WWW.DISSERTATION.XLIBX.INFO
FREE ELECTRONIC LIBRARY - Dissertations, online materials
 
<< HOME
CONTACTS



Pages:   || 2 | 3 | 4 | 5 |   ...   | 18 |

«UNDERSTANDING THE PROCESS AND KEY FACTORS OF COMMUNITY IMPLEMENTATION OF A FOOD STORE-BASED NUTRITION INTERVENTION ON THE NAVAJO NATION by Muge Qi, ...»

-- [ Page 1 ] --

UNDERSTANDING THE PROCESS AND KEY FACTORS OF

COMMUNITY IMPLEMENTATION OF A FOOD STORE-BASED

NUTRITION INTERVENTION ON THE NAVAJO NATION

by

Muge Qi, MHS

A dissertation submitted to Johns Hopkins University in conformity with the

requirements for the degree of Doctor of Philosophy

Baltimore, Maryland

July, 2014

© 2014 Muge Qi

All Rights Reserved

ABSTRACT

The prevalence of obesity is significantly higher among American Indians (AI) than in other racial/ethnic groups and is associated with increased rates of diabetes, hypertension, and cardiovascular disease. In rural AI settings, accessibility, availability and variety of healthful foods are limited. Changing the food environment in these AI communities may be a feasible way to impact diet quality and reduce obesity and chronic disease risk. The Navajo Healthy Stores (NHS) program was a food store-based intervention implemented through an academic–community partnership to improve dietary patterns on the Navajo Nation and to reduce risk for obesity. This dissertation describes the partnership process and key factors affecting the implementation and sustainability of the NHS program.

A qualitative study was conducted using a combination of semi-structured interviews with key stakeholders and a review of program documents. We found that the academic-community partnership for implementation of the NHS program evolved through an engagement, formalization, mobilization, and maintenance process, but there were important challenges needed to address in order to successfully move through the stages of implementation. Key challenges faced by the partnership included fitting into local health staff job schedule, obtaining buy-in from critical stakeholders, and overseeing implementation within the host organization. We also identified important facilitating factors for the partnership effort, including trust in the academic partners’ experience and commitment to sustainability, being responsive to the partner’s interests in capacity development, having a program champion, and having a dedicated and ii experienced field coordinator. Our study also found that local health staff was able to work with store owners/managers to implement the NHS intervention, but there were challenges in delivering intervention activities with adequate intensity and having store owners to stock healthier options. Small store managers reported lack of customer demand, lack of availability and increased cost of healthy foods from suppliers due to long transportation route as key challenges for stocking healthy foods.

The findings of this study help guide academic researchers and community practitioners in developing effective partnerships for community implementation of evidence-based nutrition interventions.

DISSERTATION COMMITTEE

ADVISOR:

Joel Gittelsohn, PhD Professor, International Health

READERS:

Laura Caulfield, PhD Professor, International Health Janice Bowie, PhD Associate Professor, Health Behavior & Society Sara Bleich, PhD Associate Professor, Health Policy & Management Caitlin Kennedy, PhD (alternate) Assistant Professor, International Health Roni Neff, PhD (alternate) Assistant Scientist, Environmental Health & Science

–  –  –

This endeavor would not have been possible without people who provided tremendous support and encouraged me through this long process. I am especially grateful to my advisor, Dr. Gittelsohn, for his guidance, encouragement, and patience that were essential to the completion of this PhD. I would like to thank my committee members, including Drs. Janice Bowie, Laura Caulfield, Sara Bleich, Caitlin Kennedy, Roni Neff, and Kate Clegg-Smith for their valuable input and kind words. Special thanks go to Drs. Terry Brown and Joanne Katz for providing me with the support I needed. I would also like to thank the U.S. Department of Agriculture and the Center for a Livable Future and the Director, Dr. Robert Lawrence, for providing generous financial support for this work.

Special recognition goes to Marla Pardilla, who provided valuable support in the field and facilitated my work. And to my friends, faculty, staff here at JHSPH, including Drs. Keith West, Youfa Wang, Parul Christian, Rolf Klemm, Carol Buckley, Rhonda Skinner, Peggy Bremer, Tom Durkin, and many others, who provided guidance and support throughout this process I offer the utmost appreciation. Most importantly I thank my family who has supported and helped me to go through this journey. Without their ultimate love, care, and encouragement, everything I’ve done would not be possible.

