OPREVENT (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans): Design of a Multilevel, Multicomponent Obesity Intervention for Native American Adults and Households

Abstract

Obesity prevalence is high in Native American (NA) adults, and there is a critical need to establish and implement evidence-based social, behavioral, and policy interventions that are theoretically informed. The use of multilevel, multicomponent (MLMC) interventions has been shown to be an effective strategy for comprehensive health behavior change; however, there is little guidance available in the literature to facilitate implementation in this underserved and understudied population. To decrease obesity and related comorbidities in NA adults, an MLMC intervention called OPREVENT (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans) was implemented in 5 rural NA communities to modify the food-purchasing environment, improve diet, and increase physical activity (PA). Five NA communities across the Upper Midwest and Southwest United States were randomly assigned to Immediate (n = 3) or Delayed (n = 2) Intervention. OPREVENT was implemented in Immediate Intervention community food stores, worksites, schools, and media over 1 y. A community-randomized controlled trial was used to evaluate intervention impact in adults at the individual and institutional levels, with individual-level data being collected on diet, PA, and psychosocial variables at baseline and follow-up; and institutional-level data being collected on food stores, worksites, and schools, media, and process measures. The OPREVENT intervention was one of the first MLMC obesity interventions in this population and provides evidence-based practices for future program development. The purpose of this article is to describe the design, implementation, and evaluation of OPREVENT. This trial was registered at isrctn.com as ISRCTN76144389.

Cultural adaptation of health interventions including a nutrition component in Indigenous peoples: a systematic scoping review

“…The majority of interventions were conducted in the USA among Native American ( n = 27 ) [ 28 , 32 , 33 , 37 , 38 , 42 , 43 , 46 , 48 , 50 , 52 , 56 – 58 , 61 – 63 , 65 , 70 , 72 – 74 , 82 , 83 , 87 , 89 , 92 ], Alaskan ( n = 4 ) [ 47 , 64 , 75 , 93 ] & Hawaiian ( n = 2 ) [ 54 , 71 ] populations. Together with Australian Aboriginal and/or Torres Strait Islander ( n = 14 ) [ 27 , 29 – 31 , 40 , 44 , 51 , 68 , 78 , 80 , 85 , 86 , 88 , 91 ] and Canadian First Nations People ( n = 11 ) [ 35 , 36 , 41 , 45 , 49 , 55 , 67 , 69 , 76 , 84 , 90 ] these three groups accounted for 85% of the literature included in this review.…”

“…Most interventions were designed for adults ( n = 29 ) [ 27 , 28 , 36 , 39 , 40 , 42 , 46 , 51 – 54 , 58 , 60 – 63 , 66 , 71 , 74 – 77 , 80 , 81 , 83 , 85 – 87 , 91 ], with less than a third ( n = 19 ) [ 29 – 31 , 34 , 35 , 38 , 44 , 47 , 48 , 50 , 59 , 65 , 68 , 69 , 73 , 78 , 79 , 88 , 90 ] designed for both adults and children. Most interventions aimed to change health outcomes for diabetes prevention ( n = 19 ) [ 27 , 28 , 36 , 38 , 44 , 55 , 56 , 60 , 62 , 67 , 69 , 70 , 79 , 81 , 82 , 88 , 89 , 92 , 93 ], obesity prevention or treatment ( n = 11 ) [ 32 , 34 , 42 , 50 , 57 , 59 , ...…”

“…Of the 46 studies that referred to formative research and also reported outcomes, most reported positive intervention outcomes ( n = 38; 83%) [ 28 , 30 – 33 , 36 – 39 , 42 , 43 , 45 , 47 , 50 , 53 , 54 , 56 – 58 , 61 , 63 , 64 , 66 – 73 , 80 , 84 – 86 , 89 – 91 , 93 ]. Nineteen interventions reported employing an underlying theory of behaviour change [ 28 , 31 – 33 , 36 , 41 , 42 , 50 , 55 , 57 , 65 , 67 , 70 , 72 , 73 , 80 , 90 , 92 , 93 ]. Of those that did, most employed multiple theories of behaviour change ( n = 9) [ 31 , 33 , 36 , 50 , 55 , 65 , 90 , 92 , 93 ] social cognitive theory ( n = 7 ) [ 28 , 41 , 42 , 57 , 72 , 73 , 80 ], or its predecessor of social learning theory ( n = 3 ) [ 32 , 67 , 70 ].…”

“…Nineteen interventions reported employing an underlying theory of behaviour change [ 28 , 31 – 33 , 36 , 41 , 42 , 50 , 55 , 57 , 65 , 67 , 70 , 72 , 73 , 80 , 90 , 92 , 93 ]. Of those that did, most employed multiple theories of behaviour change ( n = 9) [ 31 , 33 , 36 , 50 , 55 , 65 , 90 , 92 , 93 ] social cognitive theory ( n = 7 ) [ 28 , 41 , 42 , 57 , 72 , 73 , 80 ], or its predecessor of social learning theory ( n = 3 ) [ 32 , 67 , 70 ].…”

A Model Depicting the Retail Food Environment and Customer Interactions: Components, Outcomes, and Future Directions

“…Except for a few exceptions [ 137 , 138 , 139 , 140 ], relatively little work has studied the RFE using such methods, and incorporating these approaches could help to not only identify solutions that improve multiple outcomes but identify those to avoid to circumvent unexpected consequences. MLMC interventions are large, complex, multidimensional interventions that often require significant coordination, stakeholder buy-in, and resources; yet, their utility also lies in identifying which individual and/or set of components most effectively improves outcomes [ 141 , 142 ]. Both the model’s complexity and these research approaches suggest that transdisciplinary, collaborative leadership will be required.…”