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Chang, Yoo, Chung, Lee, Lee, Lee, Yoo, Choi, Lee, and Kwak: Development of the evaluat1ion tool for the food safety and nutrition management education projects targeting the middle class elderly: Application of the balanced score card and the structure-process-outcome concept∗
Research Article

J Nutr Health 2015;48(6):542-557.

Published online: 19 January 2015

DOI: https://doi.org/10.4163/jnh.2015.48.6.542

Development of the evaluat1ion tool for the food safety and nutrition management education projects targeting the middle class elderly: Application of the balanced score card and the structure-process-outcome concept∗

Hyeja Chang1, Hyoi Yoo2, Harim Chung2, Hyesang Lee3, Minjune Lee4, Kyungeun Lee5, Changhee Yoo5, Junghwa Choi6, Nayoung Lee7, Tongkyung Kwak2, †

1Department of Food Science & Nutrition, Dankook University, Gyeonggido 16890, Korea

2Department of Food & Nutrition, Yonsei University, Seoul 03722, Korea

3Department of Food & Nutrition, Andong University, Kyeongsangdo 36729, Korea

4Graduate School of Education, Yonsei University, Seoul 03722, Korea

5Department of Food & Nutrition, Seoul Women's University, Seoul 01797, Korea

6Department of Food & Nutrition, Soongeui Women's College, Seoul 04628, Korea

7Department of Food & Nutrition, Daejeon University, Daejeon 35235, Korea

†To whom correspondence should be addressed. tel: +82-2-2123-3120, e-mail: kwaktk@yonsei.ac.kr

∗ This work was carried out with the support of the 2012 Research Fund of the Ministry of Food and Drug Safety (project No. 12162KFDA109), Republic of Korea.

Received 8 October 2014       Revised 28 October 2014       Accepted 17 December 2015

Copyright © 2015 The Korean Nutrition Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The aim of this study is to develop an evaluation tool for operation of food safety and nutrition education projects for middle class elderly using the concept of the balanced score card.

Methods:

After the draft of the evaluation tool for the elderly training projects was completed, it was revised into the questionnaire and the validity of the indicators was tested by the Delphi group. The validity of the indicators was rated using a 5-point scale. The Delphi group consisted of 26 experts in the education sector, 16 government officials, and 24 professionals of the related area in communities. The first round test was conducted from July 9 to July 17, 2012, and 45 persons responded. The second round test was conducted from July 18 to July 25 and 32 persons responded.

Results:

The indicators, which were answered by more than 75 percent of the experts as ‘agree’ (4 points), ‘strongly agree’ (5 point) were included as the final indicators for the evaluation tool: 28 items out of 36 in outcome perspectives, 9 items out of 12 in process perspectives, and 17 out of 20 items in structure perspectives. The score was allocated as 50 points for outcome indicators, 20 points for process indicators, and 30 points for structure indicators.

Conclusion:

Completion of the evaluation tool is a prerequisite to determine whether the program is effectively implemented. The monitoring tool developed in the study could be applied for identification of the most optimal delivery path for the food safety and nutrition education program, for the spread of the food safety and nutrition education program for middle class elderly.

Keywords: evaluation tool for the food safety and nutrition management program, middle class elderly, balance score card, Delphi group technique

