Targeting Hypertension: Working with Rural Barbershops to Identify Hypertension and Encourage Treatment.

INTRODUCTION: Cardiovascular disease (CVD), accounting for one in every four U.S. deaths, has had a devastating impact on Mississippi's African American population. Seeking innovative mitigation models, this study assesses CVD prevalence and reach via barbershops to rural Mississippi African Americans. METHODS: Data was collected from barbershop clientele who consented to be screened and contacted for referral to clinical care if blood pressure was found to be elevated. RESULTS: Most participants were African American (97.7%, n=2,756) and male (54.4%). Descriptive findings revealed more than one-third of participants (34.2%) had elevated blood pressure at screening. Factoring in those with hypertension in control, we found lower rates of hypertension in the male population (males 51.4% vs. females 57.8%), a sharp contrast to national rates. CONCLUSION: Evaluation findings suggest CVD prevalence in rural Mississippi is comparatively high but that barbershop partners were able to successfully reach and screen the target population.

Policy, systems, and environmental change in the Mississippi Delta: considerations for evaluation design.

Community-level policy, systems, and environmental (PSE) change strategies may offer an economical and sustainable approach to chronic disease prevention. The rapidly growing number of untested but promising PSE strategies currently underway offers an exciting opportunity to establish practice-based evidence for this approach. This article presents lessons learned from an evaluation of a community-based PSE initiative targeting stroke and cardiovascular disease prevention in the Mississippi Delta. Its purpose is to describe one approach to evaluating this type of PSE initiative, to stimulate discussion about best practices for evaluating PSE strategies, and to inform future evaluation and research efforts to expand practice-based evidence. The evaluation used a descriptive mixed-methods design and focused on the second year of a multisectoral, multiyear initiative. Cross-sectional data were collected in the summer and fall of 2010 using four data collection instruments: a grantee interview guide (n = 32), a health council member survey (n = 256), an organizational survey (n = 60), and a grantee progress report (n = 26). Fifty-eight PSE changes were assessed across five sectors: health, faith, education, worksite, and community/city government. PSE strategies aligned with increased access to physical activity opportunities, healthy food and beverage options, quality health care, and reduced exposure to tobacco. Results showed that grantees were successful in completing a series of steps toward PSE change and that sector-specific initiatives resulted in a range of PSE changes that were completed or in progress. Considerations for designing evaluations of community-based PSE initiatives are discussed.

Strategic Planning for Chronic Disease Prevention in Rural America: Looking Through a PRISM Lens.

CONTEXT: Community-level strategic planning for chronic disease prevention. OBJECTIVE: To share the outcomes of the strategic planning process used by Mississippi Delta stakeholders to prevent and reduce the negative impacts of chronic disease in their communities. A key component of strategic planning was participants' use of the Prevention Impacts Simulation Model (PRISM) to project the reduction, compared with the status quo, in deaths and costs from implementing interventions in Mississippi Delta communities. DESIGN: Participants in Mississippi Delta strategic planning meetings used PRISM, a user-friendly, evidence-based simulation tool that includes 22 categories of policy, systems, and environmental change interventions, to pose what-if questions that explore the likely short- and long-term effects of an intervention or any desired combination of the 22 categories of chronic disease intervention programs and policies captured in PRISM. These categories address smoking, air pollution, poor nutrition, and lack of physical activity. Strategic planning participants used PRISM outputs to inform their decisions and actions to implement interventions. SETTING: Rural communities in the Mississippi Delta. PARTICIPANTS: A diverse group of 29 to 34 local chronic disease prevention stakeholders, known as the Mississippi Delta Strategic Alliance. MAIN OUTCOME MEASURE(S): Community plans and actions that were developed and implemented as a result of local strategic planning. RESULTS: Existing strategic planning efforts were complemented by the use of PRISM. The Mississippi Delta Strategic Alliance decided to implement new interventions to improve air quality and transportation and to expand existing interventions to reduce tobacco use and increase access to healthy foods. They also collaborated with the Department of Transportation to raise awareness and use of the current transportation network. CONCLUSIONS: The Mississippi Delta Strategic Alliance strategic planning process was complemented by the use of PRISM as a tool for strategic planning, which led to the implementation of new and strengthened chronic disease prevention interventions and policies in the Mississippi Delta.

Policy perceptions related to physical activity and healthy eating in Mississippi.

