Partnership by yurtgc548

VIEWS: 7 PAGES: 123

									 Healthier MO: From local
programs to regional policy
and environmental change
       April 26th -27th, 2010
              Day 1: Objectives
1. To provide an overview of the Prevention Research
   Center including where we have been and where we are
   going
2. To provide an overview of evidence-based policy and
   environmental changes to increase physical activity and
   healthy eating
3. To provide an assessment of the health status of the
   region
4. To describe what has been done outside of and within
   MO
5. To understand some key areas of focus
 What do people in your
   community need to
increase healthy eating?
  What do people in your
    community need to
increase physical activity?
Where have we been?

     April 26th
     1-1:30 pm
Overview and History of the
Prevention Research Center
We are part of a large and
    growing network
37 Prevention Research
    Centers in 2010
    The Prevention Research
       Center in St. Louis
• Comprised of community, practice, and academic
  partners
• Been in existence since 1994
• Collaboration between Saint Louis University School
  of Public Health and Washington University in St. Louis
  (Schools of Medicine and Social Work)
• Mission: to prevent chronic disease and improve
  population health by adapting, implementing,
  evaluating, and disseminating evidence-based
  interventions.
    PRC-StL Mission

“Prevent chronic diseases and
 improve population health by
    adapting, implementing,
 evaluating, and disseminating
 evidence based interventions”
    PRC-StL Core Components
•   Infrastructure
•   Community engagement and partnership
•   Communication and dissemination
•   Training
•   Research
•   Evaluation
  Healthier MO Communities
• PRC-StL Core Research Project for 2010-2014.
• The primary goal is: "To increase the dissemination of
  evidence-based environmental and policy
  interventions to improve physical activity and healthy
  eating in areas with high chronic disease disparities
  using a Community Based Participatory Research
  (CBPR) approach".
• The project includes partners from 12 rural
  communities in Southeast Missouri.
                 In the Past
• Academically defined programs
• Focus more on individual change and social
  support for these changes:
    – Recipe books
    – Health Fairs
    – Calendars
    – Competitions – which person walks the most or
      which church has the most walkers
    – Anti-smoking posters in schools
A nurse takes the blood pressure of a Twin Towers resident during
                      the Senior Health Fair
           In the Present…
• We are focusing more on
  – Environmental changes
  – Policy changes


• We have done some of this in the past but we
  are really focusing here now…to do this we
  needed to make some adjustments to the way
  we work with our communities
  Environmental and Policy
     Change for Health
Environmental change          Policy change for health
for health is a change in     is the creation or
the physical (natural or      enforcement of laws and
human-built), or social       regulations that make
surroundings that make it     healthy choices more
easier for people to make     available; unhealthy
healthy choices,              behaviors less available or
especially for healthy        illegal; and/or direct public
food, physical activity and   and private resources into
other behaviors.              the support of healthy
                              physical or social
                              environments.
    Breaking it down: Why
   environments and policies
• Since 1994 we have seen and been part of numerous
  projects to enhance healthy eating and physical
  activity

• Most have focused on individual and social factors…

• These are not sustainable without moving toward
  environmental and policy factors
  Breaking it down: Which 12
      counties and why?
• Pemiscot, Scott, Mississippi, Dunklin, Carter, Oregon,
  Reynolds, Shannon, Ripley, Howell, Wayne, Butler

• Rationale/understand: if move toward regional
  changes we may be able to benefit even more
  counties
Breaking it down: Why work
 regionally instead of one
    county at a time?
• Environmental and policy changes often require
  support from regional partners

• Regional partners can encourage local changes
  even when there are local challenges

• Recognize still need to implement strategies locally
  Breaking it down: What is
             CBPR
• Community based participatory research (CBPR) is
  an approach to doing research in which community,
  practice and academic partners work together to
  create and document changes
   – ideas for where to focus
   – planning, implementation, evaluation
Breaking it down: CBPR why
do we think it is important?
• Distance - need to plan and implement here - not
  in St Louis
• You know your communities and what will work
• You can sustain these efforts
• CBPR makes it more likely that the interventions will
  be the right ones and that they will make the
  desired differences
         Where are we going?
Principles of CBPR
• Involves all partners in the design, implementation, and
  evaluation of community-based efforts
• Builds programs on unique strengths and assets of local
  community
• Respects local beliefs and cultural norms
• Takes community needs into consideration
• Builds trust and respect to ensure that programs will be
  maintained and enhanced over time
      Where are we going?