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Table 1.
Draft of the evaluation tool for the food safety and nutrition management program
Section Evaluation area
Dimension BSC perspective
Structure evaluation Learning & Innovation - Providing programs, administrative organization and support system
- Plan for optimal distribution of resources (time, equipment, human resource)
Process evaluation Internal business process - Business goal (coincidence of whole goal, measurement of goal; giving shape to business activities specifying object person)
- Monitoring and assessment : means of monitering, suitability of training educators, reporting result and actinon
- Utilization of resources and information: procurement of resources and obtaining information
- Evaluation for faults in business performance process
Outcome evaluation Finance Efficiency - Outcome against the input cost
- Educational development cost, operation cost (tuition fee, number of educated people, place fee), time, appropriating resources
Customer Effectiveness - Outcome against the goal
Influence and satisfaction - Focusing on a long-term influence than short-term
- Satisfaction for educatee
- Accessibility of programs
Table 2.
Demographic characteristic of the final delphi group
Variables Item N %
Gender Male 1 3.1
Female 31 96.9
Age 39 years ≤ 2 6.3
40~49 years 19 59.4
50~59 years 7 21.9
60 years ≥ 4 12.5
Occupation Academia 17 53.1
Government organization (KFDA, Ministry of Health and Welfare, City hall etc) 6 18.8
Local community center (health care, community welfare center etc) 9 28.1
Working experience 6 years ≤ 5 15.6
7~14 years 4 12.5
15 years ≥ 23 71.9
Table 3.
Mean and Kendall's coefficient of concordance of the indicators in the outcome perspective
Outcome perspective First round1) (N = 45) Second round2) (N = 32)
Mean SD Mean rank Importance rank Test statistics Mean SD Agreement rate (%) Mean rank Importance rank Test statistics
1-1. Efficiency of the program
1 Program operation cost vs number of educatee 3.71 0.815 2.33 3 Kendall's W 0.249 Chi-Squ 32.063∗∗∗ 3.84 0.515 75.8 1.70 3 Kendall's W 0.170 Chi-Squ 10.885∗∗ Cronbach α 0.649
2 Program development cost vs number of educatee 3.33 0.905 1.86 4          
3 Program operation cost vs goal achievement rate 4.11 0.775 2.97 1 4.19 0.471 97.0 2.20 1
4 Education completion rate (number of participator vs number of completor) 4.12 0.731 2.85 2 4.09 0.588 87.9 2.09 2
1-2. Effectiveness of the program
1 Achievement rate of program 4.24 0.802 2.32 4 Kendall's W 0.078 Chi-Squ 10.473∗ 4.19 0.592 90.9 2.13 4 Kendall's W 0.153 Chi-Squ 14.650∗∗ Cronbach α 0.734
2 Behavior change rate of educatee after education 4.58 0.657 2.87 1 4.66 0.602 93.9 2.97 1
3 Knowledge improvement rate of educatee after education 4.27 0.751 2.34 3 4.31 0.592 93.9 2.34 3
4 Attitude improvement rate of educatee after education 4.36 0.712 2.47 2 4.44 0.619 93.9 2.56 2
1-3. Numbers of complain on the program
1 Number of complain 3.44 0.867                  
1-4-1. Satisfaction with the program from the director
1 Overally, I am satisfied with the program 4.23 0.649 2.34 1 Kendall's W 0.215 Chi-Squ 18.525∗∗∗ 4.19 0.592 90.9 2.39 1 Kendall's W 0.256 Chi-Squ 16.361∗∗∗ Cronbach α 0.641
