THE NEEDS OF NUTRITION AND PHYSICAL ACTIVITY EDUCATION FOR CAREGIVERS OF 

MICHIGAN MIGRANT AND SEASONAL FARMWORKER CHILDREN 

 
By 
 

Amanda Rose Feighner 

A THESIS 

Submitted to 

Michigan State University 

in partial fulfillment of the requirements 

for the degree of  

Food Science and Human Nutrition – Master of Science  

2019 

 

 
 
 
 

 

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

i 

ABSTRACT 

 
By  
 

 

Amanda Rose Feighner 

 

THE NEEDS OF NUTRITION AND PHYSICAL ACTIVITY EDUCATION FOR CAREGIVERS OF 

MICHIGAN MIGRANT AND SEASONAL FARMWORKER HEAD START CENTERS 

Migrant and seasonal farmworker (MSFW) children have high rates of overweight and obesity, 

which can lead to health issues throughout their lives, resulting in increased healthcare costs. Caregivers 

of young children who can influence environment and role model behaviors related to nutrition and 

physical activity also have high prevalence of overweight and obesity. Migrant and Seasonal Head Start 

(MSHS) programs serve young MSFW children (0-5 years) and can be a venue for health promotion. This 

situation provides important educational opportunities to meet the needs of caregivers (parents and 

MSHS staff) of MSHS children themselves and for children in their care. This study aimed to identify the 

perceived needs for content, facilitators, and barriers to participating in such programs. Of 17 total 

MSHS centers in Michigan, five of the largest sites were selected for recruitment of MSHS program 

parents and staff. Twelve focus groups were conducted between July - September 2016 with staff 

(n=27), parents (n=33), and MSHS center directors (n=13). Using consensus coding among three 

researchers, key themes were identified. Quantitative surveys were conducted with parents (n=135) at 

nine centers and staff (n=280) at all 17 MSHS centers in Michigan between July - August 2016. We found 

that desired content for programs included basic nutrition knowledge, cooking and meal planning, 

physical activity, and budgeting. Facilitators and barriers to participation in a nutrition and physical 

activity program included program structure, financial support, education format, and motivation 

factors. Caregivers competent in nutrition and physical activity knowledge may be able to influence the 

environment and behaviors of their children and the MSHS community to promote healthy lifestyles. 

This information can be used to plan future interventions for caregivers of MSHS children. 

 

 

ii 

 

 

 

 

 

 

 

 

Copyright by  
AMANDA ROSE FEIGHNER 
2019  
 

 

iii 

ACKNOWLEDGEMENTS 

 
 

This project would not have been possible without the support of many external partners. I am 

 

especially grateful for Telamon Corporation and the gracious assistance received from all staff we 

encountered, allowing us to reach both staff and parents involved with the Michigan Migrant and 

Seasonal Head Start programs. The MSU College Assistant Migrant Program was essential in connecting 

our research team to student employees for data collection. MSU Extension provided funding and 

critical feedback to survey and focus group scripts. The Research Education Program to Increase 

Diversity in Health Researchers provided funding opportunities for student researchers to assist with 

data collection and analysis. 

I am appreciative of my guidance committee for their valuable support, personally and 

professionally throughout my studies: Dr. Katherine Alaimo, Dr. Sarah Comstock, and Dr. Won O. Song. A 

special thanks goes to my advisor, Dr. Song, for the many opportunities she provided during my 

graduate studies. I am especially thankful for leadership of Dr. Sujin Song, as well as everyone who 

helped manage logistics of this project and participated in coding including Mei, Kaitlyn, Tobi, and 

Nabila. I am thankful for the peer support received by all of our additional lab members throughout the 

years, including Beatriz, Pros, Aaron, Clement, and Kyungwon. I am grateful for the friends and faculty I 

have met in the Food Science and Human Nutrition Department and for their endless encouragement 

and friendship through this process, especially Alyssa, Lauren, Ankita, Dawn, and Getrude. Finally, thank 

you to my family for their never-ending support which made it possible to pursue my undergraduate 

and graduate degrees.  

 

 
 

iv 

 

TABLE OF CONTENTS 

 
 
 
LIST OF TABLES ............................................................................................................................................ vii 
 
LIST OF FIGURES ......................................................................................................................................... viii 
 
KEY FOR ABBREVIATIONS ............................................................................................................................. ix 
 
CHAPTER 1: INTRODUCTION ......................................................................................................................... 1 
 
CHAPTER 2: LITERATURE REVIEW ................................................................................................................. 4 
2.1 Migrant and Seasonal Farmworkers Overview ................................................................................... 4 
2.2 Childhood Overweight and Obesity in the United States ................................................................... 9 
2.3 Efforts to Target Childhood OW/OB in Preschool Age Children ....................................................... 12 
2.4 Social Cognitive Theory Approach for Obesity Prevention Programs .............................................. 14 
2.5 Characteristics of Teachers in MSHS ................................................................................................. 15 
2.6 Characteristics of Parents in MSHS ................................................................................................... 19 
2.7 Federal Programs for Low-Income Audiences .................................................................................. 23 
2.8 Caregivers Can Influence Health Behaviors of Youth........................................................................ 25 

 
CHAPTER 3: METHODS ................................................................................................................................ 27 
3.1 Methods Introduction ....................................................................................................................... 27 
3.2 Study Areas, Subjects, General Recruitment Strategies ................................................................... 27 
3.2 Recruitment and Training of Bilingual Research Team ..................................................................... 29 
3.3 Quantitative Survey Study, Parallel Study to Focus Groups ............................................................. 30 
3.3.1 Parent Survey ............................................................................................................................. 30 
3.3.2 Staff Survey ................................................................................................................................ 31 
3.3.3 Analysis of Surveys ..................................................................................................................... 31 
3.4 Qualitative Focus Groups Study: Focus of this Thesis ....................................................................... 31 
3.4.1 Parent Focus Groups .................................................................................................................. 31 
3.4.2 Staff Focus Groups ..................................................................................................................... 32 
3.4.3 Director Focus Groups ............................................................................................................... 32 
3.4.4 Focus Group Data Transcription and Analysis ........................................................................... 32 

 
CHAPTER 4: RESULTS ................................................................................................................................... 34 
4.1 Overview of Focus Group and Survey Participants ........................................................................... 34 
4.2. Content Needs for Programs from Focus Groups ............................................................................ 35 
4.2.1 Basic Nutrition Knowledge ......................................................................................................... 36 
4.2.2 Cooking and Meal Planning ....................................................................................................... 39 
4.2.3 Physical Activity ......................................................................................................................... 41 
4.2.4 Budgeting/Money ...................................................................................................................... 43 
4.2.5 Summary of Content Needs ....................................................................................................... 43 
4.3 Facilitators to Participation from Focus Groups ............................................................................... 44 
4.3.1 Program Structure ..................................................................................................................... 45 

 

v 

4.3.2 Financial Support ....................................................................................................................... 46 
4.3.3 Teaching/Learning Format ......................................................................................................... 46 
4.3.4 Organizational Support .............................................................................................................. 48 
4.3.5 Factors Influencing Motivation .................................................................................................. 50 
4.3.6 Summary of Facilitators ............................................................................................................. 52 
4.4 Barriers to Nutrition and Physical Activity Program Participation from Focus Groups .................... 52 
4.4.1 Program Structure ..................................................................................................................... 53 
4.4.2 Lack of Financial Support ........................................................................................................... 54 
4.4.3 Teaching/Learning Format ......................................................................................................... 54 
4.4.4 Factors Inhibiting Motivation..................................................................................................... 56 
4.4.5 Summary of Barriers .................................................................................................................. 56 
4.5 Survey Results ................................................................................................................................... 57 

 
CHAPTER 5: DISCUSSION ............................................................................................................................. 58 
5.1 Content Needs .................................................................................................................................. 58 
5.2 Facilitators to Participation ............................................................................................................... 60 
5.3 Barriers to Participation .................................................................................................................... 63 
5.4 Overall Discussion ............................................................................................................................. 64 

 
CHAPTER 6: CONCLUSION AND IMPLICATIONS .......................................................................................... 66 
6.1 Overview ........................................................................................................................................... 66 
6.2 Strengths and Limitations ................................................................................................................. 68 
6.3 Recommendations for Future Research ........................................................................................... 69 

 
APPENDICES ................................................................................................................................................ 70 
Appendix A: IRB Application ................................................................................................................... 71 
Appendix B: IRB Approval ....................................................................................................................... 79 
Appendix C: Selected Survey Results ...................................................................................................... 80 
Appendix D: Parent Focus Group Flyer ................................................................................................... 81 
Appendix E: Focus Group Flier Staff ........................................................................................................ 82 
Appendix F: Parent Survey Flyer ............................................................................................................. 83 
Appendix G: Staff Survey Flyer ................................................................................................................ 84 
Appendix H: Sociodemographic Data from Surveys with Parents and Staff........................................... 85 
Appendix I: Sociodemographic Data from Focus Groups with Parents, Staff, and Directors ................. 89 
Appendix J: Focus Group Questions for Staff ......................................................................................... 92 
Appendix K: Focus Group Questions for Directors ................................................................................. 94 
Appendix L: Focus Group Questions for Parents (English)...................................................................... 96 
Appendix M: Focus Group Questions for Parents (Spanish) ................................................................... 98 

 
BIBLIOGRAPHY .......................................................................................................................................... 100 
 
 
 

 

 

vi 

LIST OF TABLES 

 
 
Table 1: Youth US Obesity Rates by Groups of Interest ............................................................................... 9 
 
Table 2: MSFW Child Obesity Rates from Prior Studies in the Midwest .................................................... 10 
 
Table 3: MSHS Children’s Height and Weight ............................................................................................. 10 
 
Table 4: Determinants of OW/OB in MSFW Children ................................................................................. 11 
 
Table 5: Summary of Intervention Studies in Preschools to Promote Nutrition and Activity .................... 14 
 
Table 6: MSHS Teacher and Assistant Teacher Experiences ....................................................................... 16 
 
Table 7: MSHS Teacher and Assistant Teacher Demographics ................................................................... 17 
 
Table 8: Language Capability of MSHS Teachers and Assistant Teachers .................................................. 18 
 
Table 9: Salary at MSHS for Teachers and Assistant Teachers ................................................................... 19 
 
Table 10: Demographics for MSFW Parents with Children in MSHS .......................................................... 20 
 
Table 11: Languages Spoken by MSFW Parents with Children in MSHS .................................................... 21 
 
Table 12: MSFW Parent Questions for Parents with Children in MSHS ..................................................... 22 
 
Table 13: Family Total Income for Parents ................................................................................................. 23 
 
Table 14: Overall Needs of Nutrition and Physical Activity Programs Expressed by Parents, Staff, and 
Directors from Focus Groups ...................................................................................................................... 35 
 
Table 15: Facilitators for Nutrition and Physical Activity Program Participation for Staff, Directors, and 
Parents from Focus Groups ........................................................................................................................ 44 
 

Table 16: Barriers to Nutrition Education Program Participation for Staff, Directors, and Parents from 
Focus Groups............................................................................................................................................... 53 
 
Table 17: Selected Survey Results ............................................................................................................... 80 
 
Table 18: Sociodemographic Data from Surveys with Parents and Staff ................................................... 85 
 
Table 19: Sociodemographic Data from Focus Groups with Parents, Staff, and Directors ........................ 89 
 

 

 

vii 

LIST OF FIGURES 

 
 
Figure 1: Conceptual Map for Study ............................................................................................................. 3 
 
Figure 2: Map of MSFW Migrant Streams .................................................................................................... 4 
 
Figure 3: Social Cognitive Theory ................................................................................................................ 15 
 
Figure 4: Approaches for Data Collection ................................................................................................... 27 
 
Figure 5: Map of MSHS Data Collection Sites by Type ................................................................................ 29 
 
Figure 6: Content Needs for Caregivers from Focus Groups ...................................................................... 35 
 
Figure 7: Facilitators for Caregiver Education from Focus Groups ............................................................. 44 
 
Figure 8: Barriers to Education for Caregivers from Focus Groups ............................................................ 52 
 
Figure 9: Model for Intervention in MSHS .................................................................................................. 67 

 

 

 

viii 

KEY FOR ABBREVIATIONS 

 
 
CAMP: College Assistant Migrant Program  
 
EFNEP: Expanded Food and Nutrition Education Program  
 
FPL: Federal Poverty Line  
 
MSFW: Migrant and Seasonal Farmworker 
 
MSHS: Migrant and Seasonal Head Start  
 
NHANES: National Health and Nutrition Examination Survey  
 
OW/OB: Overweight and Obesity  
 
PSE: Policy, Systems, and Environmental Change  
 
SCT: Social Cognitive Theory  
 
SNAP: Supplemental Nutrition Assistance Program 
 
SNAP-ED: Supplemental Nutrition Assistance Program Education 

 

ix 

CHAPTER 1: INTRODUCTION 

 
 

Migrant and Seasonal Farmworkers (MSFW) are integral to the United States agricultural 

system. An estimated 2,785,784 MSFW work nationally with an estimated 80,549 in Michigan (Legal 

Services Corporation 2016). MSFW fill jobs that require extensive hand labor. These jobs, often 

unwanted by locals, pay low wages, foster undesirable and unsafe work conditions, are temporary in 

nature, and require relocation for consistent work. MSFW’s absence would cause a substantial 

disruption to the agriculture industry.  

Despite their essential contributions to society, MSFW are severely marginalized. MSFW are of 

low socioeconomic status, with the majority reporting individual incomes of $17,500 - $19,999 and an 

average 8th grade education level (Hernandez 2018). Many suffer disproportionately high rates of health 

issues, possibly exacerbated by challenging and unsafe work conditions. Poor working conditions such as 

exposure to heavy metals (Quandt, Jones et al. 2010), pesticides (Robinson, Nguyen et al. 2011), and 

occupational injury (Ramos, Carlo et al. 2016) have been reported. Occupational safety hazards increase 

health risks of MSFW but their access to healthcare is limited due to transient nature of their work life. 

Only 47% of MSFWs reported having health insurance and the majority reported  not having sought 

recent healthcare (Hernandez 2018).  

In the US, racial/ethnic minorities have higher health risks including those related to nutrition 

and physical activities than the general population (Centers for Disease Control and Prevention 2018). 

MSFWs marginalized status contributes even further to nutrition related health concerns in this 

population. MSFW have high rates of food insecurity, cited at up to 82% (Kiehne and Mendoza 2015). 

Overweight and obesity (OW/OB) prevalence is also high among MSFW parents (35.5% OW, 40.8% OB) 

and their children (10% OW, 31.4% OB) in Michigan (Song, Song et al. 2015).  The high rates of OW/OB 

amongst MSFW children age 2-16 contrast with those of comparable age US children. The Healthy 

 

1 

People 2020 objectives note reducing obesity among youth especially among minority and underserved 

children, clearly including MSFW children. The majority of MSFWs and staff in MSHS programs are of 

Hispanic origin, a group which has high rates of OW/OB and diabetes (Centers for Disease Control and 

Prevention 2018). Early intervention with children, parents, and MSHS staff can reduce health care cost 

while improving the quality of life of MSFW.   

Migrant and Seasonal Head Start (MSHS) was formed in 1969 to provide childcare services to 

MSFW families. The Migrant Head Start Collaboration Office has a mission of ensuring “access to high 

quality, culturally appropriate early childhood education opportunities for the children and families of 

migrant and seasonal farm workers” (US Department of Health and Human Services 2019).  The MSHS 

program offers head start education and a variety of other health related services such as social, health, 

and disability services to migrant families, including nutritious foods for children (National Migrant and 

Seasonal Head Start Association 2017) (Telemon Corporation 2019). MSHS centers may be open 

extended 12-hour days and weekend days to meet the needs of MSFW families (National Migrant and 

Seasonal Head Start Association 2017). In Michigan, Telamon Corporation facilitates MSHS programs.  

MSHS also assist MSFW family health concerns through direct interactions with parents and 

children. Studies suggest that children’s weight status is influenced by their parents and caregivers at 

home. Studies have reported that parents (Vollmer and Mobley 2013, Melis Yavuz and Selcuk 2018) and 

childcare or school environments (Eliakim, Nemet et al. 2007) can also influence the weight status of 

children. MSHS where MSFW children spend long hours can potentially impact nutritional status and 

OW/OB issues among MSFW children. Nutritional status of MSFW pre-school age children (Quandt, 

Trejo et al. 2016) and adults (Borre, Ertle et al. 2010, Rosales, Ortega et al. 2012) are also poor.   

Important caregivers for MSFW children are MSHS staff and parents who can influence the 

behaviors of children. Staff in MSHS who serve as role models for children have high rates of OW and OB 

(24.1% and 49.5%, respectively), and low nutrition knowledge (Song, Song et al. 2016). Because of their 

 

2 

important roles for MSFW children’s risk for OW/OB, needs assessments for nutritional and physical 

activity education programs for the MSHS staff and parents became necessary to achieve the ultimate 

goal of reducing OW/OB in MSFW children.  

There is a high prevalence of OW/OB in MSFW children and parents in addition to MSHS staff. 

MSHS directors are the channel for implementing new programs for staff and parents at the centers. 

From prior quantitative studies (Song, Song et al. 2015) (Song, Song et al. 2016), the need for a nutrition 

intervention was identified.  In order to deliver a program successfully, this study aimed to assess the 

program needs of caregivers (parents and staff) of Michigan MSHS children through a survey and focus 

groups with parents of MSHS children, staff working in MSHS, and MSHS center directors. If a program 

meets the needs for caregivers of MSFW children, nutrition knowledge can be enhanced, and result in 

reduced OW/OB among caregivers and children alike.  

Specific Aims:  

Aim 1: Through a survey with parents of MSHS children and staff in MSHS centers, this study 

aimed to identify content and format needs for nutrition and physical activity education programs.  

Aim 2: Through focus group interviews with parents of MSHS children and staff in MSHS centers, 

this study aimed to identify needs, barriers, and facilitators to participating in nutrition and physical 

activity education programs.  

 
 

 
Figure 1: Conceptual Map for Study 

 

 

3 

 

CHAPTER 2: LITERATURE REVIEW 

 
 
2.1 Migrant and Seasonal Farmworkers Overview  

Definitions. United States Department of Labor (United States Department of Labor October 23, 

2006) defines a seasonal farmworker as “an individual who is employed, or was employed in the past 12 

months, in farmwork of a seasonal or other temporary nature and is not required to be absent overnight 

from his/her permanent place of residence”; migrant farmworker as “a seasonal farmworker who 

travels to the job site so that the farmworker is not reasonably able to return to his/her permanent 

residence within the same day”. Migrant and seasonal farmworkers (MSFW) is the term used to 

encompass both of these definitions, and are transient while working jobs of a temporary nature.  

Common migrant streams for travel in the United States for MSFW include the Western, 

Midwest, and Eastern streams shown below. Often MSFW will begin in the southern states in each 

stream, and progress north to follow crops seasonality.  

Figure 2: Map of MSFW Migrant Streams 

Image Source: (Association of Farmworker Opportunity Programs 2019) 

 

Demographics. The National Agricultural Workers Survey (NAWS) is conducted with nationally 

representative agriculture workers; this encompasses many MSFWs, and the information collected 

informs federal programs for MSFWs and dependents. Survey questions are related to a year timeframe 

 

4 

of the individual to show seasonality. The NAWS defines a migrant as “a person who reported jobs that 

were at least 75 miles apart or who reported moving more than 75 miles to obtain a farm job during a 

12-month period.” The most recent NAWS (2015-2016) reports 19% of those agricultural workers 

surveyed being migrants. Of those surveyed,51% are authorized to work which includes 29% being 

United States citizens, 21% legal permanent residents, and 1% through other programs. The majority of 

agricultural workers are Mexican born (69%) with 24% born in the United States, followed by 6% in 

Central America, 1% in Puerto Rico, and other regions. Eighty-three percent of agricultural workers 

identify as Hispanic (65% Mexican, 9% Mexican-American, and 9% of other groups). Seventy-eight 

percent of agricultural workers are living in the United States for at least 10 years. (Hernandez 2018) 

The majority of NAWS agricultural workers (68%) are male and 32% are female. The average age 

is 38, with a range of ages including 14-19 years (7%), 20-24 years (11%), 25-34 years (26%), 35-44 years 

(23%), 45-54 years (19%), 55-64 (11%), and 65 or older (4%). Most are married (57%), and the majority 

are parents (55%). Forty percent did not live with nuclear family (20% of this percentage were parents). 

(Hernandez 2018)  

Education/Literacy/Language. The average education level achieved by NAWS respondents is 

8th grade, with 37% completing 6th grade or less, and 4% with no schooling. This includes 19% 

completing 7-9th grade, 30% completing 10-12th grade, and 10% attaining beyond high school. 