Community-based participatory research
“A collaborative approach to research that equitably
involves all partners in the research process and
recognizes the unique strengths that each brings.”
                        ~ Community Health Scholars Program
 What will this really look like?
• Training - overview to share our perspective

• Prioritize strategies that you see as viable to address
  this this overall range of issues

• Committees to implement these strategies with funding
  and technical assistance from PRCSTL and others as
  needed
      Where are we going?
• Questions/Discussion
 What is evidence-based
environmental and policy
         change?

          April 26th
        1:30-2:15pm
            The Goals

1. What is evidence-based public health?
2. What are environmental and policy
   changes strategies that are evidence
   based?
“Public health workers (and
community leaders)… deserve
to get somewhere by design, not
just by perseverance.”



--McKinlay and Marceau
What is “Evidence”?
             What is “Evidence”?
                                                       Objective
 Scientific literature
 Public health data
 Program evaluations
 Qualitative information
       The words of community members
 Media/marketing data
 Word of mouth and personal experience


                                                      Subjective

            Like beauty, it’s in the eye of the beholder…
Sometimes we do not
connect the research
evidence with policy
      needs…
The problem  Because what you
                told me is
          Where am correct
             absolutely
          I?
  You must be but completely
              a
   researcher    useless              Yes. How
                                         You’re 30 yards
     Yes, how                          did be
                                You must youa
                                             above the
      did you                    policyknow?
                                        maker
                                            ground in a
      know?                                   balloon
    And so the lessons…

• We might speak different languages

• The evidence in some areas and/or
  populations may be limited

• We may need to design new approaches
        A simple definition
- “Evidence-based public health is the
  process of integrating science-based
  interventions with community preferences to
  improve the health of populations.”


•Today, the evidence we have gathered
on what might work in SE MO for promoting
healthy eating and physical activity
      The purpose of
environmental and policy
       change is to

  “Make the healthy
   choice the easy
      choice”
               In the Past

• Focus more on individual change and social
  support for these changes:
  – Recipe books
  – Calendars
  – Competitions – which person walks the most or
    which church has the most walkers
  – Anti-smoking posters in schools
              In the Present…
• We will focus more on
   – Environmental changes (physical and/or social
     environments)
   – Policy changes
• We have done some of this in the past but we are
  really focusing here now…to do this we need to
  make take some new approaches
• We are especially interested in regional approaches
  and bringing new partners to the table
• We want to select projects with the biggest impact
  Environmental and Policy
     Change for Health
Environmental change for         Policy change for health is the
health is a change in the        creation or enforcement of
physical (natural or human-      laws and regulations that
built), or social surroundings   make healthy choices more
that make it easier for          available; unhealthy
people to make healthy           behaviors less available or
choices, especially for          illegal; and/or direct public
healthy food, physical           and private resources into the
activity and other behaviors.    support of healthy physical or
                                 social environments.
    Environmental Changes

• Building walking trails
• Turning empty lots into gardens
• Making fruits and vegetables more available
  at local grocery stores
             Policy Changes
• Cities allow gardens on vacant lots
• School Boards make policy for healthier school lunches
  and vending machines
• Schools allow school property for community physical
  activity
• Smoking bans in schools, workplaces, businesses
 A few examples
(access with social
    marketing
  and school PE)
One important effort for
 knowing what works:

The Guide to Community
   Preventive Services

(the Community Guide)
        Example:

    What are effective
interventions for promoting
     physical activity?
Enhanced access to places for
  physical activity + outreach

   Strongly Recommended
   Trivial pursuit:

What is the famous
line from the “Field
    of Dreams”
If you build it, they (he) will
come
--Field of Dreams, 1989
   Outreach:
Social Marketing
     Social Marketing Steps

•   Select target behaviors and audiences
•   Conduct marketing research
•   Develop and test program materials
•   Implement
•   Evaluate
        A community campaign
using paid media to encourage walking
     among sedentary older adults