2 The program contributes the image of the organization 3.73 0.788 1.71 3 3.72 0.634 63.6 1.72 3
3 The public reputation of the program is high 3.88 0.823 1.95 2 3.81 0.592 72.7 1.89 2
1-4-2. Satisfaction with the program from educatee
1 I am satisfied with the promotion of the training program 3.66 0.680 3.48 10 Kendall's W 0.288 Chi-Squ 111.411∗∗∗ 3.50 0.672 45.5 2.80 10 Kendall's W 0.444 Chi-Squ 127.757∗∗ Cronbach α 0.794
2 The educator is kindness 3.89 0.804 4.34 9 3.87 0.609 81.8 4.20 8
3 There is no inconvenience in participating the training program 4.02 0.892 4.74 6 4.03 0.695 84.8 4.77 6
4 I am satisfied with the facility where training is provided 4.02 0.762 4.73 7 4.03 0.695 84.8 4.70 7
5 The educator has adequate knowledge on the program 4.31 0.633 5.85 5 4.34 0.545 97.0 6.08 5
6 Training contents are helpful for the nutrition and sanitation management in the life 4.80 0.405 7.57 1 4.81 0.397 100.0 8.02 1
7 The program is excellent compared to other organization 3.98 0.892 4.71 8 3.81 0.644 75.8 3.98 9
1-4-2. Satisfaction with the program from educatee
8 Overally, I am satisfied with the program 4.44 0.725 6.47 3 Kendall's W 0.288 Chi-Squ 111.411∗∗∗ 4.47 0.621 93.9 6.66 3 Kendall's W 0.444 Chi-Squ 127.757∗∗∗ Cronbach α 0.794
9 I will participate again the training program 4.47 0.694 6.45 4 4.41 0.665 97.0 6.41 4
10 I will tell other people to participate the program 4.56 0.503 6.66 2 4.66 0.483 100.0 7.39 2
1-4-3. Satisfaction with the program from educator
1 I am satisfied with the extent of authority given to me in implementing the program 3.67 0.826 4.10 10 Kendall's W 0.175 Chi-Squ 67.824∗∗∗ 3.63 0.609 60.6 4.25 10 Kendall's W 0.221 Chi-Squ 63.729∗∗∗ Cronbach α 0.730
2 I am satisfied with the size of workforce in implementing the program 4.00 0.853 5.30 6 3.91 0.588 78.8 5.28 6
3 I am satisfied with the financial support in implementing the program 4.13 0.786 5.88 4 4.00 0.672 78.8 5.72 4
4 I am satisfied with the facility in implementing the program. 4.00 0.879 5.26 7 3.81 0.644 69.7 4.86 7
5 I am satisfied with the equipment needed in implementing the program 3.78 0.850 4.27 9 3.69 0.592 63.6 4.27 9
6 I am satisfied with the training opportunity to provide professional knowledge needed for implementing the program 4.38 0.614 6.85 1 4.34 0.483 100.0 7.27 1
7 I have the professional knowledge needed for implementing the program 4.27 0.845 6.70 2 4.28 0.634 90.9 6.95 2
8 I am satisfied with the support from the director 4.04 0.737 5.57 5 3.94 0.504 84.8 5.41 5
9 I am satisfied with the support from the local governor 3.80 0.726 4.62 8 3.72 0.523 69.7 4.38 8
10 I am overally satisfied with the program 4.25 0.751 6.45 3 4.22 0.706 84.8 6.63 3
1-5. Evaluation index of the program from other department/communities
1 The program has benefit for communities to improve the public health through the program 4.51 0.589 3.16 1 Kendall's W 0.243 Chi-Squ 32.047∗∗∗ 4.59 0.499 100.0 3.42 1 Kendall's W 0.444 Chi-Squ 42.668∗∗∗ Cronbach α 0.732
2 The program is helpful for gaining positive a public image 4.00 0.826 2.34 3 3.84 0.574 72.7 2.08 3
3 The program is helpful for the community to form active network 4.11 0.745 2.48 2 4.09 0.530 90.9 2.50 2
4 The public reputation of the program is high 3.82 0.815 2.00 4 3.81 0.592 72.7 2.00 4

