Approaches for Implementing Healthy Food Interventions in Settings With Limited Resources: A Case Study of Sodium Reduction Interventions in Emergency Food Programs Addressing Food Insecurity.

PURPOSE: This study describes how recipients of the Centers for Disease Control and Prevention funded Sodium Reduction in Communities Program (SRCP) worked with emergency food programs to improve access to healthy food to address chronic conditions. DESIGN: SRCP recipients partnered with emergency food programs to implement sodium reduction strategies including nutrition standards, procurement practices, environmental strategies, and behavioral economics approaches. SETTING: SRCP recipients and emergency food programs in Washington County and Benton County, Arkansas and King County, Washington. SUBJECTS: SRCP recipient staff, emergency food program staff, and key stakeholders. MEASURES: We conducted semi-structured interviews with key stakeholders and systematic review of program documents. ANALYSIS: Data were analyzed using effects matrices for each recipient. Matrices were organized using select implementation science constructs and compared in a cross-case analysis. RESULTS: Despite limited resources, emergency food programs can implement sodium reduction interventions which may provide greater access to healthy foods and lead to reductions in health disparities. Emergency food programs successfully implemented sodium reduction interventions by building on the external and internal settings; selecting strategies that align with existing processes; implementing change incrementally and engaging staff, volunteers, and clients; and sustaining changes. CONCLUSION: Findings contribute to understanding the ways in which emergency food programs and other organizations with limited resources have implemented public health nutrition interventions addressing food insecurity and improving access to healthy foods. These strategies may be transferable to other settings with limited resources.

Training Employers to Implement Health Promotion Programs: Results From the CDC Work@Health® Program.

PURPOSE: Centers for Disease Control and Prevention (CDC) initiated the Work@Health Program to teach employers how to improve worker health using evidence-based strategies. Program goals included (1) determining the best way(s) to deliver employer training, (2) increasing employers' knowledge of workplace health promotion (WHP), and (3) increasing the number of evidence-based WHP interventions at employers' worksites. This study is one of the few to examine the effectiveness of a program designed to train employers how to implement WHP programs. DESIGN: Pre- and posttest design. SETTING: Training via 1 of 3 formats hands-on, online, or blended. PARTICIPANTS: Two hundred six individual participants from 173 employers of all sizes. INTERVENTION: Eight-module training curriculum to guide participants through building an evidence-based WHP program, followed by 6 to 10 months of technical assistance. MEASURES: The CDC Worksite Health ScoreCard and knowledge, attitudes, and behavior survey. ANALYSIS: Descriptive statistics, paired t tests, and mixed linear models. RESULTS: Participants' posttraining mean knowledge scores were significantly greater than the pretraining scores (61.1 vs 53.2, P < .001). A year after training, employers had significantly increased the number of evidence-based interventions in place (47.7 vs 35.5, P < .001). Employers' improvements did not significantly differ among the 3 training delivery formats. CONCLUSION: The Work@Health Program provided employers with knowledge to implement WHP interventions. The training and technical assistance provided structure, practical guidance, and tools to assess needs and select, implement, and evaluate interventions.

Understanding small business engagement in workplace violence prevention programs.

PURPOSE: Worksite wellness, safety, and violence prevention programs have low penetration among small, independent businesses. This study examined barriers and strategies influencing small business participation in workplace violence prevention programs (WVPPs). APPROACH: A semistructured interview guide was used in 32 telephone interviews. SETTING: The study took place at the University of North Carolina Injury Prevention Research Center. PARTICIPANTS: Participating were a purposive sample of 32 representatives of small business-serving organizations (e.g., business membership organizations, regulatory agencies, and economic development organizations) selected for their experience with small businesses. INTERVENTION: This study was designed to inform improved dissemination of Crime Free Business (CFB), a WVPP for small, independent retail businesses. METHODS: Thematic qualitative data analysis was used to identify key barriers and strategies for promoting programs and services to small businesses. RESULTS: Three key factors that influence small business engagement emerged from the analysis: (1) small businesses' limited time and resources, (2) low salience of workplace violence, (3) influence of informal networks and source credibility. Identified strategies include designing low-cost and convenient programs, crafting effective messages, partnering with influential organizations and individuals, and conducting outreach through informal networks. CONCLUSION: Workplace violence prevention and public health practitioners may increase small business participation in programs by reducing time and resource demands, addressing small business concerns, enlisting support from influential individuals and groups, and emphasizing business benefits of participating in the program.

