Abstract| Volume 54, ISSUE 7, SUPPLEMENT , S75, July 2022

P120 Methods for Adapting Medical Clinic Referral to EFNEP to Serve Rural Native American Communities Via Telehealth


      The objective is to develop methods to adapt an in-person urban medical clinic-based intervention to a telehealth modality serving Native Americans in a rural setting where health disparities are more pronounced.

      Use of Theory or Research

      The Expanded Food and Nutrition Education (EFNEP) program intervention is based on Social Cognitive Theory and adult learning strategies. The adaptation methods are driven by the community-based participatory implementation science framework.

      Target Audience

      Native American families residing in rural California communities.

      Program Description

      Parents with young children are referred by physicians to attend an intervention (8-weekly sessions) delivered via telehealth by EFNEP educators. The intervention is focused on obesity prevention utilizing Guided Goal Setting, obesity risk assessments, storytelling, and food-related parenting topics.

      Evaluation Methods

      Meetings (n = 4) were convened over a four month period to develop a multi-phased community-based participatory approach to adapt the intervention. Members included the State EFNEP Director and County Program Advisors (n = 2), EFNEP educator, Indian Health Center Outreach Director, Pediatric Endocrinologist, Public Health Nurse, Nutrition Education Professor, Nutrition Specialist, and Human Development Specialist with over half having experience working with rural and Native American communities (n = 6).


      A three-phased approach was identified: formative, capacity bridging, and referral model implementation with each rooted in community-based participation. Community asset mapping will be conducted in the formative phase to outline healthcare partners serving Native American communities. A community advisory board consisting of Native American elders, Tribal chairs, parents, educators, and health care providers will be created for consultation on all phases including intervention content modification, identification of community/tribal health clinic partners, and inform referral and telehealth delivery strategies.


      Adapting an intervention to a different target audience, location, and modality necessitates a thorough process to ensure relevance and sustainability. A three-phased approach with community-based participation was developed that can be used by other programs.




      Supplementary data related to this article can be found at