1) The indicators getting under 3.5 point were eliminated at the first round.

2) The indicators getting under 3.8 point or under 75% of respondents who select the items of "agree" or "strongly agree" were eliminated at the second round.

Table 4.
Allocation of score for outcome, process and structure indicators
Criteria Mean ± SD Score allocation
First round Second round
I. Performance outcome indicators 48.10 ± 10.32 49.65 ± 3.68 50
  1-1. Efficiency of the program 8.20 ± 2.68 8.97 ± 1.35 10
  1-2. Effectiveness of the program 9.95 ± 3.15 9.77 ± 1.93 11
  1-3. Number of complaints about the program 4.48 ± 2.17 4.42 ± 1.36 0
  1-4-1. Satisfaction with the program from a director 5.13 ± 1.95 5.10 ± 0.98 6
  1-4-2. Satisfaction with the program from educatees 9.50 ± 4.81 9.71 ± 2.31 11
  1-4-3. Satisfaction with the program from educators 6.73 ± 2.80 6.29 ± 1.77 6
  1-5. Evaluation of the program from other departments or communities 5.43 ± 1.78 5.06 ± 0.93 6
II. Process indicators 19.32 ± 6.15 19.06 ± 3.79 20
  2-1. Planning of the program 9.28 ± 3.43 9.26 ± 2.32 8
  2-2 Operation management of the program 10.03 ± 3.61 9.81 ± 1.83 12
III. Structure indicators 31.41 ± 5.29 31.87 ± 4.01 30
  3-1. Human resource / competence 6.23 ± 2.31 6.29 ± 1.75 7
  3-2. Organization structure 4.00 ± 1.63 4.03 ± 1.02 4
  3-3. Information / data 4.50 ± 2.04 4.45 ± 1.34 4
  3-4. Time 3.13 ± 1.76 3.29 ± 1.27 2
  3-5. Material supports/facility/equipment 4.43 ± 1.52 4.52 ± 1.18 4
  3-6. Financial securement 5.20 ± 2.02 5.35 ± 1.52 5
  3-7. System 3.78 ± 1.79 3.61 ± 1.23 4
Table 5.
Mean and Kendall's coefficient of concordance of the indicators in the process perspective
Process perspective First round1) (N = 45) Second round2) (N = 32)
M SD Mean rank Importance rank Test statistics Mean SD Agreement rate (%) Mean rank Im mportance rank Test statistics
2-1. Planing the implementation of the program
1 The director and manager in charge of planning the program are deployed 4.07 0.780 2.18 4 Kendall's W 0.141 Chi-Squ 19.030∗∗∗ 4.09 0.689 87.9 2.13 4 Kendall's W 0.276 Chi-Squ 26.518∗∗∗ Cronbach α 0.778
2 The committee for the program was organized and made reasonably decision makings on the program planing and operation 4.07 0.863 2.19 3 4.13 0.609 87.9 2.14 3
3 The proposal of the program (the operation plans for the program) is specifically written and keep in office 4.44 0.624 2.73 2 4.34 0.653 90.9 2.56 2
4 Education programs are differently developed in terms of strategy, methods and contents of the training depending on the levels of the educatee 4.56 0.693 2.90 1 4.69 0.535 97.0 3.17 1
2-2. Operation management of the program
1 The activities on dietary life program is well managed with documents 4.20 0.726 4.11 6 Kendall's W 0.266 Chi-Squ 82.026∗∗∗ 4.19 0.535 93.9 3.73 4 Kendall's W 0.414 Chi-Squ 92.705∗∗∗ Cronbach α 0.833
2 The operation plans were well equipped for target trainees to easily use them 4.40 0.688 4.83 5 4.44 0.619 93.9 4.58 3
3 Communication between employees in charge of the program is well 4.09 0.900 3.91 7          
4 The evaluation is conducted after implementation of the program 4.62 0.614 5.55 2 4.69 0.471 100.0 5.39 1
5 The satisfaction with the program (opinions) is tested after implementation of the program 4.593) 0.583 5.50 3          
6 Reputation on the activities of the program is evaluated regularly 3.78 0.850 2.88 8          
7 The feedback from the outcome of the program evaluation is reflected on the goals setting and correction of the plans 4.56 0.659 5.36 4 4.56 0.619 93.9 5.00 2
8 Promotion on the program is implemented (i.e. Homepage) 4.13 0.694 3.89 1 4.06 0.619 84.8 3.38 5

1) The indicators getting under 3.5 point were eliminated at the first round.

2) The indicators getting under 3.8 point or under 75% of respondents who select the items of "agree" or "strongly agree" were eliminated at the second round.

3) The indicator was deleted due to being regarded as the outcome related index.

