The Food for Thought program by West Winds Primary Health Centre was identified as a leading practice in our Region by Accreditation Canada. The program was asked to submit an article for the Accreditation Canada Newsletter, “Quality Matters.”  The article, titled “Leading Practice: The Impact of Peer Leadership,” appeared in their spring 2015 edition.

Written by Jacki Veregin, Tammy Wilson, Donna Nelson, Jennifer Hiebert.

Reprinted with permission from “Quality Matters.”

As part of the Canada Prenatal Nutrition Program (CPNP), Saskatoon, Saskatchewan’s Food for Thought program has had a significant impact on the lives of its participants and their infants. One of its greatest assets is its use of a highly effective Peer Leader model that could be put in place at other organizations for numerous types of health care and community programs.

In 1994, the federal government announced the creation of the CPNP to extend the support of the Community Action Program for Children, into the prenatal period. Saskatoon’s flagship project, Food for Thought, was piloted in three high schools and was a resounding success.  One year later, permanent community venues and program funding were confirmed.

Figure 1

Figure 1

Today, the Food for Thought program is funded through the Public Health Agency of Canada and is locally supported through the Saskatoon Health Region.  The primary program goal is to improve the health and birth outcomes for at-risk pregnant women and their infants.  This is achieved using the guiding values of the Food for Thought Program (see Figure 1) that put mothers and babies first.  The program focuses on the existing strengths within the participants’ families and improves program accessibility via transportation and childcare for clients and their families. The program helps build strong community partnerships, and partners take an active role alongside staff, participants, and Peer Leaders in planning, designing, implementing, and evaluating the program.

A 2009 impact evaluation identified group nutritional counselling as the most beneficial way to improve health-related behaviors and birth outcomes. It touches on reducing the risk of preterm delivery, low birth weights, and poor neonatal health (Muhajarine et al., 2009). This is one of the reasons the Food for Thought program continues to focus on the participants coming together to cook low-cost, nutritious food.

Figure 2

Figure 2

The women connect and have an opportunity to share ideas, make friends, and talk about issues they may be dealing with (see Figure 2).  The food they cook is divided and sent home with the participants to be shared with their families. A participant-driven discussion about topics related to pregnancy follows each cooking session and participants are provided with a healthy snack. The program is facilitated by an interdisciplinary team, and a core group of Peer Leaders who help staff deliver the program.

The power of Peer Leaders

Food for Thought has been running for 20 years and is a leader among the CPNPs.  Notably, it was recognized as a Leading Practice by Accreditation Canada for its Peer Leadership program.  The Peer Leader component was implemented as part of a holistic approach to enhance positive behavior modeling, delivering cost-effective programming, providing a sense of community ownership, and offering participants cultural representation on the interdisciplinary program team.

“One of the real motivations for us to implement a Peer Leader component was that our personnel did not reflect the cultural mix of the group. All of us working on the project were Caucasians, and the majority of the women we saw were Aboriginal. Also, I saw some really natural leadership skills in our participants. I felt we could really strengthen the atmosphere of welcoming and belonging by having women use their leadership skills to enhance the project work. It would foster more of a sense of ownership of the group if they saw that women who were sitting across the table from them for several months had taken on more duties and were getting paid for their time. It acknowledged and celebrated those natural leadership skills and that willingness to roll up your sleeves and be an active participant,” said Pam Woodsworth, former Project Coordinator, Food for Thought (Canadian Centre on Substance Abuse, 2001).

The Peer Leader model provides additional support to program staff with the goal of enhancing and achieving health and wellbeing for at-risk pre-/postnatal women and their children, who live with disparities. Risk factors might include poverty; age (i.e., being young); using alcohol, drugs, and tobacco; living with mental health issues; living with violence; or living in isolation with limited access to services.

A 2009 impact evaluation identified group nutritional counselling as the most beneficial way to improve health-related behaviors and birth outcomes.

