Evaluation Of Health Promotion Programs Research Articles

Neutrosophic Evaluation of Health Promotion Programs for Resource Allocation

The efficient allocation of resources to health promotion and disease prevention programs in the field of healthcare is a multidimensional and highly sensitive challenge that requires the simultaneous consideration of multiple criteria and objectives. In this context, neutrosophic logic emerges as a promising tool capable of addressing the inherent uncertainty and imprecision in health decision-making. This article explores the application of neutrosophic logic in decision-making regarding the allocation of resources to health promotion and disease prevention programs, taking into account a wide range of criteria. The main objective of this research is to validate the importance of using neutrosophic logic in resource allocation for these programs, emphasizing its ability to handle ambiguity and uncertainty effectively and equitably. The results obtained have demonstrated that neutrosophic logic is an effective tool in decision-making in the field of public health.

Determining priority areas for health promotion amongst Australian professional sporting organisations

ObjectivesProfessional sporting organisations (PSOs) are well-positioned to promote health through their reach and standing within communities. However, the health promotion (HP) priority areas of interest of PSOs are unknown. The objectives of this study were to: identify HP priority areas amongst Australian PSOs and explore the development, implementation, and evaluation of HP programming within the identified priority areas. DesignDelphi procedure with qualitative interviews. MethodsParticipants were community-focussed employees from PSOs across Australia. To identify HP priory areas, three rounds of surveys were used in a Delphi procedure. Participants were then invited to participate in semi-structured interviews focussed on the development, implementation, and evaluation of HP programmes. ResultsOf the 103 community employees invited to participate in the Delphi, 28 participated in at least one round and 16 completed all rounds. Overall, HP priorities fell under five main areas: access/participation in sport; general HP; physical activity promotion; community, culture, and inclusion; and support for HP initiatives. Eleven interviews were conducted, and central themes included needing support with programme design and evaluation, and the need to build employee capacity and greater inter-organisational collaboration. ConclusionsThis study determined HP priority areas amongst PSOs using a consensus-generating approach. Interview findings demonstrated that community-focussed employees are committed to delivering HP programmes, but encounter difficulty with funding, employee capacity, and programme design and evaluation expertise. The findings from these interviews reveal potential avenues of collaboration between organisations that can provide expertise in design and evaluation and sporting organisations for HP programming.

Effectiveness of a PRECEDE-PROCEED Model-based Educational Program on Health-Related Quality of Life and Preventive Behaviors in Patients with Breast Cancer Undergoing Chemotherapy

Background: Cancer is a chronic disease that affects different aspects of Quality of Life (QoL), including physical, financial, social, and emotional aspects. The PRECEDE-PROCEED model is a comprehensive method for assessing patients’ needs, and designing, implementing, and evaluating health promotion programs to meet their needs. This study aims to determine the effect of an educational program based on the PRECEDE-PROCEED model on Health-Related Quality of Life (HRQOL) and preventive behaviors in patients with breast cancer undergoing chemotherapy. Methods: This quasi-experimental impact evaluation study was performed on 90 outpatients with breast cancer (stages I and II) undergoing chemotherapy in Shahid Beheshti Hospital, Kashan, Iran from September 2018 to December 2019. The participants were randomly assigned into two groups of training (n=45) and control (n=45). The training group, in addition to routine care, received the educational program based on the PRECEDE-PROCEED model at eight two-hour group sessions for one month. The control group received routine care for cancer patients only. The participants completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and a researcher-made questionnaire based on the PRECEDE-PROCEED model (assessing predisposing, enabling, and reinforcing factors) before the study, immediately after, and two months after the intervention. Results: In the training group, the total Mean±SD of HRQOL before, immediately after, and two months after the intervention were 52.65±17.14, 64.79±15.66, and 63.95±18.63, respectively. Their total score of HRQOL and its dimensions (physical functioning, role functioning, emotional functioning, and symptoms) increased significantly over time (P<0.01). In this group, the scores of predisposing and enabling factors also increased immediately after and two months after the intervention (P<0.05); however, the score of reinforcing factors (social support) showed no significant increase (P>0.05). Conclusion: The educational program based on the PRECEDE-PROCEED model can improve the HRQOL and preventive behaviors in terms of predisposing factors (knowledge, attitude), and enabling factors (family support) in patients with breast cancer undergoing chemotherapy. We recommend this educational program for improving these patients’ QoL.