Bill Reger, EdD                   Adrian Bauman,PhD
Linda Cooper, MSW                 Bess Marcus, PhD
Steven Booth-Butterfield, EdD   Susan Middlestadt, PhD
Holli Smith, MA, MSW              Felicia Greer, PhD
     To get the word out
              and
 motivate physical activity
on trails among SEDENTARY
       ADULTS, we apply
 (social) marketing strategies
              like
  McDONALDS and FORD
Message Development

Our research indicated that our most effective
message needed to focus on:

                             TIME


                             ENERGY
Print ad: woman




                         WHEELING WALKS
              Overview
Examples:
 ENVIRONMENT and POLICY lessons
• community advisory committee helped plan campaign
• including local clubs, government, schools, press,
  businesses, medical society, other stakeholder

• engaged city agencies—mayor, streets, highways,
  parks, law enforcement, planning

• involved local physicians—prescriptions for walking
• Mayor designates on-going Walkable Wheeling Task Force
   School-based PE
  Curricula and Policy

Another Community Guide
    recommendation
Coordinated Approach To Child Health
           CATCH
              Peter Cribb, MEd
                UT-Houston
           School of Public Health




               512.346.6163
            CATCHTexas.org
             CATCHInfo.org
  The 4 CATCH Components

 Classroom             Physical
 Curriculum           Education




Food Service          Family
Observable Changes in Schools
Summary: What we are looking
           for…
    Examples of Env/Policy               NOT Env/Policy
               Change                          Change
Walking trails (environment)         Health fairs
Community gardens (environment)      Teaching cooking classes
School physical education            Health provider counseling
requirements (policy)
Healthy vending machine
requirements (policy)
Social marketing campaigns (social
norms)
   Questions to ponder…
• What are the priorities in this region?

• How do we link evidence-based approaches to
  strengths in your communities?

• What will have the largest, regional impact?

• What is feasible?
“Getting a new idea adopted, even when it has obvious
advantages, is often very difficult.”
-- Everett Rogers, Diffusion of Innovations
Assessment of the region

          April 26th
        2:30-3:00pm
Death rate from heart disease in 2007
Age-adjusted heart disease
mortality, Missouri, 1996-2004
Combined death rates for heart disease,
       cancer, and diabetes
      Age-adjusted chronic disease
       mortality, Missouri, 1999-2005




Age-adjusted mortality (per 100,000) from breast cancer, uterine cervical cancer, lung cancer, colorectal cancer,
coronary heart disease, stroke, diabetes, chronic obstructive pulmonary disease, and hepatic disease/cirrhosis
% of obese and overweight adults
% of adults who do not participate in
     leisure-time physical activity
    % of adults who eat fewer than 5
servings of fruits and vegetables per day
What has been done in this
         region?
          April 26th
        3:00- 3:30pm
Walking trails in the Ozarks
Community Gardens in the
      Bootheel
     Environmental Changes
Building walking trails

Turning empty lots into gardens

Making fruits and vegetables more available at
 local grocery stores
Smoke-free areas are being
 established in the Ozarks
              Policy Changes
• Smoking bans in schools, workplaces, businesses

• Cities allow gardens on vacant lots

• School Boards make policy for healthier school lunches
  and vending machines

• Schools allow school property for community physical
  activity
Other examples from the
        group?
              Brainstorm….
• What are the strengths in your community or
  region around nutrition and physical activity?
Nutrition and Physical Activity
– promising evidence based
         interventions
• Mass Media Campaigns
• Point of Prompt –Stair use for physical activity
• Social Support for physical activity -
  establishing walking groups
• School based programs for nutrition and
  physical activity
Point of Prompt –Stair use for physical activity
Brainstorm…what are some
  things we can focus on?

           April 26th
         3:30-4:30pm
  Physical activity strategies

Tell us about the strategy.

What strengths does it build on?

Could this be done locally, regionally or both?

What partners might need to be at the table?
      Nutrition strategies
Tell us about the strategy.

What strengths does it build on?

Could this be done locally, regionally or both?

What partners might need to be at the table?
Opinion generators

      April 26th
      4:30-5:00
Healthier MO training

     Day 2: April 27th
         Day 2: Objectives
1. To understand how to prioritize ideas from the
   brainstorming.
2. To describe the action planning process that
   will occur
3. To discuss key principles of partnership
   development
4. To describe how we will move the proces
   forward
How do we prioritize issues
   and approaches?


