Each year, teen pregnancy occurs in 750,000 15-to-19 year-old women in the United States (U.S.). Utah has the youngest population and the lowest teen abortion rates in the U.S. Approximately 73% of teen pregnancies in Utah result in live births. The prevalence of teen pregnancy and the nutritional risk to mother and child result in a much greater need for social support, such as nutrition education. Current literature shows that the paraprofessional model is effective in increasing positive behavior change through nutrition education. Presently, there is a lack of evidence that paraprofessional teens are capable of accurately and effectively teaching their peers nutrition information. This pilot study aims to measure the effectiveness of the peer-teaching-peer paraprofessional model in teen parenting nutrition education, and to demonstrate that peer educators ages 18-22 are capable of teaching their peers accurate nutrition information as effectively as adult paraprofessionals. In this pilot study, two females were trained to become paraprofessional peer educators. To supplement the training of peer educators, this pilot study developed and recorded a nutrition presentation for all six lessons of the paper version Missouri Extension Teen Parenting curriculum. Each trained peer educator taught 10 to 13 clients (ages 14 to 19) over three weeks. For evaluation, the study used pre/post comparisons. Assessment tools include teaching evaluations, pre-post test on nutrition knowledge, 24-hour dietary and physical activity recalls, and behavioral checklist. There was a significant difference in pre-post tests in knowledge, behavior, and exit survey among participants, indicating that peer educators are able to teach their peers effectively. Although not significant, peer educators' teaching accuracy score was high and improved consistently. Eighty-three of participants like or very much liked to be taught by their peers. Findings from this study showed great potential in having adolescents teach their peers as effectively as older educators.

In community-based peer education models, it is necessary to understand the relationship between learning, context and paraprofessional identity construction. Social relations are important in community education program implementation (Merriam, Caffarella, & Baumgartner, 2007); impacting power structure within communities and organizations (Cervero & Wilson, 1994, 2006; Forester, 1989). This study explored the conceptual and practical role of experience in a paraprofessional educator model and focused on the situated, contextual experiences of paraprofessionals in the communities they work and live as unique, challenging, and potentially positive for learning outcomes. Schön's narrative dialogue of reflection (1983) proved to be the essential missing piece in working with community educators toward successful development and autonomy. In-depth qualitative interviews with 19 paraprofessional community-based peer educators with a state level family nutrition program contributed to findings relevant to how social context, critical reflection, and identity development influence an understanding of experience and the ability to impact knowledge and behavior change in clients. Individual interviews and focus groups allowed narrative exploration of topics as they evolved throughout the study; giving voice to paraprofessional program assistants in a way not previously done. The findings of this study provide insight necessary for the assessment of new conceptualizations of practice for paraprofessional models in expanding community impact and highlight the need for assessment of contemporary program delivery in a way that fosters the continual development of lay educators through reflective practice. Recommendations are made for a reassessment of historically significant program models in order to embrace paraprofessionals as more broadly defined socially mediated and socially situated influential practitioners. / Ph. D.