Effectiveness of Expanded Food and Nutrition Education Program in Changing Nutrition-Related Outcomes Among Adults With Low Income: A Systematic Review

To review the effect of the Expanded Food and Nutrition Education Program (EFNEP) in changing nutrition-related outcomes. Relevant research conducted before December 2020 was identified using PubMed, Web of Science, Google Scholar, and the EFNEP Research Database. The methodological quality of each eligible study was assessed. Of the 406 studies found, 30 were eligible; 26 studies were on EFNEP, and 4 included both EFNEP and Supplemental Nutrition Assistance Program Nutrition Education (SNAP-Ed). The sample sizes ranged from 35 to 122,961. Outcome measures included consumption of food groups, nutrients, other nutrition-related behaviors, and food security. At least 1 immediate behavior change (P < 0.05) was reported in each study, but long-term maintenance of behavior change was not evident. This review found a consistent, immediate improvement in nutrition behaviors after program participation but poor retention over time. Overall, variation in programming and outcome measures, incomplete reporting, and generally low study quality by modern standards precluded strong conclusions. This review identified the need for control groups, improved reporting of program protocols, theory-based curriculum, and measurement of long-term outcomes.