           April 27th
         8:30 -9:30am
            The Goals

1. What are sources of information to help
   us in prioritizing?
2. How might we do this?
3. Review ideas from brainstorming session
Some sources of evidence

• What other communities have found successful
• Recommendations from health authorities like
  the CDC
• Local knowledge
• Published literature
 Scale for assessing feasibility
• “Good”: You and your partners should have considered
  most of the supporting questions and have taken some
  action to address them

• “Fair”: You and your partners may have considered some
  of the supporting questions and have brainstormed ways to
  work on them

• “Poor”: You and your partners may have not considered
  most of the issues and still have some work to do before
  you can answer the questions
    Feasibility scale (examples)
1. The level of support we have from those who will be
   affected by the intervention is… Good Fair Poor

Before you answer, have you and your partners considered or addressed the
    following?
   Who will be affected (family members, coworkers, neighbors, community
    members)?

   Have we taken steps to describe or get to know our community of
    interest?

   Has our population expressed an interest or concern about the issues
    your intervention will address?
2. The level of political support we have from key-decision
makers          is… Good Fair Poor
Before you answer, have you and your partners considered or addressed the
following?

 Who are the key decision-makers (organizational, administrators,
legislators, or advocacy groups?)

 Have we identified these individuals; interests and how to appeal to
them?

 Have we talked to these individuals about the intervention or asked
for their opinions on what might work?
3. The amount of funding we have for planning and
implementing the intervention is… Good Fair Poor
Before you answer, have you and your partners considered or addressed the
following?

 What is our current budget for the intervention? Will it be
sufficient?

How long do we want to sustain the intervention? Do we need
more funds?
4. The resources we have readily available to plan and
implement the intervention are… Good Fair Poor

Before you answer, have you and your partners considered or addressed
the following?

   What are our space and equipment needs?

   What are our technology needs?
5. Our team’s level of skills and expertise to plan and
implement the intervention is… Good Fair Poor

Before you answer, have you and your partners considered or addressed the
following?

   What are the skills and expertise on our team?

   What are our training needs?

 Will we need to bring in other outside help (e.g., consultants or
contractors)
6. The strength of our team’s leadership is… Good Fair
Poor

Before you answer, have you and your partners considered or
addressed the following?

   Do the leaders motivate and support the team?

 Do we have shared leadership? How do we define
leadership roles?

   Does our team respond favorably to the leaders?
Policy and Program Planning
          Options*
                More Important            Less Important

                Highest priority          Low priority
More Feasible


                Priority for innovative   No intervention program
Less Feasible   programs (evaluation is
                essential)
 Example, Changeability table:
 Diabetes prevention in Rio Grande Pueblo
 communities
                More important                                     Less important

More              Sustaining community support for healthy           Ideal body weight
feasible        living with diabetes
                 Availability of resources for healthy eating
                and exercise
                 Image of diabetes from one of hopelessness
                to one that engenders hope
                 Some stories of diabetes reveal poor
                outcomes, rather than success
                 Food choices at celebrations or feasts




Less feasible    History that led to social, environmental, and
                physiological changes
                 Social, work, and family obligations
        Local adaptation
• Scientific evidence is a starting point
• Realize that ALL programs need some level of
  adaptation
• Limits of scientific evidence should be noted
   – Local history
   – Local strengths
   – Work on lifestyle changes that are consistent with
     history and culture
• Seek out other forms of evidence, such as?
         Getting your input

• Opinion Generators
   – Develops instant feedback from the whole group

• Example: Ratings a series of possible interventions
  for importance and feasibility
Partnership

   April 27th
 9:30-10:30am
      What to we mean by
         partnership?
• Intentional relationships between two or more
  individuals, groups or organizations
• Committed to pursuing an agenda or goal of
  mutual benefit
• May be for information exchange, input, or joint
  planning and implementation
 Why partner for regional policy
 and environmental change?
• Accomplish something that one organization cannot
  accomplish alone

• Bring people together that are interested in similar
  cause or outcome in the region

• Pool resources – time, talent, networks

• Reduce duplication of effort
            Together we can make a difference
What makes a partnership
successful?