(Hernandez 2018) 

The majority are fluent in Spanish with limited English skills, which can create additional 

challenges to seeking assistance. Most speak Spanish (77%) as a primary language followed by English 

(21%) and indigenous languages (1%). Out of those who state Spanish is their primary language, 81% 

have the ability to read Spanish well, followed by 10% somewhat, 7% a little, and 2% not at all. Most 

have limited ability to speak English, with 30% not speaking at all, 32% speaking a little, 9% somewhat, 

 

5 

and 29% speaking well. Ability to read English included 28% reading well, 7% somewhat, 24% a little, and 

41% not at all. (Hernandez 2018)  

Work Environment and Environmental Health. Fifty-eight percent of NAWS respondents 

reported working in US farms for over 10 years. The average annual time span for agricultural 

employment included 33 weeks with 192 days of work. On average respondents worked 45 hours over 5 

days during the week prior to the survey of 2015-2016. (Hernandez 2018) 

Unfavorable working conditions of agricultural workers are documented. Only 57% received 

training from their employer about safe pesticide use. Although 89% report receiving water and cups 

daily, 5% report receiving water only and 6% receiving none. As many as 3% of the NAWS respondents 

report having no access to a toilet and handwashing facilities. Benefits received from employers vary, 

with 43% reporting unemployment insurance and 62% reporting workman’s compensation. (Hernandez 

2018)  

Housing and Transportation. Housing and transportation arrangements of agricultural workers 

vary widely with living in housing provided by employers (16%), renting elsewhere (54%), owning homes 

(28%), and housing from government/charity/other organization (1%). Many (33%) report living in 

housing classified as “crowded” as defined by “the number of persons per room was greater than one.” 

Types of housing included single family homes (57%), mobile homes (20%), apartments (20%), and 

others (4%). (Hernandez 2018) 

Eleven percent report living where they work and 70% living less than 25 miles from work. 

Transportation varies, with 58% driving a car to work, 15% paying a driver, 13% riding with other people, 

and 8% walking or taking public transit. (Hernandez 2018) 

Income/Pay Rate/Public Assistance/Health Care. In year 2015-2016, NAWS respondents report 

earning an average hourly pay of $10.60 and yet 33% of families lived in poverty. Agricultural workers’ 

 

6 

individual and family incomes ranged from $17,500 - $19,999/year, and  $20,000-$24,999/year, 

respectively. (Hernandez 2018) 

Within the two years prior to 2015-2016 survey, 54% of agricultural workers reported having at 

least one household member on public assistance such as SNAP (18%), WIC (17%), public health clinics 

(10%), and Medicaid (44%)(Hernandez 2018). Only 47% of MSFW reported having health insurance. The 

most recent health care visit was paid for completely by 34% agricultural workers, and 23% stated the 

most common difficulty for accessing health care was the cost. Only 63% reported obtaining health care 

with a US provider within 2 years. (Hernandez 2018)  

Enumeration. It is challenging to identify the number of MSFW in the US due to their transient 

lifestyle. The Legal Services Corporation provides legal assistance to low-income audiences, including 

MSFW. Legal Services Corporation estimates MSFW in a recent report published in 2016, including 

dependents of workers, both authorized and living in poverty include 2,785,784 in the US and 80,549 in 

Michigan (Legal Services Corporation 2016). Similarly, MSFW workers alone and with dependents were 

49,135 and  94,167, respectively in Michigan in 2013 (Larson 2013). Estimates for MSFW children and 

youths under age 20 in Michigan total 42,729 (27,965 migrant children/youth plus 14,764 seasonal 

children/youth) (Larson 2013), 27,988 children under 13 and 11,793 children under age 5 (Department 

of Health and Human Services 2013). This includes an estimated 4.6% under age 1, 23% ages 1-4, 37.9% 

ages 5-12, 10.4% ages 13-14, 18.6% ages 15-18, and 5.5% age 19 (Larson 2013).  

Food Insecurity Rates. Food insecurity rates among MSFW have been documented in some 

smaller studies and are found to be higher than that among the general population ranging from 8.2%-

82% (Kiehne and Mendoza 2015).  

Many of these studies examining food insecurity among MSFW were carried out in North 

Carolina and showed that 32% of preschool children were food insecure in addition to 63.8% (Borre, 

Ertle et al. 2010) and 47.1% (Quandt, Arcury et al. 2004) households were food insecure. The highest 

 

7 

rate of food insecurity (82%) was reported in border towns in southwest Texas (Weigel, Armijos et al. 

2007). Three studies on food insecurity in the Midwest reported prevalent low food security (33-44%) 

and very low food security (8-23%) (Kilanowski and Moore 2010); (Kilanowski and Lin 2012); (Kilanowski 

2010). 

When compared to national data in the US, MSFW’s food insecurity rates are higher than both 

the general population and rates among Hispanics. The rates of food insecurity between 2015-2017 

averaged 12.3% for the United States and 13.6% for Michigan. Among Hispanics, rates of food insecurity 

were 18.0% in 2017. Among households with children, 7.7% had food insecure children in 2017, showing 

MSFW rates to be higher across all categories. (Coleman-Jensen 2018) 

In summary, these issues of low socioeconomic status, low educational achievement, poor 

access to healthcare, challenging work conditions, transient lifestyle, and high food insecurity, all 

contribute to MSFW adults and children being especially vulnerable to OW/OB and related health issues.  

Importance to Agricultural Industry. In addition to the social perspective of bringing attention 

to issues facing MSFW families, it is important to note this workforce also provides a great economic 

benefit to the agricultural industry. The American Farm Bureau Federation estimates a short term loss of 

$1.5-5 billion dollars nationally if MSFW labor is lost, in addition to a $151-271.8 million production loss 

in Michigan short term (American Farm Bureau Federation Economic Analysis Team 2006). Michigan 

ranks 5th nationally for number of MSFW (Department of Health and Human Services 2013). A report 

from the Michigan State University Product Center for Agriculture and Natural Resources emphasized 

the importance of MSFW in Michigan. The temporary work season and transient nature of farm work 

makes it unappealing to permanent residents, in addition to Michigan growing many crops which rely on 

labor provided by MSFW (Knudson 2006).  

 

8 

2.2 Childhood Overweight and Obesity in the United States  

Obesity Rates Among Youth in the United States. Youth obesity rates in the US are high. 

Healthy People 2020 Objectives state the need for eliminating health disparities, with a goal of declining 

the national youth obesity rate to 14.5% (Centers for Disease Control and Prevention 2010). However, 

recent reports from the National Health and Nutrition Examination Survey (NHANES) indicate higher 

rates from 2011-2014 (Table 1). Youth (age 2-19) obesity rates are 17%, with higher rates among 

Hispanics (21.9%). Notably, preschool age (2-5) youth rates are 8.9%. (Ogden 2015) 

Lifestyle factors can contribute to obesity among youth. When examining obesity rates for youth 

by household income (Table 1), the highest income bracket (> 350% FPL) has the lowest rates of obesity 

(10.9%), followed by middle income (19.9%) (>130% to ≤350% FPL) and low income (18.9%) (≤130% 

FPL). Education level achieved by the head of the household also contributes to a disparity in youth 

obesity rates (Table 1); those with a high school graduate education had higher youth obesity (21.6%) 

than college graduates (9.6%). (Ogden 2018)     

Table 1: Youth US Obesity Rates by Groups of Interest  

 

 

Ethnicity and Age  
(Ogden 2015) 

Income (Ogden 2018) 

Education Achieved by Head of 
Household (Ogden 2018) 

Youth (2-19) US General 
Youth (2-19) US Hispanic 
Preschool age Youth (2-5) US General 
≤130% FPL 
>130% to ≤350% FPL 
>350% FPL 
High School Graduate or Less 
Some College 
College Graduate 

 

2011-2014 Obesity 
Rates for US Youth % 

17.0 
21.9 
8.9 
18.9 
19.9 
10.9 
21.6 
18.3 
9.6 

Obesity Rates Among MSFW Youth. Studies conducted among MSFW youth generally confirm 

higher rates of obesity compared to the general population (Table 2). MSFW families encompass obesity 

risk categories including low income, low education attainment, and being of Hispanic origin. This 

combination of factors, furthered by additional struggles faced by the MSFW lifestyle, likely contribute 

 

9 

to the higher rates of obesity in this population. Studies with MSFW children in Michigan resulted in 

obesity rates of 15.1% (Lee and Song 2015) and 31% (Song, Song et al. 2015), respectively of OB among 

preschool aged children, which is higher than similar national data (8.9%) for preschool age children 

(Ogden 2015). A review of OW/OB among MSFW children of various ages yielded OB rates ranging 15-

37% and OW/OB rates of 31-73% (Lim, Song et al. 2017). The strikingly high rates of OB in MSFW 

children indicate the urgent need for interventions in this vulnerable population.  

Table 2: MSFW Child Obesity Rates from Prior Studies in the Midwest 

Author 

Study Year 

Location 

Kilanowski 2010 

 

Lee 2015 
Song 2015 

2007-2008 

2012-2013 

2013 

Ohio and 
Michigan 
Michigan 
Michigan 

Sample 

Size 
60 

1357 
76 

Child 
Age 
2-13 

0-6 
0-5 

OW % 

OB % 

22 

16.1 
10 

26 

15.1 
31 

Rates of Overweight and Obesity Among MSFW Children Attending MSHS Programs. A 

 

nationally representative sample from MSHS centers measures characteristics for MSHS children in 2017 

(U.S. Department of Health and Human Services: Office of Planning Research and Evaluation 2019). 

Rates for OB children (Table 3) in MSHS for 2 year olds (12.4%) and those 3 and older (17.4%) are higher 

than national averages for 2-5 year old children (8.9%).  (U.S. Department of Health and Human 

Services: Office of Planning Research and Evaluation 2019) (Ogden 2015) 

Table 3: MSHS Children’s Height and Weight 

% of Children (24 
months and older) 

% of Children (24-

35 months) 

% Children (36 

months and older) 

Weight 

Underweight 
Normal Weight 

Overweight 

Obese 

2.3 
66.8 
14.9 
16.0 

3.0 
70.0 
14.6 
12.4 

2.1 
65.5 
15.0 
17.4 

  
Determinants of Childhood Overweight and Obesity Among MSFWs. A recent review identified 

a variety of determinants for OW/OB in MSFW children (Lim, Song et al. 2017). While research on this 

topic is limited, this provides some indicators for OW/OB. The MSHS students enrolled for three or more 

 

10 

years in MSHS programs (Table 4) had less OW compared with those enrolled for one year (Lee and Song 

2015). Rosado found in Florida that elementary aged children were more likely to be OW/OB than the 

preschool MSFW children (Rosado, Johnson et al. 2013). A study with child household food insecurity 

found higher rates of OW/OB among children who were food secure (73%) compared with those food 

insecure (33%) (Borre, Ertle et al. 2010). Parents who have OW/OB children were incorrect about child’s 

weight status compared with those with non-obese children (Song, Song et al. 2015). Parents with 

OW/OB are more likely to have children who are OW/OB (Rosado, Johnson et al. 2013) (Song, Song et al. 

2015). When MSFW families participated in SNAP benefits, their children are found to have lower rates 

of OW/OB (Lee and Song 2015). All of these determinants of education for children, SNAP participation, 

household food security, parents’ weight and weight perception should be considered as contributing 

factors to OW/OB for MSFW children.  

Table 4: Determinants of OW/OB in MSFW Children 

Paper 

n 

Lee 2015 

1357 

Rosado 
2013 

472 

Borre 2010 

Song 2015 

52 

76 

Study 
Year 
2012-
2013 

2010-
2011 

2005 

2013 

Rosado 
2013 

Song 2015 

472 

76 

2010-
2011 
2013 

Lee 2015 

1357 

2012-
2013 

Child Age 
(years) 

0-6 

3-16 

2-7 

0-5 

3-16 

0-5 

0-6 

 

 

Health 

Determinant 

Child 

Education 

Child 

Education 

Household 
Food Security 

Parents’ 

Perception of 

Children’s 
Weight 
Parents’ 

Weight Status 

Parents’ 

Weight Status 

Study 
Location 
Michigan 

Florida 

North 
Carolina 
Michigan 

Florida 

Michigan 

SNAP 

Participation 

Michigan 

11 

Key Results 

More time in MSHS 

significantly associated 

with less OW 

Higher grade levels 
associated with more 

OW/OB 

Food insecurity associated 

with lower OW/OB 
Parents with OW/OB 
children incorrectly 

predicted child’s weight 

status 

Parents with high BMI 

predict OW/OB in children 

Parents with high BMI 
more likely to have 
OW/OB children 

SNAP participation yielded 

less likely for OW/OB 

children 

Relevance of Addressing Obesity Among Youth. Youth who are obese are more likely to be 

obese as adults (Biro and Wien 2010). Obesity can lead to increased risk of disease including mortality, 

hypertension, dyslipidemia, cancers, stroke, type 2 diabetes, osteoarthritis, and coronary heart disease 

(Obesity Expert Panel 2013). Addressing obesity among youth is the opportune time to reduce risk of 

obesity and comorbidities throughout the lifecycle.  

2.3 Efforts to Target Childhood OW/OB in Preschool Age Children 

Efforts to Target Childhood Nutrition and OW/OB in Preschools. Because child obesity rates 

among MSFWs are high, and many MSFW children spend time in MSHS, this is an ideal venue to prevent 

obesity in this population. Review studies on efforts in preschools have emphasized the need for 

additional research in child care settings to prevent OW/OB among children. A review of policies and 

interventions in childcare identifies the opportunity for caregivers of children to promote health 

behaviors for children. (Larson, Ward et al. 2011) 

 

Several interventions (Table 5) in preschools are highlighted, with the majority focusing on 

minority populations in Head Start. Several interventions were shown to improve diet quality in some 

capacity. One 14 week Head Start intervention involved two lessons each week, including education and 

physical activity time, in addition to a home education component for parents (Kong, Buscemi et al. 

2016) resulted in improved diet quality. The Color Me Healthy program is offered in preschools for 6 

weeks with 3 lessons and was shown to improve child fruit and vegetable consumption at snack time 

(Witt and Dunn 2012). One program adapted a pictorial bingo game played by many Mexican-Americans 

to promote healthy foods; the game was encouraged preschool teachers and parents, and resulted in 

improved diet quality. (Piziak 2012)  

 

One intervention involving food service staff and meals served to children in Head Start resulted 

in a reduction in total and saturated fat of the meals served in addition to reduced serum cholesterol for 

children. Nutrition education in this program did not result in additional benefit to reduced cholesterol. 

 

12 

This emphasizes the importance of environmental choice offerings for children in this setting. (Williams, 

Strobino et al. 2004) 

 

Many interventions exist for preschoolers, although few show a connection to weight outcomes 

post intervention. One such study showing a reduced BMI involved a 14-week program with nutrition 

education and exercise components, including reduced BMI and percent body fat and increased fitness 

for those in the program. Children were 5-6 years old, though this was still considered a preschool 

setting, and notably was in Israel. (Eliakim, Nemet et al. 2007)    

Some barriers exist to implementing programs in Head Start settings. One such program, 

promoting physical activity and healthy foods, “I am Moving, I am Learning” underwent a feasibility 

study in Head Start Programs. After staff were trained, many reported trying to implement the program 

(96%), though many reported that there was not time to devote to the program (close to 60%). About 

half of the programs had a written implementation plan, the lack of such plans can cause issues with 

sustainability. These challenges should be noted for feasibility in additional preschool settings. (United 

States Administration for Children Families Office of Planning Research Evaluation 2007) 

 

Several items should be considered for successful preschool interventions to improve nutrition 

and OW/OB status of youth. Kong et al. emphasizes the importance of engaging staff at schools for a 

successful intervention (Kong, Buscemi et al. 2016). Parent involvement should be considered as a way 

to encourage healthful behaviors while children are at home. Environmental changes in the preschool 

environment, such as food offerings can enhance health promotion for children. An emphasis on 

sustainable program plans should be considered, in addition to barriers faced by limited resources in 

Head Start and other preschool settings.  

 

 

 

13 

Table 5: Summary of Intervention Studies in Preschools to Promote Nutrition and Activity  

Population/Location 

Intervention 

Results 

Paper 

n 

Eliakim 
2007 

101 

Child 
age 
(yrs) 
5-6 

Kong 2016 

618 

3-5 

Williams 

2004 

296 

2-5 

Israel 

Chicago, Primarily 
African American 
(94%) in Head Start 

Minority Groups 
African American 
(67%) and Latino 
(33%) in New York 

Head Start 

14 weeks, nutrition education, exercise 
45 min 6 days per week, promotion of 

less sedentary behavior and more 
physical activity outside of school 

14 weeks, 2 times per week including 
20 min healthy eating or activity lesson 

and 20 min physical activity 

movement, at home education 

component for parents. Hip Hop to 
Health Jr, education on diet and 

physical activity and less TV 

An intervention in Head Start food 
service to train cooks and offer foods 

with less total and saturated fat. 
Classroom nutrition education 
provided. Parent education and 

activities provided as well as parent 

Nutrition education did not 

meetings. 

Reduced BMI and body fat, 

increased fitness 

Improved diet quality in 
intervention, no significant 
change in TV viewing or 

weight trajectory 

Reduced total and saturated 

fat in meals served. 

Children receiving improved 
meals had reduced serum 

cholesterol. 

lower cholesterol in 

children. 

Significant increase in 
vegetables offered to 
students at home. 

Improved diet quality for 
children in intervention, 

including increase of fruit for 

snacks by 20.8% and 

vegetables for snacks by 
33.1% 3 months after 
program completion. 

Piziak 2012 

413 

2-4 

Head Start Latino 
Children in Texas 

Witt 2012 

263 

4-5 

Idaho, Boise School 

District 

Evaluation of a nutrition education 
game that is Spanish/English bilingual 

involving pictures. Parents were 
trained in playing the game at 

meetings and teachers played game 2 
times weekly with children. Parent 
home FFQ collected at beginning and 

end of school year. 

Color Me Healthy program to promote 

fruit and vegetable consumption. 6 
week program with 15-30 min lessons 
offered in 2 circle time and 1 imaginary 

trip weekly to children. 

 

 
2.4 Social Cognitive Theory Approach for Obesity Prevention Programs 

 

The social cognitive theory (SCT), developed by Albert Bandura (Bandura 2001), is one model 

explaining how human behaviors can be influenced. This theory describes how personal factors, 

environmental factors, and behaviors are related and interconnected (Zheng, Mancino et al. 2017). This 

model is applicable to nutrition education and obesity prevention programs (Zheng, Mancino et al. 

2017). Prior interventions in preschools have been based on the SCT framework (Hendy 2002). 

Behaviors related to food choices and physical activity are impacted by environmental factors, including 

 

14 

access to food and food marketing. Changing the environment to encourage healthier behaviors may 

improve positive individual behaviors and thus health outcomes. Policy, Systems, and Environmental 

(PSE) change approaches relate to this idea by changing environments, aiming to influence healthier 

choices. Personal factors are also relevant for nutrition and physical activity behaviors. For example, low 

socioeconomic status may lead to a food deficit, less nutritious choices, and less investment in personal 

health.  

 

Caregivers of children have the ability to influence environments and personal factors impacting 

children to lead to positive dietary choices of children. MSFW families have many personal factors that 

can contribute to negative health outcomes, such as being transient, low income, and of low education. 

This furthermore justifies the benefits of a PSE approach for MSFW children participating in MSHS. The 

SCT can influence interventions with parents and staff in addition to how they model behaviors to 

children in MSHS.  

Figure 3: Social Cognitive Theory 

2.5 Characteristics of Teachers in MSHS 

 

MSHS collected a nationally representative, weighted sample with MSHS teachers and assistant 

teachers in 2017. Nearly all were female (teachers 99.1%, assistant teachers 98.8%) and most were 

Hispanic or Latino (teachers 76.5%, assistant teachers 78.8%) (Table 7). Many teachers and assistant 

 

15 

teachers had family members who were MSFW (52.8%, 61.2%, respectively) or were MSFWs themselves 

(36.6%, 31.4%, respectively) (Table 6). Education levels included highest education level of high school 

diploma/equivalent of 23.9% of teachers and 32.3% of assistant teachers, while 54.7% teachers and 

26.8% of assistant teachers obtained an associates degree or higher (Table 7). The majority of both 

teachers and assistant teachers speak, read, write, and understand English and Spanish either “well” or 

“very well” (Table 8). However, some have limited to no understanding of each language, including 

14.7% of teachers and 12.5% of assistant teachers reporting understanding English “not well” (Table 8). 

Additionally, 18.8% of assistant teachers report understanding Spanish “not at all” or “not well”, while 

14.4% of teachers report understanding Spanish “not well” (Table 8). (U.S. Department of Health and 

Human Services: Office of Planning Research and Evaluation 2019) 

Household income is not included, though salaries earned at MSHS are provided. Most earn less 

than $25,000. The majority of teachers reported earning between $20,000 - $24,000 (28.4%) while most 

assistant teachers reported earning $10,000-$14,999 (36.6%) (U.S. Department of Health and Human 

Services: Office of Planning Research and Evaluation 2019). OW/OB rates among staff working in MSHS 

are high in Michigan, where MSHS staff had rates of 24.1% OW and 49.5% OB (Song, Song et al. 2016).  