OBJECTIVE: Determine the public perceptions about policies related to physical activity and healthy eating to inform efforts to change policy for these important public health issues. DESIGN: Cross-sectional, structured phone interview survey. SETTING: Ten counties in Mississippi (5 counties with the highest and 5 with the lowest obesity prevalence). PARTICIPANTS: : Random sample of 2800 adults. MAIN OUTCOME MEASURE: Level of support for each individual policy and summary of support for 10 policies related to healthy eating and activity and 4 related to local funding for infrastructure for physical activity. RESULTS: This survey showed strong policy support among Mississippi residents for a diverse set of policies aimed at promoting healthy eating and physical activity behaviors. This was particularly true for those in counties with the highest levels of obesity. Support for policies related to healthy eating and activity was highest for the following: requiring at least 30 minutes of physical activity or physical education everyday for children in kindergarten through 12th grade (93%) and lowest for the following: taxing soda and soft drinks and using the money for public education campaigns to fight obesity in children (65%). Support for the use of local government funds to build and maintain infrastructure for physical activity was high across all categories, ranging from 86% (recreation centers) to 74% (swimming pools). The levels of support for each policy varied according to several demographic characteristics; in general, support for nearly every policy was greater among African Americans, females, and those in counties with higher levels of obesity. Logistic models predicting level of support for healthy eating and physical activity found significant associations with several demographic factors.

A survey tool for measuring evidence-based decision making capacity in public health agencies.

BACKGROUND: While increasing attention is placed on using evidence-based decision making (EBDM) to improve public health, there is little research assessing the current EBDM capacity of the public health workforce. Public health agencies serve a wide range of populations with varying levels of resources. Our survey tool allows an individual agency to collect data that reflects its unique workforce. METHODS: Health department leaders and academic researchers collaboratively developed and conducted cross-sectional surveys in Kansas and Mississippi (USA) to assess EBDM capacity. Surveys were delivered to state- and local-level practitioners and community partners working in chronic disease control and prevention. The core component of the surveys was adopted from a previously tested instrument and measured gaps (importance versus availability) in competencies for EBDM in chronic disease. Other survey questions addressed expectations and incentives for using EBDM, self-efficacy in three EBDM skills, and estimates of EBDM within the agency. RESULTS: In both states, participants identified communication with policymakers, use of economic evaluation, and translation of research to practice as top competency gaps. Self-efficacy in developing evidence-based chronic disease control programs was lower than in finding or using data. Public health practitioners estimated that approximately two-thirds of programs in their agency were evidence-based. Mississippi participants indicated that health department leaders' expectations for the use of EBDM was approximately twice that of co-workers' expectations and that the use of EBDM could be increased with training and leadership prioritization. CONCLUSIONS: The assessment of EBDM capacity in Kansas and Mississippi built upon previous nationwide findings to identify top gaps in core competencies for EBDM in chronic disease and to estimate a percentage of programs in U.S. health departments that are evidence-based. The survey can serve as a valuable tool for other health departments and non-governmental organizations to assess EBDM capacity within their own workforce and to assist in the identification of approaches that will enhance the uptake of EBDM processes in public health programming and policymaking. Localized survey findings can provide direction for focusing workforce training programs and can indicate the types of incentives and policies that could affect the culture of EBDM in the workplace.

Concept mapping as a tool to engage a community in health disparity identification.

OBJECTIVES: To engage a community to critically examine local health disparities. DESIGN: Concept mapping is a tool used to rapidly assess the variations in thinking of large stakeholder groups' about a particular topic. SETTING: Jackson, Mississippi. PARTICIPANTS: Community members. METHODS: Dialog groups and community meetings were held, and participants were asked to respond to the statement, "A specific thing that causes African Americans to get sicker and die sooner is..." Aggregate responses were rated for importance and feasibility and then sorted into related groups. Aggregate sorts and ratings were then processed by using multidimensional scaling and hierarchical cluster analysis. RESULTS: There were 132 (unduplicated) reported contributors to health disparities. These responses fell into eight general clusters: economic issues, government, contextual factors, cultural factors, HIV, stress, environment, and motivation. Factors respondents felt were the most important contributors to disparities (economic factors, contextual factors, stress) did not correlate with those that they thought were most likely to be changed in society (contextual factors, government, motivation). CONCLUSIONS: Concept mapping provided a mechanism for rapidly documenting community thinking about health disparities. This mechanism stimulated community dialog and was used as a first step toward the long-term goal of creating equal community, academic, and medical partnerships for addressing disparities. The concept mapping process stimulated critical thinking about contributors to health inequities and uncovered contextual factors previously unknown to researchers and public health planners. The process allowed for active engagement and exchange of knowledge between the community and researchers and allowed a mechanism for identifying and rectifying disconnects in knowledge within and between stakeholder groups.