Understanding the process and key factors of community implementation of a food store-based nutrition intervention on the Navajo Nation
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Date
2014-07-28
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Johns Hopkins University
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 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.
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Keywords
Dissemination and implementation, community setting, nutrition intervention, Navajo Nation