Feasibility, acceptability and preliminary effectiveness of a manualized lay-led food literacy intervention for women in a community setting

Food literacy (FL) is the capability to make healthy food choices in different settings, contexts, and situations. Addressing factors such as competencies, self-efficacy and social norms enables sustainable positive change in nutrition behaviour. This study assesses the feasibility, acceptability, and preliminary effectiveness of a lay-led FL intervention for Arabic and Hebrew-speaking women in community settings, utilizing a train-the-trainer model. Feasibility was assessed through recruitment, attrition, and attendance rate, while acceptability and satisfaction were evaluated using participant feedback-forms. Preliminary effectiveness was evaluated using pre-post surveys measuring changes in FL level and Mediterranean diet adherence using validated scales (the adapted Short Perceived Food Literacy Scale (adapted SPFL, scale range 22-62) and the Israeli Mediterranean diet adherence screener (I-MEDAS, scale range 1-17)), utilizing the generalized estimating equations model. Outcomes of Hebrew and Arabic-speaking participants were compared using chi-square tests. Twenty-six lay-leaders were trained and subsequently conducted FL workshops for over 260 participants within 6 months. The 8-session workshop curriculum addressed multiple FL domains and was culturally adapted for Hebrew and Arabic-speaking populations. The intervention demonstrated feasibility with 77% attendance rate and 15% attrition rate. High acceptability was indicated by participant satisfaction with workshop content, length, structure, and lay-facilitators. The intervention demonstrated preliminary effectiveness with a three-point increase in FL level, as measured by the SPFL, from 48.66(±6.45) to 51.70(±6.13) (p < 0.001) post intervention. This change was seen in both Arab and Hebrew-speaking participants. Although overall I-MEDAS did not change significantly, Arabic-speaking groups showed a significant 0.75-point increase, and 50% of participants reported making dietary changes. The study demonstrates that lay-led FL interventions in the community utilizing a train-the-trainer model were feasible, well-accepted, and potentially effective in improving FL levels among diverse communities of women.