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Senior Nutrition Program
Class Survey

Senior Nutrition Program: Pre-Program Assessment V2

Introductions: This survey is designed to gather information about your current knowledge, skills, and behaviors related to healthy eating. Your feedback will help us determine how effective our program is in improving the eating habits of seniors. Our program goals are as follows: 



  •  Keeping the Flavor and Losing the Calories Goal:Empower participants to prepare meals that are both flavorful and lower in calories by teaching them techniques to reduce unhealthy fats, sugars, and sodium while maintaining cultural and personal taste preferences.

  • Meal Prep Time Saver and Cost Savings Goal: Equip participants with strategies to plan and prepare nutritious meals efficiently and affordably, reducing overall cooking time and minimizing food waste.

  • Healthy Ingredient Substitutions Goal: Increase participants’ knowledge and confidence in using healthier ingredient substitutions (e.g., whole grains, lean proteins, and low-fat dairy) to enhance the nutritional value of their meals without sacrificing taste or cultural significance. 

Birthday
At which park location are you taking this program?
Shenandoah Park
Charles Hadley Park
Antonio Macio Park

Section 1: Flavorful Meals with Fewer Calories

How confident are you in your ability to create meals that are both flavorful and lower in calories (e.g., by reducing fats, sugars, and sodium)?
Not confident at all
Slightly confident
Somewhat confident
Very confident
Extremely confident
Do you know techniques to reduce unhealthy fats, sugars, or sodium in your cooking while maintaining flavor?
Yes, I use these techniques often
Yes, but I use them occasionally
No, but I would like to learn
No, and I am not interested
How often do you modify traditional or cultural recipes to make them healthier?
Never
Rarely
Sometimes
Often
Always

Section 2: Meal Prep Time Saver and Cost Savings

How often do you plan your meals for the week ahead?
Never
Rarely
Sometimes
Often
Always
How confident in your ability to prepare nutritious meals within a limited amount of time?
Not confident at all
Slightly confident
Somewhat confident
Very confident
Extremely confident
What challenges do you face when trying to save time and reduce costs in meal preparation? (Check all that apply.)
How often do you use leftovers or repurpose ingredients to minimize food waste?
Never
Rarely
Sometimes
Often
Always

Section 3: Healthy Ingredient Substitutions

Are you familiar with healthy ingredient substitutions, such as using Greek yogurt instead of sour cream or whole-grain options instead of refined grains?
Yes, I use them regularly
Yes, but I use them occasionally
No, but I would like to learn
No, and I am not interested
How confident are you in identifying healthier ingredient options that align with your cultural or personal food preferences?
Not confident at all
Slightly confident
Somewhat confident
Very confident
Extremely confident
What are the main reasons you don’t use healthier ingredient substitutions? (Check all that apply.)

Section 4: Perceptions of Diet and Associations to Chronic Diseases

How strongly do you agree with the statement: "What I eat can impact my risk of chronic diseases like diabetes, high blood pressure, or heart disease"?
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Which chronic diseases do you think are most affected by diet? (Check all that apply.)

Section 5: Daily Dietary Behaviors

How many days during the week do you consume vegetables as part of your daily meals?
7 days per week
5-6 days per week
3-4 days per week
1-2 days per week
0 days per week
How many days during the week do you eat fruits as part of your daily meals?
7 days per week
5-6 days per week
3-4 days per week
1-2 days per week
0 days per week
How often do you prepare meals at home?
Never
Rarely (1-2 times per week)
Sometimes (3-4 times per week)
Often (5-6 times per week)
Always (7 days per week)
How often do you consume processed or pre-packaged meals?
Never
Rarely (1-2 times per week)
Sometimes (3-4 times per week)
Often (5-6 times per week)
Always (7 days per week)

General Questions 

What specific healthy eating goal would you like to achieve by the end of this 6-week program?
Eating more fruits and vegetables at least 3 times in a week
Cooking and preparing meals at home at least 3 times a week.
Preparing more of my cultural foods in a healthier way at least 3 times in a week.
Managing portion sizes to avoid overeating for at least 2 of my daily meals.
Other
How confident are you in your ability to meet this goal?
Not confident at all
Slightly confident
Somewhat confident
Very confident
Extremely confident

Demographics 

What is your gender identity?
Male
Female
Which of the following best describes your race or ethnicity?
White
Black or African American
Hispanic or Latino
Asian
Native American or Alaska Native
Native Hawaiian or Other Pacific Islander
Prefer not to say
Other
What is the highest level of education you have completed?
Some high school
High school graduate
Some college
Bachelor's degree
Graduate degree
What is your household's annual income level? (This information is confidential and will only be used to ensure the program is accessible to all participants.)
Less than $20,000
$20,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 or more
Prefer not to answer
Do you have a history of any chronic diseases or significant health conditions?
Yes
No
If Yes, Please explain
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