you can…

Choose the best-priced form of fruits and vegetables?

Use the same healthy ingredient in more than one meal?

Participants rated items on a Likert-type scale. The questions assessing how often a behavior occurs

range from 1 (never) to 5 (always), while the questions assessing confidence range from 1 (not at all

confident) to 5 (very confident). The Healthy Food Preparation Scale will be calculated based on an

average of all responses, and missing data for any questionnaire item will result in a missing value for

the outcome variable.

Research question #5, which explores the extent to which participants can maximize their food budgets,

will be addressed primarily through the Food Resource Management Scale. This scale will be reproduced

for assessing the extent to which participants make changes to maximize their food budgets as a result

of participating in the course. This scale is based on Share our Strength’ previously validated research

and standard questionnaire items. It comprises three items asking respondents how often they compare

prices before buying food, plan meals ahead of time, and use a grocery list when they go shopping. A

second scale builds on this basis to incorporate two additional survey items that were added for the

study: (1) looking in the pantry or refrigerator before going shopping and (2) changing the grocery list in

the store to incorporate sale items. Both scale variables were calculated by using an average of the item

responses, which range from 1 (never) to 5 (always).

There was an additional question that asked “How often do you worry that your food might run out before you get money to buy more?” The responses options range from 1 (never) to 5 (always). Additionally, three self-efficacy questions on food resource management modified from Colantonio et al. (2013)3 will be analyzed individually:

How confident are you that you can make your food money last all month?

How confident are you that you can make low-cost meals?

How confident are you that you can buy healthy foods for your family on a budget?

The three items were rated on a scale ranging from 1 (not at all confident) to 5 (very confident).

Household-level outcomes. The long-term outcome of interest in this study examines changes in

household food security (research question 7) by using the USDA “U.S. Household Food Security Survey

Module: Six-Item Short Form” (September 2012). Respondents were asked how many times in the last

30 days certain food situations were true for their households:

3 Colantonio A, Martin K, Grady J, Ungemack J. The role of self-efficacy in increasing food security among participants of a new food pantry model in Hartford, CT. Poster Presentation. CT Public Health Assoc annual meeting, Waterbury, CT. October 2013.

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The food we bought just didn’t last, and we didn’t have money to get more.

We couldn’t afford to eat balanced meals.

Did you or other adults in your household ever cut the size of your meals or skip meals because there wasn’t enough money for food? If yes, how many days did this happen?

Did you ever eat less than you felt you should because there wasn’t enough money for food?

Were you ever hungry but didn’t eat because there wasn’t enough money for food?

The first two items were rated on a 3-point scale indicating whether the situation was “often,”

“sometimes,” or “never” true. Responses of “sometimes” or “often” to these questions were coded as

affirmative, demonstrating food insecurity. The remaining three questions were simple “yes” or “no”

responses, and an additional affirmative response was recorded for those reporting that they cut the

size of their meals or skipped meals on more than 3 days in the past 30. As such, respondents could

receive a raw score ranging from 0 to 6, where 0 to 1 indicates high or marginal food security, 2 to 4

indicates low food security, and 5 to 6 indicates very low food security. Households categorized as

having low and very low food security are considered food insecure.

Independent Variables

Independent variables were created and used in the analyses to control for differences in intervention

and comparison group demographic characteristics. Participant characteristics from the survey included

race and ethnicity, age, sex, highest level of education, participation in food assistance programs, and

household income. Responses to race and ethnicity questions were used to create three dichotomous

variables representing Hispanic ethnicity, White race, and Black race. Participants’ highest level of

education is a five-category ordinal variable ranging from less than a high school degree to completion

of a 4-year college degree.

Food assistance program participation was recorded as current participation in WIC; SNAP; free or

reduced-price school breakfast, lunch, and supper; free summer meals; Head Start; and food pantries.

Dichotomous variables were created for the priority audiences and SNAP participants, for subgroup

analysis. A dichotomous “target population” variable was also created to identify pregnant women or

mothers of young children.

Household income as a percentage of poverty was calculated by comparing participants’ reported

household income in the last year and total number of people in the household to the U.S. Department

of Health and Human Services poverty guidelines for 2014.4 Mid-values for the categorical income

ranges collected in the survey were used to calculate income as a percentage of poverty; this method is

commonly applied in analyses of national datasets where only categorical income values are recorded.

Additionally, treatment group is identified in the analysis by using a dichotomous variable to indicate

participation in the intervention or comparison group.

4 U.S. Department of Health and Human Services. 2014 poverty guidelines. Washington, DC: U.S. Department of Health and Human Services; 2014. Available at: http://aspe.hhs.gov/poverty/14poverty.cfm. Accessed June 29, 2015.

http://aspe.hhs.gov/poverty/14poverty.cfm

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F. Data Analysis

Descriptive and Bivariate Analysis

Altarum produced univariate descriptive statistics (e.g., frequencies, means) to describe the samples at

various points in the study and for outcome variables of interest. Bivariate analyses were also conducted

(e.g., cross-tabulations, t-tests, chi-squared tests) to determine which sample characteristics were

associated with outcomes of interest and to measure and test for between-group differences.

Pearson’s chi-squared test statistic is used to assess changes in dichotomous independent variables and

the Mantel-Haenszel chi-squared test statistic for categorical variables when examining associations

with food security status, the only dichotomous outcome variable. Altarum used independent sample t -

tests to examine associations with continuous outcome variables and test for between-group

differences.

Statistical Models to Assess the Effects of Cooking Matters

A series of statistical models were designed to quantify and comparatively assess the effects of the

Cooking Matters curriculum. First, outcome models were designed to examine change within persons

exposed to the Cooking Matters curriculum. These models specifically examine the effect of exposure to

the curriculum and are best to address questions related to variables that are proximal to the curricular

material. Second, a series of impact models were conducted. These models include data collected from

a group of individuals who are as similar as possible to Cooking Matter participants, except for their lack

of exposure to the Cooking Matters program. These individuals constitute the counterfactual condition

and provide a measure of key variables in the absence of the intervention. By including an unexposed

group of participants, the evaluation design can rule out validity threats such as history, maturation, and

measurement effects. As the design is quasi-experimental, some validity threats (i.e., selection) cannot

be ruled out.

These analyses used repeated-measures models with fixed and random effects to examine differences in

change over time in outcome variables between Cooking Matters participants and comparison subjects

while accounting for the correlation within subjects over time. Simple regression models, only including

an intervention group and time and an interaction between the two; and multivariate regression

models, including fixed-effect demographic covariates, were conducted, including all participants and

the SNAP and targeted population samples. Linear distribution was specified for all outcomes except

food security which had a binomial distribution.

For the repeated measures models, the primary independent variable is exposure to the Cooking

Matters program and the program’s effects is quantified by the interaction between exposure and time.

The statistical model is expressed as follows:

0 1 2 3 4*it k itY TIME CM TIME CM SITE X

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In this model, the parameter of primary interest is β3, which measures the program effect as an

incremental change over time among Cooking Matters participants relative to the incremental change

over time among a similar group of non-participants, controlling for other variables in the regression

equation.

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III. Impact Evaluation Findings

A. Participant Enrollment and Characteristics at Baseline

Study Enrollment

A total of 831 Cooking Matters participants out of 1,056 attending the first week of Cooking Matters

courses were enrolled in the study, representing a study enrollment rate of 78.7 percent. On average,

participants agreeing to enroll in the study attended more classes than non-enrollees (4.7 versus 3.9 out

of 6 classes; p < 0.0001). Demographic characteristics of those choosing not to participate were not

collected, so comparisons cannot be made.

With regard to the comparison group, a total of 1,581 people were intercepted at recruitment sites,

screened, and asked to enroll in the study. Slightly more than 10 percent (n = 164) did not meet the

screening criteria (e.g., not the primary cook or shopper, under age 18, cannot read or write in English or

Spanish), and 856 people agreed to enroll in the study and completed the pencil-and-paper survey on

site (response rate: 60.4 percent) (Table 3). Field data collectors observed and recorded the non-

enrollees’ sex, age group (10 categories), and race and ethnicity, to the best of their ability, in a tracking

log.5-6

Table 3. Study enrollment rates for the intervention and comparison groups

Survey Completed Intervention Comparison

Enrolled (Eligible) Response

Rate Enrolled (Eligible)

Response Rate

Baseline 831 (1,056) 78.7% 856 (1,581) 60.4%

Post-intervention 588 (831) 70.6% N/A N/A

3-month post-intervention 371 (594) 62.5% 382 (856) 44.6%

6-month post-intervention 332 (594) 55.9% 336 (856) 39.2%

5 Analysis of data from the tracking log (non-enrollees) and survey responses (enrollees) indicate the following: Women were

1.3 times more likely than men to enroll (adjusted odd ratio [aOR]: 1.3; 95 percent confidence interval [CI]: 1.03–1.65); Hispanic persons were significantly more likely to enroll than non-Hispanic Whites (aOR: 1.7; 95 percent CI: 1.32–2.19), while there was no difference in enrollment for non-Hispanic Black persons (aOR: 1.27; 95 percent CI: 0.95–1.70) or persons of other races compared to non-Hispanic White (aOR: 0.89; 95 percent CI: 0.61–1.32); and the odds of enrollment decreased slightly with increasing age (aOR: 0.96; 95 percent CI: 0.92–0.99). 6 We compared the demographics of the intervention and comparison groups for two reasons: 1) to understand whether the groups differed based on certain factors and 2) to account for these differences in our analysis in order to ensure that these factors were not the source of differences in findings seen between the intervention and comparison groups. Thus, where significant differences in findings between the two groups are noted, it can be said with confidence that Cooking Matters was the source of these differences.

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Baseline Characteristics

The intervention and comparison groups were similar with regard to a number of demographic

characteristics at baseline (Appendix Table B-1), including race and ethnicity; language spoken (English

or Spanish); highest level of education completed; and current participation in SNAP, school breakfast,

school lunch, school supper, and accessing a food pantry or food cupboard. Participants in the

comparison group were more likely than Cooking Matters participants to be male (22.7 percent versus

13.0 percent; p < 0.0001), pregnant women (5.9 percent versus 3.0 percent; p = 0.0002), participating in

WIC (29.6 percent versus 20.9 percent; p < 0.0001), and living in poverty (70.5 percent versus 57.7

percent; p < 0.0001). Comparison group participants also had 1.5 children on average, compared to 1.1

on average in the intervention group at baseline (p < 0.0001).

