This document summarizes the development of a survey tool called Project ATHENA that assesses teacher health and nutrition attitudes and knowledge. It describes creating survey themes and questions, testing the survey in two waves with the general public and teachers, analyzing results, and revising the survey based on feedback. Key findings include teachers having moderate nutrition knowledge but room for improving health behaviors through additional wellness program support and accountability.

1. Project ATHENA
Common Threads
LAURA RUIZ | RESEARCH & DEVELOPMENT INTERN
MPH EPIDEMIOLOGY CANDIDATE | TEXAS A&M UNIVERSITY
DECEMBER 5, 2016

2. Introduction
• Grew up in Amarillo, TX
• Graduated with a B.S. in Health Education and Promotion from
Oklahoma State University
• Currently work at the Texas Department of State Health Services in
the Newborn Screening Unit
• Will graduate December 16 with a MPH in Epidemiology from Texas
A&M University
• Internship with Common Threads is a part of requirements to
graduate

3. Project ATHENA
• Assessment of Teacher HEalth and Nutrition Attitudes
• Purpose is to assess baseline health and nutrition awareness among
elementary and middle school teachers in the US
• Development of in-depth survey tool
• Includes testing survey for validity and reliability

4. Survey Development
• Review of published literature
• Few studies found looking at teacher health and nutrition
• Gaps in knowledge of health practices among teachers along with their
thoughts and attitudes of their students’ health

5. Survey Development
• Creation of six themes for questions that will be on the survey
• Nutrition Knowledge
• Teaching Efficacy
• Attitudes & Practices
• Perceived Health of Students
• Role Modeling
• Demographics
• Numerous sub-themes were also created to further organize survey questions

6. Nutrition
Knowledge
Dietary & School
Health Guidelines
MyPlate
Knowledge of
Access to
Nutrtiion
Information
Teaching Efficacy
Previous
Nutrition
Education
History of
Teaching
Nutrition in the
Classroom
Barriers to
Nutrition
Education
Perceived
Importance of
Nutrition
Education
Attitudes &
Practices
Types and
Frequency of
Foods Eaten
Perceived Health
of Current Diet
Desire to Change
Diet
Perceived Health
of Students
Perception of
Students'
Knowledge of
Nutrition
Perception of
Parents'
Knowledge of
Nutrition
Perception of
Students' Health
Status
Students'
Nutritional Needs
at Home
Role Modeling
Perceived Health
Status
Foods Eaten in
Front of Students
Foods Provided
to Students
Demographics
Age, Race,
Ethnicity, Gender
Number of Years
Teaching
Subject & Grade
Level Taught
Highest Level of
Education
Obtained
Health
Information

7. Survey Development
• Question bank
• Originally contained 148 questions
• Questions were taken from 7 previously created survey tools and additional
questions were created to cover all themes and sub-themes
• After editing, question bank was reduced to 48 questions
• Consists of multiple choice, check boxes, and fill in the blank questions
• Survey was developed in Google Forms
• Plans for two waves of testing
• Wave One consists of convenience sample of general public
• Wave Two consists of a sample of teachers

8. Wave One Testing
• Link to Google Forms survey distributed on social media
• Received 23 responses within a week
• From those responses, 3 respondents agreed to a cognitive interview
• Consists of analyzing survey taker’s thoughts and understanding of the
survey
• Survey questions were analyzed through six categories: Think
Aloud/General, Comprehension, Retrieval, Confidence, Difficulty, and
Answer Appropriateness
• Nutrition Knowledge questions were analyzed through all six categories
• All other survey questions were analyzed through Think Aloud/General,
Comprehension, and Answer Appropriateness

9. Wave One Testing Results
• Demographics
• 15 Females, 6 Males, 2 No Answer
• 19 White/Caucasian, 5 Hispanic/Latino
• 4 with teaching experience
• Nutrition Knowledge
• Average score 72%
• Score range 42%-92%
• Average BMI 26.09
• BMI range 20.03-45.57

10. 0
10
20
30
40
50
60
70
80
90
18-24 Years 25-34 Years 35-44 Years 45-54 Years 55-64 Years
Distribution of BMI and Nutrition Knowledge Score by Age
BMI Nutrition Knowledge Score

11. Wave One Testing Results
• Cognitive Testing
• Demographics
• 1 Female, 2 Males
• 1 School Curriculum Developer, 1 Student Teacher, 1 Utility Company
Employee with previous teaching experience
• Two respondents interviewed together, one alone
• Wave One testing resulted in alteration of seven questions in wording or
answer formats

12. Validity and Reliability
• Cronbach’s Alpha
• Statistical test for internal consistency
• Tests for reliability among survey questions
• α>0.7 is generally considered reliable; however, there is much criticism with this
cutoff level
• Cronbach’s Alpha test was able to be done for the Nutrition Knowledge questions (1-12)
• Cronbach’s Alpha score for questions 1-12 is 0.41
• After removing questions 2,4,8, and 9, Cronbach’s Alpha is 0.56
• Meaning
• While showing a low alpha, it’s possibly due to the variation in nutrition questions
(i.e. serving sizes, fat content, dietary guidelines).

