Family-focused obesity prevention program implementation in urban versus rural communities: a case study

Abstract

Purpose Despite public health efforts to reduce childhood obesity, there remains an unequal distribution of obesity among rural and urban children, with higher rates in rural areas. However, few studies have compared differences in program delivery. This paper aims to describe differences between an urban and rural program delivery of a family-focused, community-based intervention program to prevent and reduce obesity among children. Methods This paper uses a case study format to provide a descriptive analysis of similar obesity prevention programs, designed by the same research team, implemented in Minnesota in different settings (i.e., an urban and rural setting) with significant community engagement in the adaptation process. The rural NU-HOME program is compared to HOME-Plus, an urban family-based obesity prevention program for school-aged children. Results Community engagement in the adaptation process of an urban program to a rural program confirmed some anticipated program content and delivery similarities while identifying key differences that were necessary for adaptation related to engagement with the community, recruitment and data collection, and intervention delivery. Discussion When adapting research-tested programs from urban to rural areas, it is important to identify the modifiable behavioral, social, and environmental factors associated with obesity to ensure the content of effective childhood obesity prevention programs is relevant. Customizing a program to meet the needs of the community may increase reach, engagement, and sustainability. In addition, long-term dissemination of a tailored program may significantly reduce childhood obesity in rural communities and be implemented in other rural settings nationally.

Body Mass Index Trends before and during the COVID-19 Pandemic in Primary School Students in Split-Dalmatia County, Croatia: A Retrospective Study

“…As for fifth graders, one Croatian study showed that the differences in PA among fifth-grade students were the smallest in relation to sex [ 46 ]. Also, in most countries with a higher average income, boys are more likely to be obese than girls [ 20 ], and Croatia belongs to that group. These results suggest that sex differences in children’s BMI categories may vary depending on the community being studied, parental influence [ 14 ], and lifestyle habits [ 76 ].…”

“…Research has shown that Croatia has one of the highest prevalences of overweight and obese children among European countries, and this problem is most common among boys living in the Adriatic region, where every third child is affected by this problem [ 15 , 16 ]. Research shows that BMI in children also depends on urbanization level [ 17 , 18 ]; children from rural areas have greater problems with overweight and obesity [ 19 , 20 ]. On 11 March 2020, the World Health Organization declared COVID-19 to be a pandemic [ 21 ]; children’s BMI increased further from this point [ 22 , 23 ].…”

Weight outcomes of NU-HOME: a randomized controlled trial to prevent obesity among rural children

“…In 2016, the NU-HOME research team created a study-related Action Team by building on the established HONU leadership group that included local health systems, schools, public health departments and other stakeholders. The research team and Action Team worked together for a year to complete program adaptation, including content revision, and logistical planning that included identifying key strategies for recruitment and implementation [ 26 ]. The full scale RCT followed this planning and adaptation year.…”

Using the RE-AIM framework to evaluate the feasibility of a parent-focused intervention targeting childhood obesity

“…Moreover, translation to other locations, particularly rural and remote settings, may pose additional challenges. Families living in such areas may have reduced access to health-related services [63] and face unique geographical burdens including transportation issues, extreme weather, and food insecurity [64].…”