B. Pre- to Immediate Post-Course Findings for Cooking Matters Participants

Characteristics of Immediate Post-Course Respondents

A total of 588 Cooking Matters study participants completed the post-course survey at the end of the

last class (response rate: 70.6 percent). Respondents and non-respondents (those opting not to fill-out

the post-course survey) were similar with regard to most demographic characteristics (Appendix Table

B-2). Non-respondents however, were more likely to have children participating in the National School

Lunch and Breakfast programs and to fall into Share our Strength’ target population: 37 percent of non-

respondents were women with young children, versus 27.7 percent of respondents (p = 0.0079). Non-

respondents also had a lower attendance rate than respondents: 2.8 classes versus 5.5 classes on

average (p < 0.0001). Seven participants completing the baseline and post-course survey are excluded

from further analysis for completing fewer than four out of six Cooking Matters course sessions.

Participants completing both the baseline and immediate post-course survey (n = 581) were primarily

female (87.4 percent), non-Hispanic White or Hispanic (47.2 percent and 28.2 percent, respectively), and

spoke English as a primary language (87.4 percent; Appendix Table B-3). On average, respondents had

1.1 children in their household. In all, 50.4 percent were SNAP participants, 20.1 percent participated in

WIC, 21.9 percent had children participating in the National School Lunch Program, and 24.3 percent

were accessing a food pantry. Among participants reporting household income (n = 460), more than 57

percent were living in poverty, 30 percent had incomes between 100 percent and 200 percent of the

Federal poverty level, and 12.8 percent had incomes of 200 percent or more of the Federal poverty

level.

Share our Strength’ target population (pregnant women or mothers of young children; n = 161) were

predominantly Hispanic (45.6 percent) and non-Hispanic White (33.1 percent), English-speaking (75.2

percent), and living in poverty (65.4 percent). The majority participated in WIC (55.9 percent) and SNAP

(58.4 percent), and more than 40 percent had children participating in the National School Lunch

Program or the National School Breakfast Program. Women in the target population had an average of

2.4 children in the household.

14

SNAP participants are another subgroup of particular interest to Share our Strength, and outcomes for

this subgroup are explored separately in these analyses. More than half of SNAP participants in the

study and completing the pre and immediate post surveys were non-Hispanic White (54.4 percent),

were female (86.1 percent), spoke English (93.6 percent), and had a high school diploma or General

Educational Development (GED) certificate (33.1 percent) or some college education (29.8 percent).

More than three-quarters of SNAP participants had household incomes below 100 percent of the

Federal poverty level (75.5 percent), one-third accessed a food pantry or cupboard (34.6 percent), and

27.5 percent participated in WIC.

Immediate Post-Course: Short-Term Outcomes

Cooking confidence and barriers

Cooking Matters participants showed improvements with regard to both cooking confidence and

cooking barriers from baseline to course-completion (Appendix Table C-1). Cooking confidence

comprised four questions related to participants’ self-efficacy in using basic cooking skills, buying and

cooking healthy foods on a budget, and helping their family eat more healthily. Participants’ average

scores on this 5-point scale increased from 3.9 (just below “somewhat confident” on average) to 4.4

(midway between “somewhat” and “very confident”) over the course of the program (p < 0.0001).

Subgroup analyses showed that women in the target population and SNAP participants saw a similar

0.5-point increase in cooking confidence on the 5-point scale (p < 0.0001).

Cooking barriers were measured using an average of three items: “Cooking takes too much time,”

“Cooking is frustrating,” and “It is too much work to cook.” Participants showed a statistically significant

decrease in cooking barriers from baseline to course completion: 2.4 to 2.2 (p < 0.0001), where a 3 on

the scale is “neither agree nor disagree” and a 2 is “disagree.” SNAP participants also showed a 0.2-point

improvement on the 5-point scale, while women in the target population saw a 0.3-point improvement

(p < 0.0001). These findings indicate that participant attitudes toward cooking shifted positively after

taking the course overall and for both subgroups of interest.

Immediate Post-Course: Intermediate Outcomes

Dietary choices

Cooking Matters participants also reported making significant changes on all items assessing dietary

choices upon completion of the program (Figure 1). For instance, participants reported, on average, a

0.3-point increase in how often they choose lean protein options, from 3.7 to 4 (“often”) (p < 0.0001).

Participants also saw a significant increase in choosing low-sodium options, from 3.1 to 3.4 on average

(p < 0.0001). Finally, the frequency with which whole-grain options are chosen increased from 3.7 to 3.8

(p < 0.001).

15

Figure 1. Changes in dietary choices from baseline to course completion

Note: Based on a scale where 1 = “never”, 2 = “rarely”, 3 = “sometimes”, 4 = “often”, and 5 = “always.”

*p < 0.01. †p < 0.001. ‡p < 0.0001.

The target population (pregnant women or mothers with young children) saw fewer statistically

significant increases from baseline to immediate post-course completion on dietary choices (Appendix

Table C-2). While choosing low-fat dairy products and low-sodium options saw similar improvements,

changes in choosing lean protein options only approached statistical significance (3.7 to 3.9; p = 0.0529).

Interestingly, while there was no significant change in choosing whole-grain options among those in the

target population, they reported doing so “often” immediately post-course which is slightly higher than

in the average report from the overall Cooking Matters population. The lack of statistically significant

changes among the target population may be due in part to the decreased sample size when considering

only this subgroup.

SNAP participants saw improvements similar in magnitude and statistical significance as the overall

Cooking Matters population (Appendix Table C-3), including choosing lean protein options (p = 0.0005),

low-sodium options (p < 0.0001), and low-fat dairy products (p = 0.0006) more frequently. SNAP

participants made no significant changes with regard to low-fat milk products, healthy foods at

restaurants, and whole-grain options, however, the means demonstrate that they were moving towards

increased selection of these items.

Dietary patterns

Cooking Matters participants made a considerable number of changes to improve dietary behaviors and

patterns from baseline to course completion. Figure 2 shows changes in dietary patterns for

consumption of a variety of foods. Participants showed statistically significant increases in consumption

of fruit, green salad, and non-fried vegetables and significant decreases in consumption of fried

potatoes and eating meals from a restaurant. Participants’ reports of fruit consumption increased 0.3

points, edging closer to “once a day” on average (p < 0.0001). Similarly, participants saw a slight but

significant increase in consumption of non-fried vegetables (0.2 points; p < 0.0001) from 3.2 to 3.4,

where 3 is “more than once a week” and 4 is “once a day.” These findings indicate that Cooking Matters

3.3 3.3

3.7

3.1

3.7

3.0

3.5 3.5

3.8

3.4

4.0

3.2

1.0

2.0

3.0

4.0

5.0

Lowfat milkoptions*

Lowfat dairy products‡

Whole grain options†

Low sodium options‡

Lean protein options‡

Healthy foods atrestaurant*

Baseline Post-course

16

participants are making small but significant improvements toward meeting fruit and vegetable intake

recommendations.

Figure 2. Changes in dietary patterns from baseline to course completion

Note: Based on a scale where 1 = “not at all,” 2 = “once a week or less,” 3 = “more than once a week,”

4 = “once a day,” and 5 = “more than once a day.” *p < 0.05. †p < 0.001. ‡p < 0.0001.

Cooking Matters participants demonstrated a significant increase in water consumption and a significant

decrease in sugar-sweetened beverage consumption. Water consumption increased from 4.5 to 4.6,

shifting participants closer to the maximum response of “more than once a day” (p < 0.0045). At the

same time, consumption of sugar-sweetened beverages decreased from 2.2 to 2.1, edging closer to an

average response of “once a week or less” (p = 0.0070). Participants saw no change in consumption of

fruit juice, with responses averaging 2.5, between “once a week or less” and “more than once a week.”

Participants in the target population saw similar improvements with regard to increasing consumption

of fruit (p = 0.0002), green salad (p = 0.0071), and non-fried vegetables (p = 0.0194). While there was no

significant increase in bean consumption reported, the target population reported an average 2.7 on the

5-point scale, slightly higher than the overall population immediately post-course. Target population

participants also reported eating fried potatoes less often (p = 0.0153) and fewer meals from restaurants

(p = 0.0020), though no changes were reported with regard to how frequently sugar-sweetened

beverages and water were consumed.

Subgroup analyses also showed that SNAP participants had nearly identical dietary behavior changes as

the overall Cooking Matters population, with significant increases in consumption of fruit (p < 0.0001),

green salad (p = 0.0149), and beans (p = 0.0070) and decreases in consumption of fried potatoes

(p < 0.0001) and meals from restaurants (p < 0.0001). Notably, SNAP participants did not see a

significant increase in how often they ate non-fried vegetables. While SNAP participants reported a

slight increase in how often fruit juice (2.6 to 2.8; p = 0.0315) and water (4.5 to 4.6; p = 0.0053) were

consumed, there was no change with regard to sugar-sweetened beverages.

3.4

2.8

2.3 2.3 2.4

3.2

2.1

3.7

3.0

2.02.3

2.6

3.4

1.9

1.0

2.0

3.0

4.0

5.0

How often eat fruit‡

How often eat green salad†

How often eat fried potatoes‡

How often eatnon-friedpotatoes

How often eat beans‡

How often eat non-fried

vegetables‡

How often eat meal from

restaurant‡


17

Food preparation

Two measures related specifically to preparing food at home were assessed in the study: (1) how often

participants cooked dinner at home in the past week and (2) the Healthy Food Preparation scale, a

composite of eight items related to how often participants engage in behavior related to preparing

healthy foods. After course completion, Cooking Matters participants showed significant improvements

over baseline on both measures (Figure 3). On average, participants cooked 5.3 dinners at home in the

previous week, compared to 5.0 dinners on average before taking the course (p < 0.0001). The Share our

Strength target population saw a similar increase from 5.3 to 5.7 meals cooked at home (p = 0.0010), as

did SNAP participants (5.1 to 5.4; p = 0.0031). Cooking Matters participants also saw improvement with

regard to the healthy food preparation scale, which increased from 3.6 to 3.9 from baseline to course

completion (p < 0.0001). This means participants moved from “sometimes” towards “often engaging in

healthy food preparation activities such as: reading “nutrition facts” labels, adjusting meals to be

healthier (e.g., adding vegetables to a recipe or baking instead of frying), making homemade meals

“from scratch,” and eating breakfast within 2 hours of waking up.