–  –  –

Abstract

ACKNOWLEDGEMENTS

TABLE OF CONTENTS

LIST OF TABLES

LIST OF FIGURES

CHAPTER 1. INTRODUCTION

1.1 PROBLEM STATEMENT

1.2 SUMMARY OF DISSERTATION CHAPTERS

CHAPTER 2. LITERATURE REVIEW

2.1 OBESITY IN AMERICAN INDIANS

2.2 DIET QUALITY IN AMERICAN INDIANS

2.3 FOOD ENVIRONMENTS IN AMERICAN INDIAN COMMUNITIES............... 7





2.4 FOOD STORE-BASED INTERVENTIONS

2.5 RESEARCH ON DISSEMINATION AND IMPLEMENTATION OF

EVIDENCE-BASED NUTRITION INTERVENTIONS IN COMMUNITY

SETTINGS

2.5.1 Interventions and Target Audiences

2.5.2 Dissemination and Implementation Strategies and Theoretical Models.......... 14 2.5.3 Implementation and Sustainability

2.5.4 Gaps in the Literature

CHAPTER 3. METHODS

3.1 STUDY OVERVIEW

3.2 STUDY DESIGN AND SETTING

3.3 DATA COLLECTION METHODS

3.3.1 Fieldwork

3.3.2 Semi-Structured Interviews

3.3.3 Document Review

3.4 DATA MANAGEMENT AND ENTRY

v

3.5 DATA ANALYSIS

3.6 ETHICAL APPROVAL

3.7 FUNDING

CHAPTER 4: IMPLEMENTATION PARTNERSHIP PROCESS FOR A STOREBASED NUTRITION INTERVENTION ON THE NAVAJO NATION (PAPER 1).... 37

4.1 ABSTRACT

4.2 INTRODUCTION

4.2.1 Navajo Healthy Stores Program

4.3 METHODS

4.3.1 Conceptual Framework

4.3.2 Study Design and Data Collection

4.3.3 Data Analysis

4.4 RESULTS

4.4.1 Partnership Stages

4.4.2 Partnership Outcomes

4.5 DISCUSSION

CHAPTER 5: FACTORS AFFECTING AN ACADEMIC – COMMUNITY

PARTNERSHIP FOR IMPLEMENTATION OF A STORE –BASED NUTRITION

INTERVENTION (PAPER 2)

5.1 ABSTRACT

5.2 INTRODUCTION

5.3 METHODS

5.3.1 Study Setting

5.3.2 Participants and Procedures

5.3.3 Data Analysis

5.4 RESULTS

5.4.1 Facilitating Factors

5.4.2 Challenges or Barriers

5.5 DISCUSSION

CHAPTER 6: THE PERSPECTIVES OF LOCAL HEALTH STAFF AND STORE

OWNERS ON IMPLEMENTATION OF A STORE-BASED NUTRITION

INTERVENTION (PAPER 3)

vi

6.1 ABSTRACT

6.2 INTRODUCTION

6.3 METHODS

6.3.1 Study Setting

6.3.2 Participants and Procedures

6.3.3 Data Analysis

6.4 RESULTS

6.4.1 Store Recruitment and Relationship Building

6.4.2 Implementation Challenges

6.4.3 Store Owners/Managers’ Perceptions

6.5 DISCUSSION

CHAPTER 7: CONCLUSION

7.1 SUMMARY OF FINDINGS

7.2 STRENGTHS AND LIMITATIONS

7.3 IMPLICATIONS FOR THEORY

7.4 IMPLICATIONS FOR PRACTICE

7.5 IMPLICATIONS FOR POLICY

7.6 IMPLICATIONS FOR FUTURE RESEARCH AND METHODOLOTY.......... 141 APPENDIX A-D

APPENDIX A: CONSENT FORM

APPENDIX B: INTERVIEW GUIDE – INTERVENTIONIST

APPENDIX C: LIST OF DOCUMENTS REVIEWED

APPENDIX D: THE FINAL CODING TEMPLATE

BIBLIOGRAPHY

CURRICULUM VITAE

–  –  –

CHAPTER 2 Table 2.1.

Summary of research on the dissemination and implementation of evidencebased nutrition interventions in community settings…………………………………….17 CHAPTER 3 Table 3.1.

Type and number of NHS participating stores by intervention store area........33 Table 3.2. Study participants by affiliation (# of participants)…………………………..34 CHAPTER 4 Table 4.1. Components, activities, key challenges, and outcomes of NHS implementation partnership process………………………………………………………………............ 72 Table 4.2. Comparisons of intervention phases between the AHS and NHS programs....74 Table 4.3. Comparisons of intervention contents between the AHS and NHS programs, according to related phase …………………………………………………………….....75 Table 4.4. Actual vs. planned intervention implementation of the NHS program............80

–  –  –

CHAPTER 3 Figure 3.1.

Study setting: Navajo Nation map …………………………………………..35 Figure 3.2. Flow diagram of qualitative data analysis…………………………………...36 CHAPTER 4 Figure 4.1.

