RESUMEN

The National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention funds a program to boost progress in reducing the prevalence and incidence of multiple chronic diseases and their associated risk factors. This article describes the program, State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors, and Promote School Health, and the program's action model, design, and administration and management structure. This program is based on 4 domains of public health action: 1) epidemiology and surveillance, 2) environmental approaches, 3) health care system interventions, and 4) community programs linked to clinical services. The 4 domains of public health action leverage data to inform action, support healthy choices and behaviors, strengthen delivery of clinical preventive services, and help Americans better manage their health.

Asunto(s)

Centers for Medicare and Medicaid Services, U.S./economía , Centers for Medicare and Medicaid Services, U.S./organización & administración , Cardiopatías/prevención & control , Obesidad/prevención & control , Servicios de Salud Escolar/economía , Servicios de Salud Escolar/organización & administración , Niño , Humanos , Factores de Riesgo , Estados Unidos

RESUMEN

To reduce obesity prevalence, public health practitioners are intervening to change health behaviors as well as the policies, systems, and environments (PSEs) that support healthy behaviors. Although the number of recommended PSE intervention strategies continues to grow, limited guidance is available on how to implement those strategies in practice. This article describes the University of North Carolina at Chapel Hill, Center for Training and Research Translation's (Center TRT's) approach to reviewing, translating, and disseminating practitioner-developed interventions, with the goal of providing more practical guidance on how to implement PSE intervention strategies in real-world practice. As of August 2014, Center TRT had disseminated 30 practice-based PSE interventions. This article provides an overview of Center TRT's process for reviewing, translating, and disseminating practice-based interventions and offers key lessons learned during the nine years that Center TRT has engaged in this work.

Asunto(s)

Obesidad/prevención & control , Investigación Biomédica Traslacional , Práctica Clínica Basada en la Evidencia , Humanos , Difusión de la Información , North Carolina

RESUMEN

Obesity has been on the rise in the United States over the past three decades, and is high. In addition to population-wide trends, it is clear that obesity affects some groups more than others and can be associated with age, income, education, gender, race and ethnicity, and geographic region. To reverse the obesity epidemic, the Centers for Disease Control and Prevention) promotes evidence-based and practice-informed strategies to address nutrition and physical activity environments and behaviors. These public health strategies require translation into actionable approaches that can be implemented by state and local entities to address disparities. The Centers for Disease Control and Prevention used findings from an expert panel meeting to guide the development and dissemination of the Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities (available at http://www.cdc.gov/obesity/health_equity/toolkit.html). The Toolkit helps public health practitioners take a systematic approach to program planning using a health equity lens. The Toolkit provides a six-step process for planning, implementing, and evaluating strategies to address obesity disparities. Each section contains (a) a basic description of the steps of the process and suggested evidence-informed actions to help address obesity disparities, (b) practical tools for carrying out activities to help reduce obesity disparities, and (c) a "real-world" case study of a successful state-level effort to address obesity with a focus on health equity that is particularly relevant to the content in that section. Hyperlinks to additional resources are included throughout.

Asunto(s)

Centers for Disease Control and Prevention, U.S./organización & administración , Conductas Relacionadas con la Salud , Obesidad/etnología , Obesidad/prevención & control , Práctica de Salud Pública , Comunicación , Competencia Cultural , Dieta , Ejercicio Físico , Disparidades en el Estado de Salud , Humanos , Desarrollo de Programa , Medio Social , Estados Unidos