Figure 3. Changes in food preparation behaviors from baseline to immediate post-course completion, overall and by subgroup

Note: The scale is based on an average of eight items. Responses range from 0 to 5. Respondents could select

0 to 7 for how often they cooked dinner at home in the past week. *p < 0.01. †p < 0.001. ‡p < 0.0001.

Food resource management

Findings indicate that Cooking Matters participants made significant improvements during the course

related to managing food resources (Figure 4). Specifically, Cooking Matters participants were less

worried that food might run out before they had money to buy more, shifting from 3.3 to 3.0, where 4 is

“often” and 3 is “sometimes” (p < 0.0001). Participants also showed increased self-efficacy in being able

to buy healthy foods on a budget (3.6 to 4.2; p < 0.0001), make their food money last all month (3.4 to

3.8; p > 0.0001), and make low-cost meals (3.6 to 4.2; p < 0.0001), where 3 is “neutral” and 4 is

“somewhat confident.” The magnitudes of these observed changes (+0.4 to +0.6 points) are the largest

of all measured outcome variables from baseline to course completion.

5.0

3.6

5.3

3.6

5.1

3.6

5.3

3.9

5.7

3.9

5.4

3.9

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

How often cooked dinner at home in

past week‡

Healthy Food Preparation

Scale‡

How often cookeddinner at home in

past week*


Scale‡

How often cookeddinner at home in

past week*


Scale‡


Total Target Population SNAP Participants

18

Figure 4. Changes in self-efficacy and behaviors related to resource management from baseline to immediate post-course completion

Note: “Worry that food might run out” is based on a scale where 1 = “never,” 2 = “rarely,” 3 = “sometimes,”

4 = “often,” and 5 = “always.” “Confidence” is based on a scale where 1 = “not at all confident,” 2 = “not very

confident,” 3 = “neutral,” 4 = “somewhat confident,” and 5 = “very confident.” The Food Resource

Management Scale is based on an average of three items, and the alternate scale is based on five items, with

all items ranged from 1 (“never”) to 5 (“always”). *p < 0.05. †p < 0.001. ‡p < 0.0001.

With regard to the Food Resource Management and Alternate Food Resource Management Scales,

participants demonstrated a 0.2-point increase, which indicates that participants are engaging in

behaviors that will help them better manage their food dollars with the aim of purchasing healthier

foods. The Share our Strength target population and SNAP participants also saw significant

improvements on all food resource management measures, as shown in Table 4.

Table 4. Changes in self-efficacy and behaviors related to resource management from baseline to immediate post-course completion, target population and SNAP participants

Target population SNAP participants

Outcome N Baseline

Mean (SD) Post-course Mean (SD)

p-value N Baseline

Mean (SD)

Post-course Mean (SD)

p-value

Worry that food might run out 153 3.25 (1.20) 2.99 (1.18) 0.0038 263 3.33 (1.21)

3.00 (1.25)

< 0.0001

Confident can buy healthy foods on budget

156 3.47 (1.28) 4.16 (0.93) < 0.0001 263 3.62 (1.24)

4.17 (0.98)

< 0.0001

Confident can make food money last all month

152 3.22 (1.32) 3.74 (1.14) < 0.0001 256 3.24 (1.34)

3.77 (1.12)

< 0.0001

Confident can make low-cost meals

153 3.50 (1.21) 4.10 (0.97) < 0.0001 258 3.60 (1.17)

4.17 (0.94)

< 0.0001

Food Resource Management Scale

153 3.62 (0.99) 3.92 (0.79) < 0.0001 266 3.68 (0.94)

3.90 (0.82)

< 0.0001

Alternate Food Resource Management Scale

146 3.63 (0.87) 3.91 (0.74) < 0.0001 246 3.71 (0.86)

3.89 (0.74)

0.0001

3.33.6

3.43.6 3.7 3.7

3.0

4.2

3.8

4.23.9 3.9

1.0

2.0

3.0

4.0

5.0

Worry that food might run out‡

Confident can buy healthy

foods on budget‡

Confident can make food money

last all month‡

Confident can make low-cost

meals‡

Food Resource Management

Scale‡

Alternate Food Resource

Management Scale†


19

C. Pre- to 3-Month Post-Course Findings

Characteristics of Baseline to 3-Months Post-Course Respondents

A total of 371 Cooking Matters participants completed a survey at 3 months post-course, representing

44.6 percent of those enrolling in the study and 62.5 percent of participants who completed the class

and the immediate post-course survey. Three-month post-course completers differed from non-

respondents: Females were more likely to respond than males, non-Hispanic White and non-Hispanic

Black participants were more likely than Hispanic participants to respond, and those with less than a

high school degree were less likely to respond than those with higher levels of education. Participants

speaking English as their primary language were also significantly more likely to respond at 3 months

post-course, and those with household incomes below 100 percent of the Federal poverty level were

slightly less likely to respond than higher-income respondents. Finally, 3-month completers had fewer

children in the home on average compared to non-completers (0.9 children versus 1.3 children,

respectively) and attended slightly more classes on average (5.5 versus 5.4; p = 0.0161)

With regard to the comparison group, 382 participants completed a 3-month post-course survey

(response rate: 44.6 percent). Three-month completers in the intervention and comparison group were

similar with regard to race and ethnicity, primary language, highest level of education completed, SNAP

participation, and access to a food pantry. As at baseline, Cooking Matters participants had fewer

children (mean: 0.9 versus 1.4; p < 0.0001), were more likely to be female (90.0 percent versus 79.1

percent; p < 0.0001), and were less likely to have household incomes below 100 percent of the Federal

poverty level (51.0 percent versus 67.2 percent; p = 0.0021) or participate in WIC (16.8 percent versus

24.9 percent; p = 0.0070).

3-Months Post-Course: Short-Term Outcomes


Three months after completion of the Cooking Matters program, participants maintained the positive

gains made with regard to cooking confidence and cooking barriers, each measured on a 5-point scale,

even after controlling for a comparison group and demographic factors including age, gender, race,

ethnicity, and poverty status (Appendix Tables D-1 and D-2). Cooking Matters participants at baseline

were similar to the comparison group with regard to their cooking confidence scores, hovering around

somewhat confident (3.96 and 4.09, respectively; p > 0.05). Three months after completing the course,

however, program participants saw a 0.33-point increase in their cooking confidence scale scores

(p < 0.0001). When examining change over time for SNAP participants and the Share our Strength target

population, similar results were found: Controlling for the comparison group and demographic factors,

SNAP participants saw an increase of 0.37 (moving from 4.00 and 4.37; p <0.0001), and women in the

target population saw an increase of 0.42 (moving from 3.99 to 4.41; p = 0.0003).

Cooking Matters participants had a slightly higher score for cooking barriers on average at baseline than

the comparison group (2.42 versus 2.05, respectively; p < 0.0001). This suggests participants have a

greater need for the course given they have higher perceived barriers to cooking. Participation in the

20

course was associated with a 0.33-point decrease in perceived cooking barriers (moving from 2.46 to

2.13; p = 0.0006), even after controlling for demographic factors. Cooking Matters participants agreed

less with the notion that cooking is frustrating and it takes too much time and work after completing the

course. The decline in cooking barriers was also seen among Cooking Matters SNAP participants

(moving from 2.42 to 2.07; p = 0.0001) and was particularly prominent in the Share our Strength target

population who saw a 0.42-point decrease (moving from 2.64 to 2.22; p = 0.0006).

3-Months Post-Course: Intermediate Outcomes

Dietary choices

Cooking Matters participants appear to be making healthier dietary choices after completion of the

course. On each of the six measures related to dietary choices, Cooking Matters participants were no

different from the comparison group in how frequently they made healthy choices at baseline. On all of

those measures, Cooking Matters participants showed statistically significant increases from baseline to

3 months post-course compared to those who did not take the course and after adjustment for age,

gender, race, ethnicity, and poverty status (Figure 5, Appendix Tables D-3 through D-8). For instance,

Cooking Matters participants increased the frequency with which they choose low-fat dairy products

(e.g., cheese, yogurt) by 13 percent, from 3.26 to 3.68 on a 5-point scale (p < 0.001), moving closer to

“often” choosing low-fat dairy options. Cooking Matters participants also increased the frequency with

which they choose low-sodium products by 13 percent, from 3.15 to 3.55 on a 5-point scale (p < 0.001),

moving closer to “often” choosing low-sodium options. Similarly, Cooking Matters participants increased

the frequency with which they chose whole grain options by almost 10 percent, increasing from 3.68 to

4.04 on average from baseline to 3 months post-course.

21

Figure 5. Mean changes in dietary choices from baseline to 3 months post-course, all participants, adjusted for age, gender, race, ethnicity, and poverty status

*p < 0.05. ‡p < 0.001.

Among SNAP participants, Cooking Matters was also associated with significant improvements in making

healthier dietary choices, compared to those not participating in the Cooking Matters program and

adjusted for age, gender, race, and ethnicity. Most notably, Cooking Matters SNAP participants saw a 17

percent improvement in choosing low-fat dairy options (3.20 to 3.74), while the comparison group saw a

7.7 percent decrease from baseline to 3 months post-course (3.47 to 3.20). SNAP participants in the

Cooking Matters program also saw a large gain in choosing low-sodium options (15.2 percent increase;

p < 0.001) and choosing healthier options at restaurants (14.9 percent increase; p <0.01) associated with

participation in the program after accounting for naturally occurring changes over time and

demographic factors including age, gender, race, and ethnicity (Figure 6).

