Abstract
BackgroundAmerican Indian communities have a high prevalence of chronic diseases including diabetes, obesity, cardiovascular disease, and cancer. Innovative community-based approaches are needed to identify, prioritize, and create sustainable interventions to reduce environmental barriers to healthy lifestyles and ultimately improve health.Community ContextHealthy Children, Strong Families was a family-based and community-based intervention to increase healthy lifestyles on Wisconsin American Indian reservations. This intervention arose from a long-standing partnership between University of Wisconsin researchers and 3 of these American Indian communities.MethodsIn each community, community advisory boards (CABs) were established by the residents and university partners. CAB meetings were open and held at various times and locations to increase member participation. CABs featured continual, snowball recruitment; internal and external expert consultation; and coordination with standing tribal committees. Meetings initially focused on understanding community supports for and barriers to healthy lifestyles but quickly turned toward community action for change.OutcomeCAB interventions decreased environmental barriers to health at each site and improved options for healthy lifestyle choices. Over 5 years, 71 CAB meetings occurred with a total of 1,070 participants. Successful CAB interventions included planting community gardens and an apple orchard, conducting gardening and canning workshops, instituting food-related policies and dog control regulations, building an environmentally friendly playground, and providing access to recreational facilities. The CABs are now self-sustaining.InterpretationCABs can be highly effective action teams capable of improving community environments. Our experience shows that academic researchers can partner with community residents to generate programs and policies that will expand access to local food, increase people’s choices for engaging in physical activity, and encourage local policy changes that improve overall community health.
Highlights
Background AmericanIndian communities have a high prevalence of chronic diseases including diabetes, obesity, cardiovascular disease, and cancer
American Indian (AI) people have the highest rates of diabetes [1] and cardiovascular disease [1,2] and the poorest progress in reducing cancer rates of any ethnic or racial group in the United States [3]
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions
Summary
To support the individual and family change promoted by the HCSF childhood obesity intervention [6,8], university and tribal partners organized a CAB with each of the 3 tribes. Meetings were regularly attended by community members, academic experts, and individuals representing tribal planning, education, transportation, health clinics, nutrition and disease prevention programs, human resources, environmental services, commerce, housing, food distribution, and recreation. CAB success was supported by trusting relationships between the facilitator and CAB members; presentations by local and academic experts, some of whom joined CABs as regular members; participation of experts who spent extended periods of time in communities to complete interventions; and use of student talent. The combined power of a community’s in-kind contributions and academic engagement in bringing people together for regular meetings should not be underestimated It can mobilize and build tribal capacity to address chronic and evolving health issues and implement successful, sustainable environmental interventions. CABs can be highly effective action teams to improve community environments by expanding local food and activity choices and implementing policy changes that improve community health
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