RESUMEN

OBJECTIVE: Public health practitioners require new knowledge and skills to address the multilevel factors contributing to obesity. This article presents the systematic approach the Center of Excellence for Training and Research Translation (Center TRT) used both to assess practitioners' competencies to lead public health obesity prevention initiatives and to evaluate its annual, competency-based obesity prevention course. DESIGN: In 2006, Center TRT identified priority public health competencies for obesity prevention and then planned 7 annual courses to address the priority competencies progressively over time. Each year, a longitudinal evaluation based on Kirkpatrick's training evaluation framework was administered to course participants (n = 243) to assess perceptions of the course (daily), changes in self-reported competency (immediately pre- and postcourse), and course impact on practice over time (at 6 months). RESULTS: Participants rated the course highly for quality and relevance. Although many participants reported low levels of confidence prior to the course, following the course, at least 70% reported feeling confident to perform almost all competencies. At 6-month follow-up, the majority of participants reported completing at least 1 activity identified during course action planning. CONCLUSIONS: We identified practitioners' high-priority competency needs and then designed 7 annual courses to progressively address those needs and new needs as they arose. This approach resulted in trainings valued by practitioners and effective in increasing their sense of competence to lead public health obesity prevention initiatives. The course's continuing impact was evidenced by participants' high level of completion of their action plans at 6-month follow-up. Competency-based training is important to develop a skilled public health workforce.

Asunto(s)

Curriculum , Personal de Salud/educación , Obesidad/prevención & control , Salud Pública/educación , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Competencia Profesional , Evaluación de Programas y Proyectos de Salud , Estados Unidos

RESUMEN

PURPOSE: Obesity has reached epidemic proportions. Public health practitioners are distinctly positioned to promote the environmental changes essential to addressing obesity. The Centers for Disease Control and Prevention (CDC) and other entities provide evidence and technical assistance to support this work, yet little is known about how practitioners use evidence and support as they intervene to prevent obesity. The study's purpose was to describe how practitioners and CDC project officers characterized the obesity prevention task, where practitioners accessed support and evidence, and what approaches to support and evidence they found most useful. APPROACH OR DESIGN: Mixed-methods, cross-sectional interviews, and survey. SETTING: State-level public health obesity prevention programs. PARTICIPANTS: Public health practitioners and CDC project officers. METHOD: We conducted 10 in-depth interviews with public health practitioners (n = 7) and project officers (n = 3) followed by an online survey completed by 62 practitioners (50% response rate). We applied content analysis to interview data and descriptive statistics to survey data. RESULTS: Practitioners characterized obesity prevention as uncertain and complex, involving interdependence among actors, multiple levels of activity, an excess of information, and a paucity of evidence. Survey findings provide further detail on the types of evidence and support practitioners used and valued. CONCLUSION: We recommend approaches to tailoring evidence and support to the needs of practitioners working on obesity prevention and other complex health problems.

Asunto(s)

Obesidad/prevención & control , Salud Pública/métodos , Centers for Disease Control and Prevention, U.S./organización & administración , Estudios Transversales , Encuestas Epidemiológicas , Humanos , Entrevistas como Asunto , Gobierno Estatal , Estados Unidos

RESUMEN

INTRODUCTION: One strategy for lowering the prevalence of obesity is to increase access to and affordability of fruits and vegetables through farmers' markets. However, little has been documented in the literature on the implementation of such efforts. To address this gap, the Division of Nutrition, Physical Activity, and Obesity (DNPAO) sponsored an evaluation of the New York City Health Bucks program, a farmers' market coupon incentive program intended to increase access to fresh fruits and vegetables in underserved neighborhoods while supporting local farmers. METHODS: We conducted a process evaluation of Health Bucks program implementation. We interviewed 6 farmer/vendors, 3 market managers, and 4 program administrators, and collected data on site at 86 farmers' markets, including surveys of 81 managers and 141 farmer/vendors on their perspectives on promotion and redemption of the incentive coupons; knowledge and attitudes regarding the program; experiences with markets and products; and facilitators and barriers to program participation. RESULTS: Results indicate that respondents view Health Bucks as a positive program model. Farmers' market incentive coupon programs like Health Bucks are one strategy to address the problem of obesity and were associated with higher fruit and vegetable access and purchases in low-income communities. CONCLUSIONS: This evaluation identified some areas for improving implementation of the Health Bucks program. Farmers' market incentive programs like Health Bucks may be one avenue to increase access to and affordability of fruits and vegetables among low-income persons. Further research is needed to assess the potential effects of these programs on access and health outcomes.