Conceptual framework for stages of academic-community implementation partnerships ……………………………………………………………………………...71

–  –  –

Growing research on the relationship between food environments, dietary intake, and obesity risk suggests a need for effective strategies to improve food environments in various settings (Sallis & Glanz, 2009; Story, Kaphingst, Robinson-O'Brien, & Glanz, 2008). In recent years, retail food stores in underserved communities have become important venues to improve the availability of and access to healthy foods and to promote healthy food choices (Flournoy & Treuhaft, 2005; Glanz & Yaroch, 2004; Sallis & Glanz, 2009; Seymour, Yaroch, Serdula, Blanck, & Khan, 2004). There is sufficient evidence for effectiveness of store-based interventions in improving food-related behaviors through the combination of demand- and supply-side strategies (Escaron, Meinen, Nitzke, & Martinez-Donate, 2013; Gittelsohn et al., 2012b). It is expected that the wide-spread dissemination and implementation of effective store-based environmental interventions at the local level can produce public health impact on obesity and chronic disease prevention over the long term (CDC, 2009).

However, research on the dissemination and implementation of effective nutrition interventions in community settings is scarce. Dissemination defined as a planned process of actively spreading evidence-based interventions to the target audience via determined channels, and implementation is defined as the process of putting to use or integrating evidence-based interventions within a setting by undertaking a specific set of activities (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005; Rabin, Brownson, Haire-Joshu, Kreuter, & Weaver, 2008). The process of implementation can be categorized into four stages: exploration and adoption, program installation, implementation, and sustainability (Fixsen et al., 2005). Previous research on the dissemination and implementation of evidence-based nutrition interventions in community settings (A) was primarily guided by diffusion theory, (B) primarily used a top-down approach to dissemination and implementation, and (C) focused on school-based interventions (Ciliska et al., 2005;

Rabin, Glasgow, Kerner, Klump, & Brownson, 2010). Diffusion of Innovation theory (Roger, 2003) explains the process by which an innovation is adopted by the target audience, and has served well in variable- and dissemination- focused studies (Dearing, 2008). However, the application of diffusion theory has been limited in research on implementation that place greater attention on the process and how-to-knowledge as well as users of evidence-based interventions (Green, Ottoson, Garcia, & Hiatt, 2009; Tabak, Khoong, Chambers, & Brownson, 2012). Despite the prevalence of obesity and chronic disease is disproportionately higher in racial and ethnic minority populations (Kumanyika & Grier, 2006; O’Connell, Yi, Wilson, Manson, & Acton, 2010; Ogden et al., 2006;

Wang & Beydoun, 2007), previous studies rarely examined the dissemination and implementation of evidence-based nutrition interventions in minority population or communities. Participatory research approach, in particular Community-based Participatory Research (CBPR) have been considered as an effective approach for working with minority and underserved populations (Cargo & Mercer, 2008; Stacciarini, Shattell, Coady, & Wiens, 2007; Wallerstein et al., 2008). However, the potential of CBPR for dissemination and implementation of evidence-based interventions has yet to be explored (Glasgow, Green, Taylor, & Stange, 2012; Wallerstein & Duran, 2010).

This dissertation aimed to address these gaps in the literature by examining the implementation process of a store-based nutrition intervention on the Navajo Nation guided by the frameworks or models of participatory research and stages of implementation process. The goal of this dissertation was to understand the process and key factors of community implementation of a food store-based nutrition intervention through an academic-community partnership. The specific aims of this study and research

questions to be addressed are as follows:

1. To examine the academic-community implementation partnership process:

–  –  –

1.3 What were key challenges for the implementation partnership?

2. To identify key factors affecting the academic-community partnership effort:

–  –  –

3. To understand challenges in community implementation of the program from

the perspectives of local health staff and food store owners:

–  –  –

1.2 SUMMARY OF DISSERTATION CHAPTERS



Pages:   || 2 | 3 | 4 | 5 |   ...   | 18 |


Similar works:

«Cosmetic Dentistry Cosmetic dentistry isn't just the quest for a white smile or straight teeth. Many procedures are imperative for optimal dental health. However, despite the necessity of some of these procedures, people with diabetes must be careful about the work going on inside their mouths. dLife spoke with Dr. Michael Goldberg, DMD, a dentist and author of What The Tooth Fairy Didn't Tell You, based in New York, and Dr. Ruben Cohen, DDS, an oral and maxillofacial surgeon also based out of...»

«President’s Guidance Bulletin number 2 Case management decisions and appeals therefrom December 2010. Introduction If my first “Guidance” (regarding split-hearings, issued in May 2010 and published in the July issue of Family Law at [2010] Fam Law 752) began with a note of a health warning, such a health warning applies even more strongly to what follows. I hope, however, that it will, nonetheless, be of assistance. As I have gone around the country, a number of judges and magistrates...»