How to engage small retail businesses in workplace violence prevention: Perspectives from small businesses and influential organizations.

BACKGROUND: Small retail businesses experience high robbery and violent crime rates leading to injury and death. Workplace violence prevention programs (WVPP) based on Crime Prevention Through Environmental Design reduce this risk, but low small business participation limits their effectiveness. Recent dissemination models of occupational safety and health information recommend collaborating with an intermediary organization to engage small businesses. METHODS: Qualitative interviews with 70 small business operators and 32 representatives of organizations with small business influence were conducted to identify factors and recommendations for improving dissemination of a WVPP. RESULTS: Both study groups recommended promoting WVPPs through personal contacts but differed on other promotion methods and the type of influential groups to target. Small business operators indicated few connections to formal business networks. CONCLUSIONS: Dissemination of WVPPs to small businesses may require models inclusive of influential individuals (e.g., respected business owners) as intermediaries to reach small businesses with few formal connections.

Lessons learned from community-based approaches to sodium reduction.

PURPOSE: This article describes lessons from a Centers for Disease Control and Prevention initiative encompassing sodium reduction interventions in six communities. DESIGN: A multiple case study design was used. SETTING: This evaluation examined data from programs implemented in six communities located in New York (Broome County, Schenectady County, and New York City); California (Los Angeles County and Shasta County); and Kansas (Shawnee County). SUBJECTS: Participants (n = 80) included program staff, program directors, state-level staff, and partners. MEASURES: Measures for this evaluation included challenges, facilitators, and lessons learned from implementing sodium reduction strategies. ANALYSIS: The project team conducted a document review of program materials and semistructured interviews 12 to 14 months after implementation. The team coded and analyzed data deductively and inductively. RESULTS: Five lessons for implementing community-based sodium reduction approaches emerged: (1) build relationships with partners to understand their concerns, (2) involve individuals knowledgeable about specific venues early, (3) incorporate sodium reduction efforts and messaging into broader nutrition efforts, (4) design the program to reduce sodium gradually to take into account consumer preferences and taste transitions, and (5) identify ways to address the cost of lower-sodium products. CONCLUSION: The experiences of the six communities may assist practitioners in planning community-based sodium reduction interventions. Addressing sodium reduction using a community-based approach can foster meaningful change in dietary sodium consumption.

Attitudes & effectiveness of professional programs for primary prevention of violence: exploratory validation of the PREVENT primary prevention of violence self-assessment.

The PREVENT (Preventing Violence through Education, Networking, and Technical Assistance) project trained violence practitioners across the USA in Primary Prevention of Violence techniques (PPV). The purpose of this study is to describe the development and psychometric properties of the subscales of the PREVENT PPV Self Assessment. Of 800 participants, 585 responded (73.1%). We analyzed the data using factor analyses, reliabilities and LISREL structural equation measurement models. The Perceived PPV Project Success subscale exhibited a one-factor structure (R2 = .534, X2/df = 1.28, p = .277, GFI = .99, NNFI = .99); PPV Self-Efficacy and Support showed a four-factor structure (R2 = .583, X2/df = 3.7, p = .00, GFI = .94, NNFI = .93); Perceived PPV Collaboration showed a three factor structure (R2 = .544, X2/df = 4.20, p = .00, GFI = .92, NNFI = .93); Anticipated Future PPV Work yielded a three-factor structure (R(2) = .656, X(2)/df = 4.76, p = .00, GFI = .94, NNFI = .91); and PPV Confidence a marginally acceptable two-factor structure (R2 = .759, X2/df = 11.1, p = .00, GFI = .95, NNFI = .99). Perceived PPV Project Success demonstrated very strong predictive validity (χ2/df = 2.33, p = .0167, GFI = .984, RMSEA = .0585) of increased time devoted to PPV. These construct validated subscales represent a rich source of material for assessing professionals' attitudes and perseverance towards personal implementation of PPV. From these results, we recommend specific items from each subscale for further use by PPV trainers.