Perceptions of community-based participatory research in the Delta Nutrition Intervention Research Initiative: an academic perspective.

Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI) is an academic-community partnership between seven academic institutions and three communities in Mississippi, Arkansas, and Louisiana. A range of community-based participatory methods have been used to develop sustainable nutrition intervention strategies. Focus groups were conducted with 22 faculty and staff members from the academic partners on the project to document their perceptions of community-based participatory processes in a federally funded, multi-academic-community partnership spanning a decade. Focus groups were conducted to glean insights or lessons from the experiences of academic personnel. Focus groups were transcribed and analyzed using the constant comparative method. Two researchers analyzed each transcript independently and reached consensus on the consistent themes. Participants candidly shared their experiences of working with community members to devise research plans, implement programs, and evaluate outcomes. The majority of faculty and staff members were attracted to this project by an excitement for conducting a more egalitarian and potentially more successful type of research. Yet each academic partner voiced that there was an underlying disconnect between community practices and research procedures during the project. Additional barriers to collaboration and action, located in communities and academic institutions, were described. Academic partners stressed the importance of open and ongoing communication, collective decision-making strategies, and techniques that support power sharing between all parties involved in the project. Findings from this research can inform academic-community partnerships and hopefully improve the community-based participatory research process implemented by academic institutions and communities.

Knowledge, attitudes, and practices of underserved women in the rural South toward breast cancer prevention and detection.

The goal of this study was to understand the unique needs and barriers to breast cancer control among African American women in the rural South. This population experiences barriers that surpass that of other minorities. Researchers conducted 6 focus groups to assess barriers of minority women in Mississippi toward breast cancer prevention and clinical trials. These women had little knowledge of treatment options and negative perceptions of screening and clinical trial participation. This research equips others to identify new health education strategies. Conclusions also provide insight into prevention for other minority populations, such as Latina, Asian, and American Indian women.

Breast cancer fatalism: the role of women's perceptions of the health care system.

Cancer fatalism, which can be understood as the belief that cancer is a death sentence, has been found to be a deterrent to preventive cancer screening participation. This study examines factors associated with breast cancer fatalism among women. We analyzed data from a 2003 survey of women 40 years of age. The survey collected information about respondents' knowledge and attitudes regarding breast health. Analyses compared the characteristics of women who reported and those who did not report a fatalistic attitude. Women with a fatalistic attitude were more likely to be African American, to have a family history of breast cancer, to rate their quality of care as fair or poor, to believe that not much could be done to prevent breast cancer, to believe that breast cancer could not be cured if found early, and to believe that treatment could be worse than the disease.

Does a six-month pedometer intervention improve physical activity and health among vulnerable African Americans? A feasibility study.

BACKGROUND: Race/ethnic-specific physical activity patterns and biological responses to physical activity is one of the most understudied, yet critical aspects related to the development and adoption of physical activity recommendations. METHODS: In this 6-month community walking intervention targeting African Americans, participants wore a pedometer and maintained a pedometer diary for the study duration. Outcome measures included height, weight, percent body fat, waist circumference, blood pressure, lipids and glucose. ANOVA, Pearson Correlations, and Kruskal-Wallis tests were used to examine changes in steps/day over each month of the intervention and explore associations among pedometer-determined physical activity and anthropometric/biological change scores from month 1 to 6. RESULTS: The 83 participants were primarily African American (98%) women (94%). There was a significant increase in the average step/day beginning with 6665 (SD = 3396) during month 1 and increasing to 9232 (SD = 3670) steps/day during month 6 (F = 4.5, P < .0001). Associations among step counts and anthropometric/biological change scores were not significant. CONCLUSIONS: While this intervention resulted in significant increases in steps/day; it exemplifies that physical activity standards may be unachievable for some vulnerable, minority communities. Methodological considerations for exploring associations between changes in pedometer-determined step counts and anthropometric/biological outcomes are emphasized through this study.

Compliance and acceptability of maintaining a 6-month pedometer diary in a rural, African American community-based walking intervention.

BACKGROUND: Limited research has been done on the compliance and acceptability of maintaining pedometer diaries for an extensive time frame in community-based interventions targeting minority populations. METHODS: Community "coaches" led participants in a 6-month community-based walking intervention that included wearing pedometers and maintaining pedometer diaries for the study duration. Descriptive statistics and ANOVA tests were used to evaluate compliance rates for maintaining diaries and daily step counts. After the intervention, focus groups were used to explore opinions regarding pedometers. Audiotapes were transcribed and evaluated using systematic content analysis. RESULTS: The 8 coaches and 75 enrolled walking participants were primarily African American (98%) women (94%). Overall, the group (N = 83) submitted 85% of all possible pedometer diaries and recorded 73% of all possible daily step counts. Walking-group members were significantly (P < .01) more compliant if their coach was also compliant. Identified benefits of wearing pedometers and maintaining diaries outnumbered the barriers. Participants were enthusiastic about wearing the pedometers and indicated that the weekly diaries provided a source of motivation. CONCLUSIONS: This research suggests pedometer diaries are a viable intervention tool and research method for community-based physical activity interventions targeting African Americans and highlights the need for social support to promote pedometer diary compliance.

Conducting needs assessment using the comprehensive participatory planning and evaluation model to develop nutrition and physical activity interventions in a rural community in the Mississippi delta.

BACKGROUND: Members of a Lower Mississippi Delta community and university partners used the Comprehensive Participatory Planning and Evaluation (CPPE) model to assess nutrition and health problems and develop a menu of interventions. OBJECTIVES: We sought to identify and prioritize nutrition and physical activity problems in the community and to identify interventions to address the problems. METHODS: Community members and university partners used the CPPE process to identify and prioritize nutrition and physical activity problems. The participants developed causal models to break down the identified problems to their root causes. They then developed a menu of interventions and criteria to rank the interventions. RESULTS: The identified problems were intake of unhealthy foods, lack of nutrition education, and lack of adequate physical activity. The menu of interventions consisted of seven objectives to address poor nutrition and physical activity as well as a total of 19 interventions to meet these objectives. CONCLUSION: Directly involving community members in identifying health problems and solutions results in the development of interventions that are likely to have greater acceptability with the community.

Fit for life steps: results of a community walking intervention in the rural Mississippi delta.

BACKGROUND: A collaborative community--university--U.S. Department of Agriculture(USDA)/Agricultural Research Service (ARS) partnership developed and implemented a 6-month walking intervention whereby volunteer coaches were trained to lead community walking groups in a rural Mississippi Delta Community. OBJECTIVE: Assess the feasibility of implementing community-based participatory research (CBPR), increase physical activity, and improve anthropometric and biological measures. METHODS: This quasi-experimental design examined body mass index, percent body fat, waist circumference, blood pressure, blood glucose, lipid profile, self-reported walking, stages of change, social support, self-efficacy, and decisional balance at enrollment, 3 months, and 6 months. Participants were primarily African-American (99%) women (97%). Changes were evaluated using repeated measures analysis of variance (ANOVA) and Friedman's test. RESULTS: Community members actively participated in assessing the problem, identifying the intervention, intervention planning, data collection, and evaluation. Of the 83 enrolled participants, 66 (80%) completed the intervention. Participants exhibited significant improvements in waist circumference (-1.4 inches), systolic blood pressure (-4.3 mmHg), and high-density lipoprotein (HDL) cholesterol (+7.9 mg/dL); (PA