Paper Type

Doctoral Dissertation


Brooks College of Health

Degree Name

Doctor of Clinical Nutrition (DCN)


Nutrition & Dietetics

NACO controlled Corporate Body

University of North Florida. Department of Nutrition & Dietetics

First Advisor

Andrea Y. Arikawa, PhD, MPH, RDN, LD/N, FAND

Second Advisor

Jemisha Leftwich, DCN, RDN, LD/N, CLC, FAND

Third Advisor

Jenifer Ross, DCN, MS, RDN, LD/N, FAND

Fourth Advisor

Lauri Wright, PhD, RDN, LD/N

Department Chair

Dr. Andrea Arikawa

College Dean

Dr. Curt Lox


Background In 1998, Georgia Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) adopted the Florida Department of Public Health WIC Nutrition Training Guide. The purpose of adopting the course was to use it as a resource to properly educate and train nutrition paraprofessionals to conduct low risk education to Georgia WIC participants.1 The Georgia WIC policy requires that each nutrition paraprofessional complete the approved nutrition training prior to educating WIC participants. The current resource for training nutrition paraprofessionals in Georgia WIC is outdated. Last updated in 2007, the formal training no longer accurately trains paraprofessional staff to become nutrition assistants. The education and training requirements of registered dietitians by far exceeds the degree requirements of nutritionists and emphasizes the gap of knowledge and skills among nutrition paraprofessional staff in public health programs.

Objectives The aim of this project is to evaluate knowledge, attitude, behavior of nutrition paraprofessionals participating in a scientific evidenced based online training course for nutrition paraprofessionals in Northwest Georgia WIC. This study will assess and evaluate employees’ knowledge, attitude and behavior as related to the online nutrition education course designed for nutrition paraprofessionals to become nutrition assistants. In addition, the research will identify and measure the correlation of socio demographic variables. Employees training development will be guided by results of a qualitative preliminary study of paraprofessionals in a focus group using Andragogy Adult Learning Theory.

Design The study was a quasi-experimental correlational cross-sectional study utilizing web-based surveys, an online class platform to administer the course content and observation of skill demonstration following completion of the course.

Outcomes Measured Measures included test results, comparison of pre and post test results, comparison of pre and post course attitudes, correlation of relationship among characteristics and survey results, definition of terms, definition of job roles and responsibilities, and observation of skill demonstration.

Statistical analyses performed Calculation of descriptive statistics, Wilcoxon Signed Rank Test, and Spearman’s Rho were utilized to performed statical analyses.

Results The results did not support a significant increase in knowledge based on the pre and posttest. However, the course introductory exam and final exam resulted in a significant improvement of scores. The course assignments revealed all participants received a passing score of 70 or higher after the final attempt in each of the fourteen quizzes. The change in attitude reflected a significant difference resulting in a higher level of disagreement following implementation of the employee training course than prior to beginning the course. The demonstration of skills evaluation did not support a relationship of significant correlation with post test scores. The relationship among demographics did not have a significant correlation to the test scores.

Conclusion The attitude results identified an area needing additional research to examine the reason for change. Attitudes influence how individuals’ approach and receive training. The result of this study is not applicable for generalization as the sample size was small. However, an extension of the research in other areas of the state would strengthen the study and provide context from all around the state.

Available for download on Monday, January 13, 2025