Asunto(s)

Productos Agrícolas/economía , Abastecimiento de Alimentos/economía , Promoción de la Salud/economía , Comercio , Productos Agrícolas/provisión & distribución , Frutas/economía , Frutas/provisión & distribución , Humanos , Ciudad de Nueva York , Pobreza , Evaluación de Programas y Proyectos de Salud , Verduras/economía , Verduras/provisión & distribución

RESUMEN

As obesity prevention initiatives increasingly shift toward approaches focused on policy, systems, and environmental change, opportunities to share experiences from the field and lessons learned are growing. Stories are a tool to illustrate processes and outcomes of initiatives that can complement quantitative results. The use of stories, however, is not widely recognized, and the methods and tools available to develop stories are limited. Therefore, we describe the methods used to collect, develop, and disseminate stories featuring comprehensive obesity prevention efforts that various state health departments are planning and implementing. We also discuss potential challenges and provide recommendations that public health practitioners may consider when developing similar stories.

Asunto(s)

Anécdotas como Asunto , Documentación/métodos , Promoción de la Salud/métodos , Obesidad/prevención & control , Cultura Organizacional , Relaciones Comunidad-Institución , Recolección de Datos/métodos , Recolección de Datos/normas , Documentación/normas , Política de Salud , Humanos , Difusión de la Información , Guías de Práctica Clínica como Asunto , Investigación Cualitativa

RESUMEN

As the emphasis on preventing obesity has grown, so have calls for interventions that extend beyond individual behaviors and address changes in environments and policies. Despite the need for policy action, little is known about policy approaches that are most effective at preventing obesity. The Centers for Disease Control and Prevention (CDC) and others are funding the implementation and evaluation of new obesity prevention policies, presenting a distinct opportunity to learn from these practice-based initiatives and build the body of evidence-based approaches. However, contributions from this policy activity are limited by the incomplete and inconsistent evaluation data collected on policy processes and outcomes. We present a framework developed by the CDC-funded Center of Excellence for Training and Research Translation that public health practitioners can use to evaluate policy interventions and identify the practice-based evidence needed to fill the gaps in effective policy approaches to obesity prevention.

Asunto(s)

Práctica Clínica Basada en la Evidencia/educación , Política de Salud , Promoción de la Salud/normas , Obesidad/prevención & control , Evaluación de Procesos y Resultados en Atención de Salud , Evaluación de Programas y Proyectos de Salud/métodos , Práctica de Salud Pública/normas , Creación de Capacidad , Centers for Disease Control and Prevention, U.S. , Niño , Relaciones Comunidad-Institución , Toma de Decisiones , Difusión de Innovaciones , Eficiencia Organizacional , Federación para Atención de Salud , Implementación de Plan de Salud , Promoción de la Salud/economía , Promoción de la Salud/métodos , Humanos , Modelos Lineales , Obesidad/epidemiología , Formulación de Políticas , Práctica de Salud Pública/economía , Servicios de Salud Escolar/economía , Servicios de Salud Escolar/organización & administración , Mercadeo Social , Red Social , Impuestos , Investigación Biomédica Traslacional , Estados Unidos/epidemiología

RESUMEN

State health departments funded by the Centers for Disease Control and Prevention's Nutrition, Physical Activity, and Obesity Program collaborate with multiple partners to develop and implement comprehensive obesity prevention and control programs. A mixed-methods evaluation of 28 state programs over a 5-year period assessed states' progress on program requirements, including developing statewide partnerships and coordinating with partners to support obesity prevention and control efforts. States with greater partnership involvement leveraged more funding support for their programs, passed more obesity-related policies, and were more likely to implement obesity interventions in multiple settings. Case studies provided guidance for establishing and maintaining strong partnerships. Findings from this study offer emerging evidence to support assumptions about the centrality of partnerships to states' success in obesity program development and implementation and related health promotion activities.

