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Journey to Promoting Structural Change for Chronic Disease Prevention: Examining the Processes for Developing Policy, Systems, and Environmental Supports in Native American Nations

BACKGROUND: Obesity and chronic disease rates continue to be disproportionally high among Native Americans (NAs) compared with the US general population. Policy, systems, and environmental (PSE) changes can address the root causes of these health inequalities by supporting access to healthy food and...

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Autores principales: Jock, Brittany Wenniserí:iostha, Maudrie, Tara, Fleischhacker, Sheila, Porter, Keshia Pollack, Gittelsohn, Joel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923812/
https://www.ncbi.nlm.nih.gov/pubmed/35310617
http://dx.doi.org/10.1093/cdn/nzab031
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author Jock, Brittany Wenniserí:iostha
Maudrie, Tara
Fleischhacker, Sheila
Porter, Keshia Pollack
Gittelsohn, Joel
author_facet Jock, Brittany Wenniserí:iostha
Maudrie, Tara
Fleischhacker, Sheila
Porter, Keshia Pollack
Gittelsohn, Joel
author_sort Jock, Brittany Wenniserí:iostha
collection PubMed
description BACKGROUND: Obesity and chronic disease rates continue to be disproportionally high among Native Americans (NAs) compared with the US general population. Policy, systems, and environmental (PSE) changes can address the root causes of these health inequalities by supporting access to healthy food and physical activity resources. OBJECTIVE: We aim to describe the actors and processes involved in developing PSE changes supporting obesity prevention in NA Nations. METHODS: As part of the Obesity Prevention Research and Evaluation of InterVention Effectiveness in NaTive North Americans 2 (OPREVENT2) trial (ClinicalTrials.gov registration: NCT02803853), we collected 46 in-depth interviews, 1 modified Talking Circle, 2 workshops, and 14 observations in 3 NA communities in the Midwest and Southwest regions of the United States. Participants included Tribal government representatives/staff, health staff/board members, store managers/staff, and school administrators/staff. We used a Grounded Theory analysis protocol to develop themes and conceptual framework based on our data. RESULTS: Health staff members were influential in identifying and developing PSE changes when there was a strong relationship between the Tribal Council and health department leaders. We found that Tribal Council members looked to health staff for their expertise and were involved in the approval and endorsement of PSE changes. Tribal grant writers worked across departments to leverage existing initiatives, funding, and approvals to achieve PSE changes. Participants emphasized that community engagement was a necessary input for developing PSE changes, suggesting an important role for grassroots collaboration with community members and staff. Relevant contextual factors impacting the PSE change development included historical trauma, perspectives of policy, and “tribal politics”. CONCLUSIONS: This article is the first to produce a conceptual framework using 3 different NA communities, which is an important gap to be addressed if structural changes are to be explored and enacted to promote NA health. The journey to change for these NA Nations provides insights for promoting future PSE change among NA Nations and communities.
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spelling pubmed-89238122022-03-17 Journey to Promoting Structural Change for Chronic Disease Prevention: Examining the Processes for Developing Policy, Systems, and Environmental Supports in Native American Nations Jock, Brittany Wenniserí:iostha Maudrie, Tara Fleischhacker, Sheila Porter, Keshia Pollack Gittelsohn, Joel Curr Dev Nutr ORIGINAL RESEARCH BACKGROUND: Obesity and chronic disease rates continue to be disproportionally high among Native Americans (NAs) compared with the US general population. Policy, systems, and environmental (PSE) changes can address the root causes of these health inequalities by supporting access to healthy food and physical activity resources. OBJECTIVE: We aim to describe the actors and processes involved in developing PSE changes supporting obesity prevention in NA Nations. METHODS: As part of the Obesity Prevention Research and Evaluation of InterVention Effectiveness in NaTive North Americans 2 (OPREVENT2) trial (ClinicalTrials.gov registration: NCT02803853), we collected 46 in-depth interviews, 1 modified Talking Circle, 2 workshops, and 14 observations in 3 NA communities in the Midwest and Southwest regions of the United States. Participants included Tribal government representatives/staff, health staff/board members, store managers/staff, and school administrators/staff. We used a Grounded Theory analysis protocol to develop themes and conceptual framework based on our data. RESULTS: Health staff members were influential in identifying and developing PSE changes when there was a strong relationship between the Tribal Council and health department leaders. We found that Tribal Council members looked to health staff for their expertise and were involved in the approval and endorsement of PSE changes. Tribal grant writers worked across departments to leverage existing initiatives, funding, and approvals to achieve PSE changes. Participants emphasized that community engagement was a necessary input for developing PSE changes, suggesting an important role for grassroots collaboration with community members and staff. Relevant contextual factors impacting the PSE change development included historical trauma, perspectives of policy, and “tribal politics”. CONCLUSIONS: This article is the first to produce a conceptual framework using 3 different NA communities, which is an important gap to be addressed if structural changes are to be explored and enacted to promote NA health. The journey to change for these NA Nations provides insights for promoting future PSE change among NA Nations and communities. Oxford University Press 2022-03-16 /pmc/articles/PMC8923812/ /pubmed/35310617 http://dx.doi.org/10.1093/cdn/nzab031 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle ORIGINAL RESEARCH
Jock, Brittany Wenniserí:iostha
Maudrie, Tara
Fleischhacker, Sheila
Porter, Keshia Pollack
Gittelsohn, Joel
Journey to Promoting Structural Change for Chronic Disease Prevention: Examining the Processes for Developing Policy, Systems, and Environmental Supports in Native American Nations
title Journey to Promoting Structural Change for Chronic Disease Prevention: Examining the Processes for Developing Policy, Systems, and Environmental Supports in Native American Nations
title_full Journey to Promoting Structural Change for Chronic Disease Prevention: Examining the Processes for Developing Policy, Systems, and Environmental Supports in Native American Nations
title_fullStr Journey to Promoting Structural Change for Chronic Disease Prevention: Examining the Processes for Developing Policy, Systems, and Environmental Supports in Native American Nations
title_full_unstemmed Journey to Promoting Structural Change for Chronic Disease Prevention: Examining the Processes for Developing Policy, Systems, and Environmental Supports in Native American Nations
title_short Journey to Promoting Structural Change for Chronic Disease Prevention: Examining the Processes for Developing Policy, Systems, and Environmental Supports in Native American Nations
title_sort journey to promoting structural change for chronic disease prevention: examining the processes for developing policy, systems, and environmental supports in native american nations
topic ORIGINAL RESEARCH
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923812/
https://www.ncbi.nlm.nih.gov/pubmed/35310617
http://dx.doi.org/10.1093/cdn/nzab031
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