Development and Validation of an Oral Health Literacy Measurement for Primary School Children in Thailand.

Background Oral health promotion programs have been implemented in primary schools for many years in Thailand. Oral health literacy has been introduced as a health promotion outcome; however, no assessment tool has been developed for this age group. The objective of this study was to develop and validate the Test of Functional Health Literacy in Dentistry for Primary School Children (P-TOFHLiD). Materials and Methods. The P-TOFHLiD was developed by modifying contents and outlines using a previously validated tool for older adults, then verified by two experts for face validity. A cross-sectional study was conducted with samples collected from 118 grade-six students from two government schools in Chiang Mai Province, Thailand. The P-TOFHLiD and a previously validated word recognition test were administered, followed by oral examination to assess reliability, concurrent validity, convergent validity, and predictive validity and establish the cut-off score of the tool. The statistical analysis was performed using SPSS version 25. Results The internal reliability of P-TOFHLiD was good (α = 0.808). The correlation coefficient between the P-TOFHLiD and grade point average was 0.478 (p value <0.001), which is the represented concurrent validity of the tool. Coefficients between P-TOFHLiD and a word recognition test was 0.422 (p-value <0.001) for convergent validity. P-TOFHLiD was significantly correlated with the number of missing teeth from tooth decay (p-value <0.05), but the correlation coefficient was poor (r = −0.100). The cut-off scores for adequate oral health literacy were set at ≥21 out of the total scores of 26. Conclusion P-TOFHLiD presented good validity and reliability and was ready to use for oral health promotion program evaluation. However, the predictive validity of the P-TOFHLiD in predicting oral health status was questionable only.

Evaluation of the Coordinated Approach to Child Health (CATCH) Program in Third Through Fifth Graders in Northern Illinois

ObjectivesConducting evaluations of health promotion programs are imperative to determine the program’s impact and explore possible improvements in content and delivery. This study’s objective was to evaluate the effectiveness of CATCH program, delivered by dietetic interns and Northern Illinois University (NIU) students, to third through fifth graders in Northern Illinois, in increasing their nutrition knowledge and healthy choices behavior. MethodsIn total, 167 elementary school children in grades third through fifth in Northern Illinois participated in a non-experimental program evaluation study. We delivered six CATCH lessons throughout the academic year to five elementary schools. Lessons were focused on ‘Go, Slow, Whoa’ food categories to help children understand healthier food choices. Validated questionnaires from the CATCH Global Foundation were administered in classrooms and online pre- and post-intervention to assess nutritional knowledge and healthy choices behavior. ResultsChildren in third through fifth grades significantly increased their knowledge about nutrient-dense foods (P < .001 for each grade). Fourth and fifth graders exhibited a significant increase in their ability to make healthier food choices, P = .03 and P = .007 respectively. As grade level increased from third to fifth grade, improvement in nutrition knowledge and adoption of healthy food choices did not increase significantly; third to fourth grade, P = .973 and fourth to fifth grade, P = .637. ConclusionsWe conclude that children in grades third through fifth who participated in the six lessons of the CATCH program expanded their nutritional knowledge and improved their ability to make healthier choices. This study demonstrates the potential benefits of communiversity collaborations for nutrition education in schools. However, higher grades did not show a greater increase in knowledge or more improvement in making healthy choices than lower grades. Future research should examine the same cohort of children over three years of participation to determine the accumulation of knowledge and behavior improvement. Funding SourcesNorthwestern Medicine Kishwaukee Health Center in DeKalb, IL and Northern Illinois University provided funds to procure supplies and cover printing cost of evaluation surveys.

Electronic Tools to Bridge the Language Gap in Health Care for People Who Have Migrated: Systematic Review.