Asunto(s)

Planificación en Salud/organización & administración , Promoción de la Salud/organización & administración , Obesidad/prevención & control , Servicios Preventivos de Salud/organización & administración , Asociación entre el Sector Público-Privado , Centers for Disease Control and Prevention, U.S. , Promoción de la Salud/métodos , Humanos , Fenómenos Fisiológicos de la Nutrición , Servicios Preventivos de Salud/métodos , Desarrollo de Programa , Gobierno Estatal , Estados Unidos

RESUMEN

CDC's Division of Nutrition, Physical Activity, and Obesity (DNPAO) focuses on supporting healthy eating and active living through policy and environmental changes where Americans live, work, learn, and play. Within DNPAO, the Program Development and Translation Team (PDATT)-a cross-disciplinary team of behavioral scientists, epidemiologists, nutritionists, physical activity specialists, and public health educators-works to identify, synthesize, and disseminate evidence- and practice-based interventions to state-funded programs. In addition to the translation efforts of PDATT, DNPAO provides external funding to the Center for Training and Research Translation to translate and disseminate evidence-informed interventions and train practitioners to adapt and implement obesity-prevention interventions.

RESUMEN

Stroke is a leading cause of death and disability in the United States. However, there is limited public knowledge about stroke signs and symptoms and the importance of seeking immediate medical care. Educational efforts such as stroke awareness campaigns are one way of informing the public about stroke symptoms and the need for early medical treatment following their onset. In this article, we present recent surveillance data concerning public awareness of stroke symptoms; summarize findings from 12 studies of the effectiveness of stroke awareness campaigns; and describe the efforts by three states to develop, implement, and evaluate heart disease and stroke programs, and the lessons to be learned from their experiences.

Asunto(s)

Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Práctica de Salud Pública , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Humanos , Maine/epidemiología , Michigan/epidemiología , Montana/epidemiología , Accidente Cerebrovascular/prevención & control

RESUMEN

BACKGROUND: Success of interventions targeting heart disease risk factors depends largely on whether patients understand their risk factors, as awareness and acceptance are necessary steps in controlling and managing these conditions. The goal of this analysis was to assess whether women with identified heart disease risk factors are able to recall their diagnoses 1 year later. METHODS: The WISEWOMAN program provides heart disease screening and intervention services to low-income underinsured and uninsured women. The study used 2000-2005 data for WISEWOMAN participants with newly identified high blood pressure, high cholesterol, or diabetes to assess their likelihood of reporting never having been told of their conditions 1 year later. RESULTS: Among women with high blood pressure at baseline, 66% (n = 1140) reported never having been told they have this condition 1 year later. Black women were less likely to report never being told (OR 0.62, p < 0.01) than white women. Women older than 60 were more likely to report never being told (OR = 1.62, p < 0.01) than women younger than 50. Among women with high cholesterol at baseline, 46% (n = 1312) reported never being told 1 year later. Less educated women were more likely to report never being told (OR 2.29, p < 0.01) than high school graduates. Among women with high glucose at baseline, 54% (n = 123) reported never being told 1 year later. CONCLUSIONS: A provider-patient communication gap or inability of low-income patients to retain health information hampers public health efforts to encourage individuals with heart disease risk factors to make the behavior changes necessary to reduce these risks.

