A Health Equity Approach to Obesity Efforts Proceedings of a Workshop (2019) / Chapter Skim
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5 Lessons from the Field: Achieving Equity in Community and Public Health Approaches for Preventing and Treating Obesity
5 Lessons from the Field: Achieving Equity in Community and Public Health Approaches for Preventing and Treating Obesity
Pages 41-56
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From page 41... ...
(Pamela Schwartz) • An environmental intervention to improve tribal food environ ments in convenience stores made a key investment in part nering with tribal business sectors to agree on a process that would align business, environmental, and health agendas.
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From page 42... ...
• Cultural determinants of health are critical for indigenous pop ulations, and many native people believe a return to traditional values and practices is a solution to resolve health inequities. Two types of culturally responsive approaches have addressed obesity and its related health inequities in Hawaii: cultural adaptation, which preserves an intervention's core elements and incorporates culturally relevant elements for a new popu lation; and cultural grounding, which uses the target popula tion's sociocultural context and worldviews as a foundation for program elements.
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From page 43... ...
Haire-Joshu described two examples of partnerships between academia and home visiting organizations that aim to translate the DPP for women of childbearing age and to compensate for the disparities in social determinants they experience. Home visiting organizations are available, accessible, affordable, and convenient for mothers, she observed, and they address a family's priorities and essential needs.
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From page 44... ...
The trial evaluated gestational weight gain and 12-month postpartum weight among 267 women, half of whom received the standard PAT and half of whom received a LifeMoms PAT+ program via 10 prenatal and 12 postpartum visits. More than half of the women were single, and nearly all of them lived in poverty, Haire-Joshu said, and she noted that half of them moved at least once and another 12 percent moved at least twice during the 4-month intervention.
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Haire-Joshu closed with three lessons from her research. First, non– health care organizations that address essential living conditions may offer a roadmap for promoting health equity.
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From page 46... ...
She acknowledged that some struggle was involved in determining how to remain community-driven while also fulfilling the charge of advancing population health in the context of an obesity prevention intervention. Schwartz explained how the initiative's evaluation strategy evolved as community feedback revealed that the initial evaluation methods were not capturing all of the intervention's impact in the community.
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From page 47... ...
She identified as a common theme in the communities that experienced the greatest population health impact that they experienced a combined dose of policy, systems, and environmental change that affected a single outcome, such as physical activity, and "saturated" a single population, such as schoolchildren. As an example of outcomes, she cited two California cities in which the intervention was associated with a significant increase in the percentage of children in the "healthy fitness zone" for aerobic capacity.
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From page 48... ...
returned to discuss the THRIVE (Tribal Health and Resilience in Vulnerable Environments) study, an environmental intervention to improve tribal food environments in Chickasaw and Choctaw Nations in rural Oklahoma.
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Jernigan then described how the team conducted focus groups with convenience store workers and shoppers to gather input on placement, pricing, and promotion strategies. Jernigan characterized the plan to modify the store layout so that the intervention foods were placed prominently throughout high-traffic areas and labeled in tribal language as a "better choice." Some intervention foods had special discount pricing, she added, while others maintained the standard suggested retail price and never needed to be discounted because they sold out every week.
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CULTURALLY RESPONSIVE OBESITY AND DIABETES INTERVENTION RESEARCH IN NATIVE HAWAIIANS Joseph Keawe'aimoku Kaholokula, professor and chair of Native Hawaiian health in the John A Burns School of Medicine, University of Hawaii at Mānoa, discussed culturally responsive obesity and diabetes intervention research in Native Hawaiians.
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FIGURE 5-2 Social and cultural determinants of Native Hawaiian health. SOURCES: Presented by Joseph Keawe'aimoku Kaholokula, April 1, 2019.
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, preserves core elements of an evidence-based intervention and incorporates culturally relevant elements for a new population. The adaptation takes two forms, he elaborated: surface structure changes, such as a change in program name or incorporation of local customs regarding food and physical activity; and deep structure change, such as incorporating a particular group's worldviews, values, and practices into the intervention's core elements.
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. Next, Kaholokula briefly mentioned a culturally grounded approach using hula, the traditional dance of Hawaii, to address hypertension selfmanagement in Native Hawaiians.
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DISCUSSION A brief discussion period followed the third session of the workshop. Topics included engaging nonhealth sectors and reviving native people's traditional practices despite modern forces that drive acculturation.
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From page 55... ...
Furthermore, he added, the economic situation has driven them to adopt certain Western lifestyles, such as fast food and processed foods. He explained that a cultural empowerment approach is attempting to shift the narrative so that native people understand their healthy, proud roots and reclaim their traditional practices as they shed negative stereotypes.
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