BackgroundPeople who have migrated or with a language barrier may face significant hurdles in accessing health care. Some apps have been specifically developed to facilitate the dialogue between health care professionals and people who have migrated who have low-level language proficiency or to promote health among people who have migrated.ObjectiveWe conducted a systematic review to investigate development, acceptability, and effectiveness of these types of apps.MethodsWe conducted a search of PubMed, Scopus, and Embase databases. We included all study designs (qualitative, quantitative, mixed) reporting development, evaluation of efficacy, or acceptability of apps facilitating dialogue with a health professional or promoting health for people who have migrated, minorities, or tourists with a language barrier, using any outcome. Two researchers selected the studies independently. We collected general information about the app, information about health literacy and cultural adaptation, information about the development of the app, evidence on acceptability or efficacy, and information on app use. Data were collected by 2 researchers independently and results were reviewed to verify agreement and reported according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis).ResultsPositive results for translation apps included better communication, but with possible limitations, and reduced consultation time. Positive results for health promotion apps included improved quality of life and better management of chronic illnesses.ConclusionsOverall, the apps had good levels of acceptability, though only half had their efficacy evaluated. In those evaluations, the endpoints were mostly related to reported behavior change and knowledge improvement, which is common for evaluations of health promotion programs. In the future, as more health apps are created, it is essential that apps that claim to have a public health objective undergo a rigorous evaluation of their acceptability, efficacy, and actual use. Indicators of outcomes beyond changes in behavior and knowledge should be reported; change in health status or access to care should also be reported. This systematic review has helped us note the characteristics associated with improved acceptability and efficacy, which can be helpful for the development of future apps.

Evaluation matrix for health promotion programs in socially vulnerable territories.

Health promotion has a set of strategies for advancing health and reducing inequalities. However, evaluating the effectiveness of health promotion programs has been a challenge. This paper shows the development and application of the Evaluation Matrix, constructed with qualitative-quantitative and multidimensional indicators supported by public policies targeting socially vulnerable territories. This is a cross-sectional study with the implementation of a health promotion program in order to develop an Evaluation Matrix to be applied in two distinct socio-environmentally vulnerable areas. The Evaluation Matrix proved to be easily applicable and enabled the detection of strengths and weaknesses of health promotion programs applied in different territories. The participation of managers, teams, population and multiple sectors of society was decisive for the success of the program. Furthermore, community health workers stood out as essential stakeholders due to their linkages with the population. Contributions include a tool and methodology for evaluating health promotion programs to be applied in different territories and modified according to the territory.

A Guide for Understanding Health Education and Promotion Programs.

Planning, Implementing & Evaluating Health Promotion Programs: A Primer is a versatile and comprehensive resource on the theoretical and practical underpinnings of successful health promotion programs. The requirements for effective health promotion program development are presented with frequent use of practical planning examples, pedagogical devices, and expert rationale. Ideal for undergraduate and graduate students in health education, promotion, and planning courses, this 15-chapter textbook is organized in a manner that specifically addresses the responsibilities and competencies required of health education specialists as published in the Health Education Specialist Practice Analysis of 2015. The authors of this textbook are leaders in the field and provide readers with the skills necessary to carry out the full process of health promotion program execution, while also offering direct preparation for CHES and MCHES licensing exams.

Can inequality be tamed through boundary work? A qualitative study of health promotion aimed at reducing health inequalities

This paper examines the organisational dynamics that arise in health promotion aimed at reducing health inequalities. The paper draws on ethnographic fieldwork among public health officers in Danish municipalities and qualitative interviews from an evaluation of health promotion programmes targeting homeless and other marginalised citizens. Analytically, we focus on ‘boundary work’, i.e. the ways in which social and symbolic boundaries are established, maintained, transgressed and negotiated, both at the administrative level and among frontline professionals. The paper discusses three types of boundary work: (i) demarcating professional domains; (ii) setting the boundaries of the task itself; and (iii) managing administrative boundaries. The main argument is that the production, maintenance and transgression of these three types of boundaries constitute central and time-consuming aspects of the practices of public health professionals, and that boundary work constitutes an important element in professional practices seeking to ‘tame a wicked problem’, such as social inequalities in health. A cross-cutting feature of the three types of boundary work is the management of the divide between health and social issues, which the professionals seemingly seek to uphold and transgress at the same time. The paper thus contributes to ongoing discussions of intersectoral action to address health inequalities. Furthermore, it extends the scope and application of the concept of boundary work in the sociology of public health by suggesting that the focus in previous research on professional demarcation be broadened in order to capture other types of boundaries that shape, and are shaped by, professional practices.

The Implementation and Evaluation of Health Promotion Services and Programs to Improve Cultural Competency: A Systematic Scoping Review.