Asunto(s)

Enfermedades Cardiovasculares/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Educación del Paciente como Asunto/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Salud de la Mujer , Adulto , Anciano , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Femenino , Promoción de la Salud/organización & administración , Indicadores de Salud , Humanos , Hiperglucemia/epidemiología , Hipertensión/epidemiología , Persona de Mediana Edad , Obesidad/epidemiología , Relaciones Profesional-Paciente , Factores de Riesgo , Estados Unidos/epidemiología , Servicios de Salud para Mujeres/organización & administración

RESUMEN

BACKGROUND: Few lifestyle intervention programs address the needs of financially disadvantaged, low literacy populations. The overall goal of the Illinois WISEWOMAN Program (IWP) was to design such a program and test its effectiveness in reducing cardiovascular disease (CVD) risk, specifically physical activity and nutrition factors. The purpose of this paper is to describe the IWP study design and methods, development of the evidence-based curriculum appropriate for a low socioeconomic status (SES) population, and baseline characteristics of IWP participants. METHODS: The Cooper Institute, in collaboration with the Illinois Department of Public Health and the University of Illinois at Chicago, adapted evidence-based interventions for financially disadvantaged, low literacy populations. The study used a randomized, two-group, experimental design. In total, 1021 women were recruited from the Illinois Breast and Cervical Cancer Program, which serves uninsured and underinsured women, aged 40-64, at or below 200% of poverty. The women were randomized to either a minimum intervention (MI) or an enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational materials. Additionally, the EI group received a 12-week lifestyle intervention. RESULTS: Baseline comparisons show equivalent groups. IWP participants had a higher prevalence of obesity and smoking than similar national samples. CONCLUSIONS: IWP addressed many of the cultural and implementation barriers in programs that seek to improve the health of financially disadvantaged, low literacy populations. Because of the high burden of disease, the unique study population, and the sound design, we anticipate that our future results will contribute to the translation literature, which has largely ignored significant health disparities.

Asunto(s)

Neoplasias de la Mama/prevención & control , Enfermedades Cardiovasculares/prevención & control , Pacientes no Asegurados , Prevención Primaria/organización & administración , Neoplasias del Cuello Uterino/prevención & control , Servicios de Salud para Mujeres/organización & administración , Adulto , Neoplasias de la Mama/epidemiología , Enfermedades Cardiovasculares/epidemiología , Femenino , Investigación sobre Servicios de Salud , Humanos , Illinois/epidemiología , Tamizaje Masivo/organización & administración , Persona de Mediana Edad , Neoplasias del Cuello Uterino/epidemiología , Salud de la Mujer

RESUMEN

PURPOSE: Describe best practices for implementing a variety of lifestyle interventions targeting cardiovascular disease risk factors. APPROACH: A mixed-methods approach was used to collect and analyze data. The study was guided by the RE-AIM framework. SETTING: Selected Well-Integrated Screening and Intervention for Women Across the Nation (WISEWOMAN) projects funded by the Centers for Disease Control and Prevention. PARTICIPANTS: Five of the 15 currently operating WISEWOMAN projects were selected for study. Selection was based on availability of quantitative performance data, which were used to identify two high-performing and one low-performing sites within each project. METHOD: Qualitative data collection included a review of program materials; telephone interviews with federal, project, and local staff, and site visits. Site visits involved interviews with staff observations of the lifestyle intervention, and discussions with focus groups of participants. Analysis involved writing site reports, developing theme tables, identifying practices of interest, and applying an algorithm to identify best practices. RESULTS: Eighty-seven best practices were identified. We present a subset of 31 practices applicable to other public health programs and for which differences in how high- and low-performing sites used the practices were identified. DISCUSSION: Many of the best practices identified are applicable to broader audiences. Practitioners interested in strategies to recruit, engage, and retain participants and to facilitate behavior change can learn from these practices.