Table 6: MSHS Teacher and Assistant Teacher Experiences  

 

What experiences have you had with migrant and 
seasonal families and/or with the MSHS program before 
becoming an MSHS teacher? (Mark all that apply.) 
Family members are/were migrant and seasonal 
farmworkers 
You are/were a migrant or seasonal farmworker 
Assistant Teacher 
Teacher 
Administrator (Assistant Center Director, Assistant 
Program Director, Center Director, Area Coordinator, 
Regional Director, Program Director) 
Administrative Support (Secretary, Financial Officer, and 
Information Technology Director) 

16 

 

 

 

 

 
 
 
 

 

MSHS 

Teachers % 

n=118 

52.8 

36.6 
56.5 
n/a 
2.4 

1.2 

 

 

 

 
 
 
 

 

MSHS 
Teacher 

Assistants % 

n=99 

61.2 

31.4 
n/a 
50.6 
0.8 

0.0 

Table 6 (cont’d) 
 

 

 

9.2 

Education, Health, and Social Services (Educational 
Specialist, Education Manager, Component Coordinator, 
Outreach Staff/Recruiter, Family Service Worker, 
Counselor/Mental Health Professional, Social Worker, 
Health Care Worker, Community Organizer) 
Support Staff (Kitchen Staff, Custodial Staff, Bus Driver, 
Bus Monitor, Transportation Supervisor) 
Other 
None of the above 
(Adapted from U.S. Department of Health and Human Services: Office of Planning, Research and 
Evaluation, 2019)  
 
Table 7: MSHS Teacher and Assistant Teacher Demographics  

17.0 
10.8 

30.6 

 
 

 
 

 

 

2.3 

17.2 

11.5 
20.5 

 

 

MSHS 

Teachers % 

 

MSHS 
Teacher 

Assistants % 

n=99 

10.0 
32.3 
30.9 

14.3 
10.9 
1.6 

 

 
 
 

 
 
 

 

 
 
 

 
 
 

n=117 

32 
19.9 
2.8 

5.0 
23.9 
16.4 

What is the highest grade or year of school that you 
completed? 
Less than high school diploma/equivalent 
High school diploma/equivalent 
Vocational/technical program with some college 
(including vocational/technical diploma after HS with or 
without diploma and some college without degree) 
Associate’s degree 
Bachelor’s degree 
Higher than bachelor’s degree (including some 
professional/graduate school without degree or master’s, 
doctoral or professional degree) 
What is your sex?  
Male 
Female 
Other 
What is your race/ethnicity?  
Black or African American 
Hispanic or Latino 
White 
American Indian or Alaska Native, Asian, or Native 
Hawaiian or Other Pacific Islander 
Which Hispanic or Latino origin best describes you? 
Mexican, Mexican-American, Chicano/a 
Another Hispanic and/or Latino origin (including Puerto 
Rican and Cuban) 
(Adapted from U.S. Department of Health and Human Services: Office of Planning, Research and 
Evaluation, 2019)  

n=119 
0.9 
99.1 
0.0 
n=118 
4.9 
76.5 
24.2 
0.4 

n=86 
87.8 
12.2 

 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 

 
 
 

 
 
 

n=100 
1.2 
98.8 
0.0 
n=99 
4.9 
78.8 
17.7 
0.8 

n=79 
88.9 
12.3 

 

17 

 
Table 8: Language Capability of MSHS Teachers and Assistant Teachers  

MSHS Teachers %  MSHS Teacher 
Assistants % 

 

How well do you understand English? 
Not at all  
Not well  
Well  
Very well  
How well do you speak English? 
Not at all or Not well  
Not at all  
Not well  
Well  
Very well  
How well do you read English? 
Not at all or Not well  
Not at all  
Not well  
Well  
Very well  
How well do you write English? 
Not at all or Not well  
Well  
Very well  
How well do you understand Spanish? 
Not at all or Not well  
Not at all  
Not well  
Well  
Very well  
How well do you speak Spanish? 
Not at all or Not well 
Not at all  
Not well  
Well  
Very well  
How well do you read Spanish? 
Not at all  
Not well  
Well  
Very well  
 
 
 

 

18 

n=114 
0.0 
14.7 
35.4 
50.0 
n=115 
22.8 
n/a 
n/a 
33.6 
43.6 
n=115 
18.5 
n/a 
n/a 
32.7 
48.8 
n=115 
27.5 
29.6 
42.9 
n=114 
n/a 
2.7 
14.4 
26.9 
56.0 
n=114 
n/a 
2.5 
16.3 
29.3 
51.8 
n=114 
8.2 
10.6 
28.5 
52.6 

 
 
 

n=97 
0.0 
12.5 
38.5 
49.0 
n=99 
n/a 
0.0 
33.7 
20.1 
46.2 
n=99 
n/a 
0.0 
21.1 
31.7 
47.2 
n=99 
31.3 
24.3 
44.4 
n=99 
18.8 
n/a 
n/a 
17.3 
63.0 
n=99 
19.7 
n/a 
n/a 
17.3 
63.0 
n=99 
6.2 
14.7 
17.2 
61.9 

 
 
 

 
 

 
Table 8 (cont’d) 
 
How well do you write Spanish? 
Not at all  
Not well  
Well  
Very well  
(Adapted from U.S. Department of Health and Human Services: Office of Planning, Research and 
Evaluation, 2019)  
 
Table 9: Salary at MSHS for Teachers and Assistant Teachers  

n=114 
12.1 
11.1 
32.2 
44.5 

 
 

n=99 
7.9 
16.2 
20.2 
55.6 

What is your total yearly salary (before taxes) as a 
teacher/assistant teacher? 

Teachers % 

n=102 

Assistant 
Teachers % 

Less than $5,000 
$5,000 to $9,999 
Less than $10,000 
$10,000 to $14,999 
$15,000 to $19,999 
$20,000 to $24,999 
$25,000 or more 
$25,000 to $29,999 
$30,000 or more 
(Adapted from U.S. Department of Health and Human Services: Office of Planning, Research and 
Evaluation, 2019)  
 
2.6 Characteristics of Parents in MSHS  

0.0 
6.4 
n/a 
25.5 
23.9 
28.4 
n/a 
4.9 
10.9 

n=84 
n/a 
n/a 
13.2 
36.6 
24.2 
14.6 
11.5 
n/a 
n/a 

A nationally representative survey in MSHS identified demographic information about parents 

with children in MSHS in 2017. Nearly all parents are Hispanic/Latino (97.7%) and most are of Mexican, 

Mexican-American, Chicano/a (94.8%), and born in Mexico (75.9%). Of parents surveyed, 21.3% 

achieved high school diploma/equivalent as their highest level of education, and 33.4% achieved an 8th 

grade education or less. Nearly all understand or speak Spanish (98.7%) and many understand or speak 

English (62.7%) to some degree. Most caregivers surveyed have been involved in US agricultural work 

for an average of 7.42 years, are currently working (72.8%), and of those working, 84.3% are currently 

 

19 

employed by agricultural work. (U.S. Department of Health and Human Services: Office of Planning 

Research and Evaluation 2019) 

Many report a family income below $20,000 (36.2%), and 31.7% report having difficulty paying 

bills each month. Parents report concern of food running out before being able to purchase more (25%) 

and eating less than they should due to lack of finances (14.5%). Questions related to food insecurity 

from children are concerning, with 6.5% of parents reporting children eat less than they should due to 

finances. (U.S. Department of Health and Human Services: Office of Planning Research and Evaluation 

2019) 

Despite high rates of OW/OB among MSFW children, only 6.3% of parents surveyed report 

medical professionals informing them that their child’s weight was high (U.S. Department of Health and 

Human Services: Office of Planning Research and Evaluation 2019). In a study in Michigan, MSHS parents 

had high rates of OW and OB (27% and 31%, respectively), and parents with high BMIs are associated 

with children with higher BMIs (Song, Song et al. 2015). Parents who did not believe their own weight 

and child’s weight were high were more likely to have high BMIs (Song, Song et al. 2015).        

Table 10: Demographics for MSFW Parents with Children in MSHS  

 
Race/Ethnicity 
Hispanic or Latino 
White 
American Indian or Alaska Native or Black or African American or Native 
Hawaiian or Other Pacific Islander 
Which Hispanic or Latino origin best describes you? 
Mexican, Mexican-American, Chicano/a 
Cuban 
Another Hispanic and/or Latino origin (includes Puerto Rican) 
In what country were you born? 
US 
Mexico 
Central America  
South America 
South America, Caribbean, Southeast Asia, Pacific Islands, Asia, or Africa 
Other (includes Puerto Rico) 

 

20 

% of Parents 

n=640 
97.7 
1.8 
1.1 

n=625 
94.8 
0.0 
5.3 
n=640 
19.4 
75.9 
4.6 
0.0 
0.1 
 

 

Table 10 (cont’d) 
 
In what year did you first enter the U.S. to either work or live?  
Before 1990 
1990 — 1994 
1995 — 1999 
2000 — 2004 
2005 — 2009 
2010 — 2014 
2015 or later 
What is the highest grade or year of school you completed? 
No school 
Preschool to 5th grade 
6th to 8th grade 
9th grade 
10th grade 
11th grade 
12th grade without a diploma 
High school diploma/equivalent 
Vocational/technical program 
Vocational/technical diploma 
Some college, no degree 
Associate’s degree 
Bachelor’s degree or Some graduate school without a degree  
Master’s degree, Doctoral degree, or Professional degree 
(Adapted from U.S. Department of Health and Human Services: Office of Planning, Research and 
Evaluation, 2019)  
 
Table 11: Languages Spoken by MSFW Parents with Children in MSHS  

n=502 
5.2 
9.2 
13.6 
25.1 
31.7 
9.6 
5.7 
n=639 
1.9 
9.4 
22.1 
13.8 
4.2 
3.0 
8.7 
21.3 
1.4 
1.8 
8.2 
1.1 
3.0 
0.0 

 
What are all the languages that you understand or speak, including indigenous 
languages? 
English 
Spanish 
Mixtec 
Zapotec 
Other language  
How well do you understand English? 
Not at all 
Not well 
Well  
Very well  
How well do you speak English? 
Not at all 

% of Parents 

n=640 

62.7 
98.7 
7.4 
0.9 
4.8 
n=633 
16.2 
40.8 
16.7 
26.3 
n=630 
25.8 

21 

 
 

 

Table 11 (cont’d)  
 

36.0 
Not well 
15.1 
Well  
23.1 
Very well  
n=631 
How well do you read English?  
31.4 
Not at all 
29.8 
Not well 
13.9 
Well  
25.0 
Very well  
n=631 
How well do you write English?  
37.4 
Not at all 
27.2 
Not well 
12.2 
Well  
23.2 
Very well  
(Adapted from U.S. Department of Health and Human Services: Office of Planning, Research and 
Evaluation, 2019)  
 
Table 12: MSFW Parent Questions for Parents with Children in MSHS  

Child’s Weight Addressed by Medical Professionals  
In the past year, has a doctor, nurse, or other medical 
professional told you that [MSHS CHILD]’s weight is too low? 
In the past year, has a doctor, nurse, or other medical 
professional told you that [MSHS CHILD]’s weight is too high? 
Parent and Caregiver Work  
How many years in agricultural work in US 
Are you currently working 
Currently work in agricultural work  
How many years additional caregivers in agricultural work in US 
Is other caregivers currently working 
Other caregiver currently work in agricultural work  
Income and Food Security  
Do you have enough money each month to make ends meet? 
Do you have difficulty paying your bills each month? 
Do you worry about your food running out before you have 
money to buy more? 
In the last 12 months, did you ever eat less than you felt you 
should because there wasn’t enough money to buy food? 
In the last 12 months, did [MSHS CHILD] ever eat less than you 
felt he/she should because there wasn’t enough money to buy 
food? 
Is [MSHS CHILD] currently covered by health insurance? 
Since ([MSHS CHILD] was born, was there any time when 
(he/she) did not have any health insurance coverage? 

n 
639 

638 

 

631 
640 
475 
515 
547 
515 

 

636 
637 
638 

638 

639 

639 
640 

Yes 
3.5 

6.3 

 
 

72.8 
84.3 

 

93.9 
88.1 

 

76.9 
31.7 
25.0 

14.5 

6.5 

96.5 
25.6 

No 
96.5 

93.7 

 
 

27.2 
15.5 

 
6.1 
11.3 

 

23.1 
68.3 
75.0 

85.5 

93.5 

3.5 
74.4 

 

22 

Years 

 

 

7.42 

9.98 

 

 
 

 
 
 
 
 
 

 

 

 
 

(Adapted from U.S. Department of Health and Human Services: Office of Planning, Research and 
Evaluation, 2019)  
 
Table 13: Family Total Income for Parents  

Family Income 

% of 
Parents 

Did not work at all in 2016 (n=547) 
Less than $2,500  
$2,500 to $4,999 
$5,000 to $7,499 
$7,500 to $9,999 
$10,000 to $12,499 
$12,500 to $14,999 
$15,000 to $17,499 
$17,500 to $19,999 
$20,000 to $22,499 
$22,500 to $24,999 
$25,000 to $27,499 
$27,500 to $29,999 
$30,000 to $32,499 
$32,500 to $34,999 
$35,000 to $37,499 
$37,500 to $39,999 
$40,000 to $44,999 
$45,000 to $54,999 
$55,000 or more 
(Adapted from U.S. Department of Health and Human Services: Office of Planning, Research and 
Evaluation, 2019)  
 
2.7 Federal Programs for Low-Income Audiences 

1.3 
2.5 
2.1 
2.5 
2.5 
6.0 
5.0 
8.1 
6.2 
10.1 
8.4 
8.8 
6.1 
9.8 
6.3 
3.4 
1.9 
4.8 
3.3 
0.8 

Head Start and MSHS Programs. The Head Start Program includes the regular Head Start (3-5 

years) and early Head Start (0-2 years) programs. In 2017, 771,479 children in Head Start and 149,986 

children in Early Head Start (National Head Start Association 2017) were funded federally. In 2016 the 

MSHS had funding for 31,081 Head Start children and 1,031 Early Head Start children nationally 

(National Head Start Association 2017). MSHS produced 12,695 jobs in 2016 (National Head Start 

Association 2017). Funding for 2016 was $369,244,615 among 60 Migrant and Seasonal Head Start 

Programs in the United States (National Head Start Association 2017). The program provided  28,033 

 

23 

children with health care access and 27,124 children with dental care access (National Head Start 

Association 2017).  

MSHS programs cater to the needs of MSFW children in 38 states with approximately 32,500 

children served each year. The programs are open during the growing seasons ranging from 2 to 10 

months a year. MSHS program services are coordinated with clients’ move to different areas. The length 

of operation is often longer than a standard head start program since farmworkers work such long days. 

Because of this, MSHS centers can be open for 12 hours a day and also on weekends. (National Migrant 

and Seasonal Head Start Association 2017) In addition to child education, the MSHS programs also 

include parent education, social services to connect them with resources, health and disability services, 

and nutrition services. (National Migrant and Seasonal Head Start Association 2017) 

Telamon Corporation, a non-profit organization established in 1965, provides all MSHS 

programs in Michigan and 10 other states. Telamon’s mission “is to provide educational services that 

lead to better jobs, better lives, and better communities.” The MSHS program in Michigan began in 

1992. In 2016 when this study was conducted, 17 MSHS centers were located primarily on the West 

Coast of Michigan. In  2015-2016, 1243 children and pregnant women and 854 families utilized MSFW 

services, and 89% of families had income below the poverty level. (Telamon Corporation Michigan 2016) 

Federal Nutrition Education Programs. Federal nutrition education programs educate 

individuals of low-socioeconomic status about using limited financial resources to optimize nutrition and 

physical activity. Program operation is directed by the National Institute of Food and Agriculture (NIFA) 

and the United States Department of Agriculture (USDA) Food and Nutrition Service (FNS). Education 

content delivered through these programs aligns with USDA Dietary Guidelines for Americans. Two of 

those programs are Supplemental Nutrition Assistance Program Education (SNAP-ED) and Expanded 

Food and Nutrition Education Program (EFNEP).  

 

24 

SNAP-ED formed in 1988 in Wisconsin and expanded nation-wide by 2004 through land-grant 

institutions and subcontractors. SNAP-ED provides interventions though nutrition education, social 

marketing, and Policy, Systems, and Environmental (PSE) change. EFNEP formed in 1969 focuses on a 

paraprofessional model to offer peer educators to reach community members. EFNEP services 

approximately 200,000 adults and 450,000 youth in 50 states with education provided through both 

1862 and 1890 land-grant institutions.  EFNEP is also offered in the six US territories and District of 

Columbia. Traditionally, SNAP-ED and EFNEP have implemented direct education strategies through 

community class settings and home visits. More recently, SNAP-ED and EFNEP have begun implementing 

PSE change approaches. These efforts focus on site and community level changes to make healthy 

choices feasible for all.  

 

MSFW caregivers and children are generally income eligible for federal nutrition education 

programs. This is one avenue to provide education to this subpopulation.  

2.8 Caregivers Can Influence Health Behaviors of Youth  

Parents can influence nutrition and physical activity of children in various ways. Parenting style 

has the potential to play a role in child OW/OB rates. One study with preschooler parents discovered 

that OW/OB was higher when parents have an authoritative parenting style (Melis Yavuz and Selcuk 

2018), though a review discovered mixed results regarding weight and parenting styles (Vollmer and 

Mobley 2013).  

 

Parent beliefs about food, health, and physical activity can play a role in how they model 

behaviors to their children. Several studies have examined health beliefs in Latino parents. One study 

interviewing Latino farmworker mothers with preschool children assessed their belief of the importance 

of activity on their child’s health, with mothers agreeing activity plays a positive role in child’s health and 

obesity prevention (Grzywacz, Arcury et al. 2016). In this study, mothers also expressed that limited 

accessible play areas and concerns about neighbors limited the ability for children to be active 

 

25 

(Grzywacz, Arcury et al. 2016). A study with Latino parents examined parent perceptions of activity and 

eating, showing that parents believed it was very challenging to live a healthy lifestyle and to make 

positive changes (Taverno Ross, Macia et al. 2018). A study also shows that Latino parents have accurate 

beliefs regarding how to help children lose weight, such as reducing portion sizes. Parents also identified 

parent behavior modeling as a way to help children (Flores, Maldonado et al. 2012). Parents were open 

to trying healthier versions of traditional Latino foods (Flores, Maldonado et al. 2012). A better quality 

diet for parents also is associated with children in preschool having lower nutrition risk (Lohse 2015).  

MSHS centers are an ideal venue for educating caregivers, both parents and staff working in 

MSHS centers, and setting them up for success to influence the behavior of children and their health 

outcomes.  

 

 

 

26 

CHAPTER 3: METHODS 

 
 
3.1 Methods Introduction  

 

This study aims to assess the needs for nutrition and physical activity education among staff and 

parents of Michigan MSFW children. Data collection included surveys with parents and staff with a goal 

of identifying content and format needs for nutrition and physical activity education programs. Focus 

groups with parents, staff, and directors were conducted with the goal of identifying needs, barriers, 

and facilitators to program participation. Data collection methods by group are outlined below (Figure 

4).  

Children 

Surveys (n=135) 

Surveys with Parents of MHS 

 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 4: Approaches for Data Collection 

at 9 MSHS 
Centers 

Administered by 

5 Focus Groups 

(n=33) at 5 
MSHS Centers 

interview 

Surveys with Staff and Directors of 

MHS Centers 

Surveys (n=280) 

at 17 MSHS 

Centers 

2 Center Director 

Focus Groups 

(n=13) 

Administered 

online 

5 Staff Focus 

Groups (n=27) at 
5 MSHS Centers 

3.2 Study Areas, Subjects, General Recruitment Strategies  

The present study proposal was reviewed and exempted by the Michigan State University’s 

Internal Review Board (Appendix A). Researchers collaborated with the Telamon Corporation 

(https://www.telamon.org/) which oversees all 17 MSHS Centers in Michigan. Most MSHS Centers were 

located on the western coast of Michigan’s lower peninsula, specifically in Adrian, Bear Lake, Buen 

Pastor, Chase, Conklin, Decatur, Hart, Keeler, Kent City, Mears, New Era, South Haven, Pullman, Sodus, 

Sparta, Spinks Corner, and Suttons Bay (Figure 5).  

 

27 

Each MSHS center has a Director that manages the site and various support staff including 

coordinators, specialists, teachers, assistant teachers, center aids/assistants, food service staff, 

secretary, bus drivers, data entry clerks, custodians, special service assistants, health aides, or other 

roles. The research team held a meeting with all MSHS Center Directors at the Telamon central office in 

Lansing, MI to explain the study purpose with a request for cooperation to recruit parents and staff for 

participation.  

Participants in the study included parents with children enrolled in MSHS, staff, and directors of 

MSHS. Our surveys and focus groups took place with staff and parents at MSHS centers plus the central 

Michigan office located in Lansing, MI between July 11 – September 30, 2016. All 17 MSHS centers were 

involved in staff surveys; 9 were involved in parent surveys, and 5 were involved in focus groups. Parent 

survey sites included Bear Lake, Conklin, Decatur, Hart, Keeler, Kent City, Sodus, Sparta, and Spinks 

Corner. Focus groups sites included Conklin, Hart, Keeler, Sodus, and Sparta. A map displaying data 

collection sites is presented below (Figure 5).  

 

28 

Red: Staff Survey Sites 
Green: Staff Survey and 
Parent Survey Sites  
Blue: Staff Survey, Parent 
Survey, and Focus Group 
Sites 

 

Figure 5: Map of MSHS Data Collection Sites by Type 

3.2 Recruitment and Training of Bilingual Research Team  

The research team consisted of graduate and undergraduate students, a post-doctoral student, 

and professor. The team focused on recruiting undergraduate students who were culturally 

knowledgeable and sensitive to the needs of the study population. The majority of the data collection 

team were recruited from MSU’s College Assistant Migrant Program (CAMP). The federally funded 

CAMP program supports college students who are from a Migrant and Seasonal Farmworker family 

background by providing the first year of college financially and in a supportive community 

environment. All of the CAMP students were bilingual in Spanish and English. Four CAMP students were 

recruited, and one additional bilingual student was recruited.  