Cultural competency is a multifaceted intervention approach, which needs to be implemented at various levels of health-care systems to improve quality of care for culturally and ethnically diverse populations. One level of health care where cultural competency is required is in the provision of health promotion services and programs targeted to diverse patient groups who experience health-care and health inequalities. To inform the implementation and evaluation of health promotion programs and services to improve cultural competency, research must assess both intervention strategies and intervention outcomes. This scoping review was completed as part of a larger systematic literature search conducted on evaluations of cultural competence interventions in health care in Canada, the United States, Australia, and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched. Overall, 64 studies on cultural competency interventions were found, with 22 being health promotion programs and services. A process of thematic analysis was utilized to identify key intervention strategies and outcomes reported in the literature. The review identified three overarching strategies utilized in health promotion services and programs to improve cultural competency: community-focused strategies, culturally focused strategies, and language-focused strategies. Studies took different approaches to delivering culturally competent health interventions, with the majority incorporating multiple strategies from each overarching category. There were various intermediate health-care and health outcomes reported across the included studies. Most commonly reported were positive reports of patient satisfaction, patient/participant service access, and program/study retention rates. The health outcome results indicate positive potential of health promotion services and programs to improve cultural competency to impact cardiovascular disease and mental health outcomes. However, due to measurement and study quality issues, it is difficult to determine the extent of the impacts. Examined together, these intervention strategies and outcomes provide a framework that can be used by service providers and researchers in the implementation and evaluation of health promotion services and programs to improve cultural competency. While there is evidence indicating the effectiveness of such health promotion interventions in improving intermediate and health outcomes, further attention is needed to issues of measurement and study quality.

Teaching Economic Evaluation of Health Promotion Programs

One of the essential functions of public health is evaluating the effectiveness and quality of population-based health services. To do this, health professionals and lawmakers must understand the true cost of programs and, in many cases, the future monetary savings that these programs generate. To address calls for consistent economic evaluation of health promotion programs, the Council on Linkages Between Academia and Public Health Practice directs that public health professionals should know how to “describe/use financial analysis methods used in making decisions about policies, programs, and services (e.g., cost-effectiveness, cost–benefit, cost–utility analysis, return on investment).” Anecdotal experience suggests that many undergraduate students are initially intimidated by the prospect of doing economic analysis, worried that it will involve understanding and applying complicated statistics—when, in reality, the math required is very basic. This article outlines, with handouts and instructor notes, a 50-minute lesson on simplified economic evaluation of health programs using lecture, examples, and an in-class, group-based case study.

Strengths and limitations of a tool for monitoring and evaluating First Peoples' health promotion from an ecological perspective.

BackgroundAn ecological approach to health and health promotion targets individuals and the environmental determinants of their health as a means of more effectively influencing health outcomes. The approach has potential value as a means to more accurately capture the holistic nature of Australian First Peoples’ health programs and the way in which they seek to influence environmental, including social, determinants of health.MethodsWe report several case studies of applying an ecological approach to health program evaluation using a tool developed for application to mainstream public health programs in North America – Richard’s ecological coding procedure.ResultsWe find the ecological approach in general, and the Richard procedure specifically, to have potential for broader use as an approach to reporting and evaluation of health promotion programs. However, our experience applying this tool in academic and community-based program evaluation contexts, conducted in collaboration with First Peoples of Australia, suggests that it would benefit from cultural adaptations that would bring the ecological coding procedure in greater alignment with the worldviews of First Peoples and better identify the aims and strategies of local health promotion programs.ConclusionsEstablishing the cultural validity of the ecological coding procedure is necessary to adequately capture the underlying program activities of community-based health promotion programs designed to benefit First Peoples, and its collaborative implementation with First Peoples supports a human rights approach to health program evaluation.

Quality assessment of economic evaluations of health promotion programs for children and adolescents-a systematic review using the example of physical activity.

