What is Partners in Wellness (PIW)?

How is PIW Delivered?

Why is PIW Needed?

What is the theoretical basis of PIW?

Who are PIW’s partners?

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Partners in Wellness (PIW) is a nutrition education program targeted to older adults who are food-stamp eligible/recipients and is funded by USDA contract from 1998 to 2004. It is delivered at congregate nutrition sites (CNSs) throughout North Carolina prior to the hot meal that is provided by each site. PIW is based on the Socio-ecological Model which targets the individual and the surrounding environment to achieve behavior change. Each level in the model (individual, interpersonal, organizational, communal and societal) is addressed in PIW delivery.

The program consists of 14 modules that are composed of 4-5 educational sessions, which are delivered once a week. Each 15-30 minute session involves group interaction, skill building, taste testing, and a variety of activities designed to influence behavior change. Additionally, nine ‘songs that teach nutrition’ (nutrition lyrics put to old tunes) were developed as part of the educational component of selected modules. Each song was used in its appropriate module to assist with specific knowledge.







The program is delivered by NC Cooperative Extension Family and Consumer Science Educator Agents (FCEs) along with help from part time Wellness Assistants (WAs). The FCEs and WAs develop and purchase materials to support the modules they deliver at each CNS. The PIW web site and program cd are available for downloading educational materials, curriculum, and interactives for use with CNS participants and for marketing. Between modules, WAs use educational games, educational songs, and other educational materials at the sites to extend the module objectives.







The current and projected rates of increase in the aging population in the US and in North Carolina (NC) are dramatic. Older adults are the fastest growing population and the older population itself is getting older in NC and across the nation. In 1997, nearly one million of NC’s seven million residents were age 65 and older; and 103,000 were 85 or older. Food security and dietary quality are problems for this population because of a variety of economic, physical, and social changes they face that can compromise nutritional well-being. Approximately one-fifth of those 65 and older and one-third of those 85 and older lived at or below the federal poverty level in 2000. Approximately 27% were living within 185% of the federal poverty level. Even though many are eligible for Food Stamps their participation is low. Receiving Food Stamp assistance helps with food security but is not designed to ensure that they would then have enough money to buy all the food needed each month.

Good nutrition status is critical to the overall well-being, independence, and quality of life of older adults. Even the decline in self-sufficiency exhibited by many older adults is not necessarily age-dependent and may respond to nutrition intervention. Therefore, proper nutrition is important. However it is difficult to obtain proper nutrition without sufficient resources to buy the food that is needed. Therefore a high percentage of those limited in income are also susceptible to malnutrition.

One way to affect the nutritional status of older adults is to provide nutrition education at Congregate Nutrition Sites (CNSs) where they receive a hot noonday meal and an assortment of programming. Many CNS managers are untrained in the fields of nutrition and education. To comply with the federal and state guidelines to provide nutrition education at their sites, some depend on nutrition information that they find in magazines, newspapers, or other sources or from nutrition professionals they invite to speak at their sites. This has not been shown to bring about positive behavior change. However the effective way to improve the nutritional status of older adults is to first assess their needs and then use an education program that helps address these identified needs in an appropriately targeted manner.

A statewide survey of over 10,500 older adults attending congregate nutrition sites in North Carolina showed that 36% were at moderate risk for malnutrition and 33% were at high risk. The top ten identified risk factors for malnutrition in order of prevalence (starting with the most prevalent) include: eating alone (79%); living alone (62%); having a diet-related chronic disease (57%); taking 3 or more different drugs/day (44%); lacking appetite (29%); lacking enough money for food (40%); getting 2 or fewer meals/day (28%); getting few fruits/vegetables/or dairy products per day (22%); having mouth/tooth problems making it hard to eat (21%); and having lost/gained weight without trying (20%). As a result of this assessment using the DETERMINE Your Own Health Nutritional Checklist from the Nutrition Screening Initiative, the Partners In Wellness program was developed to reduce the risk of malnutrition in lower-income older adults through nutrition education.








The Partners in Wellness Program is based on one over-arching theoretical model, the Social-ecological Model (Ref: McLeroy et al. An ecological perspective on health promotion programs. _Health education Quarterly_ 1988; 15:351-77). The Social-ecological Model represents an individual’s behavior as being affected by an ever-widening sphere of influence, from peers (at the CNS) to the organization level (the CNS itself) to policy making (those with decision-making authority regarding elder nutrition). Behavior change theories appropriate to each of these levels of influence were operationalized into the program.

Theories incorporated into individual module development include the Health Belief Model, Adult Learning Theory/Principles, Transtheoretical Module and the Social Marketing Theory. For Example, Module 11: Pills, Potions, and Powders was developed from a social-cognitive theory of behavior change, which stresses the importance of self-efficacy and outcome expectations that re specific to the behavior change under consideration. Education materials and activities were designed to support self efficacy and outcome expectations.

• The Department of Family and Consumer Sciences at North Carolina State University.


• North Carolina Cooperative Extension Service at North Carolina State University and in over 60+ Cooperative Extension Centers.


• North Carolina Department of Health and Human Services Divisions of: Aging, Public Health, Dental Health, and Social Services.


• North Carolina Institute for Health, Science, and Society at UNC-Greensboro.


• The Departments of Psychology, Animal Science, Agricultural & Extension Education, and Political Science at NCSU.


• The Department of Nutrition at UNC-Greensboro.


• The North Carolina Institute on Aging at UNC-Chapel Hill.