Asunto(s)

Conductas Relacionadas con la Salud , Promoción de la Salud/organización & administración , Estilo de Vida , Práctica de Salud Pública , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos

RESUMEN

The Centers for Disease Control and Prevention's Division for Heart Disease and Stroke Prevention created the Prevention Research Centers (PRCs) Cardiovascular Health Intervention Research and Translation Network (CHIRTN) in 2005 to develop partnerships and create a research agenda that addresses cardiovascular health promotion. Six participating universities with expertise in heart disease and stroke prevention research collaborate with their PRC partner communities and other partners to (a) conduct demonstration research projects and (b) identify gaps in knowledge and make recommendations for future research to address those gaps. This report describes the structure and current efforts of the CHIRTN. The goal of these efforts is to promote cardiovascular health for Americans, particularly underserved, at-risk populations.

Asunto(s)

Enfermedades Cardiovasculares/prevención & control , Conducta Cooperativa , Promoción de la Salud/organización & administración , Investigación/organización & administración , Accidente Cerebrovascular/prevención & control , Centers for Disease Control and Prevention, U.S. , Medicina Basada en la Evidencia , Humanos , Estados Unidos

RESUMEN

OBJECTIVE: To determine if a clinic-based behavioral intervention program for low-income mid-life women that emphasizes use of community resources will increase moderate intensity physical activity (PA) and improve dietary intake. METHODS: Randomized trial conducted from May 2003 to December 2004 at one community health center in Wilmington, NC. A total of 236 women, ages 40-64, were randomized to receive an Enhanced Intervention (EI) or Minimal Intervention (MI). The EI consisted of an intensive phase (6 months) including 2 individual counseling sessions, 3 group sessions, and 3 phone calls from a peer counselor followed by a maintenance phase (6 months) including 1 individual counseling session and 7 monthly peer counselor calls. Both phases included efforts to increase participants' use of community resources that promote positive lifestyle change. The MI consisted of a one-time mailing of pamphlets on diet and PA. Outcomes, measured at 6 and 12 months, included the comparison of moderate intensity PA between study groups as assessed by accelerometer (primary outcome) and questionnaire, and dietary intake assessed by questionnaire and serum carotenoids (6 months only). RESULTS: For accelerometer outcomes, follow-up was 75% at 6 months and 73% at 12 months. Though moderate intensity PA increased in the EI and decreased in the MI, the difference between groups was not statistically significant (p=0.45; multivariate model, p=0.08); however, moderate intensity PA assessed by questionnaire (92% follow-up at 6 months and 75% at 12 months) was greater in the EI (p=0.01; multivariate model, p=0.001). For dietary outcomes, follow-up was 90% for questionnaire and 92% for serum carotenoids at 6 months and 74% for questionnaire at 12 months. Dietary intake improved more in the EI compared to the MI (questionnaire at 6 and 12 months, p<0.001; serum carotenoid index, p=0.05; multivariate model, p=0.03). CONCLUSION: The EI did not improve objectively measured PA, but was associated with improved self-reported and objective measures of dietary intake.

Asunto(s)

Dieta , Recursos en Salud , Estilo de Vida , Actividad Motora , Estado Nutricional , Evaluación de Programas y Proyectos de Salud , Características de la Residencia , Adulto , Femenino , Humanos , Persona de Mediana Edad , North Carolina , Evaluación Nutricional , Encuestas Nutricionales , Medición de Riesgo , Encuestas y Cuestionarios , Salud de la Mujer

RESUMEN

BACKGROUND: In Georgia an estimated 32% of blacks and 28% of whites have high blood pressure. In 2004 the rate of death from stroke in Georgia was 12% higher than the national average, and blacks in the state have a 1.4 times greater rate of death from stroke than that of whites. CONTEXT: The Georgia legislature funds the Stroke and Heart Attack Prevention Program (SHAPP) to provide treatment and medications for indigent Georgians. The median rate of blood pressure (BP) control among SHAPP enrollees is approximately 60%, compared with the national average of 35%. METHODS: SHAPP was evaluated through interviews with key health care and administrative staff and through focus groups of patients in two clinics. CONSEQUENCES: Outcomes for patients were increased knowledge of their BP and improved compliance with taking medication and keeping clinic appointments. INTERPRETATION: Successful components of SHAPP include an easy enrollment process; affordable medication; use of evidence-based, documented protocols and patient tracking systems; routine follow-up of patients; and effective communication between staff and patients. Challenges and recommendations for improvement are identified.

