Identifying Barriers and Facilitators to Nutrition and Physical Activity among Public Housing Residents Using Photovoice.

BACKGROUND: Weight management is a national health priority for health disparity-facing populations. There is a paucity of literature examining perceptions of diet and physical activity behaviors for weight management among public housing residents. Photovoice is a qualitative technique in which participants take photographs to document and discuss personal, social, and environmental factors around a particular topic. OBJECTIVES: To use photovoice to identify facilitators and barriers to weight management, including diet and physical activity behaviors, among urban public housing residents. METHODS: Four 2-hour sessions were held in each of four housing developments (16 total sessions). Participants were given three photo missions to take photographs of the meaning of health, facilitators, and barriers. Participants then discussed and wrote narratives of their most meaningful photographs. RESULTS: The majority of participants (n = 28) were obese (60%), female (82%), and African American or Black (71%) residents. Qualitative analysis of the transcripts revealed multiple facilitators and barriers that influenced weight management at the individual (e.g., self-control), interpersonal (e.g., peer influence), and community (e.g., access) levels. Additional themes that were specific to the housing development level included built environment at the development, feelings of community support, the development tenant/resident task force, and living conditions. CONCLUSIONS: Findings revealed multiple facilitators and barriers to healthy eating, physical activity, and weight management among public housing residents with additional factors influencing health within the housing development. Photovoice was a feasible method to engage community members in discussions and may be useful to inform multilevel interventions.

Changing the housing environment to reduce obesity in public housing residents: a cluster randomized trial.

BACKGROUND: Public housing residents face significant social, economic, and physical barriers to the practice of health behaviors for prevention of chronic disease. Research shows that public housing residents are more likely to report higher rates of obesity, current smoking, disability, and insufficient physical activity compared to individuals not living in public housing. Because these behaviors and conditions may be shaped by the built and social environments in which they live, we conducted a study to test an environmental level diet and physical activity intervention targeting obesity among urban public housing developments. METHODS: This study was a cluster randomized controlled trial of public housing developments, the unit of analysis and randomization. A total of 10 public housing developments were recruited and subsequently randomized to either receive the intervention package or to serve as comparison sites. The year-long intervention included components to change the dietary and physical activity-related environments of the developments. Surveys at baseline and one-year follow-up provided data on changes in behaviors and weight from participants in both intervention and control developments. RESULTS: Intervention participants significantly changed their eating and activity behaviors and body weight from baseline to one-year follow-up (p's < .05) while comparison participants reported no significant changes in any study variable. CONCLUSIONS: These data provide initial support for the idea that interventions targeting the environment of public housing developments can assist residents to change unhealthy behaviors and can possibly reduce the high levels of chronic disease among public housing residents.

Resident health advocates in public housing family developments.

Translation of research to practice often needs intermediaries to help the process occur. Our Prevention Research Center has identified a total of 89 residents of public housing in the last 11 years who have been working in the Resident Health Advocate (RHA) program to engage residents in improving their own and other residents' health status by becoming trained in skills needed by community health workers. Future directions include training for teens to become Teen RHAs and further integration of our RHA program with changes in the health care system and in the roles of community health workers in general.

What do public housing residents say about their health?

BACKGROUND: Residents of public housing have poorer health indicators than comparably resourced individuals from the larger community. OBJECTIVES: To identify major health concerns, issues, and barriers to health of community members living in public housing developments, especially as related to cardiovascular disease prevention. To identify similarities and differences between data collected using two methods to inform future health promotion programs and policies. METHODS: Key informant interviews were conducted with resident leaders and analyzed qualitatively in eight housing developments. Results were compared with quantitative data collected from a resident health survey with a large sample that analyzed individual and development-level characteristics, major health concerns, and barriers. RESULTS: Several development-level characteristics were significantly associated with residents' health concerns and barriers, including development size, percentage of Spanish speakers, and presence of a tenant task force (TTF); important health promotion barriers included lack of resident engagement, inconsistency in programming, lack of knowledge of actions to prevent chronic disease, and lack of resources for health promotion. Safety-related health concerns were named as a priority. CONCLUSIONS: Multiple data collection methods can yield important data about community health priorities and barriers; areas of difference and similarity between methods are especially useful in guiding health promotion efforts and opportunities.

Connecting Boston's public housing developments to community health centers: who's ready for change?

BACKGROUND: Despite close proximity to community health centers, public housing residents are at increased risk of uncontrolled chronic disease, in part because of underutilization of routine health care. OBJECTIVES: To assist in program planning, the Partners in Health and Housing Prevention Research Center (PHH-PRC) used the Community Readiness Model to compare readiness of public housing developments and community health centers to address community-identified health priorities. The model assumes that program success to affect change depends on matching the community's level of readiness to address the issue. METHODS: Key respondent interviews were conducted across 15 communities: Eight housing developments and seven health centers. Interviews were scored across six dimensions on an anchored, 9-point scale and averaged to provide a composite readiness score. Higher scores indicate increasing levels of readiness. Interview transcripts were reviewed for consistent themes. RESULTS: Health centers scored significantly higher (mean, 5.88) than housing developments (mean, 3.33), corresponding with the Preparation stage of readiness compared with the Vague Awareness stage, respectively. Both scored highest in Existing Programs and Resources and lowest in Knowledge of Efforts. Qualitative analysis revealed a lack of existing partnerships between housing developments and health centers as well as significant social barriers preventing housing residents from engaging in care. CONCLUSION: We found a mismatch in readiness to address community health priorities. Although health centers have programs to address health issues, community awareness of programs is limited and barriers to engaging in care persist. The model provided a useful tool for engaging communities into shared program planning.