3.46

3.38

3.83

3.07

3.93

3.10

3.41

3.54

3.78

3.24

3.90

3.14

3.68

3.68

4.04

3.55

4.12

3.36

3.32

3.26

3.68

3.15

3.78

2.98

1.00 2.00 3.00 4.00 5.00

Lowfat Milkoptions*

Lowfat Dairy Products‡

Whole Grain Options‡

Low Sodium Options‡

Lean Protein Options‡

Healthy Food at Restaurants‡

Cooking matters - BL Cooking Matters - 3 MO Comparison - BL Comparison - 3 MO

Never Rarely Sometimes Often Always

22

Figure 6. Mean changes in dietary choices from baseline to 3 months post-course, SNAP participants, adjusted for age, gender, race, and ethnicity

*p < 0.05. †p < 0.01. ‡p < 0.001.

Women in the target population saw improvements associated with the Cooking Matters program with

regard to dietary choices at 3 months post-course, adjusted for age, gender, race, and ethnicity.

Participants significantly increased the frequency with which they chose low fat dairy options by over 17

percent (from 3.29 to 3.87; p < 0.05), chose low-sodium options by 17 percent (from 3.18 to 3.71;

p < 0.01), and chose healthier foods at restaurants by 16 percent (from 3.04 to 3.52; p <0.05) compared

to those not participating in Cooking Matters.

3-Months Post-Course: Long-Term Outcomes

Dietary patterns

Three months after taking the Cooking Matters course, participants responding to the survey

maintained improvements in dietary behaviors and patterns. Figure 7 shows mean changes in dietary

patterns for consumption of foods, after adjustment for demographic factors, including age, gender,

race, ethnicity, and poverty status. Cooking Matters participants showed statistically significant

improvements compared to comparison subjects in reported consumption of fruit, green salad, non-

fried vegetables, fried potatoes, and 100% fruit juice. At baseline, when compared to the comparison

3.32

3.20

3.75

2.93

3.78

2.85

3.34

3.47

3.71

3.10

3.68

2.92

3.70

3.74

4.10

3.56

4.16

3.40

3.26

3.20

3.68

3.09

3.77

2.96

1.00 2.00 3.00 4.00 5.00

Lowfat Milkoptions*

Lowfat Dairy Products‡

Whole Grain Options†

Low Sodium Options‡

Lean ProteinOptions*

Healthy Food at Restaurants†


Never Rarely Sometimes Often Always

23

group, Cooking Matters participants had similar levels of consumption of fruit and non-fried vegetables

(p > 0.05) but slightly lower consumption of cooked beans (p = 0.0098), green salad (p = 0.0352) and

100% fruit juice (p<0.0001). At 3 months post-course, Cooking Matters participants increased fruit

consumption from 3.41 to 3.61 on average, which reflects an almost 6 percent increase associated with

participation in the program (p = 0.0066). Cooking Matters participants saw a similar increase with

regard to green salad, which increased from 2.83 to 2.94, nearing an average response of “more than

once a week” and representing an average increase of about 3.9 percent over baseline reports

(p = 0.0055). Cooking Matters also participants reported significantly higher consumption of non-fried

vegetables from 3.18 to 3.43, representing an 8 percent increase at 3 months post-course (p < 0.0001).

Notably, Cooking Matters participants reported significantly lower baseline consumption of cooked

beans than the comparison group (2.37 versus 2.55; p = 0.0098), but participation in the program was

associated with a 7.6 percent increase in cooked bean consumption at 3 months post-course

(p = 0.0001), versus a slight decrease for comparison participants. Participants also saw an increased in

100 percent fruit juice consumption from baseline to 3 months post-course (from 2.39 to 2.57; p =

0.00002) and a decrease in consumption of fried potatoes (from 2.24 to 2.08; p=0.0140), nearing “once

a week or less”. Cooking Matters participants did not maintain gains reported from baseline to course

completion with regard to consumption of meals from restaurants, sugar-sweetened beverages, or

water.

24

Figure 7. Mean changes in dietary patterns from baseline to 3 months post-course, all participants, adjusted for age, gender, ethnicity, and poverty status

*p<0.05. †p < 0.01. ‡p < 0.001.

Examined separately, SNAP participants also saw statistically significant improvements in dietary

patterns with regard to fruit (9 percent increase; p = 0.0042), non-fried vegetables (8 percent increase;

p = 0.0002), cooked beans (4 percent increase; p = 0.0025), and 100 percent fruit juice (11 percent

increase; p = 0.0024) over the comparison group. Women in the target population also saw similar

improvements over the comparison group regarding frequency of fruit consumption (9 percent increase;

p = 0.0017), non-fried vegetables (7 percent increase; p = 0.0044), and 100 percent fruit juice (2.5

percent increase; p = 0.0385). Notably the improvements for fruit consumption were greater among

SNAP participants and women as compared to the Cooking Matters population. See Appendix Tables D-9

to D-18 for complete model specifications for dietary patterns measures.

Food preparation

Cooking Matters participants also showed significant improvements in food preparation measures

compared to those not participating in Cooking Matters, after adjustment for demographic factors

including age, gender, race, ethnicity, and poverty status. With regard to the number of meals cooked in

the previous 7 days, Cooking Matters participants increased overall by 6% from baseline to 3 months

post-course (5.18 to 5.47 meals per week), but this significant increase was not seen in the SNAP

3.54

2.89

2.17

2.42

3.29

2.75

3.54

2.97

2.19

2.50

3.35

2.86

3.61

2.94

2.08

2.55

3.43

2.60

3.41

2.83

2.24

2.37

3.18

2.42

1.00 2.00 3.00 4.00 5.00

How often eat fruit†

How often eat green salad†

How often eat friedpotatoes*

How often eat beans‡

How often eat non-fried vegetables‡

How often drink 100% fruit juice‡


Not at all Once a week or less

More than once a week

Once a dayMore than once a day

25

participants or the target population when examined separately. Nearly 20 percent of respondents

failed to answer this question in the 3-month follow-up survey, which posed a particular challenge in

modeling this outcome variable and may introduce bias into the findings.

Cooking Matters participants also showed significant improvement from baseline to 3 months post-

course on the healthy food preparation scale overall over comparison subjects, increasing from an

average response of 3.63 on a 5-point scale to 3.96 (p < 0.0001; Figure 8). This indicates that Cooking

Matters participants were increasingly using strategies to prepare healthier low-cost meals. Cooking

Matters SNAP participants saw a similar improvement on the healthy food preparation scale, increasing

from a baseline score of 3.63 to 3.95 at 6 months (p<.0001). Women in the Share our Strength target

population also saw a similar improvement on the healthy food preparation scale, increasing from a

baseline score of 3.58 to 4.0 at 6 months (p<.0001).

Figure 8. Mean changes in healthy food preparation behaviors from baseline to 3 months post-course, overall and by subgroup, adjusted for age, gender, race, ethnicity, and poverty status (in total only)

Note: The scale is based on an average of eight items. Responses range from 0 to 5. ‡p < 0.0001.


Cooking Matters participants significantly increased their food resource management behaviors from

baseline to 3 months as compared to the comparison group, charting a 5% increase in their overall score

on the alternate food resource management scale (3.82 to 4.03). Results were similar when using the

original food resource management scale for measurement, showing that Cooking Matters participants

increased how often they compare prices before buying food, plan meals ahead of time, and use a

grocery list when they go shopping. Findings were similar among SNAP and target participants who also

saw 5% increases in their alternate food resource management scale scores (0.18-point and 0.20-point

increases, respectively).

3.633.79

3.63 3.67 3.583.79

3.963.78

3.953.68

4.003.84

1.00

2.00

3.00

4.00

5.00

Cooking Matters‡ Comparison Cooking Matters‡ Comparison Cooking Matters‡ Comparison

Total SNAP Participants Target Population

Baseline 3 months post

26

As with other findings, there was a significant increase in all factors measuring self-efficacy in food

resource management in the Cooking Matters population compared to the comparison group after 3

months post-intervention. While the self-efficacy of the comparison group remained about the same,

there was a significant increase in the self-efficacy of the Cooking Matters population, indicating that

they retained self-efficacy at three months after completing the class. Most notable in the findings

(Figure 9) is the increased confidence in the abilities to buy healthy food on a budget (3.67 to 4.17, a

13.6 percent increase) and prepare low-cost meals (3.65 to 4.28, a 17.2 percent increase).

Findings relative to self-efficacy in food resource management were similar in SNAP and Share our

Strength target population participants who saw significant increases from baseline to 3 months in their

confidence in buying healthy food on a budget (14.9 and 17.0 percent increase, respectively). While

SNAP participants demonstrated significant improvements in confidence related to making food money

last all month and making low-cost meals (13.3 and 17.6 percent increase, respectively), increases were

incremental but not significant among the target population.

Figure 9. Mean changes in self-efficacy and behaviors related to resource management from baseline to 3 months post-course, adjusted for age, gender, race, ethnicity, and poverty status

‡p < 0.0001.

3.69

3.33

3.94

3.31

3.97

4.01

3.82

3.44

3.94

3.25

3.96

4.00

4.17

3.79

4.28

2.70

4.02

4.03

3.67

3.35

3.65

3.01

3.82

3.82

1.00 2.00 3.00 4.00 5.00

Confident that can buy healthy food on

a budget‡

Confident can make food money last all

month‡

Confident can make low-cost meals‡

Worry that food might run out‡

Food resource management‡

Alternate food resource

management scale‡


27

Food Security

At 3 months after completion of Cooking Matters, course participants were not significantly more likely

to be food secure than the comparison group; however, they did show some movement in this direction

(parameter estimate of 0.34; p= 0.2042). The explanation for this may be that the Cooking Matters

participants were already 44% more likely to be food secure compared to the comparison group (p =

0.0226) at 3-months post-completion (i.e. there was less room to demonstrate improvement over the

comparison group as a result of completing the course). Similarly, Cooking Matters target and SNAP

participants were not significantly more likely to be food secure 3 months after taking Cooking Matters.