Asunto(s)

Hipertensión/prevención & control , Hipertensión/fisiopatología , Pobreza , Servicios Preventivos de Salud/organización & administración , Evaluación de Programas y Proyectos de Salud , Antihipertensivos/economía , Antihipertensivos/uso terapéutico , Presión Sanguínea/fisiología , Centros Comunitarios de Salud/organización & administración , Georgia , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Hipertensión/tratamiento farmacológico , Cooperación del Paciente , Resultado del Tratamiento

Asunto(s)

Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Centers for Disease Control and Prevention, U.S. , Simulación por Computador , Humanos , Modelos Biológicos , Servicios Preventivos de Salud/organización & administración , Factores de Riesgo , Estados Unidos

RESUMEN

A diet high in fruits and vegetables (F&V) has been associated with a decreased risk of certain cancers, reduced morbidity and mortality from heart disease, and enhanced weight management. Yet to date, most of the US population does not consume the recommended amount of F&V despite numerous interventions and government guidelines to promote consumption. Research has found various impediments to F&V consumption, such as high costs, an obesogenic environment and low socio-economic status. However, studies have not sufficiently focused on barriers and enablers to F&V intake among adult multi-ethnic populations. The present qualitative study examines 147 focus group participants' perceptions of impediments and enablers to F&V consumption. Twelve focus groups were conducted among African American, Hispanic and Caucasian men and women in North Carolina and Connecticut. Focus groups were audiotaped, transcribed verbatim and entered into QSR NVivo Software. Text data were systematically analyzed by investigators to identify recurrent themes both within and across groups and states. Focus group results indicate that most participants were aware of the health benefits associated with a diet rich in F&V. Yet many admitted not adhering to the Health and Human Service's recommendations. Individual impediments consisted of the high costs of F&V and a perceived lack of time. Early home food environment was perceived as affecting F&V consumption later in life. Other barriers reported were ethnic-specific. The African American participants reported limited access to fresh produce. This finding is consistent with numerous studies and must be addressed through health promotion intervention. Both the church and primary care clinics were described by African Americans as appropriate settings for health behavior interventions; these findings should be considered. Hispanic participants, mostly immigrants, cited inhibiting factors encountered in their adopted US environment. There is a need to improve the availability and access to fresh F&V commonly available in the home countries of Hispanic immigrants.

Asunto(s)

Dieta/etnología , Etnicidad , Frutas , Conocimientos, Actitudes y Práctica en Salud , Verduras , Adolescente , Adulto , Factores de Edad , Femenino , Grupos Focales , Conductas Relacionadas con la Salud , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos

RESUMEN

Interventions that are effective are often improperly or only partially implemented when put into practice. When intervention programs are evaluated, feasibility of implementation and effectiveness need to be examined. Reach, effectiveness, adoption, implementation, and maintenance make up the RE-AIM framework used to assess such programs. To examine the usefulness of this metric, we addressed 2 key research questions. Is it feasible to operationalize the RE-AIM framework using women's health program data? How does the determination of a successful program differ if the criterion is (1) effectiveness alone, (2) reach and effectiveness, or (3) the 5 dimensions of the RE-AIM framework? Findings indicate that it is feasible to operationalize the RE-AIM concepts and that RE-AIM may provide a richer measure of contextual factors for program success compared with other evaluation approaches.

Asunto(s)

Investigación sobre Servicios de Salud/métodos , Evaluación de Programas y Proyectos de Salud/métodos , Salud de la Mujer , Recolección de Datos , Medicina Basada en la Evidencia , Estudios de Factibilidad , Femenino , Investigación sobre Servicios de Salud/estadística & datos numéricos , Humanos , North Carolina