 

29 

The bilingual research assistants were trained by the research team on IRB training, focus group 

procedures, and practices through a mock focus group. One CAMP research assistant was trained in 

depth to lead focus groups in Spanish with the parents since the other research team members 

facilitating focus groups were not bilingual; training consisted of observing focus groups and discussing 

how to probe for questions in depth. Others were trained to take thorough notes during focus groups in 

addition to recording and transcribing. Research assistants were instructed to administer surveys orally 

and record responses.  

3.3 Quantitative Survey Study, Parallel Study to Focus Groups 

Survey questions were developed from a survey conducted as part of a pilot study from this lab 

in 2013. The survey included questions about demographics, knowledge of federal nutrition programs, 

nutrition knowledge, attitude, and behaviors. Surveys were developed for both parents and staff.  

3.3.1 Parent Survey  

Sites for parent surveys were selected based on convenience sampling related site proximity, 

dates of events hosted by the center, target population available, and willingness of the center to 

coordinate data collection times with the research team. Survey questionnaires were collected at parent 

events at each center and reviewed on site for their completeness.  

Student interviewers bilingual in Spanish and English collected the parent surveys by reading 

questions to participants and recording on a hard copy to combat literacy issues. Students read the 

consent forms and, if the subject consented orally, they participated in the study.  Each parent who 

participated received a $10 gift card to Walmart or Meijer. Students then entered the survey responses 

into Survey Monkey in the research lab and results were exported and analyzed.  

Parents were surveyed at nine MSHS Centers including Bear Lake (n=2), Conklin (n=25), Decatur 

(n=27), Hart (n=15), Keeler (n=23), Kent City (n=9), Sodus (n=16), Sparta (n=11), and Spinks Corner (n=7). 

A total of 135 parent survey responses were received out of 672 possible parents at these nine sites 

 

30 

(1,158 parents were available across all sites). Surveys were obtained between July 14 – August 16, 

2016.  

3.3.2 Staff Survey 

Staff surveys were administered online through Survey Monkey. Telamon recruited all staff in 

MSHS Centers and central office staff in Lansing to participate via email and through word of mouth at 

meetings. Staff who elected to participate read consent forms online and accepted before continuing 

with the survey. A catered lunch incentive was offered to the site with the highest response rate. 

 

Staff survey responses were received from all 17 MSHS Centers in addition to the central office. 

Centers included Adrian (n=21), Bear Lake (n=23), Buen Pastor (n=6), Chase (n=17), Conklin (n=28), 

Decatur (n=12), Hart (n=29), Keeler (n=11), Kent City (n=19), Lansing (n=6), Mears (n=17), New Era 

(n=10), South Haven (n=2), Pullman (n=38), Sodus (n=23), Sparta (n=10), Spinks Corner (n=4), and 

Suttons Bay (n=4). Staff surveys yielded 280 responses out of 591 total staff. Staff surveys were obtained 

from July 11 to July 29, 2016.  

3.3.3 Analysis of Surveys 

For surveys, descriptive statistics were analyzed in SAS to present results related to content and 

delivery format for education.  

3.4 Qualitative Focus Groups Study: Focus of this Thesis  

Focus group questions were developed with the aim to discover content needs, barriers, and 

facilitators to participation in nutrition and physical activity education. Barriers and facilitators for child 

health and personal health were also included. Scripts were created for focus groups consisting of 

parents, staff, or directors.  

3.4.1 Parent Focus Groups 

A total of 33 parents participated in five focus groups, one at each of the five selected MSHS 

centers including Conklin (n=8), Hart (n=6), Keeler (n=5), Sodus (n=8), and Sparta (n=6) between July 26 

 

31 

to September 30, 2016. These five MSHS Sites were selected based on location and ability to schedule a 

focus group at the site. Parent participants were recruited by staff at the MSHS Centers. Childcare was 

provided by the MSHS Centers to allow for parent to participate. All parents were given a $15 gift card 

to Walmart or Meijer for their participation in addition to refreshments that were served during the 

focus group. 

3.4.2 Staff Focus Groups  

A total of 27 staff participated in five focus groups, at MSHS centers including Conklin (n=6), Hart 

(n=6), Keeler (n=5), Sodus (n=6), and Sparta (n=5) between July 26 to September 30, 2016. Locations for 

staff focus groups were selected in conjunction with parent focus groups. Staff were recruited by the 

centers. Incentives for staff included a free meal and refreshments during the focus group.   

3.4.3 Director Focus Groups 

Director focus groups were conducted at a statewide director meeting when MSHS Center 

directors were present on August 24, 2016. A total of 13 directors participated in two simultaneous 

focus groups (n=13). Directors were recruited by staff organizing the meeting and were invited to 

participate. Directors received a free luncheon incentive for focus group participation.  

3.4.4 Focus Group Data Transcription and Analysis  

The focus group leader read consent forms at the beginning of each focus group to ensure 

everyone was willing to participate; if willing, participants signed consent forms. One researcher led 

each focus group while two assistants took notes. Focus groups were audio recorded and transcribed. 

For parent groups, scripts were transcribed in Spanish, then translated to English. At least one additional 

bilingual student validated these translations for each focus group. 

To analyze focus group transcripts, the first five transcripts were coded in detail, using line by 

line coding by two trained researchers. The two researchers then developed a codebook based on the 

most relevant themes that emerged. Additional codes were added as necessary when new themes were 

 

32 

discovered in additional transcripts. Three trained researchers applied the codebook to all transcripts, 

by first coding individually. Using a consensus coding approach, the three trained researchers discussed 

and agreed on the final codes used for analysis. Final codes were entered using NVivo 11 software 

(https://www.qsrinternational.com/nvivo/nvivo-products). Data was extracted for each code and placed 

into table matrices and summary statements were written in tables to compare data across groups 

(Miles, Huberman et al. 2014). The number of focus groups where themes emerged was noted in the 

results. However, the number of individual participants mentioning a theme was not identified because 

multiple others may have agreed with this theme even if they did not specifically discuss it in a focus 

group setting. All themes carry relevance regardless of how many groups identified them.   

 

 

 

 

 

33 

CHAPTER 4: RESULTS 

 
 
4.1 Overview of Focus Group and Survey Participants  

 

Surveys included a total of 280 staff and 135 parent participants. Parents were primarily 

Hispanic/Latino (97%), female (82.2%), of low education status (17.8% completing Highschool/GED), and 

low income (34.8% reporting less than $10,000 yearly family income). Staff were Hispanic/Latino 

(51.8%), female (90.7%), of higher education attainment (30.7% completing high school/GED and 67.5% 

receiving advanced education beyond high school), and report varying levels of income. (Appendix H) 

Focus groups comprised a total of 73 participants including parents (n=33), staff (n=27), and 

directors (n=13). Most parents were Hispanic/Latino (84.4%), female (72.7%), of low education (21.2% 

obtaining high school/GED equivalency), low income (100% reporting family income below $29,999), 

and 56.3% reported lack of health insurance. Staff were primarily Hispanic/Latino (70%), female (93%). 

Income and education for staff varied with most reporting an income of $15,000-$19,999 (39.3%) and 

associates degree level education (32%). Most directors were female (92%), not Hispanic/Latino (69%), 

and reported higher income and education levels than staff and parents. Nearly all directors had 

completed an associates or bachelor’s degree (46.2% and 46.2%, respectively) and most report a family 

income between $80,000-$99,999 (46.2%). (Appendix I)  

 

 

 

 

 

 

 

 

 

34 

 

 

 
4.2. Content Needs for Programs from Focus Groups 

 

 

 

 

 

 

 

 

 

 
 

Budgeting 
and Money 

Basic 

Nutrition 
Knowledge 

Content 
Needs 

Physical Activity 

Cooking and 
Meal Planning 

Figure 6: Content Needs for Caregivers from Focus Groups 

Table 14: Overall Needs of Nutrition and Physical Activity Programs Expressed by Parents, Staff, and 
Directors from Focus Groups 

Content Needs for Program  

Parents 

Staff 

Director 

Basic Nutrition Knowledge 

Food Composition  
Healthy Eating 

Food Labels and Portions 
Healthy Foods 

Eating Healthy Versions of Foods You Enjoy 

Food Preservation and Gardening 
Lifestyle Incorporation 

Children Trying More Nutritious Foods 

 

X 

 

X 

X 

 

 

 

 

35 

X 

X 

X 

 

X 

X 

X 

X 

 

 

 

 

 

 

X 

 

Table 14 (cont’d) 

Nutrition to Benefit Children and Family 
Health Education 

 

X 

 

Cooking and Meal Planning 

X 

X 

X 

Physical Activity 

 

 

 

X 

Budgeting/Money 

 

 

Convenient Cooking 

Cooking to Benefit Child and Family 

Other Cooking Suggestions 

Activity Related to Healthy Weight 
Activity with Children 

Simple and Easy Physical Activity 
Other Physical Activity 

Healthy Foods with Limited Budget 
Activity with Limited Budget 

 
4.2.1 Basic Nutrition Knowledge        

 

 

X 

X 

 

X 

X 

X 

X 

X 

X 

X 

 

 

X 

X 

 

X 

 

X 

X 

X 

 

 

Needs of basic nutrition knowledge were expressed by staff (four out of five), director (two of 

two), parent (four out of five) focus groups. (Table 14) 

Food Composition. The themes of basic nutrition knowledge included food composition of such as 

calories and protein among staff groups and vitamins among staff and parents. One staff member said 

they wanted to learn about what is “good” and “healthy”. One staff member commented on needs to 

learn about foods that are “loaded with calories” and considered a healthy food.  The comment 

indicates that he/she does not have a thorough understanding of calories and their health effects. (Table 

14) 

Healthy Eating. Another staff member expressed needs to learn how the body uses food one eats and 

choice of foods that prevent disease. One staff member (Staff 1, Keeler) shared,   

 

36 

“I think if it was a class for families and kids, a good thing for the kids to know would be ‘You can 
eat food and get full’. You can eat a lot of food but it just depends on what kinds of food you’re 
eating to get full. You don’t have to feel like you have to eat just the minimum. You’re able to eat 
a good quantity of food and be full. You don’t have to be hungry.”  

 
The statement indicates that some adults or children may think staying healthy means starving oneself, 

and children in particular should be educated on healthy eating to one’s satisfaction. (Table 14) 

Food Labels and Portions. A staff member (Staff 3, Sparta) expressed the need to learn about food 

labels, 

 

“I always wanted to learn more about them because it feels like everything is a foreign language. 
So you don't really know what you're reading.”     

Healthy portion sizes for youth and adults were mentioned in parent and staff groups. The need 

to learn about portion sizes and moderation was discussed in staff groups. (Table 14) 

Healthy Foods. Parent groups mentioned the need to learn about the healthiest forms of food to eat. 

Benefits of eating certain foods was shared by parents. Ways to eat less fat was mentioned by parents; 

they may believe that eating less fat is healthy, and may not be aware that some fat is needed for a 

healthy diet. Additional information about healthy fats could be beneficial. (Table 14) 

Eating Healthy Versions of Foods You Enjoy. Staff discussed the need to learn about eating healthy 

versions of foods they enjoy. One participant (Staff 1, Keeler) shared, 

“I think the biggest thing is learning how to put certain foods together to make them more 
nutritious. Different ways you can substitute different stuff to put in to make it more nutritious 
and still have a good quality and taste.”  

 
This indicates that participants are interested in learning about ways to make foods that are healthy but 

still desirable to eat. It was also suggested to learn how to eat healthy while including foods they enjoy 

(pizza was an example). A need to learn about healthier foods that children desire to eat was 

mentioned. (Table 14) 

 

37 

Food Preservation and Gardening. Staff discussed the need to learn about gardening and food 

preservation. This included growing foods without chemicals. Food preservation was mentioned by one 

participant (Staff 5, Sparta), 

“Preserving is a good one because my food it seems like it goes bad before I can really use it. 
Especially potatoes, they start growing other potatoes before I can use it.”  

 
Teaching information about how to store produce can prevent food waste and extend food resources 

for low income families. (Table 14) 

Lifestyle Incorporation. One staff and one director group discussed a need to learn ways to incorporate 

nutrition practices and physical activities into their lifestyle. This could imply they have a difficult time 

spending a lot of energy and time thinking about health. Directors mentioned how it can be helpful to 

provide real practical examples in education programs. (Table 14) 

Children Trying More Nutritious Foods. Staff groups discussed the need for addressing children who do 

not want to eat healthy foods. One participant (Staff 6, Conklin) shared,  

“Some of the barriers I have is my kids are very picky eaters. So it's hard for me to get them to 
eat nutritional foods. It would be nice to have some tips on how to get them to eat the good 
foods. Even like some of our kids here, they are supposed to eat the vegetables. We try to get 
them, to encourage them by eating them and telling them, ‘These are really, really good, you 
know. Why don't you try your carrots? You can be like a rabbit.’ You can try those creative things 
but they just, they don't seem to want to eat those vegetables.” 
 

Providing methods to encourage children to make healthy choices could be included in staff training and 

in parent education programs. A parent also expressed that some associate healthy eating behaviors 

with feeling hungry. Educating to promote the understanding that food is essential for energy and for 

health is a point to consider. A need for healthy foods that appeal to children was discussed. (Table 14) 

Nutrition to Benefit Children and Family. The desire to learn about healthy foods so their child can eat 

these foods and grow was mentioned, indicating parents are interested their child’s health. Parents 

discussed the need to teach children about the differences between healthy and unhealthy foods in 

addition to learning about individual needs for children. One parent shared (Parent 2, Keeler), 

 

38 

“Yes, because there are parents that give too much as well. And there are some that don’t know. 
Sometimes we want them to be fat when they are skinny. They can say we will give them more 
junk food because with that they will not gain weight. It depends on every kid as well. Every kid 
has a different body.”  
 
Learning about healthy habit and changes in the body while growing can help parents 

 

understand how to feed their children in a healthy way. (Table 14) 

A parent (Parent 3, Hart) shared,  

“….Before my son came here we didn’t know what nutrition was what was healthy to give to our 
children. Being here has given us a lot of benefits, now we know what’s good for our children 
and what they lack. A lot of the times education helps a lot.”  

 
Health Education. A need for education regarding additional health education topics (beyond nutrition 

and physical activity) was discussed in one director and one staff focus group. Examples given by directors 

and staff included education about chronic disease including diabetes, with specific mention of a need to 

learn  about  medication  and  carbohydrate  counting.  A  need  to  learn  about  high  blood  pressure  was 

mentioned by directors. Educating children about oral health was also discussed by directors. (Table 14) 

4.2.2 Cooking and Meal Planning 

 

A desire needing to learn about cooking and meal planning were expressed in staff (four out of 

five), director (two out of two), and parent (five out of five) focus groups. (Table 14) 

Convenient Cooking. A need for cooking convenient foods was mentioned in staff, director, and parent 

groups. Directors shared additional needs for convenience including cooking and meal planning ahead of 

time to prevent purchasing fast foods. Directors suggested that cookbooks with five ingredients or less, 

or cookbooks using slow cookers be promoted to make cooking easier.  

Staff shared about the need to manage time while cooking in addition to cooking convenient 

foods since they are busy with work; this could be a benefit to encourage caregivers to prepare meals 

since many work long hours. One staff participant was discouraged from trying recipes that have too 

many steps. Staff also discussed the need to learn about time management while preparing foods, and 

cooking foods that are convenient (Staff 6, Sodus),  

 

39 

“…and convenient. Sometimes, the time, we work, so we get home, we want to cook something 
that is easy because we don't have the time. sometimes I’ll look up recipes but then I see all 
those steps and I am like, ‘oh no never mind’.”  
 

Teaching how to cook easy meals can increase the likelihood meals are prepared since MSFW work long 

hours. There was a need expressed to prepare foods in a way that is easy for people in a household 

working opposite schedules.  

 Parents discussed a need for recipes that are convenient and can be reheated. A parent (Parent 

3, Hart) discussed how food choices are determined based on their jobs, 

“The thing about field work is that it’s a hard job, a lot of the times we say, ‘oh, we’ll just eat 
cereal or [a] sandwich.’”  

 
Because MSFW parents work long hours, this can limit their time to prepare meals. (Table 14) 
 
Cooking to Benefit Children and Family. Parents discussed a need to learn about information that 

 

benefits their children and their family. A need to learn methods for cooking healthy foods that children 

will eat was discussed.  

“So what I think I need is someone who can teach me to cook healthy to cook delicious for the 
children.” (Parent 6 Conklin) 
“And that it’s delicious.” (Parent 3 Conklin) 
“If it doesn’t taste delicious they’re not going to want to eat it.” (Parent 5 Conklin) 
“Like if there were a menu or something we’ll know how to make it.” (Parent 4 Conklin) 
“Yes, like you said a menu this is how it’s made and that and I would follow it.” (Parent 6 
Conklin) 
“Or also substituting one thing for another and the flavor is similar and good and it’s Mexican 
but a flour tortilla, no.” (Parent 7 Conklin) 
 
In this conversation, parents express the need for learning to cook foods that are healthy for 

children, but are also appealing to children. Menus and recipes to assist with child friendly foods are 

desired by parents. Parents expressed the need to cook with healthy substitutions while still creating a 

desirable food. Preparing foods that children can make themselves was mentioned. Learning to prepare 

fast and easy foods to prevent the need for convenient foods (such as instant Ramen Noodles) was 

mentioned. (Table 14) 

 

40 

Other Cooking Suggestions. Staff groups discussed the need to learn about cooking foods that are not 

expensive. Cooking demonstrations during programs was suggested; this could be a hands-on approach 

to education. Staff (Staff 2, Keeler) offered suggestions for programs including, 

“…having them participate and create the meal because then they are self-aware as to what 
they are putting inside their body.”  

 
Another staff member (Staff 3, Sodus) shared about the need to learn to cook foods that are not boring,  

“I think different ways to cook. because sometimes when you eat healthy, you get bored because 
you only know how to cook things a certain way. Or a lot of people when they think nutrition, 
they think like salads, and people get bored eating salads. So I think if there was something that 
people can learn how to cook healthy meals better and more fulfilling, people would be happy.”  

 
Cooking without animal based foods was mentioned by staff; this could also facilitate more economical 

cooking since animal based foods are often more expensive than plant based foods.  

 

Director focus groups mentioned a need to learn about healthy cooking; they discussed Mexican 

cultural norms of cooking with high amounts of lard and oil. The need for culturally appropriate foods 

was stated.  

 

Parent groups discussed a need to cook healthy foods. Learning to cook foods that appeal to 

children was stated, including easy meals that children can reheat, and foods that hold the interest of 

children. The desire for cooking demonstrations and unique recipes were mentioned, specifically 

cooking vegetables and other foods with less fat. (Table 14) 

4.2.3 Physical Activity  

 

Physical activity was a content need expressed in staff (four out of five), director (two out of 

two), and parent (three out of five) focus groups. (Table 14) 

Activity Related to Healthy Weight. A desire to learn about weight loss was discussed by staff. This 

included healthy ways to lose weight and tips for maintaining a healthy weight without strenuous 

exercise. This implies that some people may believe that being a healthy weight or losing weight 

requires a lot of exercise that is not manageable for them. This misconception should be corrected so 

 

41 

they learn how to improve health with simple lifestyle modifications. Making participants aware of 

healthy weight levels and risks for health is important. (Table 14) 

Activity with Children. Staff and directors mentioned the need to learn about physical activities with 

children. When considering programs for staff or parents, incorporating classes with a family centered 

approach could encourage participants to engage in activity with children. Staff can also be trained to 

incorporate activity while children are in the MSHS Centers. (Table 14) 

Simple and Easy Physical Activity. Directors and staff also discussed the need to learn about physical 

activity that is easy to implement. Staff discussed the idea of minimal exercise to support healthy but 

that is not too strenuous; directors discussed the need for simple exercise that will not be discouraging. 

This could imply they have the perception that exercise is associated with being difficult, tedious, or 

negative. The desire to learn ways to exercise without a gym was also mentioned by staff and directors. 

Directors shared that physical activity, including Zumba classes were popular for at their MSHS Centers 

in prior years. In regard to staff training about physical activity, a director (Director 5, Group 1) shared,  

“Maybe just kind of taking it to the education side of it…maybe understand why it’s so important 
to have your large motor activities and be impactful. You’re not just putting the same ones on 
the lesson plan all the time, but realizing this goes on here for a reason and getting more 
information about what different things you could do to make it more interesting.” 
 

Other Physical Activity. Staff discussed the need to learn about the best exercises for individuals and 

their personalized health. Learning the appropriate amount of exercise in a day was mentioned; this 

connects with the need for personalized health as this is dependent on many health factors. The desire 

to learn yoga was mentioned.  

 

Directors discussed a need to educate about physical activity in a way that benefits the MSFW 

lifestyle. This included activities that can be conducted in the camps where families work and stretching 

for work. Health benefits of exercise and the harmful effect of not exercising enough were mentioned as 

a need.  

