Process evaluation of a store-based environmental obesity intervention on two American Indian Reservations

Abstract

Obesity and other diet-related chronic diseases are widespread in American Indian communities. Inadequate access to healthy food on many reservations has led to a high-fat, high-sugar diet. The purpose of this paper is to report on the results of the process evaluation of a food store-based program to improve diet on two American Indian reservations. Process data were collected from 11 intervention stores to document the implementation of the Apache Healthy Stores (AHS) program. Process evaluation instruments recorded the stocking of promoted foods, presence of in-store communication materials, implementation of and participation in the cooking demonstrations and taste tests, and the transmission of mass-media messages. At the store level, the program was implemented with a high level of dose and reach, and a moderate to high level of fidelity. At the community level, the AHS program was implemented with a moderate degree of fidelity and dose. At the individual level, the cooking demonstrations and taste tests reached a large number of community members with a high dose. Implementing the AHS program on multiple levels (store, community, individual) was challenging, and differed between levels. Overall, improvements were seen from start to finish as program staff monitored, documented and responded to barriers to implementation. Process data will be tied to outcomes and will be useful for the planning of future store-based programs.

Implementing American Heart Association Pediatric and Adult Nutrition Guidelines

“…121 Interventions at community corner stores are a relatively new mechanism to affect dietary intake in communities. 122 Programs typically include 1 or several components ranging from infrastructure changes (eg, the addition of refrigeration) to the use of social marketing. Current data suggest that these types of interventions hold promise for shifting shopping habits and knowledge.…”

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“…In response to this fact, a food store-based program was implemented to improve diets on two American Indian reservations (Curran, Gittelsohn, Anliker, Ethelbah, Blake, Sharma, & Caballero, 2005). The Apache Healthy Stores The study reported at the store level, the AHS intervention had a high level of reach, and a moderate to high level of fidelity was stated in terms of promoting food availability and shelf labeling along with posters and educational displays.…”

“…The Curran et al (2005) project was important for learning useful lessons for future programs on other American Indian reservations in rural or urban settings. For instance, greater challenges were reported with smaller stores to stock specific healthier food items such as lower fat milk and fresh fruit than larger stores (Curran et al, 2005).…”

“…For instance, greater challenges were reported with smaller stores to stock specific healthier food items such as lower fat milk and fresh fruit than larger stores (Curran et al, 2005).…”

“…One missing element for the AHS program reported by Curran et al (2005) was an underlying lack of support from the reservation communities. They had problems with radio stations, newspapers, and businesses not airing or printing the health related advertisements developed for the program.…”