Process evaluation of a multi-institutional community-based program for diabetes prevention among First Nations

Abstract

Epidemic rates of diabetes among Native North Americans demand novel solutions. Zhiiwaapenewin Akino'maagewin: Teaching to Prevent Diabetes was a community-based diabetes prevention program based in schools, food stores and health offices in seven First Nations in northwestern Ontario, Canada. Program interventions in these three institutions included implementation of Grades 3 and 4 healthy lifestyles curricula; stocking and labeling of healthier foods and healthy recipes cooking demonstrations and taste tests; and mass media efforts and community events held by health agencies. Qualitative and quantitative process data collected through surveys, logs and interviews assessed fidelity, dose, reach and context of the intervention to evaluate implementation and explain impact findings. School curricula implementation had moderate fidelity with 63% delivered as planned. Store activities had moderate fidelity: availability of all promoted foods was 70%, and appropriate shelf labels were posted 60% of the time. Cooking demonstrations were performed with 71% fidelity and high dose. A total of 156 posters were placed in community locations; radio, cable TV and newsletters were utilized. Interviews revealed that the program was culturally acceptable and relevant, and suggestions for improvement were made. These findings will be used to plan an expanded trial in several Native North American communities.

A Food Store–Based Environmental Intervention Is Associated with Reduced BMI and Improved Psychosocial Factors and Food-Related Behaviors on the Navajo Nation

“…Those respondents who were part of the intervention group or more exposed to the intervention were much more likely to purchase shelf label-promoted healthy foods. This finding is in line with much of our previous research on the utility and effectiveness of shelf labels as means of promoting healthier foods in retail food stores (23)(24)(25).…”

“…The fact that we saw an impact on psychosocial and behavioral factors provides additional support for the validity of our associations. We have conducted food storecentered trials in other settings with indigenous peoples that have shown positive impacts on psychosocial factors and foodrelated behaviors (23)(24)(25)(26).…”

“…A few trials have been conducted to improve the food environment in AI communities. The Zhiwaapenewin AkinoÕMaagewin (23,24) and Apache Healthy Stores (25,26) programs both sought to improve the local food environment by working with food stores. These interventions showed positive changes in individual psychosocial measures, characterized by increased knowledge, and demonstrated indirect improvements in diet as measured by the frequency of healthy food acquisition.…”

Welke factoren bepalen de implementatie van een lokale integrale aanpak van overgewicht bij kinderen?

“…De gevonden implementatiegraad (52 %) is relatief hoog. Hoewel meer onderzoeken naar de implementatie van een integrale aanpak een dergelijke implementatiegraad rapporteren [18,19], is een compleetheid van meer dan 50 % ongebruikelijk hoog te noemen [20]. Daarnaast werd een positief verband gevonden tussen de mate van ervaring met implementatie en de compleetheid van implementatie.…”

Disease prevention and health promotion programs: benefits, implementation, quality assurance and open questions—a summary of the evidence

“…Subtypes include media campaigns that combine mass media messages (e.g., series of exhibitions, lectures or ads on the reduction of alcohol consumption or smoking in adolescents (Bonfadelli and Friemel 2006). Another subtype involves the social development of a broad alliance of health care and political actors for concerted promotion of health awareness on different issues, such as rapid and highquality care for stroke victims through many channels, in many cases, with supportive media campaigns (Hannon et al 2009;Rosecrans et al 2008;Scheier and Grenard 2010). (structural, environmental): involve sociopolitical action aimed at changing risk behavior opportunities and decreasing the accessibility and costeffectiveness of risk substances by measures such as raising taxes, banning advertising and/or restricting access to cigarettes or alcohol and installing water coolers in schools.…”