Table 6.
Mean and Kendall's coefficient of concordance of the indicators in the structure perspective
Structure perspective First round1) (N = 45) Second round2) (N = 32)
M SD Mean rank Importance rank Test statistics Mean SD Agreement rate (%) Mean rank Importance rank Test statistics
3-1. Human resource / competence
1 A employee who is entirely in charge of the program was employed 4.24 0.857 2.67 2 Kendall's W 0.214 Chi-Squ 28.912∗∗∗ 4.38 0.707 93.9 2.84 2 Kendall's W 0.307 Chi-Squ 29.503∗∗∗ Cronbach α 0.767
2 The employee has professionalism on the program 4.49 0.695 3.03 1 4.50 0.622 93.9 3.08 1
3 Experiences of the project performance on the dietary life related program were equipped 3.93 0.780 2.07 4 3.87 0.609 81.8 1.94 4
4 Network and supports of experts keep actively going with organizations in community 4.02 0.783 2.23 3 4.00 0.622 81.8 2.14 3
3-2. Organization structure
1 More than three employees inside of the organization participate the program 3.40 0.889 1.21 2 Kendall's W 0.501 Chi-Squ 22.533∗∗∗           NA3)
2 The organization to operate the program has a clear structure and supports between jobs were reached 4.24 0.830 1.79 1 4.13 0.751 84.8    
3-3. Information / data
1 Information related to the program implementation is easy to gather 3.91 0.802 1.98 2 Chi-Squ 0.404 Kendall's W 0.005 3.84 0.574 75.8 2.14 1 Kendall's W 0.075 Chi-Squ 4.789 Cronbach α 0.682
2 More than three types of training tools and contents being needed in the program implemen tation is equipped 3.95 0.776 2.06 1 3.75 0.622 72.7 2.02 2
3 The employee who is in charge of the program received a specialized training related on the program twice every year 3.91 0.858 1.97 3 3.62 0.660 66.7 1.84 3
3-4. Time
1 The time consuming on planning and operation of the program is adequate 0.834 0.834     N = 45 3.84 0.677 75.8      
3-5. Material supports/facility/equipment
1 The facilities needing for implementing the program (meeting room, training place, cooking class lab, equipment etc) is excellent 3.91 0.793 1.87 3 Kendall's W 0.081 Chi-Squ 7.304∗ 3.84 0.515 78.8 1.94 2 Kendall's W 0.088 Chi-Squ 5.636 Cronbach α 0.836
2 Facilities and equipment needing for implementing the program are sufficiently equipped 4.18 0.576 2.20 1 4.00 0.440 90.9 2.17 1
3 Facilities and equipment were utilized and supported each others by actively networking among organizations in communities. (e.g. teaching aids, equipment rent) 3.98 0.690 1.93 2 3.81 0.644 75.8 1.89 3
3-6. Financial securement
1 Development cost of the program maintains an optimal level 3.96 0.737 2.59 2 Kendall's W 0.121 Chi-Squ 16.332∗∗ 3.88 0.609 78.8 2.73 2 Kendall's W 0.349 Chi-Squ 33.497∗∗∗ Cronbach α 0.782
2 Operation cost maintains an optimal level 4.07 0.809 2.80 1 3.94 0.669 81.8 2.84 1
3 About fifty percent of the operation cost of the program is supported from the local government 3.58 0.839 2.07 4 3.31 0.644 33.3 1.70 4
4 One hundred percent of the operation budget is totally utilized in the program operation 3.93 0.863 2.54 3 3.94 0.669 81.8 2.72 3
3-7. System
1 Development programs for employee's potentials are systematically equipped and supported 4.13 0.757 2.11 1 Kendall's W 0.045 Chi-Squ 4.000 4.09 0.641 90.9 2.11 1 Kendall's W 0.090 Chi-Squ 5.765 Cronbach α 0.746
2 A performance appraisal system for employees is systematically established 4.09 0.821 2.05 2 4.09 0.641 90.9 2.11 1
3 The program is systematically operated with the utilization of the technology (e.g. computerization) 3.95 0.806 1.84 3 3.84 0.574 75.8 1.78 3

1) The indicators getting under 3.5 point were eliminated at the first round.

2) The indicators getting under 3.8 point or under 75% of respondents who select the items of “agree” or “strongly agree” were eliminated at the second round.

3) NA: not applicable due to the variable number being one.

