Healthy eating and active living policy, systems, and environmental changes in rural Louisiana: a contextual inquiry to inform implementation strategies.

BACKGROUND: Healthy eating and active living policy, systems, and environmental (PSE) changes are implemented across the United States through Cooperative Extension. However, translating multisector PSE changes to practice in community settings is challenging and there is a lack of knowledge about barriers and facilitators to PSE changes among state Extension systems using standardized frameworks. Therefore, a research-to-practice partnership effort aimed to identify Louisiana Cooperative Extension Service Family and Consumer Science (LFCS) practitioners' barriers and facilitators to implementing PSE changes in rural Louisiana communities. METHODS: A qualitative approach using the 2022 Consolidated Framework for Implementation Research (2022 CFIR) was used. Focus group discussions were conducted at five LFCS regional trainings between February and May 2022. All LFCS practitioners with any level of experience implementing healthy eating and active living PSE changes were eligible to participate, with emphasis on understanding efforts within more rural communities. Focus group discussions were audio-recorded and transcribed verbatim. Researchers analyzed qualitative data using the constant comparison method and 2022 CFIR domains and constructs including Inner Setting (LFCS organization), Outer Setting (rural Louisiana communities), Innovation (PSE changes), and Individuals (PSE change implementation actors/partners). RESULTS: Across the five regions, LFCS practitioners (n = 40) described more barriers (n = 210) than facilitators (n = 100); findings were often coded with multiple 2022 CFIR domains. Reported Inner Setting barriers were lack of formal or informal information sharing and lack of access to knowledge and information. Outer Setting barriers included sustaining and initiating community partnerships and local environmental or political conditions. Individual barriers included a lack of time and expertise, and Innovation barriers included the complex nature of rural PSE changes. Facilitators were mentioned at multiple levels and included community partner buy-in and practitioners' motivation to implement PSE changes. CONCLUSIONS: Implementation strategies are needed to build on organizational strengths and to overcome multi-level barriers to PSE change implementation among LFCS practitioners. The results from the in-depth contextual inquiry used could serve as a guide for future pragmatic assessment efforts among other state Extension systems or as a model for identifying barriers and facilitators and associated implementation strategies among other public health systems in the U.S. and abroad.

Louisiana trucking companies' implementation of workplace health promotion programs: Explanatory sequential mixed method case study.

BACKGROUND: Trucking companies may be key partners for workplace health promotion programs to improve heavy and tractor-trailer drivers' health and wellbeing. OBJECTIVE: To identify barriers and facilitators to implementing workplace health promotion programs among Louisiana trucking companies' leadership and staff. METHODS: A case study approach following an explanatory sequential mixed method research design was used. A quantitative survey, based on the Theoretical Domains Framework (TDF), was adapted and distributed online to a convenience sample. Survey respondents were recruited for an interview to gain additional insight on multi-level barriers to implementing workplace health promotion programs. Quantitative data was analyzed using descriptive statistics to describe barriers and facilitators following TDF constructs. Qualitative data were independently coded among two researchers following the TDF and the Consolidated Framework for Implementation Research (CFIR) to determine themes. RESULTS: Eleven workplace leaders or staff took the survey. Two engaged in a follow-up interview. Regarding the quantitative results, most (82%) believed workplace health promotion programs would save their company money, although were not offering them. No TDF constructs were indicated as barriers given mixed results; however, several were facilitators: Social/Professional Role and Identity; Emotion; Action Planning; Knowledge; Motivation and Goals; and Beliefs about Consequences. Qualitative results captured several Inner (e.g., time, money) and Outer Setting contextual (e.g., truckers' needs and resources) factors considered important to trucking companies' implementation of health promotion programs. CONCLUSION: Results suggest leadership and staff of Louisiana trucking companies value workplace health promotion programs, although are challenged by limited resources and the broader trucking environment.

Supplemental Nutrition Assistance Program (SNAP)-authorised store marketing environments in Louisiana encourage the selection of less nutritious foods and beverages.

Marketing influences consumers' dietary purchases. However, little is known about marketing environments in Supplemental Nutrition Assistance Program (SNAP)-authorised stores. The present study explored SNAP-authorised store marketing environments in Louisiana by rurality, store ownership and store type (n 42). Sampling methods were designed to include randomly selected stores in each geographic area of the state. The GroPromo was used to measure placement, promotion, and child-focused aspects of marketing strategies used for healthier (fruits and vegetables) and less healthy products (chips, candy, sugar-sweetened beverages, child-focused cereal) in medium- and high-prominence marketing areas. In using multivariate analysis of variance (MANOVA) (P < 0⋅05) for data analysis, variations in GroPromo scores were found among SNAP-authorised stores by rurality (P < 0⋅05) and store ownership (P < 0⋅001); no differences were found by store type (P > 0⋅05). Future research, practice and policy strategies are required to understand the influence of marketing environments on SNAP participants' dietary quality and to design responsive public health interventions.

Supplemental Nutrition Assistance Program (SNAP)-authorized retailers received a low score using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool.

BACKGROUND: The Supplemental Nutrition Assistance Program (SNAP) supports Americans with lower income to purchase dietary products at authorized retailers. This research aimed to evaluate SNAP-authorized retailers' public commitments in support of nutrition security and to examine differences between traditional grocers and nontraditional (e.g., convenience, drug, dollar) SNAP-authorized retailers' public commitments. METHODS: Prominent United States (U.S.) SNAP-authorized retailers nationally and in two U.S. states (California and Virginia) were identified based on number of store locations (n = 61). Public information available in grey literature were reviewed and scored using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool. SNAP-authorized retailers were classified as traditional (e.g., grocery) or nontraditional (e.g., non-grocery) retailers. Total BIA-Obesity from 0 to 615, representing low to optimal support) and category scores were calculated for corporate strategy, relationships with external organizations, product formulation, nutrition labeling, product and brand promotion, and product accessibility. Descriptive statistics were used to describe BIA-Obesity scores overall and by category. Mann-Whitney U was used to test for potential differences in median BIA-Obesity total scores between traditional and nontraditional SNAP-authorized retailers (a priori, p < 0.05). RESULTS: Average total BIA-Obesity scores for SNAP-authorized retailers ranged from 0 to 112 (16.5 ± 23.3). Total BIA-Obesity scores for traditional SNAP-authorized retailers (32.7 ± 33.6; median 25) were higher than nontraditional SNAP-authorized retailer scores (11.2 ± 16; median 5) (p = 0.008). For BIA-Obesity categories, average scores were highest for the category relationships with external organizations (8.3 ± 10.3) and lowest for promotion practices (0.6 ± 2.1). CONCLUSIONS: Results of this research underscore a dearth of available evidence and substantial opportunity for improvement regarding SNAP-authorized retailer strategies to support nutrition security among Americans with lower income.