While significant improvements were not seen in food security status at 3 months after taking Cooking

Matters, participants did demonstrate a 13% increase in their confidence to make food money last all

month relative to the comparison group (3.35 to 3.79; p < 0.0001). Three months after taking the

course, Cooking Matters participants were also significantly less likely to worry that food might run out

(3.01 to 2.70, p < 0.0001). The comparison group did not experience an improvement.

D. Pre- to 6-Month Post-Course Findings

Characteristics of Baseline to 6-Month Post-Course Respondents

A total of 332 Cooking Matters participants completed a 6-months post-survey, representing 39.9

percent of those enrolling in the study and 55.9 percent of participants who completed the class and the

immediate post-course survey. Six-month post-course completers differed from non-respondents: Non-

Hispanic White participants were more likely to respond than Hispanic and non-Hispanic Black

participants (54.7 percent versus 18 or fewer percent; p<0.05). Finally, 6-month completers were more

likely than non-completers to participate in Head Start (10.9 percent versus 0.0 percent participation;

p = 0.0216).

With regard to the comparison group, 336 participants completed a 6-month post-course survey

(response rate: 39.2 percent). Six-month completers in the intervention and comparison groups were

similar with regard to primary language, highest level of education completed, pregnancy status, SNAP,

school breakfast and lunch and summer food program participation, and access to a food pantry. As at

baseline, Cooking Matters participants had fewer children (mean: 0.9 versus 1.6; p < 0.0001), were more

likely to be female (90.1 percent versus 79.8 percent, p=0.0002), and more likely to participate in the

school supper and Head Start programs. Cooking Matters participants were also less likely to be Hispanic

(18.7 versus 27.3 percent; p=0.0289), less likely to participate in WIC (16.5 versus 25.2 percent;

p=0.0067), and less likely to have household incomes below 100 percent of the Federal poverty level

(51.4 percent versus 66.1 percent; p = 0.0261).

6-Months Post-Course: Intermediate Outcomes


Six months after completion of the Cooking Matters program, participants maintained the positive gains

made with regard to cooking confidence and barriers, after controlling for a comparison group and

28

demographic factors including age, gender, race, ethnicity, and poverty status. More specifically,

program participants saw a 0.38-point increase in their cooking confidence scale scores at six months

post-course completion relative to baseline (4.33 versus 3.95, respectively; p<0.0001), moving from

“somewhat confident” about their cooking skills to “very confident.” When examining change over time

for Cooking Matters SNAP participants and the Share our Strength target population, similar results

were found. Controlling for the comparison group and change over time, Cooking Matters SNAP

participants saw an increase of 0.36 (4.02 to 4.38; p < 0.0055), and women in the target population saw

an increase of 0.43 (3.99 to 4.42; p = 0.00169) (Appendix Tables D-1 and D-2).

Participation in the course was associated with a 0.26 decrease in perceived cooking barriers (2.46

versus 2.20, respectively; p < 0.0001), indicating that Cooking Matters participants agreed less with the

notion that cooking is frustrating and it takes too much time and work after completing the course. The

decline in cooking barriers was also seen among Cooking Matters SNAP participants who saw a 0.23-

point decrease (2.41 to 2.18; p = 0.0061) and the Share our Strength target population who saw a 0.40-

point decrease (2.63 to 2.23; p = 0.00015).

Dietary choices

Cooking Matters participants appear to be making healthier dietary choices after completion of the

course. On five of six measures related to dietary choices, Cooking Matters participants showed

statistically significant increases from baseline to 6 months post-course (Appendix Tables D-3 through D-

8). More specifically, Cooking Matters participants increased the frequency with which they chose whole

grain options by 8 percent, increasing from 3.67 to 3.98 on average from baseline to 6 months post-

course (p < 0.0001). Similarly, Cooking Matters participants increased the frequency with which they

choose low-fat dairy products (e.g., yogurt, cheese) by 8 percent, from 3.27 to 3.54 on a 5-point scale

(p = 0.0001), moving closer to “often” choosing low-fat dairy options (Figure 10). Cooking Matters

participants also increased the frequency with which they choose lean-protein by 8 percent, from 3.79

to 4.08 on a 5-point scale (p < 0.0001), moving closer to “often” choosing lean-protein options. Cooking

Matters participants increased the frequency with which they choose low-sodium by 11 percent, from

3.15 to 3.51 on a 5-point scale (p < 0.0001), moving closer to “often” choosing low-sodium options.

29

Figure 10. Mean changes in dietary choices from baseline to 6 months post-course, all participants, adjusted for age, gender, race, ethnicity, and poverty status

*p < 0.01. **p < 0.001. †p < 0.0001 1=Never, 2=Rarely, 3=Sometimes, 4=Often, and 5=Always

Cooking Matters SNAP participants also saw significant improvements in making healthier dietary

choices after adjustment for a comparison group and demographic factors. Most notably, SNAP

participants saw a 11.4 percent improvement in choosing low-sodium options (3.15 to 3.51), while the

comparison group saw a 2.7 percent decrease from baseline to 6 months post (3.23 to 3.14). SNAP

participants also saw a large gain (11.7 percent) in choosing healthier options at restaurants (2.98 to

3.33; p = 0.0002) and choosing low-fat dairy options (3.27 to 3.54, an 8.2 percent increase; p = 0.0082),

associated with participation in the program after adjusting for a comparison group and demographic

characteristics.

Cooking Matters women in the target population also saw improvements with regard to dietary choices

at 6 months post-course compared to those in the comparison group. Women increased the frequency

with which they chose healthier foods at restaurants by 19 percent (from 2.91 to 3.46; p = 0.0103),

chose low-fat dairy options by 17 percent (from 3.23 to 3.79; p = 0.0049), and chose low-sodium options

by 17 percent (from 3.11 to 3.64; p = 0.0421). This means the Cooking Matters target population went

from “sometimes” to “often” choosing healthier choices like low-fat dairy and low-sodium comparing

baseline to 6-months post course.

3.05

3.81

3.14

3.70

3.33

3.54

3.14

3.89

3.23

3.79

3.52

3.42

3.33

4.08

3.51

3.98

3.54

3.62

2.98

3.79

3.15

3.67

3.27

3.33

1.00 2.00 3.00 4.00 5.00

Healthy Food at Restaurants**

Lean Protein Options**

Low-sodium Options*

Whole Grain Options†

Low-fat Dairy Options**

Low-fat Milk Options

Cooking Matters - BL Cooking Matters - 6 MO Comparison - BL Comparison - 6 MO

30

6-Months Post-Course: Long-Term Outcomes

Dietary patterns

Six months after taking the Cooking Matters course, participants responding to the survey maintained

improvements in dietary behaviors and patterns compared to the comparison group and after

adjustment for demographic factors. Figure 11 shows changes in dietary patterns for consumption of

foods. Cooking Matters participants showed statistically significant increases compared to comparison

subjects in reported consumption of beans, green salad, and non-fried vegetables and significantly

reduced consumption of fried potatoes. When each of the individual measures of vegetable

consumption were combined into a single measure, the results were also significant, demonstrating a

4.6% increase by 6 months (p=0.0004). At 6 months post-course, Cooking Matters participants increased

bean consumption from 2.37 to 2.53 on average, which reflects a 7 percent increase associated with

participation in the program (p = 0.0008). Cooking Matters participants saw a similar increase with

regard to green salad, which increased from 2.82 to 2.97, nearing an average response of almost “more

than once a week” and representing an average increase of about 5 percent over baseline reports

(p = 0.0270). Cooking Matters participants also increased non-fried vegetable consumption from 3.17 at

baseline to 3.36 at 6-month post-course, representing an average increase of about 6 percent

(p = 0.0270).

Figure 11. Mean changes in dietary patterns from baseline to 6 months post-course, all participants, adjusted for age, gender, race, ethnicity, and poverty status

*p < 0.05. †p < 0.001.

2.95

2.41

3.33

2.15

2.98

2.50

3.35

2.20

2.97

2.53

3.36

2.02

2.82

2.37

3.17

2.24

0.00 1.00 2.00 3.00 4.00 5.00

How often eat green salad*

How often eat beans†

How often eat non-fried vegetables**

How often eat french fries or fried potatoes*


31

Cooking Matters participants did not maintain gains reported from baseline to course completion with

regard to consumption of fruit, non-fried potatoes, meals from restaurants, sugar-sweetened beverages,

or water. Participants did, however, see an increase in 100 percent fruit juice consumption from

baseline to 6 months post-course (from 2.42 to 2.62; p = 0.0049).

Examined separately, SNAP participants also saw statistically significant improvements in dietary

patterns over the comparison group with regard to beans (2.32 to 2.50, an 8 percent increase;

p = 0.0003) and 100 percent fruit juice (2.50 to 2.87, a 15 percent increase; p = 0.003). Women in the

target population did not exhibit significant improvements over the comparison group with regard to

their dietary patterns. See Appendix Tables D-9 to D-18 for complete model specifications for dietary

patterns measures.

Food preparation

Cooking Matters participants showed significant improvement from baseline to 6 months post-course

on the healthy food preparation scale overall relative to comparison subjects, increasing from an

average response of 3.63 on a 5-point scale to 3.95 (p < 0.0001). This indicates that Cooking Matters

participants were increasingly using strategies to prepare healthier low-cost meals. SNAP participants

and women in the Share our Strength target population saw a similar improvement on the healthy food

preparation scale (Figure 12).

Figure 12. Mean changes in healthy food preparation behaviors from baseline to 6 months post-course, overall and by subgroup, adjusted for age, gender, race, ethnicity, and poverty status

Note: The scale is based on an average of eight items. Responses range from 0 to 5.*p < 0.001; †p < 0.0001.