   Think of an experience with a group or
 partnership when things went well. What are
    the three things that contributed to the
            success of that group?
Characteristics of successful
      partnerships
1.   Community readiness – right issue, right time
2.   Community history – turf issues, leadership
3.   Membership – diversity, representation
4.   Relationships – trust, respect
Characteristics of successful
      partnerships
5.   Shared vision and mission
6.   Resources – skills, money
7.   Leadership and staffing –committed, inclusive
8.   Structure and organization – defined roles,
     responsibilities, processes
9.   Ability to take action
  Different ways of engaging
            partners
• What are the rights and responsibilities of each
  partner?

• Who has decision making power?

• Is there respect for all voices/concerns?

• What is the expectation of engagement in various
  activities needed accomplish goals?
        Community-based
       participatory research
• a collaborative approach to research
• equitably involves all partners in the research process
  and recognizes the unique strengths that each brings.
• begins with a research topic of importance to the
  community,
• combine knowledge with action and achieving social
  change to improve health outcomes and eliminate
  health disparities.
  Prevention Research Center in
        St. Louis Example
1. We are committed to equity, collective decisions, and
   collective action

2. We are committed to high quality, ethical research

3. We are committed to addressing social inequalities that
   affect health and those that constrain participation

4. We are committed to maximizing opportunities for
   learning within environs of the local community
Things to consider when building
      regional partnership
 Develop trust: show respect, follow through, attend to each
  other’s interests and needs

 Provide leadership: shared leadership, delegation,
  task/maintenance functions

 Develop processes for shared power and influence:
  equity, mutual influence, co-learning, balance of power
Things to consider when building
      regional partnership
 Address conflict: necessary part of group process, identify
  reasons for conflict, establish norms for conflict management

 Establish shared decision-making processes: determine how
  decision s will be made and enable all members of the group to
  be engaged as appropriate

 Choose a fiscal agent – determine which organization will be
  responsible for administering funds and a process for making
  financial decisions as a group
Potholes…what to look out for once
 you decide to take the plunge…
• Poor communication and language differences

• Lack of shared understanding of financial
  requirements and structures

• Differences in values and mission

• Deadlines

• Different learning and action styles- email vs.
  phone/in person

• Undeclared agendas
Action Planning

      April 27th
  10:45am-11:45am
            Action planning
• Structured process to move from

  – Goal or Vision.. to

  – Objectives - what do you need to achieve to
    accomplish your vision..to

  – Activities or action steps that need to be taken to
    accomplish your objectives
    How action planning will
            occur
• Action planning committees
  – Each will focus on a different strategy- priority
    from earlier
  – Sign up for issue(s) of interest
  – Each member of the committee will be asked to do
    some specific tasks between meetings to help move
    things forward
  – Each member of the committee may be asked to
    garner local support for desired changes
 Action planning committees

• Once issues are chosen PRC staff will provide
  additional assessment data for these issues
• Work together
   – to identify any work already underway
   – to determine how best to complement existing interventions
   – To maximize use of existing resources and opportunities
     (e.g., if there is any financing issue already on the books)
 Action planning committees
• Technical assistance will be provided by PRC staff in
  St. Louis and locally
• Time frame-
   – planning meetings over the summer;
   – technical assistance to move toward these plans during the
     fall
• Funding
   – will be determined by the way the issues are defined and
     the strategies chosen
Outline Plan for moving
        forward
          April 27th
     11:45am - 12:00pm
              Moving forward
• Sign up for committee(s) of interest
   – PRC will contact you for next meetings
   – Go through action planning steps
   – Consider who else needs to be at the table
• PRC will provide technical assistance and support - if
  need training on advocacy will provide this
• Identify communication plan- prefer to email…if this is
  a problem please let us know a better way to contact
  you
  Who else needs to be at
the table for regional policy
and environmental change
  to address nutrition and
physical activity in southern
          Missouri?
      Things to consider when
      engaging policy-makers
•   Provide compelling data
•   Listen to their needs
•   Understand their issues of interest
•   Find win-win issues
       Committee meetings
• Next meeting will be in smaller groups

• Committees will meet monthly

• First meeting will discuss how the group
  members will work together and determine
  partnership principles
 Contact the Prevention
Research Center in St. Louis

  PRC St. Louis Website: http://prcstl.wustl.edu

  PRC St. Louis General Email: prcstl@wustl.edu

  PRC St. Louis General Phone: 314-362-9643

								
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