Linking Service and Nutrition Research: An Approach to Community Engagement in Community Based Participatory Research

Prewitt, T.E.1, McCabe-Sellers, B.2, Strickland, E.2, Bogle, M.2, Hyman, E.G.3, McGee, B.4, Day, O.5, Seals, L.5, Williams, G.5, VonKanel, M.5

1University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2USDA Agricultural Research Service, Little Rock, AR, USA; 3University of Arkansas at Pine Bluff, Pine Bluff, AR, USA; 4Southern University and A&M College, Baton Rouge, LA, USA; 5Marvell Nutrition Intervention Research Initiative, Marvell, AR, USA.

Purpose: To describe how community service activity can evolve as a way to identify and initiate community-based, participatory research projects in healthy eating and healthy weight. Background: The Delta Nutrition Intervention Research Initiative (NIRI) is sponsored by the United States Department of Agriculture, Agricultural Research Service, to address nutritionally responsive problems of Lower Mississippi Delta communities in Arkansas, Mississippi and Louisiana. The community-based, participatory research (CBPR) model is the guiding framework for carrying out the Delta NIRI mission. Partnerships between academic institutions, community organizations and the Cooperative Extension Service in each state are conducting intervention research to address eating patterns, physical activity, nutritional health and chronic disease risk in rural communities. CBPR requires a strong academic-community partnership and, in particular, active involvement of the community in all phases of the research process. As part of initial efforts , the Arkansas NIRI initiated healthy eating service activities as a strategy to benefit the community, broaden outreach and increase community awareness. Methods/Key Points: Service activities identified by community partners around healthy eating afforded shared learning, community capacity building, the identification of mechanisms for sustainability and a platform to initiate community-wide nutrition education efforts. Taken together, the service activities also provide foundation for community engagement and empowerment in nutrition research—including the design, implementation and dissemination of culturally appropriate, evidence-based nutrition interventions in the community. Conclusions: In the context of CBPR, service-related activities can help build requisite support for nutrition intervention research which can be translated to benefit community health. Support: USDA, ARS #5862-51-3. Support: USDA, ARS #6251-53000-004-00D.

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CONCLUSIONS CONCLUSIONS In the context of CBPR, service-related activities can build requisite support for nutrition intervention research. Service activities can provide a foundation for research questions and projects that ultimately provide endogenous solutions to nutritionally responsive health problems in the community.

METHODS METHODS An organized sequence of activities lead to

research, service and outreach projects in the Marvell NIRI. The activities begin in working

groups, where ideas and plans are developed collaboratively by community members and academic and Cooperative

Extension partners. Once developed, the plans are reviewed by the intervention and planning committees (comprised primarily of

community members) for final approval and implementation (Figure 6).

Food Demonstration and Healthy Eating Working Group Through the CPPE process, Marvell community members prioritized food preparation skills and healthy eating as major areas that needed to be addressed. Subsequently, the Food Demonstration/Healthy Eating working group was formed. The working group expressed concern about how to increase motivation and engage the community in adopting a healthy lifestyle. The group identified additional pressing concerns that included lack of knowledge and awareness about healthy eating, low availability of healthy foods and the high prevalence of obesity and hypertension in the community. The working group selected objectives and service activities consistent with CBPR principles to promote healthy eating; the DASH (Dietary Approaches to Stop Hypertension)13 eating pattern was selected as an evidence-based approach to address research questions on obesity and hypertension risk in the community. The working group is conducting service and publicity events as a framework for increasing awareness and engaging the community in intervention research. The working group and CBPR objectives, service activities along with preliminary research topics are provided in Table 1.

BACKGROUND BACKGROUND Community-based, participatory research (CBPR) involves scientific investigation conducted through partnerships between researchers and communities. The approach is an active process whereby communities and organizations gain greater influence and control in addressing endogenous problems. CBPR is structured so that those affected by the condition studied serve as full partners in every phase of the research—including conceptualization, design, implementation, analysis, interpretation and communication of findings1. CBPR is rooted in the traditions of grassroots activism and community empowerment1,2,3,4 and its principles and methods have effectively addressed an array of social and public health issues, including nutritional deficiencies,5 infant mortality,6 needs assessment,7 after-school care,8