With regard to the number of meals cooked at home in the previous 7 days, overall participants

increased from baseline (5.15 meals per week) to 6 months post-course (5.51 meals per week), but this

7% increase was not significant relative to the comparison group who also increased their number of

meals cooked during this time. A significant increase was not seen in the target population when

examined separately; however, SNAP participants did see a significant increase of 10 percent in the

3.58 3.63 3.63

4.02 3.97 3.953.79 3.66 3.793.74 3.66 3.76

0.00

1.00

2.00

3.00

4.00

5.00

Target Population† SNAP Participants* Total†


32

average number of meals cooked at home per week relative to the comparison group (5.05 to 5.57;

p=0.029).


Similar to the change seen at 3 months, Cooking Matters participants significantly increased their food

resource management behaviors from baseline to 6 months as compared to the comparison group,

charting a 5% increase in their overall score on the alternate scale (3.82 to 4.01). Results were similar

when using the original food resource management scale for measurement. This shows that even 6-

months post-course, Cooking Matters participants increased how often they compared prices before

buying food, planned meals ahead of time, and used a grocery list when shopping.

There was a significant increase in all factors related to self-efficacy in food resource management in the

Cooking Matters population compared to the comparison group after 6 months post-intervention after

adjustment for demographic factors. The most notable changes were in confidence to make low-cost

meals and to buy healthy food on a budget (Figure 13). Findings were similar among SNAP participants

but were not significant for Share our Strength target participants.

Figure 13. Mean changes in self efficacy for food resource management from baseline to 6 months post-course, overall and by subgroup, adjusted for age, gender, race, ethnicity, and poverty status (for total only)

*p < 0.05. †p < 0.01. ‡p < 0.001.

3.85

3.42

3.99

3.11

3.98

4.03

3.82

3.43

3.93

3.24

3.96

4.00

4.16

3.88

4.28

2.65

4.01

4.03

3.66

3.35

3.65

3.01

3.82

3.82

1.00 2.00 3.00 4.00 5.00

Confident that can buy healthy food on

a budget‡

Confident can make food money last all

month‡

Confident can make low-cost meals‡

Worry that foodmight run out*

Alternate food resource

management scale†

Food resource management†


33

Food Security

Six months after completion of Cooking Matters, course participants were not significantly more likely to

be food secure based on the USDA six-item measure than the comparison group; however, they did

show some movement in this direction (parameter estimate of 0.37; p= 0.1996). Similarly, Cooking

Matters target and SNAP participants were not significantly more likely to be food secure than the

comparison group 6 months after taking Cooking Matters. One possible explanation for this may be that

the Cooking Matters participants were already 43% more likely to be food secure relative to the

comparison group (p<0.0001) at the 6-month time point. Also, influence to food security generally

requires more time for measurement, as the measure itself requires respondents to assess each aspect

of food security from their standpoint “within the last 12 months,” which means that ideally

measurement would take place over a year or more to see improvements.

While significant improvements were not seen in food security status at 6 months after taking Cooking

Matters, participants did demonstrate a 16% increase in their confidence to make food money last all

month relative to the comparison group (3.35 to 3.88; p < 0.001). Cooking Matters participant also

experienced a significant 12% decrease in how often they worry that food might run out when

comparing baseline to 6-months post-course (3.01 to 2.65, p < 0.05).

34

IV. Qualitative Findings from Focus Groups and Interviews

A. Participant Characteristics Five focus groups and eight in-depth interviews were conducted with Cooking Matters program

participants completing courses held in Colorado, Maine, and Michigan during October–December 2014.

In-depth interviews were conducted in Spanish among Colorado participants only. Focus groups were

held at select locations nearby course participants between January and March 2015 (approximately 3–6

months after respondent participation in the course). In total, there were 8 interview participants and

38 focus group participants, including 8 from Colorado, 4 from Maine, and 26 from Michigan.

Participants provided demographic characteristics (gender, age, race/ethnicity, education level, and

number of children living in household, and participation in supplemental food programs) when

participating in a focus group or interview. Overall, nearly all participants were women (96%) with an

average age of 56 years old. The majority of participants were White (51%) or African American (42%)

and 5% reported being of Hispanic or Latino background. Focus group participants had a relatively high

level of education compared to the Cooking Matters study population, as more than three-quarters

reported that they had completed a four-year college degree (41%) or some college (44%); the

remainder had completed a two-year college degree (7%), or a high school education or less (8%) (Figure

14).

Figure 14. Educational background of focus group and interview participants

Less than one-fifth of participants reported having young children ages 0–5 living in their household

(15%) and a similar percentage (16%) reported having on children ages 6-17 in their household.

4%4%

44%

7%

41%

Less than a high schooldegree

High school degree orGED

Some college but havenot graduated

Two-year college degree

Four-year college degree

35

Participants were asked whether they or any household members participate in food assistance

programs (currently or in the last year) and more than one-quarter said they receive SNAP currently or

received it in the last year. The other food programs had less than 15% of respondents participating

currently or within the last year (Figure 15).

Figure 15. Supplemental food program participation among focus group and interview participants

B. Program Access

Recruitment into the Class

In order to gain a better understanding of participants’ experience with the Cooking Matters program, it

is first important to understand how they gained access to the program and their motivations for

participating. When asked how they first heard about Cooking Matters, participants provided a variety

of responses (within and across partner organizations) but most frequently mentioned seeing

information about the program advertised at local program sites or other community locations (e.g.,

recreation center, library, church, food matrix center), hearing about the classes from friends or family

members familiar with the program, or hearing about it from the doctor or at parent meetings at their

child’s school.

Reasons for Participating

When asked why they signed up for the Cooking Matters

classes, respondents most often referenced a desire to learn

the basics of how to cook or how to do so in healthier ways

(e.g., using less butter and fat). A few Michigan respondents

cited diabetes as health issues in their family and said that

they took the class to help improve the diets of themselves

or family members with the disease. Furthermore, some said that they wanted to learn how to cook on

a budget or for fewer people (e.g., those who no longer cook for a large family). A few said that they

0%

20%

40%

60%

80%

100%

120%

Now

In the last year

Neither

“I didn’t want to be committed that

long, but [it] went by fast…. It wasn’t

long enough once we got started. I

was like, ‘Wow!’”

—Michigan focus group participant

36

were encouraged to participate by the fact that they were receiving groceries and could take home and

practice what they learned. The only uncertainties cited with regard to participation were related to the

length of the course and the ability to commit to participating for several consecutive weeks; however,

this did not seem to deter participants from signing up for and completing the class.

C. Perceptions of Cooking Matters

Favorite Aspects of the Program

During focus groups and interviews, Cooking Matters participants were asked about their favorite parts

of the program. Respondents cited a variety of program components that they enjoyed, including

learning how to substitute new ingredients (e.g., using soy sauce instead of salt), experimenting with

new foods (e.g., trying new vegetables in a dish), taking

the shopping tour and learning how to read labels, and

acquiring better knife skills. Some respondents

described the grocery store tour as “an adventure” and

described fun activities from their class, such as an

impromptu cooking session, where they had to cook a

meal within so many minutes, or surprising

demonstrations of how much sugar is in certain foods.

Receipt and Use of Program Materials

Nearly all respondents reported receiving the recipe books and groceries as part of their Cooking

Matters course. Most participants had tried at least one of the recipes at home and cited the following

as some of their favorites:

Jambalaya, Chicken dishes (with dumplings or apples and

raisins), Egg burrito, Salmon croquettes, Homemade soup, and Chocolate cake.

Many participants noted that they used the groceries. Several said they wished that they had sent home

more groceries or spices for seasoning the dishes that they learned how to make in class, since some did

not have these in their kitchen cupboard. About half of respondents said that they continued to buy

some of the same foods that were sent home, depending on whether or not their families liked the

recipes. Some noted that some of the foods that were sent home were not available at their local store

or were too expensive.

“The part that I enjoyed was [learning]

that you can use ingredients you wouldn’t

normally think about, and once you put it

in, you can’t tell it’s there. [It’s nice to] use

something other than what you are

accustomed to and still have a good meal.”


“It was appreciated that we got the

groceries, but it wasn’t complete. We

didn’t have spices or oil. You can assume

some have this at home, but it’s an

additional expense. That was an issue for

me.”


37

Usefulness of the Information

Most participants said that they use the information

from Cooking Matters when they fix meals at home; in

particular, they cited certain techniques that were

especially useful such as how to cook brown rice, baking

instead of frying, and substituting healthier options for

unhealthy ones (e.g., Greek yogurt for sour cream,

whole-grain bread instead of white bread). Overall,

participants varied on what they found to be most useful

but said that taking the class has changed the way in

which they cook. A few found the course too basic,

saying that they knew most of what was taught already.

D. Impact of Cooking Matters

General Perceptions of Cooking

When asked whether they cook at home, the

majority of respondents indicated that they did. In

thinking about whether the course changed how

confident they feel about cooking, respondents had

mixed feedback. Several said they felt ‘more

adventurous’ or ‘creative’ in the kitchen and more

comfortable experimenting with new or unfamiliar

ingredients. Many respondents also used the word

‘fun’ when describing how they feel about cooking,

suggesting that they have a more positive

perspective of it than they did prior to taking the

course. A few Maine respondents said their

viewpoint of cooking has not changed.

Most respondents mentioned several new cooking concepts or skills learned as a result of participating

in Cooking Matters. Some examples of skills they mentioned

include new cutting techniques, steps to prepare for cooking

(e.g., putting out all the ingredients first), incorporating

leftover ingredients into subsequent meals, substituting

healthier ingredients (e.g., using oil instead of lard), and

food safety (e.g., how to properly thaw and wash chicken).

In thinking about cooking homemade meals or meals from

scratch, several participants said that this is still a challenge

to do, primarily because time is an issue. Some said the

“I use ground turkey [for tacos], but

instead of using a taco mix in an

envelope—what I usually would have

done—I used my own spices. I looked at a

Cooking Matters recipe, and I looked

online. My husband was a little leery, but

after we [ate] them, he said, ‘This is really

good.’”


“I’ve been told repeatedly about kale,

spinach, and blueberries and all the things

that are good for you to put in [smoothies].

And they used kale, I think, every week. I

would never have put kale in something I had

to taste…I’m a believer now. Without that, I

never would have bought a bag of kale and

add[ed] it to this or that.”

