participatory policy study in a northern new mexico community new mexico healthier weight council...
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Participatory Policy Study in a Northern New Mexico Community
New Mexico Healthier Weight Council
Quarterly Meeting
March 31, 2011
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Victoria Sánchez 1, Yolanda Cruz2, Ron Hale3, Perdita Wexler4, Vonnell
Bettencourt 4, Corazon Halasan4
1Master of Public Health (MPH) Program University of New Mexico
2 San Miguel County Family and Community Health Council3Office of Health Promotion/Community Health Improvement,
Public Health Division4Diabetes Prevention and Control Program, Chronic Disease Bureau, Public
Health Division
Funded by the Robert Wood Johnson Foundation
Center for Health Policy at the University of New Mexico
Faculty Research Grants Program
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Community Diabetes Collaborative (CDC2)
• San Miguel County Family & Community Health Council
• Office of Health Promotion and Community Health Improvement (OHPCHI), NM Dept. of Health
• Diabetes Prevention and Control Program (DPCP), NM Dept. of Health
• Evaluation Team, University of New Mexico (UNM) Health Sciences Center
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Partnership Background• Initial meeting: mid 2008
– Model a planning and evaluation process that can work in other health priority areas
• MOU (UNM/DOH/SMCHC): fall 2008
• Statewide planning framework – Jan 2009
• RWJF Grant: April 2009 – April 2010– Develop and pilot a participatory research process to build
upon community identified needs and our ongoing partnership
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Purpose of Study
Pilot study Examine school nutrition and physical activity
policies in two school districts in one community
Intended result Analyze success, gaps, and policy areas to serve as
a foundation for community mobilization to reduce youth obesity in partnership with Las Vegas schools
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New Mexico Department of Health Regions
Policy Study Site
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Study Team
San Miguel Health Council
Yolanda Cruz
Lacey Houdek
Adam Metcalf
Darla Tenorio
Master of Public Health Program: UNM
Mark Andrews
Victoria Sánchez
Office of Health Promotion and Community Health Improvement*
Ron Hale
Diabetes Prevention and Control Program*
Vonnell Bettencourt
Cora Halasan
Perdita Wexler
*Public Health Division New Mexico Department of Health
Research Protocols
UNM/HSC Human Research Review Committee (HRRC) approval
– Collaborative Institutional Training Initiative (CITI) training
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Principles
• Co-learning process
• Local capacity building
• Long-term commitment
• Balance research and action
Israel, et al., 1998; 200310
Methods
• Policy Scan
• Key Informant Interviews (n = 9) Learn about the implementation (facilitating factors
and barriers) of the physical activity and nutrition policies at the district and school level
• Focus Group (n = 2) Learn about students’ experiences with physical activity
and nutrition policies11
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Results
Implementation• Facilitating Factors• Barriers/Challenges• Recommendations
Policy Creation
Policy Adoption
PolicyImplementation
PolicyEvaluation
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Facilitating Factors Physical Activity Nutrition
•Additional PE instructors funded•Exercise equipment purchased•Increased PE at elementary school level•Administration support for initiatives (e.g. recess before lunch, two recess periods per day) •PE or Wellness curriculum 3 times a week in elementary schools
•Compliance with 50/50 rule•Parental compliance with food requirements for class parties•Increased availability of fresh fruit •Elimination of vending machines selling sodas, candy, and high calorie snacks•Free or reduced cost lunches available to all students•Food service program complies w/school nutrition guidelines at every site
General Facilitating Factors: Individual Champions/Advocates
Grants - e.g. 21st Century, Carol White, International Food Grant, Coordinated Approach to
Children's Health (CATCH)
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Barriers/Challenges Physical Activity Nutrition
•PE only required twice between 6th and 12th grades•Competing demands (e.g. No Child Left Behind, general academic requirements)•More sports needed for girls
•Taste/appearance/ variety of cafeteria food•Vendors compete with cafeteria•Open campus•Food sent from home•Students skipping lunch•Bake sales everyday
General Barriers/Challenges:• Lack of funds
• Lack of time in schedules • Gaps in understanding of written policies among staff and parents
• Lack of knowledge about the function of the SHAC
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Barriers: Nutrition
In reference to food vendors who sell food directly adjacent to the campus:
…it is creating a competing interest for the district in which we can’t compete …because we can’t sell the sugar and the cokes and those kinds of food items. So, that’s a big inhibiter to full implementation to this policy. Until we get support from the City there is nothing the district can do.
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Results
Accountability
Needs Analysis
Create
Implementation Evaluation
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Evaluation
Accountability– Tied to understanding policy– No shared understanding of who is responsible for
enforcement
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Accountability
I believe that there is not sufficient enforcement of it. It’s kind of left up to each administrator, left up to almost down to the individual teacher. Nobody comes over and asks “are you doing this…are you meeting this and that goal?”
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RecommendationsPhysical Activity Nutrition
• Increase physical activity across all grades
Physical Education Integrate activity in classroom More after school activities
• Review vending policies and practices• Improve taste and variety in cafeteria food•More choices in cafeteria•More fresh fruit and vegetables
General Recommendations: • Policy training for administrators, teachers, and staff
• Make wellness policy a working document
• Increase outreach to parents and students
• Increase communication with the SHAC
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Recommendations
I think teachers need to be given more trainings on how to carry out the policy so that there is no question or any doubt as to how to go about it and so that they can be models for the program.
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What can the Health Council Do?
Help increase or strengthen facilitating factors Outreach and education to parents and
community Continue to work with SHAC to find new
communication linkages with PTA, local businesses, school board, city council
Seek funding for school initiatives
Discussion
• Successes in policy implementation may
reflect areas of activity over which the
schools have direct control (e.g., vending
machine changes, recess time)
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Discussion
• Nutrition policy barriers reflected larger community norms and practices: – Autonomy of food vendors–Community parental attitudes/ practices
• May require different strategies than physical activity policies
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Questions?
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