Our values

The Food for Thought program is guided by the overarching value of respecting others by creating a friendly, non-threatening environment in which participants meet people with similar issues to freely discuss their concerns. A strength-based approach is used to recognize that each woman is an expert on how to bring about change in her own life. Participants are encouraged to work toward small changes that are realistic within the context of their everyday lives and to help them discover the power they possess within themselves. Peer Leaders are identified as being able to model key program values and behaviours, and play a positive role in the program’s delivery.

Who are the Peer Leaders?

Women can either express an interest in becoming a Peer Leader or staff may recruit those with natural leadership skills.  They are provided with additional training, ongoing support, and an honorarium, and work with the staff to deliver the sessions to participants.  Our Peer Leaders are current or past participants who are willing to commit to being a Peer Leader for 12 months. They have natural leadership qualities and demonstrate respect, empathy, initiative, and confidence; enjoy cooking in a group environment; and encourage others to make their own decisions.  They are positive role models for other participants, and understand that their experiences are valuable, and they have lessons to share.

Recruitment and training

The Peer Leaders are provided with three days of training in a variety of areas that build on skills they already have. Training topics include self-care, boundaries, goal setting, kitchen safety, basic nutrition, and the roles and responsibilities of the Peer Leader. They are also offered Food Safe Level 1 certification as part of their orientation. The training is delivered by interdisciplinary staff and a seasoned Peer Leader (as a mentor) using a trainee-centered approach.

Support

Peer Leaders are provided with ongoing support because many of them continue to live in poverty and face the same struggles as other participants. Their openness about these challenges is valuable, as participants can see that despite the challenges, the Peer Leaders are valued in our program and have an important contribution to make to the team. Peer Leaders are also provided with transportation to and from the program, childcare at the program site, and a small honorarium for each day they work.

Research results

Research indicates that the program is having a positive effect on the participants (Markham et al., 1999):

  • Peer Leaders help create a sense of community.
  • Mothers are more likely to hear and assimilate messages if they believe the messenger is similar to them in lifestyle and faces similar concerns and pressures.
  • Peer Leaders are cost effective.
  • Peer Leaders are effective role models who encourage behavioral changes in participants; their effectiveness results in part from participants knowing the Peer Leaders have had similar life experiences.
  • Peer Leaders play a key role in planning and implementing the program by providing regular feedback on program activities.
  • They also help strengthen the program by providing a welcoming atmosphere and a sense of belonging for participants, largely because they have a shared culture and life experience.

Successes

For many women, the Peer Leader experience has been a stepping stone into other community work, paid employment, and further education. They are proud of pursuing and furthering their education and careers. The program helps them sharpen their skills and recognize their own potential for growth, and gives them a sense of ownership and accountability for the program’s delivery and the empowerment of women in their community. Overall, the program results in the women strengthening their skills, competencies, and abilities, so they can overcome obstacles. It also fosters greater connections among the women. Peer Leaders empower participants, model healthy parent-child relationships, and create a safe environment for productive conversations. What’s more, it is valuable for participants to see that despite the struggles a Peer Leader may have had, her contributions to Food for Thought are valued and celebrated.

Courtney’s story

“A huge part of what made Food for Thought feel like a safe place was the Peer Leaders. I still remember looking at them in awe and admiration; they all had been through similar hardships and difficulties and were in the same social class as me, and they were volunteering and helping out, and providing a bridge for me to talk to and relate to … I figured if they were trusting of the staff members, I might be able to trust the staff too.  It was so cool to perceive people who had a position in the program as equals, not all just grownups with degrees.”

Rabia’s story

Rabia

Peer Leader Rabia

“I really liked that everybody’s equal and respected in this program. Everyone’s ideas and suggestions are welcome. … Food for Thought was and is like a second family for me. I can share any problem with them and always get support. … I started to know new people and learned new skills in the kitchen as well as my social life. Luckily, I started to get back my self-confidence and be myself again. Then I was chosen to be a Peer Leader with Food for Thought which gave me more confidence in myself, and I got the opportunity to use skills I had long forgotten. I think all this would not have been possible without having a great team at Food for Thought. I feel safe.”

Tammy Wilson

Tammy Wilson

Jennifer Hiebert

Jennifer Hiebert

Donna Nelson

Donna Nelson

Jacki Veregin

Jacki Veregin