community development,5,9 and capacity building.5,9,10 The CBPR approach utilizes community and academic partners equitably in collaboration, drawing on the unique strengths of each in addressing health disparities, community problems and social change. The Lower Mississippi Delta (LMD) Nutrition Intervention Research Initiative (Delta NIRI) is a USDA-supported project using the CBPR approach in three rural communities (Marvell, Arkansas; Franklin Parish, Louisiana; and Hollandale, Mississippi). The research team is comprised of the three communities, six universities, USDA-Agricultural Research Service-USDA, and the Cooperative Extension Service, working in partnership to address nutritionally responsive disease conditions (Figures 1 and 2). Four of ten leading causes of death in LMD are potentially preventable or managed through healthy eating. As such, obesity, hypertension, diabetes, cardiovascular disease and food insecurity are major threats to health in LMD communities.11 These problems are precipitated and aggravated by numerous factors, including poverty, unemployment, lack of access to healthy foods, lack of physical activity and poor quality of fruits and vegetables when available. The academic-community partnerships (working groups) in each community address nutrition and health-related problems identified and prioritized by the community through the Comprehensive Participatory Planning and Evaluation (CPPE) process a dynamic, participatory approach to problem-solving used by individuals and organizations on national, state, regional, and grassroots levels.12 Projects can also be initiated by collaborating with other community groups or by working group members. Information on eating patterns and obesity from FOODS 2000, a cross sectional survey of the population 3 years and older in 36 Delta Counties data showed that consumption of dairy, fruit and vegetables was less than national averages in the Arkansas Delta (Figure 3). Meat and added sugar consumption, on the other hand, were higher than the national average (Figure 4). Rates of adult obesity and childhood overweight were also higher in the Arkansas Delta compared to national data (Figure 5). The Marvell NIRI organizational structure is illustrated in Figure 6. Community residents and researchers are members of working groups, intervention and planning committees. Here we summarize the process by which community service activities in Marvell provide a platform for engaging in broader community research to address healthy eating, healthy weight and hypertension risk reduction.

Figure 1

Little Rock, AR hUSDA/ARS hAR Children’s Hospital Research

InstitutionhDelta NIRI Data Analytic CenterhUAMS, College of Public HealthhUniv. of Arkansas Cooperative

Extension

Pine Bluff, AR h University of Arkansas

at Pine Bluff

Alcorn State, MSh Alcorn State University

Hattiesburg, MS h University of Southern

Mississippi

Baton Rouge, LAh Southern University &

A&M College h Pennington Biomedical

Research Centerh LSU Ag Center

Cooperative Extension

Starkville, MShMSU Cooperative

Extension

Partner InstitutionsPartner Institutions

Phillips Co.Phillips Co. ••Marvell, ARMarvell, AR

Washington Co. Washington Co. ••Hollandale, MSHollandale, MS

Franklin ParishFranklin Parish ••Winnsboro, LAWinnsboro, LA ••Wisner, LAWisner, LA

Figure 2 Partner Communities:

1Foods 2000 Study

2225

17

4

9

5

0

5

10

15

20

25

Percent Intake Less than National Average

Adults Children

Eating Patterns in The Arkansas Delta: Dairy, Fruits and Vegetables1

DairyFruitsVegetables

Figure 3

17

11

53

02468

1012141618

Percent Intake Intake Greater

Than NationalAverage

Adult Children

Meat and Added Sugar Consumption in the Arkansas Delta1

Added Sugar

Meat

1Foods 2000 Study

Figure 4

36

17

25

16

0

5

10

15

20

25

30

35

40

Perc

ent

Adult Obesity ChildhoodOverweight

Rates of Adult Obesity and Childhood Overweight in the Arkansas Delta1

Arkansas Delta

National Rate

1Foods 2000 Study

Figure 5

Marvell Intervention Subcommittee(Detail Review, Science Decision)

Approves plans and budget submitted by working groups; submits to Marvell NIRI

Marvell NIRI Approves plans and budgets for project implementation

Figure 6

MARVELL NIRI Organizational Structure

1working groups select and implement interventions through a collaborative, iterative process

Working Groups(Detail Planning and Science Implementation)

Identify, select research service or outreach projects; develop plans and budget, submits to Intervention Committee

Service Research Outreach*Food Demonstration/Healthy Eating *Walking Trail *Community Garden*Walking Club *Worksite *Highway-Adopt-A-Spot

*Summer Day Camp *School

CPPE

Community Organizations

Individuals

Table 1 Marvell NIRI Service ActivitiesLeading to Nutrition Research

Impact of DASH on weight and blood pressure in the community

Promoting the DASH Eating PlanReduce Obesity and Hypertension(OUTCOME)

Promoting community assets for healthy eating•farmers markets•gardening skills•human capital development

Capacity Building

Pilot Studies:•Feasibility of adapting/translating the DASH eating plan in the Lower Mississippi Delta

•Norms, values and beliefs about diet, healthy weight, hypertension

•Knowledge and skills in healthy eating: committee members, community-wide

Working Group Meetings •The DASH eating plan—learning principles, etc.

•Culturally acceptable and appropriate foods, food habits in the LMD consistent with DASH eating pattern, barriers, etc.

•Integrate DASH principles and local food patterns

Shared Learning

•Development of Marvell Master Chef Program

Taste Testing Activities for the Community• Modifying existing recipes and cooking methods using culturally appropriate recipes reduced in sodium, fat and added sugar; consistent with DASH

Increasing awareness of healthy eating

Pending NutritionResearch

Ongoing Service/Education Activities

Working Group and CBPR Objectives