 

42 

Parents mentioned the desire to learn about physical activity but did not provide details about 

this. Since they are expressing the desire to learn about physical activity, this topic should be considered 

in future programs. (Table 14) 

4.2.4 Budgeting/Money   

 

The need to learn about information related to the relationship between a low income and 

nutrition and physical activity was mentioned in staff groups (three of five). (Table 14) 

Healthy Foods with Limited Budget. One participant (Staff 5, Sparta) shared the need to learn about 

eating healthy foods with a limited budget, saying,  

“Maybe ways to eat healthy when we have a hard time or hard budget like we have. Or like I live 
with my fiancé and it’s just the two of us and he works 3rd shift and I work 1st so it's hard to do 
meals because we don't really eat together. So maybe a class that would help how to figure out 
how to do those kinds of meals so we could eat healthy.”  
 

One participant (Staff 6, Hart) shared, 

“It’d be kind of nice to almost have like somebody to help you figure out how to budget in those 
more expensive things too. Knowing your income is so limited, what can we do to help budget 
that in.”  
 

Having healthy, convenient, budget friendly meals could increase the likelihood participants can adhere 

to a nutritious diet successfully.  

 

Others discussed the need to learn ways to cook creatively with limited budget. Budgeting in 

some expensive foods was mentioned as well as learning more about foods that are not expensive. 

There was a concern that both healthy foods and supplies to cook could be cost prohibitive. (Table 14) 

Activity with Limited Budget. Related to physical activity, gym memberships were mentioned as cost 

prohibitive and a need was expressed to learn ways to exercise without a gym. (Table 14) 

4.2.5 Summary of Content Needs  

 

Content needs included basic nutrition knowledge, cooking and meal planning, physical activity, 

and budgeting/money. These topics can be included in nutrition and physical activity education 

programs to increase interest for participants and best meet their needs. (Table 14) 

 

43 

4.3 Facilitators to Participation from Focus Groups  

Program 
Structure 

Teaching/ 
Learning 
Format  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 7: Facilitators for Caregiver Education from Focus Groups 

Facilitators 

Organizational 

Support  

Factors Influencing 

Motivation 

Financial Support 

Table 15: Facilitators for Nutrition and Physical Activity Program Participation for Staff, Directors, and 
Parents from Focus Groups 

Facilitators to Participation 

Parents 

Staff 

Director 

Convenient Time for Participation 
Class Location 

Program Fees 

Incentives 

Program Structure  

X 

X 

Financial Support 

 

X 

Teaching/Learning Format 

Formats for Learning Style 

Education Delivery 
Delivery for Specific Health Concerns 

Learning with Children and Family 

 

 

 

 

X 

 

 

44 

X 

 

X 

X 

X 

 

X 

X 

X 

X 

 

 

 

X 

 

 

Table 15 (cont’d) 

Organizational Support 

Child Care and Children Responsibilities  

X 

 

 

 

 

 

X 

 

 

 

 

 

X 

X 

X 

X 

 

X 

X 

X 

X 

X 

 

 

X 

 

Health Care Referrals 
Lack of Eligibility or Interest 

Lack of Knowledge of Programs 

Transient/Caseworker Issues 
Marketing Programs to Parents 

Benefits to Children and Families 

Group Support 
Work 

Desire to be Healthy 

 
4.3.1 Program Structure 

Factors Influencing Motivation 

X 

 

 

 

Convenient Time for Participation. Convenient times for participation were mentioned as a facilitator to 

participation in one staff, one director, and one parent group. For staff, this was mentioned in the 

context of WIC offering appointments that promote participation and meet the needs of the individual. 

Directors mentioned including more physical activity in parent meetings and banquets at Telamon to 

reach parents with additional education at times they may already be present. Staff shared that classes 

should be offered during the work day. Staff shared if classes occur in the evening, a participant could be 

too tired from work to participate. One parent shared that meeting in the afternoon would be best for 

them. (Table 15) 

Class Location. Class location was mentioned as a facilitator in one director group. It was suggested to 

offer programs in the migrant camps to expand reach to parents and reduce the need for travel. One 

 

45 

parent group discussed location of nutrition programs as a barrier, sharing the programs can be far 

away. (Table 15)  

4.3.2 Financial Support  

Program Fees. One staff group discussed that free programs can facilitate participation due to 

eliminating the barrier of paying for this. (Table 15) 

Incentives. Incentives were mentioned as a way to facilitate program participation in two staff and two 

parent groups. Staff recalled benefits from WIC including health care and food vouchers. Parents 

mentioned the use of food vouchers including WIC and SNAP. Parents also mentioned receiving recipes 

at nutrition banquets through Telamon. (Table 15) 

4.3.3 Teaching/Learning Format  

Formats for Learning Style. Appropriate learning styles were discussed as a facilitator in one staff group. 

Programs should be offered in a way that meets the needs of the audience. One person (Staff 1, Keeler) 

shared:  

“With any form of education you really need to make sure it’s at that person’s education level 
because you don’t want to give too much information and have them not understand it. I think a 
little bit of information is better for them to retain instead of just overwhelming somebody with 
too much.”  
 

Including hands-on teaching methods to practice the topics learned was mentioned and preferred to 

online learning. One person (Staff 2, Keeler) shared,  

“I think hands on activities. Because if we do exactly what they are telling us, half the time we 
are not retaining the knowledge from it. Versus actually doing it yourself and you know if you are 
doing too much or too little.”  
 

Education Delivery. Directors (two of two) and staff (five of five) discussed education delivery methods. 

Delivery is outlined for both staff and parents.  

For staff, Directors suggested offering in person trainings for staff monthly or annually. 

Additional online trainings would allow staff to participate remotely while working at their MSHS centers 

to reduce travel.  To benefit the staff’s personal nutrition and physical activity, methods to track their 

 

46 

own foods and activity, such as a website was suggested. Providing education during teacher meetings 

and was suggested in addition to education at health fairs. Directors discussed how modeling to children 

can be important in promoting physical activity and nutrition. One director (Director 3, Group 2) shared,   

“Well I see a lot stuff going on at the playground you know it’s all about the adult interaction, 
and the level of education that our caregivers have as well. I mean I see a lot of good stuff going 
on a lot of physical activity, sometimes we just need to get out there and encourage the staff as 
well to get involved. They see the center director out there, they're going to want to get involved. 
They will start to move when they see me so I have to lose something as well. And I have to play 
with the children and model that’s what it is about modeling.” 
 
Directors believe that there should be more training for staff at Telamon about nutrition and 

 

physical activity. They are under the impression that topics covered in recent years are more minimal, 

and that monthly wellness emails do go out to staff. Staff are trained on I am Moving I am Learning 

(IMIL) and they suggested enhancing training with portion sizes for children, since they serve family style 

at the centers. More general nutrition content was suggested for them.  

For parents, delivery methods to facilitate participation were discussed. This included nutrition 

educators at Telamon through nutrition banquet events for parents. Education at WIC was mentioned. 

Directors also mentioned that the dedicated parents come to meetings, and many other parents can be 

difficult to reach.  

 

Times and frequency desired for programs varied. Frequency of education was suggested to be 

weekly after 5:00 pm, during afternoons, or on weekends. Class length was suggested from one half 

hour to 2 hours. It was mentioned that many people cannot attend when they are working on farms 

since this takes so much of the day. Offering classes that involve activities for children were mentioned.  

Receiving education through videos for those who cannot attend parent meetings was included as one 

way to reach additional parents. (Table 15) 

 

47 

Delivery for Specific Health Concerns. Health conditions were a barrier to participation in one staff 

group. Specific conditions mentioned included scoliosis, asthma, and heart conditions. Some believed 

these may prevent them from participating in physical activity during a program. (Table 15) 

Learning with Children and Family. Staff (three of five groups) discussed the need to learn about nutrition 

and physical activity with children and their families. One staff member (Staff 3, Conklin) shared,  

“I guess with physical activity. It would be nice to learn more like with children cause it’s 
different. Like I would used to go play soccer. It’s different when you have kids because you can’t 
do the same activities you used to do. It would be kind of more based on them than yourself.”  
 

After having children, it may be difficult to continue with the former physical activities adults were used 

to participating in. Incorporating education with adults and their children may be one way to encourage 

physical activity program participation to benefit the entire family. Staff expressed interest in programs 

focused on teaching children to eat healthy foods. Staff suggested educating with children and parents 

together, including cooking and exercise with children. (Table 15) 

4.3.4 Organizational Support  

Child Care and Children Responsibilities. Child care was discussed as a facilitator for participation in one 

parent group. Parents are more likely to participate if they are provided with child care, as this can 

relieve the logistical and financial burden of needing to find someone to care for their children.  

 

Responsibilities for children were discussed as a barrier in three staff and three parent groups. 

Parents and staff both expressed a need for child care, with staff mentioning a lack of child care due to 

both access and the expense associated with child care. Parents and staff mentioned responsibilities of 

taking care of children; staff discussed needs for children associated with after school activities, 

transportation for them, and cooking for them. (Table 15) 

Health Care Referrals. Health care referrals were with directors (one of two). At Telamon, referral systems 

are in place to assist children; when children have a high BMI they are referred to a doctor who can provide 

health education. Parents can receive education about the health of their children with the doctor. A 

 

48 

suggestion was made to add parents to this referral system to enhance health resources for parents; 

education received here has the potential to benefit the entire family in the future. (Table 15) 

Lack of Eligibility or Interest. Lack of eligibility was a barrier in one director group (one of two). Some 

directors shared that some may not be eligible for federal programs like WIC, SNAP, or EFNEP. One 

director (Director 5, Group 2) shared: 

“And some of them choose not to because they have to work and don't want the hassle with 
going to get the WIC and stuff like that because of the time. So I know they make it a priority 
because they need the formula but afterwards for the regular milk sometimes they don't go. 
They don't get them.”  
 

The incentive of providing formula in WIC is enough to encourage some to participate, though they may 

become less involved once they lose this incentive that is a priority for them. (Table 15) 

Lack of Knowledge of Programs. Parents and staff discussed the barrier of not being aware of programs.   

Parent groups (three of five) discussed a lack of knowledge of existing nutrition education 

programs. Some were not aware of free federal nutrition programs like SNAP-ED, EFNEP, or WIC. One 

parent shared that they did not feel they received a lot of information about nutrition from federal 

programs. One parent shared they were not aware of programs outside of the school (Telamon).  

Lack of knowledge was discussed in staff groups (three of five). One staff was not aware of 

physical activity programs. Others mentioned not knowing about nutrition programs and that they do 

not see this advertised. Some believe that programs either have a fee or that it takes great effort to find 

a free program. (Table 15) 

Transient/Caseworker Issues. One director group (one of two) discussed difficulties with MSFW being 

transient and also with caseworker issues for receiving benefits. Due to the nature of MSFW work being 

transient, they may not be able to invest in new caseworkers. One director thought that Department of 

Health and Human Services (DHHS) staff could improve their ability to reach out to parents. One shared 

(Director 1, Director Group 2),  

 

49 

“But for us they don't really follow through for case workers. Like the DHHS office, they're out 
but they're not really at the camps. They're not really with the families.”  
 

This implies that directors think they are not engaged enough with the community. (Table 15) 

Marketing Programs to Parents. Two director groups discussed how to market information to parents 

to facilitate sharing health related information. This included sharing information through Telamon. 

Health and nutrition programs and WIC were mentioned as ways to share information. Case workers at 

DHHS can refer parents to programs, but it was noted that there can be issues with quality service. 

(Table 15) 

4.3.5 Factors Influencing Motivation  

Benefits to Children and Families. This was discussed as a facilitator for program participation in two 

staff and two parent groups. Staff shared how a benefit to children can be a motivator for participating, 

such as a desire to learn information that supports their children. One shared (Staff 6, Conklin), 

“I always wanted to take nutritional classes just so I can teach my kids how to eat.”  

Information pertaining to children is of higher importance than information about their own health. 

Related to this, another staff (Staff 1, Keeler) shared, 

“With me, I retain the information because I worry about my children’s health. So, I would 
probably pay more attention to something that had to do with my children than I would for 
myself because I know I’m responsible for making sure that they are healthy.”  
 
Parents expressed concern about their children’s weight and risk for becoming obese. A need to 

 

learn about health care for children and how nutrition impacts health was mentioned. A parent also 

referenced incentives children received to help them including education materials (including a 

MyPlate), and Telamon assisting children with outdoor play and eating well. One shared (Parent 3, Hart) 

about not being aware of nutrition needs for their children until learning more about this from Telamon.  

“…before my son came here we didn’t know what nutrition was, what was healthy to give to our 
children. Being here has given us a lot of benefits, now we know what’s good for our children and 
what they lack. A lot of the times education helps a lot.”  
 

 

50 

Group Support. Four staff focus groups discussed group support as a facilitator. One type of support 

mentioned was group activities through work. Participating in exercise as a group can motivate 

participation. One participant (Staff 5, Sodus) shared,  

“Because sometimes it’s really boring when I try to do exercises at home. I put the video on and 
after 10 minutes I am tired. But when I go to the class, I stay one hour because I see old ladies, 
‘oh my god the old ladies do it good. No! I can do it. I can do it.’ Maybe a good group support 
help.” 
 

Staff also explained how the people surrounding an individual can influence food choices. One 

participant (Staff 1, Sparta) shared,  

“My father started having diabetes and he started pushing me all the time to be better. He 
started having three days for healthy food in the house, for example. Everybody ate the same 
thing he ate and it was a very good idea to push everybody.”  
 

Work. Work was discussed as both a facilitator and barrier related to program participation in one staff 

(Staff 4, Hart) and two director groups.  

Staff (one of five focus groups) recalled supervisors requiring participation in programs as a way 

to facilitate participation. Work was mentioned as a barrier in one staff group, this could be related to 

being tired from work or the time that it takes to commit to work in a day. 

Directors in one focus group mentioned staff conducting physical activity related to USDA and 

CAC guidelines that are in Head Start Centers. Two director groups discussed the difficulties MSFW 

parents face from their jobs, working very long hours. One shared (Director 4, Director Group 2) about 

their spouse who works as a MSFW,  

“I hear this from my husband because he walks a lot during the day. He's like I already walked all 
day, I already picked all day, and I already squatted all day. They don't want to go home and do 
that again with the kids.”  
 
Being forced to do things at work for staff at Telamon was also discussed in a director group. I 

 

am Moving, I am Learning (IMIL) activities are used to promote physical activity breaks with children at 

Telamon, and these activities are also conducted with staff at meetings. It was mentioned that some 

staff do not enjoy being forced to do this activity in meetings. (Table 15) 

 

51 

Desire to be Healthy. Three staff groups discussed a desire to be healthy as a facilitator. This included 

discussion of health issues staff wanted to learn about which included high blood pressure, high 

cholesterol, weight, general health, pregnancy, and being motivated by a successful diet from a doctor. 

(Table 15) 

4.3.6 Summary of Facilitators  

 

Facilitators included program structure, financial support, teaching/learning format, 

organizational support, and factors influencing motivation. Many of these facilitators can be viewed as a 

barrier if not implemented to promote program participation. This information can inform future 

program content and structure to increase participation. (Table 15) 

4.4 Barriers to Nutrition and Physical Activity Program Participation from Focus Groups 

Teaching/ 
Learning 
Format 

 
 
 
 
 
 
 
 
Lack of Financial 
 
 

Barriers 

Program 
Structure 

Support 

Factors 
Inhibiting 
Motivation 

Figure 8: Barriers to Education for Caregivers from Focus Groups 

 

 

 

 

 

 

52 

Table 16: Barriers to Nutrition Education Program Participation for Staff, Directors, and Parents from 
Focus Groups 

Barriers to Nutrition and Physical Activity 

Program Participation 

Parents 

Staff 

Director 

Program Structure  

X 

X 

Lack of Financial Support  

X 

Teaching/Learning Format 

 

X 

Factors Inhibiting Motivation 

X 

 

 

 

X 

X 

X 

 

 

X 

X 

X 

X 

X 

 

X 

X 

 

 

 

 

X 

Lack of Time 

Transportation 

Lack of Money 

More Tangible Materials 

Language and Culture 

Lack of Energy 

Lack of Self-Motivation 
Low Self-Esteem 

General Life 

 
4.4.1 Program Structure  

Lack of Time. Time was a barrier to participation discussed in staff, director, and parent groups. Five 

staff groups mentioned time.  

 

Two director groups discussed time as a barrier including the time parents spend working, which 

makes it difficult for them to participate in programs. It was suggested to offer physical activity 

programs at meetings parents may already attend at Telamon. Parents may have a higher priority than 

being concerned about their own health education.   

Three parent groups mentioned time as a barrier. One parent (Parent 4, Keeler) shared,  

“Sometimes time. Because when we get off work we are more with our kids.”  

53 

 

 

 This could indicate that the necessity or desire to be with children is higher priority than participating in 

an education program. (Table 16) 

Transportation. Transportation was a barrier mentioned in one staff and in three parent groups. It was 

commented that location for classes can be far away.  (Table 16) 

4.4.2 Lack of Financial Support  

Lack of Money. Lack of finances was a barrier discussed in staff, director, and parent groups. Directors 

and staff both mentioned the barrier of participating when programs have a fee.  

 

This theme arose in three staff focus groups.  Money was discussed as a barrier to pay for 

classes and other costs associated with promoting nutrition and physical activities, such as cost of child 

care. Some said they are unwilling to pay for child care to be in a program. Money needed for 

transportation was also mentioned.  

 

Directors also mentioned Telamon education specialists not being able to pay for some program 

activities in their budget. Parents mentioned money as a barrier in two groups. (Table 16) 

4.4.3 Teaching/Learning Format  

More Tangible Materials. One director group discussed the need for using tangible materials for 

education delivery.  

“And I know our families like anything like that versus like a pamphlet. And brochures are nice, 
but they see so many of those everywhere that they go.” (Director 2, Group 2)  
“They get lost and thrown away.” (Director 5, Group 2) 
 

It was suggested instead of items like pamphlets, to use educational materials like a plate with serving 

sizes for different foods. These materials could be given to participants to reinforce messages at home, 

and may be more successful than printed materials. (Table 16) 

Language and Culture. Two parent groups discussed language as a barrier. A lack of offering nutrition 

education programs in Spanish was mentioned. One also shared about difficulty enrolling for SNAP food 

 

54 

assistance benefits without speaking English. They said they were connected with translators by phone, 

however, they were required to wait for translation services.  

 

Both director groups mentioned cultural barriers. One director (Director 3, Director Group 1) 

shared,  

“Their life is based on surviving. They don’t have the luxury of, ‘I think I’ll go to the gym 
tonight’…it’s not like that and I don’t know that we could ever change the migrant lifestyle.” 
 

Directors share about the challenges faced by MSFW lifestyles which in some regard, are not possible to 

overcome. Some commented that they thought staff lifestyles could be changed.  

Directors discussed cultural norms related to food choices MSFW make. A director (Director 

Group 1, Participant 3) shared,  

“I think they cook the way their parents or grandmothers taught them how to cook. So when I 
make rice, I’m going to pour more oil in the pan than I need to, or when I fry meat. you know, 
there’s a lot of oil-based things and fattening stuff and that is just because that is the way that 
they were taught. Again, we go back to education and lack of resources. And they are not people 
that are going to sit and …they are going to worry about feeding their family…”   
 

Many people learn to cook from their families, so if the “healthy” method taught goes against their 

cultural norm, this may not be acceptable to them. Also shared was,  

“Beans are great until you put half a cup of lard in them” (Director Group 1, Participant 3)  
“That is a cultural thing also.” (Director Group 1, Participant 7)  
 

It is common to cook with a lot of fat in Hispanic culture, so teaching about low-fat cooking may not be 

accepted well among participants. Also shared (Director Group 1, Participant 8) was the view that men 

have influence on foods served,  

“Going back to cultural, I think that the men have a lot to say about what gets put on the table 
to eat.”  
 

Family dynamics of how foods are served should be included in education materials for instructors. 

Directors also mentioned that parents give children candies. (Table 16) 

 

55 

4.4.4 Factors Inhibiting Motivation 

Lack of Energy. Having a lack of energy was described in (two of five) staff and (two of five) parent 

groups. Staff and parents shared about experience feeling tired from work. Staff indicated that other 

things in life would take priority over participating in a program. Staff expressed they did not have 

energy for “extra things”. This indicates that focusing on self-health may not be a priority in their life. 