«: SHIPS uNITIES R ARTNE H COmm P LDING IONS WIT BUI DS TH NEE S RSAT CONVE ENTAl HEAl ENGTH m R ABOuT mmuNITy ST O AND C RITIES H DISpA HEAlT S C DAVI R REDuCING u fO CENTER Acknowledgments This project conducted by the UC Davis Center for Reducing Health Disparities (CRHD) in collaboration with the California Department of Mental Health represents an effort to reach out, to engage, and collect community voices that have previously not been heard. Through this project, CRHD developed...»

«JBC Papers in Press. Published on March 14, 2001 as Manuscript M100034200 You and Pickart A HECT domain E3 enzyme assembles novel polyubiquitin chains Downloaded from http://www.jbc.org/ by guest on October 17, 2016 Jianxin You and Cecile M. Pickart Department of Biochemistry and Molecular Biology, School of Public Health, Johns Hopkins University, Baltimore, MD 21205 Running head: HECT domain-catalyzed polyUb chain assembly Address correspondence to: Cecile M. Pickart Department of...»

«Safety of Fipronil in Dogs and Cats : a review of literature Conducted on behalf of the Australian Pesticides and Veterinary Medicines Authority (APVMA) Fipronil Animal Safety Review Table of Contents 1 Introduction 2 Methodology of assessment 3 Mechanism of action 4 Metabolism of fipronil 5 Published studies investigating the efficacy of fipronil-containing products 6 Adverse drug experience reports for fipronil in dogs and cats 6.1 ADEs in Australia 6.1.1 Off label use of fipronil 6.1.2...»

«Guideline Developmental Care: NISC 1. Purpose Neonatal Services aims to provide an excellent standard of health care to the newborn and their families and education to health professionals involved in perinatal care. Newborn Intensive and Special Care aims to provide care in a multidisciplinary family centred environment. Developmental care will support and enhance the attainment of the Neonatal Services vision, mission, and values. By formally integrating developmental care practices into our...»

«B. PACKAGE LEAFLET 25 Package leaflet: Information for the user Zoely 2.5 mg/1.5 mg film-coated tablets Nomegestrol acetate/estradiol This medicine is subject to additional monitoring. This will allow quick identification of new safety information. You can help by reporting any side effects you may get. See the end of section 4 for how to report side effects. Read all of this leaflet carefully before you start using this medicine because it contains important information for you. Keep this...»

«Monday morning 1. OBSTETRICAL IMAGING: IMAGINE THE FUTURE 1.1 Quantitative ultrasound in the fetus, Lawrence D. Platt, David Geffen School of Medicine at UCLA, Los Angeles, CA, ldplatt@gmail.com (invited overview). Quantitative ultrasound techniques are currently under development for assessment of the fetal lung and heart. This talk will review those techniques and discuss other fetal organ systems that have potential for quantitative assessment. 1.2 Pitfalls of point-of-care ultrasound in...»

«GENETIC AND ENVIRONMENTAL EFFECTS ON PHENOLIC COMPOSITION AND AGRONOMIC PERFORMANCE IN BLACK SORGHUM (Sorghum bicolor L.) HYBRIDS A Thesis by CHAD MATTHEW HAYES Submitted to the Office of Graduate Studies of Texas A&M University in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE Approved by: Chair of Committee, William L. Rooney Committee Members, Joseph M. Awika Stephen R. King Head of Department, David D. Baltensperger December 2012 Major Subject: Plant Breeding...»

«SAS Global Forum 2013 Poster and Video Presentations Paper 276-2013 10 SAS Skills for Grad Student Survival: A Grad Student “How-To” Paper Elisa L. Priest1,2 1 University of North Texas School of Public Health 2 Institute for Health Care Research and Improvement, Baylor Health Care System ABSTRACT Grad students learn the basics of SAS programming in class or on their own. Classroom lessons focus on statistical procedures and the datasets are usually ready for analysis. Students may learn...»

«Medicare’s Skilled Nursing Facility (SNF) Three-Day Inpatient Stay Requirement: In Brief Scott R. Talaga Analyst in Health Care Financing June 2, 2016 Congressional Research Service 7-5700 www.crs.gov R44512 Medicare’s Skilled Nursing Facility (SNF) Three-Day Inpatient Stay Requirement: In Brief Contents Medicare SNF Coverage and the Three-Day Inpatient Stay Requirement Hospital Outpatient Observation Care Modifying or Eliminating the Three-Day Inpatient Stay Requirement OIG Reports on the...»

«ANTIMICROBIAL USE GUIDELINES University of Wisconsin Hospital and Clinics Pharmacy and Therapeutics Committee Department of Pharmacy Drug Policy Program July 2011 to June 2012 Twenty-First Edition PREFACE The Antimicrobial Use Guidelines represent the expert opinion and advice of attending physicians of the University of Wisconsin Hospital and Clinics, particularly, the Infectious Diseases Section of the Department of Medicine and Department of Pediatrics. Originally conceived in 1988 as a...»





 
<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.