13. Wave Two Testing
• Received permission from school district superintendent of Dumas
Independent School District in Dumas, TX
• Five Elementary Schools (grades PreK-4)
• One Intermediate School (grades 5-6)
• One Junior High (grades 7-8)
• One High School (grades 9-12)
• Google Forms link distributed to teachers’ email
• Total of 148 responses

14. Wave Two Testing Results
• Of the 148 responses, 70 were teachers
• Other responses were non-teaching school staff and incomplete or
blank responses
• Total of 309 teachers in Dumas ISD
• 22.7% Response Rate

15. Wave Two Testing Results
• Teacher Demographics
• 56 Females, 9 Males, 5 No Answer
• 54 White/Caucasian, 7 Hispanic/Latino, 2 Native American or Alaska Native,
5 Multiple Race/Ethnicity, 1 Other, and 1 No Answer
• Nutrition Knowledge
• Average score 70%
• Score range 17%-100%
• Average BMI 28.04
• BMI range 18.47-51.37

16. 0
10
20
30
40
50
60
70
80
18-24 Years 25-34 Years 35-44 Years 45-54 Years 55-64 Years
Distribution of BMI and Nutritional Knowledge Score by Age
BMI Nutrition Knowledge Score

17. 0
10
20
30
40
50
60
70
80
90
Less than 5 Years 5-9 Years 10-14 Years 15-19 Years 20 or More Years
Distribution of BMI and Nutrition Knowledge Score by Number of Years
Teaching
BMI Nutrition Knowledge Score

18. 0
5
10
15
20
25
30
35
40
45
0 Times 1-3 Times 4-6 Times 7-9 Times 10 or More Times
BMI by Amount of Fruit or Vegetables Eaten in Past Week
Vegetables Fruit

19. Table 1. Distribution of Teacher Survey Respondents
Variable Average Score of Nutrition Knowledge Questions
Mean (SD)
Average BMI
Mean (SD)
Years Teaching Less than 5 years 0.68 (0.11) 26.82 (3.88)
5-9 years 0.66 (0.09) 28.74 (8.82)
10-14 0.66 (0.18) 27.28 (6.29)
15-19 0.65 (0.12) 28.34 (7.06)
20 or more 0.77 (0.14) 28.51 (5.00)
Participation in Wellness Programs No, I have not participated 0.70 (0.11) 26.78 (7.70)
Yes, I participated once 0.63 (0.22) 30.47 (8.38)
Yes, I participated several times 0.69 (0.13) 27.77 (5.28)
Yes, I participate often 0.79 (0.11) 28.45 (3.73)
Received Nutrition Education Never 0.69 (0.16) 25.84 (4.16)
Received nutrition education in one or more
settings
0.71 (0.14) 28.76 (6.63)
Number of Times Fruit was Consumed in
Last Week
0 Times 0.72 (0.05) 29.60 (10.05)
1-3 Times 0.69 (0.12) 29.10 (6.87)
4-6 Times 0.75 (0.18) 27.22 (5.02)
7-9 Times 0.65 (0.14) 28.35 (5.30)
10 or More Times 0.69 (0.12) 21.36 (0.56)
Gender Male 0.67 (0.23) 26.58 (4.19)
Female 0.72 (0.12) 28.13 (6.46)
Age 18-24 Years 0.46 (0.41) 24.65 (0.63)
25-34 Years 0.67 (0.11) 26.19 (3.56)
35-44 Years 0.65 (0.11) 28.47 (8.54)
45-54 Years 0.74 (0.12) 28.32 (5.34)
55-64 Years 0.74 (0.16) 29.30 (7.04)
Race/Ethnicity White/Caucasian 0.71 (0.12) 27.32 (5.70)
Hispanic/Latino 0.69 (0.09) 28.22 (5.41)
Multi-Race/Ethnicity 0.57 (0.27) 31.69 (11.13)

20. Wave Two Testing Results
•Nutrition knowledge not necessarily correlated with health
•It appears these sample of teachers know what they should be doing to be
healthier, but are just not taking action
•Wellness programs may need to take additional steps with action programs over
education programs
• Group exercise
• Meal planning
• Accountability
• Contests

21. Conclusion
• Additional testing planned for teachers in upcoming conference
• Explore additional reliability tests
• Further editing and revising expected
• Survey tool to be used in further studies

22. Afterthoughts
• First experience with nutrition education
• First experience in survey development
• Will take experience with Common Threads and apply to all career goals and
aspirations
• Thank you all for your wisdom and guidance during my time at Common
Threads. I have gained invaluable knowledge and experiences that will stay
with me.