Parents also shared about generally having a lack of energy. (Table 16) 

Lack of Self-Motivation. All five staff groups discussed self-motivation as a barrier to program 

participation. Some mentioned laziness or motivation as a barrier. Staff shared that it is important to 

find something that is not boring and is enjoyable for them to participate in nutrition and physical 

activity. Some shared that physical activity at home on their own is boring; group support may help 

make this more exciting. One shared that since children are grown and not living with them, they do not 

need a program like this anymore. This indicates that the individual is more interested in learning for 

their children than for themselves. (Table 16) 

Low Self-Esteem. One staff group discussed low self-esteem as a barrier to participation. Personal 

shame regarding weight or other health barriers may prevent participants from being motivated. If 

participants do not feel empowered from programs, they may want to avoid them. (Table 16) 

General Life Other life priorities were mentioned as a barrier in staff (one of five) group and director 

(one of five) group. This implies that being busy with other things can make it difficult to have the 

energy for self-care or to make self-health a priority by participating in programs. (Table 16) 

4.4.5 Summary of Barriers  

 

Barriers included program structure, lack of financial support, teaching/learning format, and 

factors inhibiting motivation. All of these barriers can influence the content and ways to deliver 

programs to best meet the needs of the audience. This information can influence program design by 

making programs as easy as possible for participation. (Table 16) 

 

56 

4.5 Survey Results  

Content discussed in focus groups demonstrates a need and desire to participate in nutrition 

and physical activity education programs in this population. Supplemental survey questions related to 

this also demonstrate this need (Appendix C). Based on the survey results, the majority of parents 

(91.1%) and staff (68.9%) are interested in nutrition or physical activity education. The most popular 

ways for staff to receive education were on a weekly (33.2%) or monthly (33.2%) basis, with parents 

desiring weekly (54.5%) and monthly (38.2%) as well. This further justifies the desire for a longer-term 

education series. The content discussed in focus groups also included similar content desired in the 

survey. Staff were interested in foods on a budget (53.9%), meal preparation (48.2%), physical activity 

(60%), and breastfeeding/infant health (13.9%). Parents were interested in foods on a budget (37.4%), 

meal preparation (72.4%), physical activity (56.1%), and breastfeeding/infant health (30.9%). Parents 

were most interested in receiving education in person with a class or cooking demonstration (52%). Staff 

were more interested in receiving information with newsletters (58.6%) or online (39.6%), which may be 

conducive to staff training at remote locations.  

 

 

 

57 

CHAPTER 5: DISCUSSION 

 
 
5.1 Content Needs 

Basic Nutrition Knowledge. Needs regarding basic nutrition knowledge should be incorporated 

into programs. Food composition including calories, macronutrients, vitamins and minerals could be 

beneficial, with special focus on why these nutrients are needed for the body, and how to eat healthy 

foods to not feel hungry.  All these topics can be packaged in a lesson on food label reading and serving 

sizes, tying in how healthy eating can prevent disease and impact quality of life. Future programs can 

include topics about incorporating activities into daily life to make education more relevant for 

participants. 

Future programs should include information about including healthy foods that participants 

enjoy. The theme of discussing healthy alternatives with recipes can encourage participants to cook 

healthy foods they will want to eat. Nutrition education programs should incorporate ways to eat foods 

people enjoy in moderation without eliminating them. Healthy meals geared toward children should 

also be included. Teaching children that food is needed to fuel the body for health should be included. 

Policy, systems, and environmental interventions can promote healthy choices when serving foods to 

children at Telamon. 

Future programs should include methods to grow and preserve food is one way to promote cost 

savings. Simple food preservation ideas such as freezing portions of prepared or fresh foods should be 

incorporated into food resource management education. Methods for storing foods for maximum shelf 

life should also be included.  

 

Cooking and Meal Planning. Future nutrition programs should encompass cooking and meal 

planning. Since the target population is low income, a focus should be included for nutritious 

inexpensive foods. Cooking demonstrations should be integrated in programs, with a focus on cooking 

 

58 

convenient foods that are fast and easy. Consideration of culturally appropriate foods is essential to 

create a meaningful program. Special consideration to the MSFW lifestyle should be considered for 

program development related to cooking since this lifestyle makes it difficult to have time to eat and 

cook.  

Future programs should include recipes that appeal to children, and recipes that are convenient.  

Presenting information in the context of benefits to children and families may motivate parents to 

create change more so than focusing on health for themselves.   

Physical Activity. Future programs should include physical activity. Including education as a 

family centered approach can reinforce a familial culture for promoting activity in daily life. A family 

approach to teaching lessons can also encourage program participation and potentially eliminate the 

need for child care. Education about exercise that can be conducted at home rather than a gym could 

prevent exercise from being cost prohibitive. For parents, including activities and education that could 

benefit a lifestyle with physical labor could be beneficial; this could include activities to be done at work. 

The presentation of physical activity should include ways to be active that are manageable for 

participants with a busy lifestyle. An emphasis on ways exercise benefits health and tips for 

individualized exercise should be included.  

 

Future programs should include weight management including maintaining a healthy weight 

long term, with a focus on exercise that is manageable for participants. Limitations of weight as a 

measure for overall health should be included. 

Budgeting/Money. Future programs should be low cost or cost free when possible, and financial 

incentives may increase participation. Low cost solutions should be included whenever possible. 

Education on healthy, nutritious, and creative meals should be included to increase understanding that 

healthy eating does not have to be expensive. Content about physical activity that can be conducted in 

the home or other low-cost methods should be incorporated. 

 

59 

5.2 Facilitators to Participation 

Convenient Time for Participation. Future programs should survey participants to see what 

program times work best for them to ensure they can participate. Incorporating additional education 

programs into existing events at Telamon may be successful to reach parents in additional ways.  

Free Programs. Future programs should be free for participants or low cost whenever possible. 

Providing financial incentives to participants, or other incentives may help increase participation as well.  

Child Care and Children Responsibilities. Future programs can offer child care to increase 

participation, or educate parents and families simultaneously. Providing child care can help increase 

program participation for parents, as parents are low income and may have difficulty paying for this. 

Some Telamon activities provide child care.  

Incentives. Individuals developing future programs should consider how incentives can 

encourage participation. Additional information related to cooking and items to help with nutrition 

reinforcement with cooking may help parents use these food resources effectively. Referrals should be 

in place to help those participating in education programs connect with food resources such as SNAP 

and WIC.  

Group Support. Future programs and efforts to support health should include group support to 

enhance programming. Telamon can include group support efforts for their own staff during work and 

outside of work. Group support components could be included for parents as well.  

Appropriate Learning Style. Future programs should be designed to include interactive ways to 

practice the material in class. Information should be presented in a way that is appropriate for the 

learner to retain.  

Education Delivery Methods. Future training for staff can include education that is remote and 

in person to reach staff throughout the MSHS season. Telamon can change at the policy level to 

incorporate these suggestions into staff training. For staff, continuing additional trainings more 

 

60 

frequently, including more basic nutrition content could improve their knowledge base. Policies can be 

implemented to create a healthier environment for staff. Identifying ways to reach parents that are not 

as involved with additional education should be explored.  

 

Times programs are offered should be individualized to the group of parents as this can change 

with the growing season. Parents should be surveyed to find the best way maximize participation. 

Education methods to reach those who cannot come to a program should be considered. Topics focused 

on cooking healthy foods with demonstrations should be included. Referrals should continue to external 

agencies that can offer additional support. Providing education in other formats including in person and 

also in other means such as by video could reach additional parents. Including activity modifications for 

people with certain health conditions may increase likelihood that others can be involved with activities 

in a class. 

Class Location. Future programs can investigate if education at camps is feasible, or other ways 

to reach parents conveniently to increase parent participation. Surveying parents before a program to 

determine a suitable location could increase participation. Investigating locations which are more 

convenient to parents, such as closer to home or work may help them join a program.  Providing 

transportation may also increase attendance.  

Learning with Children and Family. Future programs can offer physical activities or nutrition 

education that can be conducted with children and families as one method to overcome some barriers 

to education. Classes could be structured to educate parents and children together, and ideas for 

integrating this content into promoting a healthier lifestyle for families overall can be included.  

 

Future programs should structure should consider including education for the entire family. This 

can increase family support systems surrounding nutrition and physical activity and can also prevent the 

need for child care which can facilitate participation.  

 

61 

Referrals and Resources for Parents and Families. Creating a referral system for parents can 

help provide additional health education to benefit families, and potentially help reduce rates of 

overweight and obesity among MSFW families. Creating materials for doctor’s offices to provide 

additional nutrition and physical activity education efforts may also aid these efforts. 

  

Promoting the awareness of federal nutrition programs for parents and staff, through Telamon 

especially, could benefit parents. Offering additional programs and resources at Telamon could provide 

supplemental education. If funding is available, quality incentives may make it more likely that parents 

participate. Helping to refer parents to programs they are eligible for is important and making them 

aware of what benefits they can receive if desired. Telamon may be able to help fill a gap and help 

families with referrals for federal nutrition programs or encourage them to apply for new cases.  

Marketing Programs to Parents. Including referrals as part of a program can help share 

information to parents. Marketing at Telamon can also share information about additional programs 

and resources as well as general nutrition and physical activity information for parents.  

Benefit to Family or Child. Future programs should include education through the lens of how 

this benefits the child since this is important to parents and staff. Education centered around the health 

of the family may increase participation and their interest in learning the material. Providing incentives 

that benefit the child or family can help motivate them.  

Work. Future programs should note that the workplace can be encouraging for nutrition and 

physical activity promotion, although forcing participation may not be the best way to promote health 

among staff. If policies exist at Telamon to promote activities with staff, surveying staff about what kinds 

of activities that interest them may make them feel more desire to participate. Education delivery style 

and times offered should make programs appealing for those working long hours. Including training and 

programs as part of the work day, or policies to promote a healthier environment may make this easier 

for staff to live a healthy lifestyle.  

 

62 

Desire to be Healthy. Focusing future education initiatives on ways that connect health issues 

with staff can increase interest, make this more relevant to their needs, and increase participation.  

5.3 Barriers to Participation 

Lack of Money. Being able to offer free programs, such as SNAP-ED, and promoting these so 

people know they are available can help increase participation since it seems some are unaware free 

programs exist. Providing free child care or transportation or additional financial incentives during 

programs may increase participation. Providing training opportunities to staff at work may help increase 

participation by reducing barriers like childcare and transit. Policies to promote designated funds for 

programs at Telamon centers would be beneficial so education specialists can promote these programs.  

Lack of Time. For staff, incorporating activities in the workplace for nutrition and physical 

activity promotion may help them practice a healthier lifestyle despite the barrier of time. Considering 

policy, systems, and environmental changes to help with staff health promotion should be explored. For 

parents, innovative ways to offer programs to save time may increase participation, including during 

existing meetings they attend with Telamon. Since time is a barrier, it may help to think of ways to reach 

them remotely with additional education materials. For parents, it is essential to understand barriers 

related to time with work, and that the priority may be to spend time with family instead of taking care 

of themselves. Blending classes to support the whole family in education or providing child care may 

help increase participation.  

More Tangible Materials. Including incentives to use for education could help with reinforcing 

messages at home with participants as funding allows.  

Language and Culture. Future programs for this population should offer programs and materials 

in Spanish to make this more welcoming. When delivering and designing a program, one must keep in 

mind how difficult it is for MSFW to include personal health as a priority when they life a busy and 

difficult lifestyle. Every effort should be made to make programs easy for them to access. It is important 

 

63 

to be sensitive to the cultural norms surrounding food in this population. Educators should understand 

that many barriers may make it difficult to make health a priority, and instructors should receive training 

in this topic. 

Lack of Energy.  It is important to understand how tired parents and staff can be after working 

and try to make programs that are easy to complete around their schedule. Policies at Telamon can 

encourage a healthy atmosphere at work to promote healthy activities for staff. Educating about the 

benefits for good health may help them see the need to prioritize this in their life.  

Lack of Self-Motivation. Group support, including wellness groups through Telamon may help 

promote a positive environment for staff. Promoting the need for health for children, as well as personal 

benefit, should be encouraged since some participants expressed concern for learning about ways to 

promote health in their children.  

Low Self-Esteem. Low self-esteem, including health barriers can become a barrier to 

participating in nutrition education programs. Future programs should note positive ways to encourage 

behavior change in training those conducting these programs.  

Transportation. Offering free transportation or vouchers for transit or holding classes in 

locations that reduce the need for transportation may increase participation.  

General Life. When establishing a program, one should realize that this population has 

restricted time interest in a health program may not be their top priority. Making a program that is easy 

for them to access and requires minimal effort may increase participation.  

5.4 Overall Discussion  

To date, we are not aware of nutrition and physical activity educational programs exclusively 

catering to MSHS caregivers and children that provide in-house training and operate long term. This 

study identified needs for a sustainable in-house program to meet the needs of MSHS caregivers and 

children to promote healthy lifestyles. In this focus group study, the program content needs, barriers, 

 

64 

and facilitators to participation in nutrition and physical activity education programs by MSHS caregivers 

were identified. Overall, major themes related to content needs (n=4), barriers (n=4), and facilitators 

(n=5) were identified. Content needs identified included nutrition knowledge, cooking and meal 

planning, and physical activity. Nutrition knowledge included desire to learn about components of food, 

food labels, food preservation, learning how to eat healthy foods that are enjoyable, and benefits for 

children and families to eat healthy. Cooking and meal planning included convenient cooking and 

cooking in ways to benefit children and their families. Physical activity included approaches that are 

simple and activity involving children. The need for budget friendly nutrition and activity practices were 

identified. Notably, all these topics align with content of federal nutrition education programs such as 

SNAP-ED or EFNEP. 

Therefore, future education interventions for this population can be best achieved by aligning 

with existing federal nutrition program resources as well as creating referrals for these programs 

through MSHS. Given MSFW caregivers are likely to qualify for federal assistance programs, an 

opportunity exists for coordination at the national level by tailoring existing federal nutrition program 

resources to meet the needs of this audience around the country. This can be a significant way to reach 

MSFW and MSHS populations with existing funding sources and network systems while increasing 

outreach of federal nutrition programs.  However, one important caveat is to involve bilingual and 

culturally competent staff members for the target population, and those who are willing to work around 

the transient MSFW’s lifestyles and in remote locations where MSFW and MSHS programs are clustered.  

Other themes emerged regarding clinical health education including diabetes, high blood 

pressure, and oral health. Since these clinical topics are not covered by federal nutrition education 

programs such as SNAP-Ed and EFNEP, opportunity emerges to enhance community health education 

efforts for the target population. In the meantime, healthcare referrals should continue for children and 

expand to parents to meet their medical needs to address these topics of interest.  

 

 

65 

CHAPTER 6: CONCLUSION AND IMPLICATIONS 

 
 
6.1 Overview  

Whether education efforts are aligned with existing federal nutrition programs or are developed 

through other funding sources, programmatic implications should be considered before launching an 

intervention in community-based education for this unique high-risk population. Several opportunities 

and barriers related to program delivery aimed at the specific needs of MSFW caregivers, including 

parents and MSHS staff, were identified in focus groups. One major barrier to program participation was 

cost, suggesting the need to offer program at no cost. Offering desirable incentives that offset financial 

struggles in this population may encourage participation. For example, offering free child care for 

participants an alleviate this additional cost and increase program accessibility. This may also offer an 

opportunity to provide children with similar programmatic lessons simultaneously. Classes should also 

be in a convenient location to avoid additional transportation costs for parents. Parents input should be 

considered given that their availability may constantly change due to the nature of their work. 

Additional ways to increase program accessibility to caregivers, such as reaching out to key community 

sites, should be explored for education delivery. Other learning approaches beyond direct education 

should be explored, such as use of videos, online content, or other learning approaches. For instance, 

online education for MSHS staff may reduce travel time and increase education opportunities. An 

approach based in social cognitive theory can address the multitude of factors that can prevent MSFW 

caregivers from making healthy choices.  

Another important theme identified by this study was the importance of interpersonal 

components such as esteem, group support, and instructional delivery. When training instructors to 

deliver these programs, the results of these focus groups suggest that a community peer model would 

be beneficial since the MSFW lifestyle faces so many health-related barriers. If this is not feasible, 

 

66 

training instructors to be aware of cultural barriers unique to this population is crucial. Low self-esteem 

was a barrier identified in focus groups. Training should emphasize strategies to help participants feel 

good about attending to    encourage rather than discourage participation. Group support can be 

offered to help motivate individuals. Another consideration for program content in this population is 

addressing the participants’ desire to learn how nutrition can benefit children. Focusing education 

material around ways nutrition and activity helps the child and family can make this more relevant for 

participants and increase their interest. Additionally, physical activity content should include activities 

conducted with children; this can be offered to staff in MSHS to incorporate throughout the school day 

in addition to ideas for parents to participate in physical activity with their children at home. 

 

Figure 9: Model for Intervention in MSHS 

Policy, systems, and environmental approaches can benefit staff and children at MSHS. Some 

examples of PSE applications could include healthy snack and meal policies for events, additional toys to 

encourage activity or playground equipment for children, or fruit and vegetable posters in staff 

breakrooms and in classrooms. Fostering support groups for staff, and possibly parents can encourage a 

supportive environment to motivate change. Physical activity with staff can include PSE approaches by 

involving both children and staff at centers to motivate all to be healthy, such as scheduled physical 

 

67 

activity breaks for children and staff. PSE can also help staff improve their own health and the 

atmosphere for child health at centers, if this is done in a positive way, such as an incentive program 

rewarding positive behaviors such as physical activity or consumption of fruits and vegetables by staff. 

The MSHS environment can be enhanced to provide an environment promoting health for children and 

caregivers with emphasis on nutrition and activity.  

Related to PSE efforts, policy at MSHS can improve the health environment for children and 

caregivers. Establishing policy recommendations and resources to support parent healthcare referrals, 

similar to those referrals in place for children, can benefit the health of the entire family. Creating MSHS 

policy to promote resources for and marketing of existing local and federal programs for families can 

benefit them. Examples could include existing nutrition and physical activity programs among other 

community resources.  

In conclusion, we identified content and delivery needs for nutrition education programs for 

MSFW caregivers. Aligning nutrition education for this population with existing federal nutrition 

education programs can benefit the MSFW population nationwide. PSE initiatives in MSHS across the 

country can encourage the health of MSHS staff and MSFW families. Future research should focus on 

program interventions and their effectiveness in this unique and vulnerable population.  

6.2 Strengths and Limitations 

A unique and significant strength of this study is the partnership with key organizations and 

programs that work with MSFW: Telamon Corporation and MSU College Assistant Migrant Program 

(CAMP). Telamon Corporation, an agency with strong rapport and services in place to serve the MSFW 

population, made it logically possible to reach participants. MSU CAMP provided community peers from 

an MSFW background to facilitate focus groups and collect surveys with parents in Spanish directly, 

without need for a translator, likely increasing accuracy and depth of information collected. Data 

 

68 

collection at MSHS centers and with CAMP students made it possible to reach parents in a culturally 

appropriate way and in a familiar environment to encourage participation. A multitude of perspectives 

were provided by parents, MSHS staff, and MSHS center directors. A qualitative approach provided rich 

data from MSFW child caregivers who are challenging to reach.  

Limitations include focus groups primarily addressing education delivery and content for this 

population, not providing extensive opportunity to explore values and beliefs regarding nutrition and 

physical activity among MSFW caregivers. Additional information regarding these beliefs could inform 

successful interventions in this population. In this study, all MSFW parent participants have children 

enrolled in MSHS. Because they receive services from Telamon, their perspectives may be different than 

MSFW lacking access to community resources. By nature of qualitative studies, the qualitative data 

collected is not generalizable to the entire population of MSHS parents or staff participants. This sample 

only included MSHS staff and parents in Michigan, and needs may differ geographically. While Spanish 

focus groups were translated and verified by bilingual student researchers, it is possible some details in 

focus groups were lost in translation. Self-selection bias may have impacted MSFW parent participants.  

6.3 Recommendations for Future Research 

Future research should develop and implement nutrition education programs to meet the needs 

of MSFW caregivers and explore the efficacy of these programs through monitoring and evaluation. 

Innovative ways to reach the MSFW population with education delivery should be explored. Programs 

can align with existing federal nutrition efforts when feasible to coordinate resources and save costs. 

Intervention studies should investigate the impact these education programs have on nutrition and 

physical activity knowledge, attitudes, and behaviors of staff and parents. Studies should also identify 

the impact of program attendance on feeding practices and OW/OB status of parents, staff, and children 

over time.    

