Implementation of a multilevel, multicomponent intervention for obesity control in Native American communities (OPREVENT2): challenges and lessons learned

Abstract

OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve access and demand for healthier food and physical activity opportunities in six Native American communities in the Southwest and Midwest. OPREVENT2 worked with worksites, food stores, schools (grades 2–6), through social media and mailings, and with a local community action committee (CAC), in each of the three intervention communities, and was implemented in six phases. We conducted a process evaluation to assess implementation of each intervention component in terms of reach, dose delivered and fidelity. Implementation of each component was classified as high, medium or low according to set standards, and reported back at the end of each phase, allowing for improvements. The school and worksite components were implemented with high reach, dose delivered and fidelity, with improvement over time. The school program had only moderate reach and dose delivered, as did the social media component. The CAC achieved high reach and dose delivered. Overall, study reach and dose delivered reached a high implementation level, whereas fidelity was medium. Great challenges exist in the consistent implementation of MLMC interventions. The detailed process evaluation of the OPREVENT2 trial allowed us to carefully assess the relative strengths and limitations of each intervention component.

Technology-based Health Education Resources for Indigenous Adults: A Scoping Review

“…Of the nine articles included in this review, two included Native Hawaiians, 65,66 one Alaska Natives, 67 three included Native peoples from a variety of rural American Indian tribes, [68][69][70] one included First Nations and Inuit peoples from Canada, 71 one included Indigenous peoples from the Aboriginal Torres Strait in Australia, 72 and one included Māori and Pasifika from New Zealand. 73 The focus of the health education interventions described in these papers included: physical activity (1); 65 nutrition (3); 67,70,72 pre/ postnatal physical activity and health (2); 65,67 both nutrition and physical activity (4); 66,68,69,73 and weight management (6). 65,66,[68][69][70]72 Note that numbers total more than nine as some studies focused on more than one health education topic (e.g., both physical activity and weight management).…”

“…73 The focus of the health education interventions described in these papers included: physical activity (1); 65 nutrition (3); 67,70,72 pre/ postnatal physical activity and health (2); 65,67 both nutrition and physical activity (4); 66,68,69,73 and weight management (6). 65,66,[68][69][70]72 Note that numbers total more than nine as some studies focused on more than one health education topic (e.g., both physical activity and weight management). Details on the health topics covered, chronic disease focus, and technology employed can be found in Table 2.…”

“…65,67 Although all articles focused on health education for adults, as was required by inclusion criteria for this scoping review, four studies extended health education to families, specifically with children in the home. [67][68][69]71 Two of these studies collected outcomes data on children as well as adults, or plan to do so. 68,69 All of these studies met criteria for inclusion because they focused on health education and behavior for adults as well as children.…”

“…[67][68][69]71 Two of these studies collected outcomes data on children as well as adults, or plan to do so. 68,69 All of these studies met criteria for inclusion because they focused on health education and behavior for adults as well as children. No studies were included if the health education or behavior outcomes were focused on children only.…”

“…Types of technology utilized varied across identified studies. Technology used included: telephone, 65 website, 65,70 social media, 68,69,72 radio, 72 television, 67,72 CD-ROM, 71 DVD, 66 text messaging, 69 application (apps), 73 or combinations of these. Three studies used more than one form of technology in their intervention.…”