-- Maine focus group participant

“The chef took an entire potato and

just cut a small piece off the bottom

so the potato would lay there just

[and be] sturdy. I said ‘I’ve never done

that before. How many of us had

thought of that before?’”

-- Maine focus group

participant

38

course helped them learn techniques for making homemade meals such as how to season certain foods

using ingredients at home (e.g., replacing taco seasoning with spices from the pantry) and how to

preserve and reuse leftovers later.

Food Resource Management

Several respondents indicated that they did not plan meals ahead of time prior to taking the course for

reasons related to: living alone, not having enough time, or letting whatever is on sale dictate what they

purchase and consume. After taking the course, many acknowledged that they still struggled in planning

ahead for going to the grocery store but expressed increased confidence in looking at store flyers prior

to shopping and in preparing and following a shopping list while in the store.

When asked what they learned about grocery shopping for

healthy foods, many participants mentioned looking at the

ingredients in foods more closely (e.g., for sodium and sugar

content), selecting more whole grains, and a willingness to

look at and select certain foods that they might have ignored

previously (e.g., certain vegetables in the produce

department). In terms of being budget conscious and using

money-saving tips, some Michigan participants said they

learned to look at unit pricing for the better deal, the

importance of shopping seasonally, and to select foods from the bottom shelves for lower prices.

Healthy Eating

When asked whether they eat or cook different foods as a result of participating in Cooking Matters,

respondents mentioned several foods that they either

added or used as a substitute for some unhealthy they were

eating; some examples include substituting Greek yogurt for

sour cream, adding or mixing in more vegetables into meals,

using lower sugar substitutes such as honey, and replacing

regular pasta with whole wheat pasta. Some were surprised

by their ability to make healthy changes and that they didn’t

desire the same foods they used to; for example, one

woman said: “I don’t want the sweets anymore. I use more

seasoning and gradually left the sweets alone. I just turned down a red velvet cupcake and my sisters

said ‘You’re no fun anymore.’ I make a cake and only had one slice. I shocked myself!”

“[I’m now] walking into the vegetable

department and actually looking

instead of saying ‘I’m not going to

touch that.’ There are a lot of good

things out there.”

- Maine focus group participant

“I look at the ingredients now [and

say], ‘Oh I can’t get this! This has too

much sodium….that’s too much sugar

[or] too [many] carbs.’ Diabetes runs

in our family.”

- Michigan focus group participant

39

A few said they encountered challenges making healthier changes because it took them time and

rethinking to develop the new habit or their families were resistant to the change. Although they

wanted to make changes in their diets, some reluctantly resorted to cooking unhealthy options or

maintaining larger portion sizes for meals to accommodate

certain family members’ preferences.

During focus groups and interviews, parents with children

under 18 were asked specific questions about changes in

their meal and snack planning for children at home. After

taking Cooking Matters, a few parents said they have

involved their children more in doing the cooking and

noted that as a result, they are more eager to try the food

after helping to prepare it. Parents also mentioned the

techniques they learned in class about seasoning fruits and

vegetables or adding sauces when cooking and how those

were helpful in getting their children to incorporate these foods into their snacks and meals.

E. Recommendations for Improvement

Focus group and interview respondents were asked how the Cooking Matters could be improved, in

terms of how it is administered and how it could better help participants incorporate meal preparation

and cooking skills into daily life. With regard to implementation, many respondents indicated that their

classes were held in facilities without kitchens or other

equipment for cooking and had to improvise when cooking

(e.g., made a cake in the microwave). Other respondents

described classrooms with limited countertop space or

places to prepare food; in these scenarios, they mentioned

having to take turns waiting for others to finish. For this

reason, several respondents said that classes could be

improved if they were held in locations with more space and

better cooking equipment (e.g., ovens, knives) and kitchen

facilities (e.g., home economics classrooms).

Many respondents liked the class so much that they

suggested offering the program for a longer duration or a

more advanced course for those who wanted to continue

practicing their cooking skills or learn about other cooking

skills and topics. Some said that their questions during

class were often left unaddressed for the sake of time and

a result, felt that the class duration or 6-week format was

too condensed. Similarly, others said their class often ran

up to 30 minutes over the allotted time. For these reasons,

“A home ec room is the perfect place.

You would think that would be

available everywhere. Don’t all

schools have home ec? Maybe it’s

important to find those places that

have those types of kitchen facilities

to use.”

—Maine focus group participant

“My daughter was not big on fruits and

vegetables [so] we talked about making

them taste better. One tip was to buy

McCormick pepper and garlic. I cut up

apples with peanut butter [and] that

has been a lifesaver. She’ll eat every

apple now. [It] absolutely has helped to

get [my] kids to eat healthier.”


“We ran over the time often [going]

20-30 minutes late most nights. An

additional week or secondary course

would be beneficial. The program itself

was fantastic. I would have signed up

for life if they would [have] let me.”


40

participants suggested that classes be extended 30 minutes or that more classes be offered as part of a

course.

In terms of teaching style and class administration, some of those who attended classes held in both

English and Spanish felt that the class lasted unnecessarily long due to the translation in both languages.

In these cases, the Spanish speakers were always a step behind the rest of the class and struggled to

keep up. They suggested holding classes for Spanish speakers separately so that they get the full benefit

of the learning experience.

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V. Limitations

While Share our Strength and the study team designed a rigorous quasi-experimental design, there were

some limitations in collection of both qualitative and quantitative data. While not directly measured, if

the size of the program might influence success, then this could influence the generalizability of the

study findings. This purposeful selection, however, has benefits that far outweigh this limitation.

Specifically, large established programs are more likely to be ready for an impact evaluation and reflect

the true outcomes of participation in the program, unaffected by challenges that may arise when

program logistics or other issues are still being worked out.

Furthermore, the qualitative findings were limited by a small sample size, with fewer than 30

respondents representing each study state. Given the constraints in sample size, the qualitative findings

have limited generalizability across all CMA stakeholders and the program experience on a national

scale. Further study of this program that uses qualitative methods should include a broader sample of

program partners and respondents when conducting focus groups or in-depth interviews.

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VI. Conclusions and Discussion

The Cooking Matters program teaches participants to shop smarter, use nutrition information to make

healthier choices and cook delicious, affordable meals. This study sought to measure achievement of

these objectives and the overarching evidence suggests that the program is having an impact consistent

with its goals, as many key measures of meal preparation, resource management, and eating behaviors

significantly increased both in the short term and long term after participation. The study findings also

suggest that the program is having measurable impacts on certain sub-populations including SNAP

participants and mothers with young children, including pregnant women. In addition, many Cooking

Matters participants expressed a high degree of satisfaction with the program, which is important for

program sustainability. This section discusses some of the key findings, in the context of the study

research questions, and provides some explanations for outcomes.

Number of meals cooked at home increased from baseline among all Cooking Matters

participants and were maintained 3 months later.

National estimates indicate that adults cook 5 dinners at home per week, on average7, which is where

the study population started at baseline. By 3 months post-course, Cooking Matters participants had

significantly increased the number of dinners cooked at home relative to the comparison group (by 6%;

going from 5.18 to 5.47 times per week) but significant improvements were not sustained at 6-months

relative to this comparison group. While number of dinners cooked at home is certainly moving in the

right direction (at 5.51 times per week), there is still more work to be done beyond teaching cooking

skills to make this kind of a cultural shift. Similarly, focus group and interview respondents expressed

continued challenges finding time to make homemade meals post-course. The ability to cook meals at

home is greatly impacted by schedules, family, and other commitments and factors. Further research is

needed regarding how Cooking Matters could increase the frequency of cooking dinner at home. For

future program studies, Share our Strength may consider exploring other influences on cooking at home

that may be impacted by the program.

Healthy food preparation scale scores increased among Cooking Matters and were

maintained at 6 months after the course.

Eight healthy food preparation confidence measures and behaviors were assessed, including for

example: adjusting meals to make them healthier, making meals from scratch using basic whole

ingredients, and confidence in using the same healthy ingredient in more than one meal. Cooking

Matters participants showed significant improvement from baseline to 3 and 6 months post-course in

their healthy food preparation scores relative to comparison subjects, increasing from an average

response of 3.63 at baseline to 3.95 (p < 0.0001) at 6-months post course. This suggests hat not

7 Virudachalam, Long, Harhay, Polsky, Feudtner.Prevalence and patterns of cooking dinner at home in the USA: National Health and Nutrition Examination Survey (NHANES) 2007-2008. Public Health Nutr. 2014 May;17(5):1022-30. Epub 2013 Oct 10.

43

One potential explanation for improvements in healthy meal preparation is the provision of groceries to

Cooking Matters participants after their class. The grocery bags contain healthy items that enable

participants to practice the concepts they learned in class at home and to try food or ingredients they

may not have otherwise purchased on their own at the store. This is an indirect way of reinforcing and

supporting learned behaviors taught in the course, including adjusting meals to make them more

healthy which is a component of the healthy food preparation measure.

Participants were more frequently choosing healthy foods (e.g., whole grains, low-fat dairy

products, low-sodium options) 6-months after completing Cooking Matters.

Cooking Matters participants report making healthier dietary choices after completion of the course. On

all six measures of dietary choices, Cooking Matters participants showed statistically significant

improvements from baseline to immediately post-course and 3 months post-course. At six months, they

retained these changes for five of the six measures of dietary choice (all except for choosing low-fat

milk). For instance, Cooking Matters participants increased the frequency with which they chose whole

grain options by 8 percent, increasing from 3.67 to 3.98 on average from baseline to 6 months post-

course (p < 0.0001). Research has shown that increased whole grain consumption is associated with

better weight control8 and reduced risk of type 2 diabetes and cardiovascular diseases9. Results of this

study suggest that participation in the Cooking Matters program may be associated with reduced risk for

certain chronic conditions, given that course participation results in increased whole grain consumption.

Cooking Matters participants increased the frequency with which they choose low-fat dairy products

(e.g., yogurt, cheese) by 9 percent, from 3.27 to 3.55 on a 5-point scale (p = 0.0001), moving closer to

“often” choosing low-fat dairy options. Similar improvements were seen for the selection of low sodium

options with an increase of 11% and lean protein options with an increase of 8% (p < 0.0001).