 

 

69 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPENDICES 

70 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

Appendix A: IRB Application  

 
 

71 

 

 

Appendix A: (cont’d) 

 

 
 

72 

 

 

Appendix A: (cont’d) 

 

 
 

73 

 

 

Appendix A: (cont’d) 

 

 
 

74 

 

 

Appendix A: (cont’d) 

 

 
 

75 

 

 

Appendix A: (cont’d) 

 

 

 
 
76 

 

Appendix A: (cont’d) 

 

 
 

77 

 

 

Appendix A: (cont’d) 

 

 
 

78 

 

 

Appendix B: IRB Approval  

 
 

79 

 

 

Appendix C: Selected Survey Results 

Table 17: Selected Survey Results 

 
 

 

 

 

 

Staff # 

Staff % 

Parent # 

87 
193 

Select Survey Results for Staff and Parents  
Staff n = 280, Parents n=135 
 
Interest in nutrition or physical education or training? 
No 
Yes 
How often would you like to receive nutrition or physical activity education or training? 
Other 
Daily 
Weekly 
Monthly 
Yearly 
What topics would you like to learn (multiple choice)? 
Breastfeeding/Infant health 
Healthy choices on a budget 
Meal preparation 
Physical activity 
Other 
What delivery model would work best for you (multiple choice)? 
Newsletters 
Class/Cooking demonstration 
Online course 
Group discussion 
None 

58.6 
36.8 
39.6 
22.1 
3.9 

13.9 
53.9 
48.2 
60.0 
0.4 

39 
151 
135 
168 
1 

164 
103 
111 
62 
11 

31.1 
68.9 

8.6 
7.1 
33.2 
33.2 
17.9 

24 
20 
93 
93 
50 

12 
123 

2 
4 
67 
47 
3 

38 
46 
89 
69 
1 

51 
64 
19 
30 
2 

Parent % 

8.9 
91.1 

1.6 
3.3 
54.5 
38.2 
2.4 

30.9 
37.4 
72.4 
56.1 
0.8 

41.5 
52.0 
15.4 
24.4 
1.6 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

80 

 

 

Appendix D: Parent Focus Group Flyer  

 
 

 

81 

 

 
Appendix E: Focus Group Flier Staff  

 

82 

 

 
Appendix F: Parent Survey Flyer 

 

83 

 

 
Appendix G: Staff Survey Flyer  

 

84 

 

 
Appendix H: Sociodemographic Data from Surveys with Parents and Staff  

 
 
Table 18: Sociodemographic Data from Surveys with Parents and Staff  

  

Interview 
Language 
Center 

Gender 

Age 

 
 
 
 
 
 
Marital Status 

 

English  
Spanish 
Adrian 
Bear Lake 
Buen Pastor 
Chase 
Conklin 
Decatur 
Hart 
Keeler 
Kent City 
Lansing 
Mears 
New Era 
South Haven 
Pullman 
Sodus 
Sparta 
Spinks Corner 
Suttons Bay 
Male 
Female 
< 25 y 
25-29 y 
30-34 y 
≥ 35y 
<30 years 
30-39 year 
40–49 years 
50–59 years 
60–69 years 
≥70 years 
Single 
Married 
Cohabitating 

Parents (n=135) 
% 
n 
22 
16.3 
113  83.7 
 
 
1.5 
2 
 
 
 
 
18.5 
25 
20.0 
27 
11.1 
15 
17.0 
23 
6.7 
9 
 
 
 
 
 
 
 
 
 
 
11.9 
16 
8.2 
11 
5.2 
7 
 
 
24 
17.8 
111  82.2 
17.0 
23 
29.6 
40 
24.4 
33 
39 
28.9 
 
 
 
 
 
 
 
 
 
 
 
 
28 
20.7 
50.4 
68 
37 
27.4 

Total n 
135 
135 
 
135 
 
 
135 
135 
135 
135 
135 
 
 
 
 
 
135 
135 
135 
 
135 
135 
 
 
 
 
 
 
 
 
 
 
135 
135 
135 

Staff (n=280) 
n 
280 
30 
21 
23 
6 
17 
28 
12 
29 
11 
19 
6 
17 
10 
2 
38 
23 
10 
4 
4 
26 
254 
 
 
 
 
83 
74 
55 
40 
21 
6 
91 
137 
15 

%  
100 
10.7 
7.5 
8.2 
2.1 
6.1 
10.0 
4.3 
10.4 
3.9 
6.8 
2.1 
6.1 
3.6 
0.7 
13.6 
8.2 
3.6 
1.4 
1.4 
9.3 
90.7 
 
 
 
 
29.8 
26.5 
19.7 
14.3 
7.5 
2.2 
32.5 
48.9 
5.4 

Total n 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
 
 
 
 
279 
279 
279 
279 
279 
279 
280 
280 
280 

85 

Table 18 (cont’d) 
 

Hispanic/Latino 

Education 

Number of 
people living in 
house hold 

Number of 
children below 5 

 
 
 
 
 
Family income 

Migrant or 
Seasonal  
How many years 
of MSFW 

Separated/Divorced/Widowed 
Yes 
No 
No school 
Elementary school 
Middle school  
High school/GED 
Some College 
Associate’s Degree/Certificate 
College or above 
Bachelor’s Degree or Beyond 
1 
2 
3 
4 
5 
6 
7 
8 
9 
0 
1 
2 
3 
4 
5 
6 
Less than $10,000 
$10,000-$14,999 
$15,000-$19,999 
$20,000-$29,999 
$30,000 or above 
>$15,000 
$15,000-$24,999 
$25,000 - $34,999 
$35,000 - $49,999 
$50,000 - $74,999 
$75,000 or above 
Migrant 
Seasonal 
0-2 years 
3-5 years 
6-9 years 
10 or more years 

2 
1.5 
131  97.0 
4 
3.0 
2.2 
3 
37.0 
50 
47 
34.8 
17.8 
24 
 
 
 
 
11 
8.1 
 
 
 
 
3.0 
4 
11 
8.2 
24.4 
33 
34.8 
47 
22 
16.3 
7.4 
10 
3.0 
4 
3.0 
4 
2 
1.5 
37.8 
51 
35.6 
48 
26 
19.3 
4.4 
6 
0.7 
1 
0.7 
1 
47 
34.8 
28.9 
39 
20.0 
27 
8.9 
12 
10 
7.4 
 
 
 
 
 
 
 
 
 
 
 
 
98 
72.6 
27.4 
37 
11.9 
16 
18 
13.3 
21.5 
29 
72 
53.3 

135 
135 
135 
135 
135 
135 
135 
 
 
135 
 
 
135 
135 
135 
135 
135 
135 
135 
135 
135 
135 
135 
135 
135 
135 
135 
135 
135 
135 
135 
135 
 
 
 
 
 
 
 
 
 
 
 
 

 

86 

37 
145 
135 
  
2 
3 
86 
58 
63 
 
68 
18 
82 
43 
61 
46 
14 
9 
7 
 
203 
43 
23 
10 
0 
1 
 
 
 
 
 
 
40 
80 
45 
47 
42 
26 
 
 
 
 
 
 

13.2 
51.8 
48.2 
 
0.7 
1.1 
30.7 
20.7 
22.5 
 
24.3 
6.4 
29.3 
15.4 
21.8 
16.4 
5.0 
3.2 
2.5 
 
72.5 
15.4 
8.2 
3.6 
0.0 
0.4 
 
 
 
 
 
 
14.3 
28.6 
16.1 
16.8 
15.0 
9.3 
 
 
 
 
 
 

280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
 
 
 
 
 
280 
280 
280 
280 
280 
280 
 
 
 
 
 
 

Table 18 (cont’d) 

How many years 
child MSHS 

Position 

Do you speak 
Spanish? 

Do you speak 
English? 

Health 
insurance? 
Heard about 
federal gov. 
prog. 
Which programs 
have you heard 
of? 

Where do you 
get info from? 

 
 

 

0-2 years 
3-5 years 
6-9 years 
10 or more years 
Director 
Coordinator 
Specialist 
Teacher 
Assistant teacher 
Centre aide/assistant 
Food service staff 
Secretary 
Bus Driver 
Data entry clerk 
Custodian 
Special service assistant 
Health aide  
Other 
Not at all 
Not very well 
Very well 
Not at all 
Not very well 
Very well 
Yes 
No 
Yes 
No 

SNAP 
SNAP-Ed 
EFNEP 
WIC 
Other 
Friends/Family 
Internet/Social Media 
Flyer/Poster 
Church/Religious Group 
Clinic/Hospital 
Telamon MHS 
Government Agency 
School/College/Class 
Other 
None 

25.2 
34 
25.2 
34 
23.7 
32 
25.9 
35 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
0.7 
1 
3.7 
5 
129  95.6 
48.2 
65 
31.1 
42 
28 
20.7 
37.8 
51 
84 
62.2 
132  97.8 
3 
2.2 

72.7 
96 
9.1 
12 
5 
3.8 
129  97.7 
3.8 
5 
73 
55.3 
4.5 
6 
6.1 
8 
4 
3.0 
23.5 
31 
12.9 
17 
6.8 
9 
4 
3.0 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
135 
135 
135 
 
 
 
135 
135 
135 
135 

132 
132 
132 
132 
132 
132 
132 
132 
132 
132 
132 
132 
132 
 
 

87 

 
 
 
 
16 
2 
58 
50 
16 
58 
16 
14 
19 
10 
8 
7 
3 
3 
56 
75 
149 
 
 
 
250 
30 
262 
18 

240 
23 
14 
247 
4 
189 
60 
55 
9 
10 
19 
16 
8 
4 
14 

 
 
 
 
5.7 
0.7 
20.7 
17.9 
5.7 
20.7 
5.7 
5.0 
6.8 
3.6 
2.9 
2.5 
1.1 
1.1 
20.0 
26.8 
53.2 
 
 
 
89.3 
10.7 
93.6 
6.4 

91.6 
8.8 
5.3 
94.3 
1.5 
72.1 
22.9 
21.0 
3.4 
3.8 
7.3 
6.1 
3.1 
1.5 
5.3 

 
 
 
 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
 
 
 
280 
280 
280 
280 

280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 
280 

Table 18 (cont’d) 

Do you 
participate in 
federal 
government 
programs? 
What programs 
do you 
participate in? 

 
 

 

Yes 
No 

SNAP 
SNAP-Ed 
EFNEP 
WIC 
Other 

 

106  78.5 
29 
21.5 

135 
135 

81 
199 

28.9 
71.1 

280 
280 

65 
2 
0 
97 
6 

 
 
 
 
 

106 
106 
106 
106 
106 

59 
2 
1 
40 
2 

72.8 
2.5 
1.2 
49.4 
2.5 

81 
81 
81 
81 
81 

88 

Appendix I: Sociodemographic Data from Focus Groups with Parents, Staff, and Directors 

 
 
Table 19: Sociodemographic Data from Focus Groups with Parents, Staff, and Directors 

 

Center 

Conklin 

 

Hart 
Keeler 
Sodus 
Sparta 
Mixed groups  
<30 y 
30–39 y 
40–49 y 
50–59 y 
60–69 y 
≥70 y 
Teacher  
Teacher Assistant 
Center Aide 
Specialist 
Secretary 
Other 
Male  
Female 
Single 
Married 
Cohabitating 
Separated/Divorce
d/Widowed 
Yes 
No 
American 
Indian/Alaskan 
Native 
Asian 
Native 
Hawaiian/Pacific 
Islander 
Black/African 
American 

Age 

MSHS 
Position 

Gender  

Marital Status 

Hispanic/ 
Latino 
Race 

 

Parents 
n 
% 

Staff 

Total n  n 

6 

6 
5 
6 
5 
 
7 
11 
3 
4 
0 
1 
13 
3 
7 
3 
1 
1 
2 
25 
3 
11 
6 
6 

19 
8 
1 

2 
0 

0 

8 

6 
5 
8 
6 
 
10 
14 
4 
0 
0 
0 
 
 
 
 
 
 
4 
9 
6 
17 
6 
1 

27 
5 
 

 
 

 

24.2 
 
18.2 
15.2 
24.2 
18.2 
 
35.7 
50.0 
14.3 
0 
0 
0 
 
 
 
 
 
 
27.3 
72.7 
20.0 
56.7 
20.0 
3.3 

84.4 
15.6 
 

 
 

 

33 

33 
33 
33 
33 
 
28 
28 
28 
28 
28 
28 
f 
 
 
 
 
 
33 
33 
30 
30 
30 
30 

32 
32 
 

 
 

 

89 

% 

Total 
n 
21.4  28 

21.4  28 
17.9  28 
21.4  28 
17.9  28 
 
27 
42 
12 
15 
0 
4 
46 
11 
25 
11 
4 
4 
7 
93 
12 
42 
23 
23 

 
26 
26 
26 
26 
26 
26 
28 
28 
28 
28 
28 
28 
27 
27 
26 
26 
26 
26 

70 
30 
5 

9 
0 

0 

27 
27 
22 

22 
22 

22 

 

 
 
 
 
13 
0 
5 
5 
1 
2 
0 
 
 
 
 
 
13 
1 
12 
1 
9 
2 
1 

4 
9 
1 

 
 

 

Directors 
n 
% 

 

Total 
n 
 

 
 
 
 
 
 
 
 
13 
100 
 
 
13 
38 
13 
38 
13 
8 
13 
15 
 
 
 
 
 
 
 
 
 
 
 
 
13 
100 
13 
8 
13 
92 
7.7 
13 
69.2  13 
15.4  13 
7.7 
13 

31 
69 
8 

 
 

 

13 
13 
13 

13 
13 

13 

Table 19 (cont’d) 

 

Education 

Household 
size 

 
Children 
Under 5 

 
 

 
 

9 
23 

White/Caucasian 
Other (please 
specify) 
Not reporting  
No school 
Elementary school  18 
Middle school  
7 
7 
High school/GED 
1 
Some College 
Associate’s 
 
Degree/Certificate 
College or above 
Bachelor’s Degree 
or Beyond 
1 
2 
3 
4 
5 
6 
7 
8 
 
0 
1 
2 
3 
4 
5 
6 

Family income  Less than $10,000 
$10,000-$14,999 
$15,000-$19,999 
$20,000-$29,999 
$30,000 or above 
>$15,000 
$15,000-$24,999 
$25,000 - $34,999 
$35,000 - $49,999 
$50,000 - $74,999 
$80,000-$99,999 
$100,000-
$149,999 

 

 

 

 
12 

 
93 

13 
13 

 
 
 
 
1 
 
6 

 
6 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
2 
2 
2 
6 
1 

 
 
 
 

 
 
 
 
46.2  13 
 
46.2  13 

 

 

 
46.2  13 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
15.4  13 
15.4  13 
15.4  13 
46.2  13 
7.7 
13 

19 
4 

2 
 
 
 
7 
4 
9 

 
8 

1 
7 
2 
7 
8 
0 
1 
0 
1 
 
 
 
 
 
 
 
 
 
 
 
 
3 
11 
2 
3 
5 
2 
2 

86 
18 

 
 
 
 
25 
14 
32 

 
29 

22 
22 

 
 
 
 
28 
28 
28 

 
28 

27 
27 
27 
27 
27 
27 
27 
27 
27 
 
 
 
 
 
 
 
 
 
 
 
 

4 
26 
7 
26 
30 
0 
4 
0 
4 
 
 
 
 
 
 
 
 
 
 
 
 
10.7  28 
39.3  28 
7.1 
28 
10.7  28 
17.9  28 
28 
7.1 
7.1 
28 

28.1 
71.9 

 
 
54.5 
21.2 
21.2 
3.0 
 

 
 

0 
0 
9.4 
25.0 
34.4 
21.9 
6.3 
3.1 
 
0 
33.3 
40.0 
13.3 
13.3 
0.0 
0.0 
37.5 
18.8 
28.1 
15.6 
 
 
 
 
 
 
 
 

32 
32 

 
 
33 
33 
33 
33 
 

 
 

32 
32 
32 
32 
32 
32 
32 
32 
 
30 
30 
30 
30 
30 
30 
30 
32 
32 
32 
32 
 
 
 
 
 
 
 
 

90 

0 
0 
3 
8 
11 
7 
2 
1 
 
0 
10 
12 
4 
4 
0 
0 
12 
6 
9 
5 
 
 
 
 
 
 
 
 

 
 

 
 

 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
38.5  13 
23.1  13 
38.5  13 
 
 
 
 
 
 
 
100 

 
 
 
 
 
 
 
13 

Table 19 (cont’d) 

Migrant or 
Seasonal 
Farmworker 
How many 
years of 
MSFW 

How many 
years child 
MSHS 

Do you speak 
Spanish? 

Do you speak 
English? 

Languages 
spoken at 
home 
Health 
insurance? 

 

 

 

10 
24 

2 
7 
13 
11 
8 
13 
6 
6 
0 
2 
31 
17 
13 
3 
5 
32 
5 
18 
14 

30.3 
72.7 

6.1 
21.2 
39.4 
33.3 
24.2 
39.4 
18.2 
18.2 
0 
6.1 
93.9 
51.5 
39.4 
9.1 
15.2 
97.0 
15.2 
56.3 
43.8 

33 
33 

33 
33 
33 
33 
33 
33 
33 
33 
33 
33 
33 
33 
33 
33 
33 
33 
33 
32 
32 

Migrant 
Seasonal 

0-2 years 
3-5 years 
6-9 years 
10 or more years 
0-2 years 
3-5 years 
6-9 years 
10 or more years 
Not at all 
Not very well 
Very well 
Not at all 
Not very well 
Very well 
English  
Spanish 
Other 
No 
Yes 

 

 
 

 
 
 
 
 
 
 
 
3 
8 
17 
 
 
 
 
 
 
2 
26 

 
 

 
 
 
 
 
 
 
 
11 
29 
61 
 
 
 
 
 
 
7 
93 

 
 

 
 
 
 
 
 
 
 
28 
28 
28 
 
 
 
 
 
 
28 
28 

 
 

 
 
 
 
 
 
 
 
5 
3 
5 
 
 
 
 
 
 
 
13 

91 

Appendix J: Focus Group Questions for Staff 

1.  What does healthy eating mean to you?  

a.  Probe 1: Can you name some examples of healthy foods?  

 
 

 

 

 

 

 

2. 

3. 

If you currently or (have in the past) participated in nutrition and physical activity programs, can 
you share what you learned?  

a.  Probe 1: Have you received government supported nutrition programs? If so, what 

program was it? (Bridge Card, WIC, SNAP-ED, EFNEP) 

b.  Probe 2: What encouraged you to participate in them? What made it easy to 

c.  Probe 3: What do you wish you could learn more of? 
d.  Probe 4: How did you use the knowledge learned from these programs in your everyday 

participate? 

life? 

 
If you have not participated in nutrition and physical activity programs, what prevents you from 
participating? 

a.  Probe 1: What made it difficult for you to participate in them? (Are the programs 

running at an inconvenient time, lack of child care, lack of transportation, language 
barriers etc.?) 

b.  Probe 2: Are there any health concerns or specific (personal) situations that prevent you 

from participating in a nutrition and physical activity program?  

4.  What nutrition or physical activity topics would you like to learn?  

a.  Probe 1: What resources (gym, support groups, etc.) would you want access to help you 

improve your own nutrition and physical activity practices? 

5.  How should trainings at Telamon be administered to better meet your training needs?  
a.  Probe 1: How long should the programs last per session (hours, minutes, etc.)?  
b.  Probe 2: How long should the programs run (for how many weeks or months, etc.)?  
c.  Probe 3: What time of day would make it more possible for you to attend? (at the end of 

work day, weekends, before the start of work day, during end of crop/work season, 
before start of crop/work season etc.?) 

d.  Probe 4: What delivery model would work best for you (online, in person, info sheets, 

etc.)? 
 

6.  What prevents you as a caregiver of Migrant Head Start children from being physically active 

and practicing healthy nutrition habits? 

a.  Probe 1: What prevents you from practicing these at work? 
b.  Probe 2: What prevents you from practicing these at home?  

7.  How much control or influence do you have over the eating and physical activity behaviors of 

Migrant Head Start children?  

a.  Probe 1: How can you influence children’s behaviors at the MHS centers?  
b.  Probe 2: Do you have little or no influence on them?  

92 

c.  Probe 3: What factors (children’s habit, inattentiveness, time of the day, etc.) make it 

difficult for you to influence children’s behavior?  

d.  Probe 4: What techniques do you use to encourage good behaviors among the children? 

8.  What prevents you as a caregiver of Migrant Head Start children from modeling good nutrition 

and physical activity behaviors to children?  

a.  Probe 1: Do you personally struggle with healthy eating and physical activity and 

therefore find it hard to be a good role model for children?  

b.  Probe 2: Have you been trained or indicated to promote good nutrition and physical 

activity among the children? 

9.  What prevents children from eating healthy and being physically active at Migrant Head Start 

Centers? 

a.  Probe 1: What foods and beverages do the children typically eat at the MHS centers? 
b.  Probe 2: What activities are the children involved in for physical activity each day? 

10. What encourages children to eat healthy and be physically active at Migrant Head Start Centers? 

 

 

 

(MUST ASK ALL PROBES) 

physically active?  

a.  Probe 1: What types of resources at the MHS centers encourage children to eat healthy? 
b.  Probe 2: What types of resources at the MHS centers encourage children to be 

 
Closing Statement: 
This is the end of our questions. Based on our discussion, do you have any addition comments for us?  
 
Thank you for sharing this information. This will help us identify new opportunities for nutrition and 
physical activity programs in migrant family communities.  
 

 

 

93 

Appendix K: Focus Group Questions for Directors  

 
 

 

 

 

 

 

1.  What does healthy eating mean to you?  

a.  Probe 1: Can you name some examples of healthy foods?  

2.  What may prevent caregivers of Migrant Head Start children from participating in nutrition and 

physical activity programs? 

c.  Probe 1: What would make it difficult for caregivers to participate in them?  
d.  Probe 2: Are there any programs caregivers cannot participate in? If so, why? 
e.  Probe 3: How should the programs be administered to encourage caregivers’ 

participation? 

learn about? 

3.  What would caregivers need to understand the importance of nutrition and physical activity?  
a.  Probe 1: What nutrition and physical activity topics would be important for caregivers to 

b.  Probe 2: What resources (info sheets, support groups, gym, etc.) would caregivers want to 

help them understand the importance of nutrition and physical activity? 

4.  What prevents caregivers of Migrant Head Start children from being physically active and 

practicing healthy nutrition habits? 

a.  Probe 1: What prevents them from practicing these at work? 
b.  Probe 2: What prevents them from practicing these at home?  

5.  How should staff trainings be designed to ensure they meet your staff’s needs (in regards to 

nutrition and physical activity)?  

e.  Probe 1: How long are the trainings running currently? 
f.  Probe 2: How long should the trainings ideally last (hours, minutes, etc.)? How often 

should trainings ideally occur (weekly, monthly, etc)? 

g.  Probe 3: When should they occur (early summer training, or throughout the summer, 

 

etc.)? 

h.  Probe 4: How should they be delivered (online or in person, info sheets)? 