An increasing number of primary prevention programs aimed at promoting physical exercise in children and adolescents are being piloted. As resources are limited, it is important to ascertain the costs and benefits of such programs. The aim of this systematic review is to evaluate the currently available evidence on the cost-effectiveness of programs encouraging physical activity in children and adolescents and to assess their quality. A systematic review was conducted searching in well established literature databases considering all studies before February 2015. Citation tracking in Google Scholar and a manual search of the reference lists of included studies were used to consolidate this. The fundamental methodological elements of the included economic evaluations were extracted, and the quality of the included studies was evaluated using the Pediatric Quality Appraisal Questionnaire (PQAQ). In total, 14 studies were included. Considering the performance of the economic evaluation, the studies showed wide variation. Most of the studies used a societal perspective for their analyses and discounted costs and effects. The findings ranged from US$11.59 for a person to become more active (cheapest intervention) up to US$669,138 for a disability adjusted life year (DALY) saved (most expensive intervention), with everything in between. Overall, the results of three studies are below a value of US$3061, with one of them even below US$200.00, for the achieved effects. For the other programs, the context-specific assessment of cost-effectiveness is problematic as there are different thresholds for cost-effectiveness in different countries or no clearly defined thresholds at all. There are multiple methodological difficulties involved in evaluating the cost-effectiveness of interventions aimed at increasing physical activity, which results in little consistency between different evaluations. The quality of the evaluations ranged from poor to excellent while a large majority of them was of very good methodological quality. Better comparability could be reached by greater standardization, especially regarding systematic consideration of implementation costs.

Exploring Outcomes to Consider in Economic Evaluations of Health Promotion Programs: What Broader Non-Health Outcomes Matter Most?

BackgroundAttention is increasing on the consideration of broader non-health outcomes in economic evaluations. It is unknown which non-health outcomes are valued as most relevant in the context of health promotion. The present study fills this gap by investigating the relative importance of non-health outcomes in a health promotion context.MethodWe investigated the relative importance of ten non-health outcomes of health promotion programs not commonly captured in QALYs. Preferences were elicited from a sample of the Dutch general public (N = 549) by means of a ranking task. These preferences were analyzed using Borda scores and rank-ordered logit models.ResultsThe relative order of preference (from most to least important) was: self-confidence, insights into own (un)healthy behavior, perceived life control, knowledge about a certain health problem, social support, relaxation, better educational achievements, increased labor participation and work productivity, social participation, and a reduction in criminal behavior. The weight given to a particular non-health outcome was affected by the demographic variables age, gender, income, and education. Furthermore, in an open question, respondents mentioned a number of other relevant non-health outcomes, which we classified into outcomes relevant for the individual, the direct social environment, and for society as a whole.ConclusionThe study provides valuable insights in the non-health outcomes that are considered as most important by the Dutch general population. Ideally, researchers should include the most important non-health outcomes in economic evaluations of health promotion.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0908-y) contains supplementary material, which is available to authorized users.

보건소 건강증진사업 담당인력으로서 보건교육사 역할의 우선 순위 분석

Objectives: The purpose of this study was to analyze the roles of workforce required for effective execution of health promotion programs of community health centers in Korea. Methods: Survey was undertaken on 92 people in community health centers and the Analytic Hierarchy Process was employed in order to obtain results regarding the relative importance of role required for health educators. Results: The analysis suggests that of all 5 categories, 'Assess needs for health education' and 'Evaluate health promotion programs and Conduct related research' were relatively more important than the other categories of role. Taking into account the weightings of the main categories and the subcategories, the analysis shows that the order of importance follows, 'Use existing health-related statistical data', 'Collect health-related data', 'Survey method and knowledge and skills related to health statistics', 'Write an evaluation report', 'Understand and apply health education planning theories'. Conclusion: As a health promotion expert of community health center, a health educator is preferentially required to perform 1) the role to analyze the needs of the community and enable the planning for a customized health promotion program, 2) the role to execute evaluation throughout a health promotion programs and disseminate evaluation findings and apply them in following programs, in consideration of higher relative importance of these roles.

Supporting health promotion practitioners to undertake evaluation for program development.

