IMPLEMENTATION AND EVALUATION OF COMMUNITY-BASED STRATEGIES TO IMPROVE RURAL HEALTH: A MIXED-METHODS APPROACH
Rural populations, particularly women in rural areas, experience significant disparities in health outcomes relative to their urban counterparts. This is partly attributable to environmental conditions, including limited access to healthy foods and opportunities for physical activity. Although existing community-based programs have shown promise in changing women’s health behaviors, few programs have simultaneously targeted environmental factors or focused on rural populations. Civic engagement - collective actions designed to identify and address issues of public concern - is a potential strategy for improving rural environments and health outcomes; however, evaluation of these civic engagement approaches has been limited. The overall objectives of this dissertation were to evaluate the implementation and effectiveness of rural civic engagement and health behavior change strategies. These objectives were achieved through mixed-methods evaluation of two rural community-based programs: Healthy Eating and Activity in Rural Towns (HEART) Club and Strong Hearts, Healthy Communities (SHHC). To assess the feasibility and effectiveness of the HEART Club civic engagement curriculum, we conducted a pilot-study in three rural Northeastern U.S. towns. Participants reported increased awareness of community needs and assets, and successfully leveraged existing resources to improve local physical activity opportunities. To evaluate the implementation of SHHC intervention components, we conducted a mixed-methods process evaluation in rural Montana and central New York. Overall, the SHHC program was well-received by rural participants and intervention components were delivered with high fidelity. Recommendations for improvement including increasing class length, allocating more time for nutrition education, and creating more opportunities for group discussion. A mixed-methods evaluation was also used to assess the implementation and effectiveness of the HEART Club curriculum within the context of SHHC. Intervention sites reported good fidelity to the HEART Club curriculum; however, group progress towards project benchmarks was highly variable. Although some groups approached the HEART Club process with enthusiasm, many participants wished to prioritize personal behavior change over civic engagement activities. Taken together, these results highlight both the potential and challenges associated with rural civic engagement and health behavior change interventions. Findings from this research have informed modifications to the HEART Club and SHHC programs for future dissemination efforts in rural communities.
Public health; Nutrition
Sobal, Jeffery; Wells, Nancy M.; Leonard, Lori
Doctor of Philosophy
dissertation or thesis