Table 7.
The final indicators' numbers and their scores in outcome, process and structure perspectives
Perspective   Indicator Points Number o indicators
Outcome perspective 1-1. Efficiency of the program 10 3
1 Program operation cost vs number of educatee 2
2 Program operation cost vs goal achievement rate 5
3 Education completion rate (number of participator vs number of completer 3
1-2. Effectiveness of the program 11 4
1 Achievement rate of program 5
2 Behavior change rate of educatee after education 2
3 Knowledge improvement rate of educatee after education 2
4 Attitude improvement rate of educatee after education 2
1-4-1. Satisfaction with the program from educatee 11 9
1 The educator is kindness 1
2 There is no inconvenience in participating the training program 1
3 I am satisfied with the facility where training is provided 1
4 The educator has adequate knowledge on the program 1
5 Training contents are helpful for the nutrition and sanitation management in the life 2
6 The program is excellent compared to other organizations 1
7 Overally, I am satisfied with the program 1
8 I will participate again the training program 1
9 I will tell other people to participate the program 2
1-4-2. Satisfaction with the program from educator 6 6
1 I am satisfied with the size of workforce in implementing the program 6
2 I am satisfied with the financial support in implementing the program 1
3 I am satisfied with the training opportunity to provide professional knowledge needed for implementing the program 1
4 I have the professional knowledge needed for implementing the program 1
5 I am satisfied with the support from the director 1
6 I am overally satisfied with the program 1
1-4-3. Satisfaction with the program from the director 6 2
1 Overally, I am satisfied with the program 3
2 The public reputation of the program is high 3
1-4-4. Evaluation of the program from other department/communities 6 4
1 The program has benefit for communities to improve the public health through the program 2
2 The program is helpful for gaining positive a public image 1
3 The program is helpful for the community to form active network 2
4 The public reputation of the program is high 1
Process perspective 2-1. Planing the implementation of the program 8 4
1 The director and manager in charge of planning the program are deployed 2
2 The committee for the program was organized and made reasonably decision makings on the program planing and operation 2
3 The proposal of the program (the operation plans for the program) is specifically written and keep in office 2
4 Education programs are differently developed in terms of strategy, methods and contents of the training depending on the levels of the educatees 2
2-2. Operation management of the program 12 5
1 The activities on dietary life program is well managed with documents 2
2 The operation plans were well equipped for target trainees to easily use them 2
3 The evaluation is conducted after implementation of the program(i.e. satisfaction, reputation on the program) 4
4 The feedback according to the result of the program evaluation is reflected on the goals setting and correction of the plans 2
5 Promotion on the program is implemented (i.e. Homepage) 2
Structure perspective 3-1. Human resource / competence 7 4
1 A employee who is entirely in charge of the program was employed 2
2 The employee has professionalism on the program 2
3 Experiences of the project performance on the dietary life related program were equipped 1
4 Network and supports of experts keep actively going with organizations in community 2
3-2. Organization structure 4 2
1 The organization to operate the program has a clear structure 2
2 Supports among jobs were reached 2
3-3. Information / data 4  
1 Information related to the program implementation is easy to gather (More than three types of training tools and contents needing for the program implementation is equipped) 2
2 The program is systematically operated with the utilization of the technology (e.g. developing Database) 2
3-4. Time 2 1
1 The time consuming on planning and operation of the program is adequate 2
3-5. Material supports/facility/equipment 4 3
1 The facilities needing for implementing the program (meeting room, training place, cooking class lab, equipment etc) is excellent 1
2 Facilities and equipment needing for implementing the program are sufficiently equipped 2
3 Facilities and equipment were utilized and supported each others by actively networking among organizations in communities. (e.g. teaching aids, equipment rent) 1
3-6. Financial securement 5 3
1 Development cost of the program maintains an optimal level 2
2 Operation cost maintains an optimal level 2
3 One hundred percent of the operation budget is totally utilized in the program operation 1
3-7. System 4 2
1 Development of the programs for employee's potentials are systematically equipped and supported 2
2 A performance appraisal system for employees is systematically established 2
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