6.  How much control/influence do caregivers of Migrant Head Start children have over the eating 

and physical activity behaviors of children?  

e.  Probe 1: How can caregivers of Migrant Head Start Centers influence children’s 

behaviors at the centers?  

f.  Probe 2: Do caregivers have little or no influence on them?  
g.  Probe 3: What factors (children’s habit, inattentiveness, time of the day, etc.) make it 

difficult for caregivers to influence children’s behavior?  

h.  Probe 4: What techniques do caregivers use to encourage good behaviors among the 

children? 

 

7.  What prevents caregivers of Migrant Head Start children from modeling good nutrition and 

physical activity behaviors to children? 

c.  Probe 1: Are the caregivers trained or indicated to promote good nutrition and be 

physically active among the children?   

94 

 

 

8.  What prevents children from eating healthy and being physically active at Migrant Head Start 

Centers? 

c.  Probe 1: What foods and beverages do the children typically eat at the MHS centers? 
d.  Probe 2: What activities are the children involved in for physical activity each day? 

9.  What encourages children to eat healthy and be physically active at Migrant Head Start Centers? 

a.  Probe 1: What types of resources at the MHS centers encourage children to eat healthy? 
b.  Probe 2: What types of resources at the MHS centers encourage children to be 

(MUST ASK ALL PROBES) 

physically active?  
 

 
Closing Statement: 
This is the end of our questions. Based on our discussion, do you have any addition comments for us?  
 
Thank you for sharing this information. This will help us identify new opportunities for nutrition and 
physical activity programs in migrant family communities.  

 

 

 

 

95 

Appendix L: Focus Group Questions for Parents (English) 

1. 

Icebreaker Question: What is your favorite food?  

2.  What does healthy eating mean to you?  

a.  Probe 1: Can you name some examples of healthy foods?  

 
If you currently or (have in the past) participated in nutrition and physical activity education 
programs, can you share what you learned? 

a.  Probe 1: Have you received government supported nutrition programs? If so, what 

program was it? (Bridge Card, WIC, SNAP-ED, EFNEP) 

b.  Probe 2: What encouraged you to participate in them? What made it easy to 

c.  Probe 3: What do you wish you could learn more of? 
d.  Probe 4: How did you use the knowledge learned from these programs in your everyday 

participate? 

life? 

If you have not participated in nutrition and physical activity programs, what prevents you from 
participating? 

a.  Probe 1: What made it difficult for you to participate in them? (Are the programs 

running at an inconvenient time, lack of child care, lack of transportation, language 
barriers etc.?) 

b.  Probe 2: Are there any health concerns or specific (personal) situations that prevent you 

from participating in a nutrition and physical activity program?  
 

5.  What nutrition or physical activity topics would you like to learn?  

a.  Probe 1: What resources (gym, support groups, etc.) would you want access to help you 

improve your own nutrition and physical activity practices? 

6.  How should nutrition and physical activity programs be administered to encourage your 

participation?  

a.  Probe 1: How long should the programs last per session (hours, minutes, etc.)?  
b.  Probe 2: How long should the programs run (for how many weeks or months, etc.)?  
c.  Probe 3: What time of day would make it more possible for you to attend? (at the end of 

work day, weekends, before the start of work day, during end of crop/work season, 
before start of crop/work season etc.?) 

d.  Probe 4: What delivery model would work best for you (online, in person, info sheets, 

etc.)? 

7.  What prevents you from being physically active and practicing healthy nutrition habits?  

a.  Probe 1: What prevents you from practicing these at work? 
b.  Probe 2: What prevents you from practicing these at home?  

8.  What prevents you from good nutrition and physical activity behaviors to your children? 

a.  Probe 1: Do you personally struggle with healthy eating and physical activity? 
b.  Probe 2: Do you find it hard to be a good role model for your children?  

96 

3. 

 
4. 

 
 

 

 

 

 

 

 

  

 

 

9.  What prevents your children from eating healthy and being physically active at home?  

a.  Probe 1: What foods and beverages are typically eaten by your children? (this is asked a 

probe in question 9 in Spanish transcript)  

 
b.  Probe 2: What foods and beverages are typically served and eaten by your children? 
c.  Probe 3: What activities are your children involved in for physical activity each day? 

 
10. What encourages your children to eat healthy and be physically active at home? 

a.  Probe 1: What facilities (kitchen equipment, serving utensils, healthy recipes, more 
funds for food, etc.) or resources are needed at home to encourage children to eat 
healthy?  

b.  Probe 2: What facilities (games, playground, parks, green areas, etc.) or resources are 
needed at home to encourage children to be physically active? (this questions are all 
probes for question 10 in Spanish transcript) 

 

97 

Appendix M: Focus Group Questions for Parents (Spanish)  

 
 
1.Icebreaker 
 ¿Cuál es su comida favorita? 
 
2. ¿Qué significa una alimentación saludable para usted? 

a.  Sonda 1: ¿Puede nombrar algunos ejemplos de alimentos saludables? 

 
3. Si en este momento o (en el pasado) participaron en programas de educación de nutrición y actividad 
física, ¿puede compartir lo que aprendido? 

a.  Probe 1: ¿Ha recibido apoyó de los programas de nutrición que ofrece el gobierno? Si es así, 

¿qué programas era? (Tarjeta del puente (estampías), WIC, SNAP-ED, EFNEP) 

b.  Probe 2: ¿ Por que participo? Qué fue lo que lo hizo fácil para participar? 
c.  Probe 3: ¿Qué le gustaría aprender más? 
d.  Probe 4: ¿Cómo utiliza lo que aprendió de esos programas (WIC, Tarjeta del puente) en sus 

vidas? 

 
4. Que le impide su participación en programas de nutrición y actividad física? 

a.  Probe 1: ¿Qué hace que sea difícil para que usted pueda participar en ellos? (¿ 

Los programas se juntan en un momento inoportuno, no tiene a nadie que le cuide los niños, la 
falta de transportación, las barreras del idioma, etc.?) 

b.  Probe 2: ¿Tiene problemas de salud o situaciones específicas (personales) que le impiden 

participar en un programa de nutrición y actividad física? 

 
5. ¿Qué temas de nutrición o actividad física le gustaría aprender? 

a.  Probe 1: ¿Qué recursos (gimnasio, grupos de apoyo, etc.) le gustaría tener para ayudar a 

mejorar sus prácticas de nutrición y actividad física? 

 
6. ¿Cómo se deben administrar los programas para incluir su participación? 

a.  Probe 1: ¿Cuánto tiempo le gustarían que los programas duren por sesión (horas, minutos, etc.)? 
b.  Probe 2: ¿Cuántas semanas o meses deben de durar los programas? 
c.  Probe 3: ¿A qué hora del día seria más posible para usted (Al final del día de trabajo, los fines de 

semana, antes del inicio de la jornada de trabajo, durante el final de la temporada de cultivo / 
trabajo, antes del inicio de la temporada de cultivos / trabajo, etc?) 

d.  Probe 4: ¿Qué tipo de clase funcionaría mejor para usted (en línea, en persona, hojas 

informativas, etc.)? 

 
7. ¿Qué le impide practicar buenos hábitos de nutrición y de ser físicamente activo? 

a.  Probe 1: ¿Qué le impide la práctica de estos hábitos en el trabajo? 
b.  Probe 2: ¿Qué le impide practicar estos hábitos en casa? 

 
8. ¿Qué le impide a usted de ser un buen ejemplo para sus hijos en tener una buena nutrición y ser 
físicamente activo? 

a.  Probe 1: ¿Usted personalmente lucha con tener una alimentación saludable y ser 

físicamente activo? 

b.  Probe 2: ¿ Por qué se le hace difícil en ser un buen ejemplo para sus hijos? 

 

98 

 
9. ¿Qué impide que sus niños tengan una dieta saludable y que se mantengan activos físicamente en 
casa? 

a.  Probe 1: ¿Qué alimentos y bebidas normalmente coman sus hijos? 
b.  Probe 2: ¿Si sus hijos son físicamente activos que tipo de actividades hacen?  

 
10. ¿Qué motiva a sus niños a comer saludable y hacer actividad física en casa? 
(MUST ASK ALL PROBES) 

a.  Probe 1: ¿Qué tipos de recursos tienen en sus casas para que sus hijos coman más 

saludable? 

activos físicamente? 

b.  Probe 2: ¿Que clase de recursos tienen en sus casa para que sus hijos pueden ser más 

 
 
 
Hemos terminado todas las preguntas. 
En respecto de nuestra discusión de hoy, tienen algún comentario sobre de lo que estuvimos hablando?   
Muchas gracias por su tiempo aquí con nosotros, esto nos ayudará en tener un mejor conocimiento para 
crear nuevos programas de nutrición y actividad física en las comunidades de familias migrantes.  

 

 

 

 

99 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

BIBLIOGRAPHY 

100 

BIBLIOGRAPHY 

 
 
 
American Farm Bureau Federation Economic Analysis Team (2006). Impact of Migrant Labor Restrictions 
on the Agricultural Sector. 
 
Association of Farmworker Opportunity Programs. (2019). "Learn the Facts."   Retrieved August 19, 
2019, 2019, from https://afop.org/cif/learn-the-facts/. 
 
Bandura, A. (2001). "Social Cognitive Theory: An Agentic Perspective." Annual Review of Psychology 
52(1): 1-26. 
 
Biro, F. M. and M. Wien (2010). "Childhood obesity and adult morbidities." The American journal of 
clinical nutrition 91(5): 1499S-1505S. 
 
Borre, K., L. Ertle and M. Graff (2010). "Working to eat: Vulnerability, food insecurity, and obesity among 
migrant and seasonal farmworker families." American Journal of Industrial Medicine 53(4): 443-462. 
Centers for Disease Control and Prevention (2010). Healthy People 2020. 
 
Centers for Disease Control and Prevention. (2018). "National Health Interview Survey, Tables of 
Summary Health Statistics."   Retrieved November 5, 2019, from 
https://www.cdc.gov/nchs/nhis/shs/tables.htm. 
 
Coleman-Jensen, A. R., Matthew P.; Gregory, Christian A.; Singh, Anita (2018). Household Food Security 
in the United States in 2017. United States Department of Agriculture. 
 
Department of Health and Human Services (2013). Concentration of Migrant and Seasonal Farmworkers 
and Dependent Nonworkers by County 2013. 
 
Eliakim, A., D. Nemet, Y. Balakirski and Y. Epstein (2007). "The effects of nutritional-physical activity 
school-based intervention on fatness and fitness in preschool children." Journal of Pediatric 
Endocrinology Metabolism 20(6): 711-718. 
 
Flores, G., J. Maldonado and P. Durán (2012). "Making tortillas without lard: Latino parents' perspectives 
on healthy eating, physical activity, and weight-management strategies for wverweight Latino children." 
Journal of the Academy of Nutrition and Dietetics 112(1): 81-89. 
 
Grzywacz, J. G., T. A. Arcury, G. Trejo and S. A. Quandt (2016). "Latino mothers in farmworker families' 
beliefs about preschool children's physical activity and play." Journal of Immigrant and Minority Health 
18(1): 234-242. 
 
Hendy, H. M. (2002). "Effectiveness of trained peer models to encourage food acceptance in preschool 
children." Appetite 39(3): 217-225. 
 
Hernandez, T., Gabbard, S. (2018). Findings from the National Agricultural Workers Survey (NAWS) 2015-
2016: A Demographic and Employment Profile of United States Farmworkers, JBS International. 

 

101 

Kiehne, E. and N. S. Mendoza (2015). "Migrant and seasonal farmworker food insecurity: prevalence, 
impact, risk factors, and coping strategies." Social Work in Public Health 30(5): 397-409. 
 
Kilanowski, J. F. (2010). "Patterns and correlates of nutrition among migrant farm-worker children." 
Western Journal of Nursing Research 34(3): 396-416. 
 
Kilanowski, J. F. and L. Lin (2012). "Rasch analysis of US household food security survey module in Latino 
migrant farmworkers." Journal of Hunger & Environmental Nutrition 7(2-3): 178-191. 
 
Kilanowski, J. F. and L. C. Moore (2010). "Food security and dietary intake in midwest migrant 
farmworker children." Journal of Pediatric Nursing 25(5): 360-366. 
 
Knudson, W. A. (2006). The Impact of Migrant Farmworkers on Michigan Agriculture. MSU Product 
Center for Agriculture and Natural Resources. 
 
Kong, A., J. Buscemi, M. R. Stolley, L. A. Schiffer, Y. Kim, C. L. Braunschweig, S. L. Gomez-Perez, L. B. 
Blumstein, L. Van Horn, A. R. Dyer and M. L. Fitzgibbon (2016). "Hip-Hop to Health Jr. randomized 
effectiveness trial: 1-year follow-up results." American Journal of Preventive Medicine 50(2): 136-144. 
 
Larson, A. C. (2013). Migrant and Seasonal Farmworker Enumeration Profiles Study: Michigan Update 
June 2013. State of Michigan Interagency Migrant Services Committee  
 
Larson, N., D. S. Ward, S. B. Neelon and M. Story (2011). "What role can child-care settings play in 
obesity prevention? A review of the evidence and call for research efforts." Journal of the American 
Dietetic Association 111(9): 1343-1362. 
 
Lee, K. and W. O. Song (2015). "Effect of enrollment length in Migrant Head Start on children's weight 
outcomes." Health & Social Work 40(2): 142-150. 
 
Legal Services Corporation (2016). Final Ag Worker Estimates-Tables I-VI (August 2016). 
 
Lim, Y. M., S. Song and W. O. Song (2017). "Prevalence and determinants of overweight and obesity in 
children and adolescents from migrant and seasonal farmworker families in the United States-a 
systematic review and qualitative assessment." Nutrients 9(3). 
 
Lohse, B. (2015). "Preschool children of eating competent parents have higher quality of life and lower 
nutrition risk." Journal of Nutrition Education and Behavior 47(4, Supplement): S36. 
 
Melis Yavuz, H. and B. Selcuk (2018). "Predictors of obesity and overweight in preschoolers: The role of 
parenting styles and feeding practices." Appetite 120: 491-499. 
 
Miles, M. B., M. A. Huberman and J. Saldana (2014). Qualitative Data Analyisis: A Methods Sourcebook. 
Los Angeles, CA, Sage. 
 
National Head Start Association. (2017). "2016 Migrant and Seasonal Head Start Profile." from 
https://www.nhsa.org/files/resources/fact_sheet_mshs.pdf. 
 

 

102 

National Head Start Association. (2017). "National Head Start Fact Sheet."   Retrieved November 20, 
2017, from https://www.nhsa.org/facts. 
 
National Migrant and Seasonal Head Start Association. (2017). "What do local grantees do."   Retrieved 
November 14, 2017, from https://www.nmshsa.org/local-grantee/what-do-local-grantees-do/. 
 
National Migrant and Seasonal Head Start Association. (2017). "Who do local grantees serve."   
Retrieved November 14, 2017, from https://www.nmshsa.org/local-grantee/who-local-grantees-serve/. 
 
Obesity Expert Panel (2013). Managing overweight and obesity in adults: systematic evidence review 
from the Obesity Expert Panel, 2013. U.S. Department of Health and Human Services National Institute 
of Health. 
 
Ogden, C. L., Carroll, M. D., Fakhouri, T. H., Hales, C. M., Fryar, C. D., Li, X., Freedman, D. S. . (2018). 
"Prevalence of obesity among youths by household income and education level of head of household - 
United States 2011-2014."   Retrieved July 4, 2019, from http://dx.doi.org/10.15585/mmwr.mm6706a3. 
 
Ogden, C. L., Carroll, M. D., Fryar, C. D., Flegal, K. M. (2015). Prevalence of Obesity Among Adults and 
Youth: United States, 2011–2014. U.S. Department of Health and Human Services Centers for Disease 
Control and Prevention. 
 
Piziak, V. (2012). "A pilot study of a pictorial bilingual nutrition education game to improve the 
consumption of healthful foods in a head start population." International Journal of Environmental 
Research and Public Health 9(4): 1319-1325. 
 
Quandt, S. A., T. A. Arcury, J. Early, J. Tapia and J. D. Davis (2004). "Household food security among 
migrant and seasonal latino farmworkers in North Carolina." Public Health Reports 119(6): 568-576. 
 
Quandt, S. A., B. T. Jones, J. W. Talton, L. E. Whalley, L. Galvan, Q. M. Vallejos, J. G. Grzywacz, H. Chen, K. 
E. Pharr, S. Isom and T. A. Arcury (2010). "Heavy metals exposures among Mexican farmworkers in 
eastern North Carolina." Environmental Research 110(1): 83-88. 
 
Quandt, S. A., G. Trejo, C. K. Suerken, C. A. Pulgar, E. H. Ip and T. A. Arcury (2016). "Diet quality among 
preschool-age children of Latino migrant and seasonal farmworkers in the United States." Journal of 
Immigrant and Minority Health 18(3): 505-512. 
 
Ramos, A. K., G. Carlo, K. Grant, N. Trinidad and A. Correa (2016). "Stress, depression, and occupational 
injury among migrant farmworkers in Nebraska." Safety (Basel, Switzerland) 2(4): 23-23. 
 
Robinson, E., H. T. Nguyen, S. Isom, S. A. Quandt, J. G. Grzywacz, H. Chen and T. A. Arcury (2011). 
"Wages, wage violations, and pesticide safety experienced by migrant farmworkers in North Carolina." 
New Solutions: A Journal of Environmental and Occupational Health Policy 21(2): 251-268. 
 
Rosado, J. I., S. B. Johnson, K. A. McGinnity and J. P. Cuevas (2013). "Obesity among Latino children 
within a migrant farmworker community." American Journal of Preventive Medicine 44(3, Supplement 
3): S274-S281. 
 

 

103 

Rosales, C., M. I. Ortega, J. G. De Zapien, A. D. C. Paniagua, A. Zapien, M. Ingram and P. Aranda (2012). 
"The US/Mexico border: a binational approach to framing challenges and constructing solutions for 
improving farmworkers' lives." International Journal of Environmental Research and Public Health 9(6): 
2159-2174. 
 
Song, W. O., S. Song, A. Gonzalez, D. Shin and V. Nieves (2015). "Parents’ BMI and weight perception are 
associated with overweight and obesity among children in Michigan migrant and seasonal farm worker 
families." Jacobs Journal of Community Medicine 1. 
 
Song, W. O., S. Song, V. Nieves, A. Gonzalez and E. Crockett (2016). "Nutritional health attitudes and 
behaviors and their associations with the risk of overweight/obesity among child care providers in 
Michigan Migrant and Seasonal Head Start centers." BMC Public Health 16(1): 648. 
 
Taverno Ross, S. E., L. Macia, P. I. Documét, C. Escribano, T. Kazemi Naderi and I. Smith-Tapia (2018). 
"Latino parents' perceptions of physical activity and healthy eating: At the intersection of culture, family, 
and health." Journal of Nutrition Education and Behavior 50(10): 968-976. 
 
Telamon Corporation Michigan (2016). Migrant and Early Head Start Programs. 
 
Telemon Corporation (2019). Migrant and Early Head Start Programs: Annual Report 2018-2019. 
 
U.S. Department of Health and Human Services: Office of Planning Research and Evaluation. (2019). 
"Data Tables: Migrant and Seasonal Head Start Study 2017." from 
https://www.acf.hhs.gov/sites/default/files/opre/mshs_data_tables_06_18_19_sxf.pdf. 
 
United States Administration for Children Families Office of Planning Research Evaluation (2007). 
"Results from the "I Am Moving, I Am Learning" stage 1 survey: Final interim report [Executive 
summary]." 
 
United States Department of Labor. (October 23, 2006, January 23, 2017). "Who are Farmworkers?"   
Retrieved December 3, 2017, from https://www.doleta.gov/programs/who_msfw.cfm. 
 
US Department of Health and Human Services. (2019). "Migrant and Head Start Collaboration Office."   
Retrieved November 5, 2019, 2019, from https://eclkc.ohs.acf.hhs.gov/programs/article/migrant-
seasonal-head-start-collaboration-office. 
 
Vollmer, R. L. and A. R. Mobley (2013). "Parenting styles, feeding styles, and their influence on child 
obesogenic behaviors and body weight. A review." Appetite 71: 232-241. 
 
Weigel, M. M., R. X. Armijos, Y. P. Hall, Y. Ramirez and R. Orozco (2007). "The household food insecurity 
and health outcomes of U.S.-Mexico border migrant and seasonal farmworkers." Journal of Immigrant 
and Minority Health 9(3): 157-169. 
 
Williams, C. L., B. A. Strobino, M. Bollella and J. Brotanek (2004). "Cardiovascular risk reduction in 
preschool children: the "Healthy Start" project." Journal of the American College of Nutrition 23(2): 117-
123. 
 

 

104 

Witt, K. E. and C. Dunn (2012). "Increasing Fruit and Vegetable Consumption among Preschoolers: 
Evaluation of Color Me Healthy." Journal of Nutrition Education and Behavior 44(2): 107-113. 
 
Zheng, Y., J. Mancino, L. E. Burke and K. Glanz (2017). Chapter 9 - Current Theoretical Bases for Nutrition 
Intervention and Their Uses. Nutrition in the Prevention and Treatment of Disease (Fourth Edition). A. 
M. Coulston, C. J. Boushey, M. G. Ferruzzi and L. M. Delahanty, Academic Press: 185-201. 

 

 

 

105