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An Incremental Shift To The Ecological Approach Of Obesity Prevention: Extension Nutrition Managers' Use Of Environmental Strategies
Recommendations and strategic plans for obesity prevention emphasize u se of the socioecological approach that necessitates collaborations among multiple stakeholders. As a partner in community-based projects aimed at improving the lives of N ew York r esidents, Cornell Cooperative Extension' s (CCE) nutrition programs, supervised by Extension Nutrition Managers (ENMs), deliver direct education to low -income audiences disproportionately affected by obesity. ENMs' u se of environmental strategies was previously undocumented. This descriptive, sequential mixed methods study explored strategies ENMs used to change various environments to support healthy eating and physical activity . Guided by the Theory of Planned Behavior, multiple regression s and bootstrapping were performed to investigate the association bet ween ENMs' strategy use and related factors. The organizational culture perspective was applied to examine ways ENMs used the strategies within their existing job context. In-depth qualitative interviews (n=7) informed development of and corroborated findings from an extensive quantitative survey (n=58). Results indicated ENMs had limited and uncertain u se of environmental strategies, and were ambivalent about their impact. The strategies u sed had multiple dimensions: setting targeted, content (nutrition or physical activity) addressed, and tasks performed in applying each strategy. Strategy use was positively associated with whether ENMs had allocated funds; program size; community networking; perceptions of community readiness and job expecta tions; beliefs about obesity prevention; and time devoted to environmental work. Only at moderately high levels of networking were ENMs effective in u sing environmental strategies. While direct funding for environmental work promoted strategy use, all ENM s applied organizational norms to begin this work despite lack of resources and r estrictive funding objectives. When presented with opportunities through existing r elationships, ENMs were motivated to engage by program objectives, a gency requests, job scope, and personal interests. ENMs adapted the norms of conducting direct education to using environmental strategies by expanding the content, audience, and purpose of nutrition education, applying a systems perspective, a nd aiming to make small, incremental changes in their work. Strategy use happened only when intrinsic motivations complemented extrinsic opportunities. This study provides evidence for support by funders, program leaders, and local organizations for use of environmental strategies for obesity prevention.
Cooperative Extension; socio-ecological model; obesity prevention; environmental change
Dollahite, Jamie S.
Constas, Mark Alexander; Sonnenstuhl, William James; Pinstrup-Anderson, Per
Ph.D. of Nutrition
Doctor of Philosophy
dissertation or thesis