These changes may likely be explained by the inclusion of a weekly nutrition lesson as part of the

Cooking Matters course and as a result, the reiteration of how to make healthy food selection concepts

throughout the course. More specifically, each lesson highlights key nutrition concepts such as selection

of whole grains versus processed grains and a demonstration or activity in class to reiterate the concept.

Similarly, grocery store tours taken as part of the course emphasize shopping skills that promote healthy

food selection, such as reading ingredient lists and food labels to identify whole grains or low-sodium

options.

Participants made improvements in their fruit and vegetable consumption over time as result

of Cooking Matters course participation.

Findings from the study indicate that fruit, green salad and non-fried vegetable consumption increased

as a result of participation in Cooking Matters and that this was maintained at 3 months post-course

completion. Even more noteworthy, Cooking Matters participants sustained an increase in green salad

8 Simin Liu, Walter C Willett, JoAnn E Manson, Frank B Hu, Bernard Rosner, and Graham Colditz.(2003). Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women. Am J Clin Nutr: vol. 78 no. 5 920-927. 9 Eva Qing Ye, Sara A. Chacko, Elizabeth L. Chou, Matthew Kugizaki, and Simin Liu. (2012). Greater Whole-Grain Intake Is Associated with Lower Risk of Type 2 Diabetes, Cardiovascular Disease, and Weight Gain. Nutr. vol. 142. no. 7 1304-1313.

44

and non-fried vegetable consumption at 6 months post-course. Participants may be nearer to meeting

recommended consumption of fruits and vegetables daily as a result of taking the course, compared to

the comparison group (although consumption was not measured in a way to approximate the meeting

of recommendations). The study findings suggest that the program is not only improving meal

preparation skills but that the nutrition lessons are translating to healthier food selection and

consumption. Several scientific studies have demonstrated a link between increased consumption of

fruit and vegetables with reduced risk of obesity and chronic disease, in particular, type 2 diabetes and

heart disease10. Based on this information and the improved fruit and vegetable consumption findings of

this study, this suggests that participation in Cooking Matters may result in improved health outcomes.

One possible explanation for Cooking Matters participants’ increased vegetable consumption post-

course may be participants’ significant reduction in consumption of fried potatoes from baseline to 6

months (i.e., participants were consuming healthier vegetables instead). Another explanation for the

change may be the course’s hands-on emphasis on cooking with fruits and vegetables (at nearly every

class) and on incorporating them into meals. This was described as a key takeaway by many focus group

and interview respondents who had participated in Cooking Matters courses representing different

implementing partners.

Participant attitudes towards cooking shifted positively after taking Cooking Matters and

these changes were sustained at 6 months post-course.

Attitudes towards cooking were measured in two key ways: by assessing cooking confidence (using basic

cooking skills, buying and cooking healthy foods on a budget, and helping their family eat more

healthily) and perceived barriers to cooking (whether it takes too much time, is frustrating, and is too

much work). Cooking Matters participants showed greater cooking confidence and reduced cooking

barriers from baseline to course-completion and at 3 and 6 months after course completion. More

specifically, program participants saw a nearly 10% increase in their cooking confidence scale scores at 6

months post-course completion relative to baseline and a nearly 11 percent decrease in perceived

cooking barriers during this time (p < 0.0001). Similar results were found when examining change over

time for SNAP participants and the Share our Strength target population of women with young children.

These findings suggest that course participants’ attitudes toward cooking shifted positively after taking

the course, including for both subgroups. Possible explanations for these results are the hands-on

nature of the course and the exposure to cooking skills throughout each class. The provision of groceries

after each class also likely solidifies the cooking skills taught in class by encouraging participants to

practice what they learned.

Participants were significantly more confident in food resource management skills and

increased their food resource management behaviors 6-months after completing the Cooking

Matters course.

10 Lydia A. Bazzano, MD, PHD1, Tricia Y. Li, MD, MS2, Kamudi J. Joshipura, and Frank B. Hu,Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women.

45

Cooking Matters participants made significant improvements during and after the course related to

managing food resources. Cooking Matters participants significantly increased their use of food

resource management strategies from baseline to immediate post-course and even 3 and 6 months

later, including comparing prices when buying food, planning meals ahead of time, and using a grocery

list when shopping. By six months post-course, Cooking Matters participants were less worried that

food might run out before they had money to buy more, shifting from “sometimes” worried to “rarely”

worried (3.01 to 2.65; p < 0.05). For all follow-up survey periods (immediately post-course, 3-months

post, and 6 months post), participants had significantly greater self-efficacy in being able to buy healthy

foods on a budget, make their food money last all month, and make low-cost meals. SNAP participants

maintained similar improvements at 6 months post-course; however, target audience participants

(women with young kids) retained food resource management self-efficacy until 3 months post-course.

One possible explanation for the improvement in food resource management and self-efficacy over time

is the course’s emphasis on how to shop for healthy food on a budget (e.g., comparing unit prices).

Cooking Matters courses include a tour of the grocery store during one of the six lessons, which provides

participants with real, hands-on exposure to observe and practice the money-saving tips they have

learned. Several focus group and interview participants discussed their trip to the store as being

influential and mentioned using the money saving and other shopping skills several months post-course.

While there were mixed results within subgroups, there were some significant gains in

healthy eating, healthy food preparation, and food resource management.

Two important groups for Cooking Matters are mothers with young children (including pregnant

women) and SNAP recipients. Women with young children in the Cooking Matters group saw fewer

statistically significant increases in dietary choices from baseline to immediate post-course completion

and at 3-months and 6-months as compared to the Cooking Matters population. Interestingly, while

there was no change in choosing whole grain options, these women reported choosing whole grains

“often,” prior to the classes, which is slightly higher than the overall Cooking Matters population. A

“ceiling effect” may account for the lack of statistically significant changes among this population. In

regards to dietary patterns, women in the target audience participating in Cooking Matters had

significant increases in fruit consumption and non-fried vegetable consumption from baseline to

immediate post-course and at 3-months post-course, but not at 6-months. However, women with

young children did make significant gains in choosing low-fat dairy products and low-sodium options

from baseline to 6 months and these gains were greater than those made by the overall Cooking

Matters participant population. Women in the target population saw improvements on the healthy food

preparation scale and on food resource management similar to the overall Cooking Matters participant

population.

SNAP recipients in the Cooking Matters group were more likely to see improvements similar in

magnitude and statistical significance as the overall Cooking Matters population including selection of

lean protein options, low-sodium options, and low-fat dairy products. SNAP participants made no

changes with regard to low-fat milk products, whole grain options, and choosing healthy foods at

restaurants. In addition, SNAP participants had nearly identical dietary behavior changes as the overall

46

Cooking Matters population, with significant increases in consumption of fruit, green salad, and bean

consumption and decreases in eating fried potatoes and meals from restaurants. SNAP participants saw

improvements on the healthy food preparation scale and on food resource management similar to the

overall Cooking Matters population.

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VII. Recommendations for Program Implementation

Since its beginning in 1993, Share Our Strength’s Cooking Matters program has steadily expanded to

reach more than 369,000 low-income families. With this expansion and reach, it is important to

understand the program’s impact in terms of the knowledge and attitudes participants are learning and

adopting in their daily lives. The goal of this evaluation was to assess the extent to which knowledge and

attitudes were improved during the course of the program and whether behavior changes resulting

from the program were maintained over time. Findings from this study suggest that the program’s

desired short- and immediate-term outcomes are being achieved in several key areas but there may be

some areas where the program can seek to have a greater impact or improved implementation. In this

section, Altarum describes some recommendations for Share our Strength to consider in its continued

program implementation efforts. All recommendations were identified by program participants or

Altarum staff through information gathered as part of this evaluation.

Find ways to encourage full program attendance among mothers and parents of young

children.

Attendance findings from the study indicate that the target population generally had lower attendance

than others, which may be one of the reasons why this population exhibited fewer significant efficacy

and behavior changes relative to a comparison group of moms with kids and the Cooking Matters

intervention group as a whole. Mothers of young children are typically balancing several competing

priorities and may find it difficult to attend a full 6-week course. As a result, more flexible course times

and formats may need to be offered in order to reach this group. It is also recommended that further

program and research efforts explore how best to reach mothers of young children and encourage their

continued participation in the program.

Factors that influence cooking meals at home should be further explored to determine how

improvements can be made in this area.

Findings from this study suggest that there is still more work to be done beyond teaching cooking skills

to encourage and support the cooking of meals (particularly dinner) at home. Further exploration is

needed regarding how Cooking Matters could increase the frequency of cooking dinner at home. For

future program studies, Share our Strength may consider using baseline data from the study to further

compare the findings to national estimates of meals cooked at home. This may help Share our Strength

identify specific subgroups of participants that could use additional skills to increase the number of

meals cooked at home, inform subsequent research efforts regarding barriers to cooking at home, and

finally provide Share our Strength with an action plan to increase cooking meals at home.

Consider options to offer supplemental or advanced opportunities for continued

development of cooking skills.

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Through this study, a number of participants indicated a desire to continue participating in Cooking

Matters, either through advanced or refresher opportunities, as many felt they were just becoming

confident in their meal preparation skills when the class was ending. In order to better ensure that

participants are sufficiently adopting skills for long-term incorporation into their meal preparation and

eating habits, it is recommended that Share our Strength consider supplemental opportunities for

continued practice or more advanced learning.

Identify options to administer courses in settings with better cooking facilities.

Feedback from focus group and interviews suggest that some Cooking Matters classes need more

equipment and space. Respondents discussed challenges related to cooking in classrooms without a

kitchen, counter space, or equipment and that they often had to improvise when cooking (e.g., taking

turns or cooking in a microwave). This suggests that participants are not practicing their skills in an

environment that is similar to what they would have at home and may inhibit some gains that

participants could be making in improving their cooking skills. For this reason, it is recommended that

Share our Strength encourage partners to take a closer look at course site kitchen facilities and capacity

to accommodate typical class sizes.

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