BackgroundThe vital role of evaluation as integral to program planning and program development is well supported in the literature, yet we find little evidence of this in health promotion practice. Evaluation is often a requirement for organisations supported by public funds, and is duly undertaken, however the quality, comprehensiveness and use of evaluation findings are lacking. Practitioner peer-reviewed publications presenting evaluation work are also limited. There are few published examples where evaluation is conducted as part of a comprehensive program planning process or where evaluation findings are used for program development in order to improve health promotion practice.DiscussionFor even the smallest of programs, there is a diverse array of evaluation that is possible before, during and after program implementation. Some types of evaluation are less prevalent than others. Data that are easy to collect or that are required for compliance purposes are common. Data related to how and why programs work which could be used to refine and improve programs are less commonly collected. This finding is evident despite numerous resources and frameworks for practitioners on how to conduct effective evaluation and increasing pressure from funders to provide evidence of program effectiveness. We identify several organisational, evaluation capacity and knowledge translation factors which contribute to the limited collection of some types of data. In addition, we offer strategies for improving health promotion program evaluation and we identify collaboration of a range of stakeholders as a critical enabler for improved program evaluation.SummaryEvaluation of health promotion programs does occur and resources for how to conduct evaluation are readily available to practitioners. For the purposes of program development, multi-level strategies involving multiple stakeholders are required to address the organisational, capacity and translational factors that affect practitioners’ ability to undertake adequate evaluation.

特定保健指導の効果評価と対照設定の方法に関する研究

特定保健指導の効果評価と対照設定の方法に関する研究

The Utilization of Process Evaluations in Childhood Obesity Intervention Research: A Review of Reviews

Process evaluations are an essential component to evaluating health promotion programs, however they are consistently under-utilized and oftentimes not reported upon in the literature. This study reports the use of process evaluations in childhood obesity prevention interventions implemented over the past three decades. Seven meta-analyses and systematic reviews were located for this review or reviews, and from these, 119 unique references were identified. Each article was retrieved and read for appropriateness, and 20 were excluded for a variety of reasons (ex. not published in English language), resulting in 99 articles included for this study. Overall, process evaluations were not well reported upon. Only 38 studies reported the fidelity of program implementation, 25 studies tracked participant attendance, 29 studied evaluated participant satisfaction, and 49 studies reported how staff members were trained. Additionally, one-third of the studies did not report using a single type of process evaluation, and only 5 studies reported using all four types. Results from this study suggest that the use of process evaluations has been low in this area of research, which may explain why many obesity prevention studies have reported mixed or modest results. Suggestions for implementing simple, yet effective process evaluations in future studies will be presented.

USING A SOCIAL-ECOLOGICAL MODEL IN DEVELOPMENT OF TREATMENT PROGRAMS THAT TARGET BEHAVIOR CHANGE

Horticultural therapy and therapeutic horticulture programs often lack a clearly specified theoretical foundation or conceptual model, thus it is difficult to clearly articulate the outcomes a patient or client may experience from the program. One approach that may help with this challenge is to use a social-ecological model in horticultural therapy programming. Social ecology is the study of the influence of the social context on behavior, including institutional and cultural variables and is used to develop practical guidelines for designing, implementing, and evaluating health promotion programs. The most common models to describe this approach are 5-level (individual, interpersonal, organizational, community, and public policy) or 4-level (individual, relationship, community, and societal) and can be represented by an onion, with one level wrapping around another. For an intervention to be effective it must address multiple levels since, through research, we know that factors at multiple levels affect human behavior. This paper will explain the social-ecological model and provide an example of how it can be used to develop an intervention.

“All of Those Things We Don't Eat”: A Culture-Centered Approach to Dietary Health Meanings for Asian Indians Living in the United States

This article applies a culture-centered approach to analyze the dietary health meanings for Asian Indians living in the United States. The data were collected as part of a health promotion program evaluation designed to help Asian Indians reduce their risk of chronic disease. Community members who used two aspects of the program participated in two focus groups to learn about their health care experiences and to engage them in dialogue about how culture impacts their overall health. Using constructionist grounded theory, we demonstrate that one aspect of culture, the discourses around routine dietary choice, is an important, but underrecognized, aspect of culture that influences community members' experiences with health care. We theorize community members' dietary health meanings operate discursively through a dialectic tension between homogeneity and heterogeneity, situated amid culture, structure, and agency. Participants enacted discursive homogeneity when they affirmed dietary health meanings around diet as an important means through which members of the community maintain a sense of continuity of their identity while differentiating them from others. Participants enacted discursive heterogeneity when they voiced dietary health meanings that differentiated community members from one another due to unique life-course trajectories and other membership affiliations. Through this dialectic, community members manage unique Asian Indian identities and create meanings of health and illness in and through their discourses around routine dietary choice. Through making these discursive health meanings audible, we foreground how community members' agency is discursively enacted and to make understandable how discourses of dietary practice influence the therapeutic alliance between primary care providers and members of a minority community.