Background
Childhood obesity is disproportionately higher among low-income women and children, racial and ethnic minorities, and rural populations. To effectively promote sustainable change, healthy eating and active living (HEAL) initiatives are beginning to apply an individual + policy, systems, and environmental (I + PSE) framework for change.
Objective
Development of strategic plans to include I + PSE into 4 states’ nutrition programming.
Study Design, Setting, Participants
Four, State Department of Public Health, Title V, maternal and child nutrition leaders participated in a 12-month technical assistance (TA) opportunity to develop strategic plans to include I + PSE into each state's nutrition programming. TA was delivered through a combination of online modules, community of practice group meetings, and individual coaching sessions.
Measurable Outcome/Analysis
Semi-structured, in-depth interviews were conducted post TA delivery with the 4 state nutrition leaders. Interviews were audio-recorded and transcribed verbatim. Two independent coders used qualitative content analysis to analyze the data characterizing themes and sub-themes.
Results
Facilitators to implementing I + PSE in state program planning included having education delivered through online modules, a community of practice to discuss ideas and issues that arose, individual coaching to address local barriers to implementation and supervisor support. Barriers identified were time and funding limitations, working in isolation, and lack of self-efficacy and infrastructure. Co-learning helped TA participants to overcome stagnancy and promote development of creative solutions. Participants recognized relationship-building as integral to systems development.
Conclusions
The TA identified factors that drive improved nutrition programming utilizing I + PSE in the planning process. Inclusion of both upstream and downstream influences is key to achieving optimal impact to improve HEAL in individuals and communities.
Funding: Health Resources Services Administration, Maternal and Child Health Bureau.
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© 2020 Published by Elsevier Inc.
